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

Incidents per State

State Total
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 1327011
Sex: F
Age: 49
State: IN

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No

Symptom List:

Symptoms: Achy feeling in back & legs Tiredness Small headache

Other Meds: Ibuprofen

Current Illness: No

ID: 1327012
Sex: F
Age: 47
State: MD

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Keflex, Percocet, Prednisone, Topamax

Symptom List:

Symptoms: On 5/14/21 patient began having high subjective fever and skin felt hot like a sunburn. Then, had rigors the same evening. On 5/15/21 patient began vomiting and continued to have subjective fevers off and on and associated sweats On 5/16/21 patient noticed that skin on legs were peeling while taking a shower. No other skin peeling, no swelling, no SOB, wheezing. On 5/18/21 patient called office reporting this reaction and now clinically better. Fevers gone, no more skin peeling, energy level better.

Other Meds: Ambien, Retin A gel, Tramadol, Phentermine, Metrogel, Ibuprofen, Eletriptan, Alprazolam, Albuterol

Current Illness: None

ID: 1327013
Sex: F
Age: 47
State:

Vax Date: 04/27/2021
Onset Date: 04/30/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Facial twitching developed on the left cheek, under eye. Began three days after vaccine on 4/30/21 - continued intermittenly until 5/16/21. This developed after the entire lower jar, teeth and eustachian tubes became sore within 18 hours after vaccination. Pain and soreness stopped on 4/29/21. Pain and soreness at the injection site occurred at the same time as well as low grade (101.5) degree fever - both ended on 4/29/21.

Other Meds: None

Current Illness: None

ID: 1327014
Sex: F
Age: 48
State: CA

Vax Date: 04/12/2021
Onset Date: 05/13/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Severe vertigo, and dizziness.

Other Meds: None

Current Illness: None

ID: 1327015
Sex: F
Age: 36
State: CA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Headache, 9/10 severe abdominal cramping and dibilatating pain. Started 30 minutes after injection, lasted for 14 hours., unable to sleep or get comfortable. 3/10 dull abdominal pain from hours 14-24.

Other Meds: Vitamin D

Current Illness: None

ID: 1327016
Sex: F
Age: 47
State: IL

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Allergic to Quinalones

Symptom List:

Symptoms: Fever, chills, muscle and joint pain, pain in arm and underarm

Other Meds: Blisovi -low dose birth control

Current Illness:

ID: 1327017
Sex: F
Age: 15
State: OR

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Sore throat and nasal congestion

Other Meds: None

Current Illness: None

ID: 1327018
Sex: M
Age: 20
State:

Vax Date: 05/12/2021
Onset Date: 05/13/2021
Rec V Date: 05/18/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: Acute chest pain diagnosed as Myocarditis, 24 hours after the second dose of the vaccine.

Other Meds: n/a

Current Illness:

ID: 1327019
Sex: F
Age: 43
State: CA

Vax Date: 05/15/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Codeine Mushrooms Papaya Walnuts

Symptom List:

Symptoms: 05/16/2021: (1) occasional mild itching at and around injection site, (2) substantial soreness of injection are to touch and upon movement, (3) chills, (4) full body aches 05/17/2021 (1) occasional mild itching at and around injection site, (2) approximately 3 inch by 4 inch area of redness of skin around injection site and red skin area hot to the touch

Other Meds: Nortel 1/35-28 Cetirizine 10mg Cranberry 500mg Renew Life Women's Care Probiotic 90 billion One A Day Women's multivitamin

Current Illness: N/A

ID: 1327020
Sex: M
Age: 53
State: CA

Vax Date: 04/15/2021
Onset Date: 04/19/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No Known Allergies

Symptom List:

Symptoms: Muscular Weakness Right side of Face (Bells Palsy), External Massage/Therapy

Other Meds: Humulin 100 units/Injection Glyburide 10 mg x 2/day Lisinopril 10 mg x 1/day Omeprazole 20 mg x 1/day Levothyroxin 200 mcg x 1/day Metformin Hcl 1000 mg x 2/day Prevastatin Sodium 40 mg x1/day Aspirin 80 mg x 1/day

Current Illness: None

ID: 1327021
Sex: M
Age: 28
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Headache, tiredness, body ache.

Other Meds:

Current Illness:

ID: 1327022
Sex: F
Age: 46
State: MN

Vax Date: 05/12/2021
Onset Date: 05/14/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: unknown

Symptom List:

Symptoms: Redness on left arm below injection site, warm to the touch. Rash on neck, chest, back, and stomach. Denies any shortness of breath or difficulty breathing. Reports previous similar reaction to a vaccine in the past. She reports she is going to take oral Benadryl and she has contacted her primary care physician.

Other Meds: Unknown

Current Illness:

ID: 1327023
Sex: F
Age: 71
State: MN

Vax Date: 02/13/2021
Onset Date: 02/16/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: ACE-inhibitors (anaphylaxis), amitriptyline (anaphylaxis), atorvastatin (myalgia), Bactrim (N/V), hydromorphone (N/V), metformin (diarrhea), Nexium (nausea), shellfish (GI upset), cefprozil (rash), codeine (rash)

Symptom List:

Symptoms: Pt received 1st Moderna COVID-19 vaccine on 2/13/21. Starting on 2/16/21, pt developed tinnitus, which has persisted since that time.

Other Meds: APAP PRN, amlodipine 10mg daily, ASA 81mg daily, Tums as needed, dicyclomine 10mg as needed, HCTZ 25mg daily, Basaglar 77 units daily, levothyroxine 88mcg daily, Cytomel 5mcg BID, loperamide 2mg daily, lorazepam 0.5mg PRN, metoprolol tartra

Current Illness: None

ID: 1327024
Sex: F
Age: 48
State: PA

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulfa drugs

Symptom List:

Symptoms: ?Moderna COVID?19 Vaccine EUA? Swollen lymph node of left underarm Earache of left ear Chills Fatigue Joint pain

Other Meds: Zyrtec, Tylenol

Current Illness: None

ID: 1327025
Sex: M
Age: 71
State: CT

Vax Date: 04/01/2021
Onset Date: 04/11/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Shortness of breath, spitting up blood, heart stopped and unable to resuscitate. All happened within a 20-minute time. No chest pains.

Other Meds: Lisinopril; Atorvastatin; Amlodipine; Atenolol

Current Illness: None

ID: 1327026
Sex: F
Age: 50
State: CO

Vax Date: 03/25/2021
Onset Date: 05/01/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: 5 weeks after second Pfizer shot I began experiencing un-explained dizziness and bilateral arm numbness. It has lasted more than 2 weeks now.

Other Meds: None

Current Illness: None

ID: 1327027
Sex: M
Age: 67
State: WI

Vax Date: 04/06/2021
Onset Date: 04/12/2021
Rec V Date: 05/18/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient hospitalized on 4/12/21 for 8 days. Patient presented to the ED and was subsequently hospitalized on 4/23/21. These visits were within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1327028
Sex: M
Age: 40
State:

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: 40 Y/O M 15 mins post vaccine- A/Ox0, presented disoriented with a confused daze followed by complaint of dizziness and general feeling of "not right". v/s within normal limits. PT given emesis bag for episode of nausea. PT A/Ox3 w/in 2 minutes post-episode. W/in 10 minutes still feels "cloudy". EMS called for evaluation.

Other Meds:

Current Illness:

ID: 1327029
Sex: M
Age: 65
State: AZ

Vax Date: 03/22/2021
Onset Date: 03/27/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No

Symptom List:

Symptoms: Tinnitus, ringing in ears, exacerbation of existing condition

Other Meds: Tamsulosin, Finasteride

Current Illness: None

ID: 1327030
Sex: F
Age: 2
State: IL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: amoxicillin [rash not hives]

Symptom List:

Symptoms: onset of generalized back pain along with low grade fever.

Other Meds: none

Current Illness: none

ID: 1327031
Sex: F
Age: 49
State: WA

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: PCN and Keflex

Symptom List:

Symptoms: 30 minutes post-vaccine she developed irritation to her throat and urticaria generalized. She denies any shortness of breath or wheezes. Took H2 and the symptoms resolved in 24 hours. She was not seen in the ER for this She has not had a major reaction to a vaccine in the past.

Other Meds: 10/2020Adderall XR 30 mg Cap ER 24hr 1 capsule orally daily in the morningAlso includes: Adderall XR 10/2020Ambien CR 6.25 mg Tab ER 1 tablet orally daily at bedtime as neededAlso includes: Ambien CR 10/2020buPROPion ER (XL) 150 mg Tab ER 2

Current Illness: None

ID: 1327032
Sex: M
Age: 60
State: NC

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: no

Symptom List:

Symptoms: Coughing started right away and has gotten progressively worse. I saw a specialist about three weeks ago and I'm not bad enough to have COPD but close. Treatments with inhalers with steroids and I have been on those for two weeks. I started feeling pain in back of my left leg. I thought it was a blood clot and went to ER but it wasn't a blood clot. No treatment for that. I still feel the pain occasionally at this time. I have been taking Tylenol for it.

Other Meds: Omeprazole; Multi-Vitamin

Current Illness: no

ID: 1327033
Sex: F
Age: 56
State: CA

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Pt experienced chest pain 25 min post vaccination. BP 165/77; HR 99; RR 20. 911 was called 1hr post vaccination & pt taken to ED

Other Meds:

Current Illness:

ID: 1327034
Sex: M
Age: 15
State: MI

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: Patient received vaccine at 5:30pm and started to feel dizzy. Patient was given water, juice and snack. Patient after 5 minutes felt tingling in the arms and lips. EMS was called to take patient to the hospital.

Other Meds: none

Current Illness: none

ID: 1327035
Sex: M
Age: 58
State: CO

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none known

Symptom List:

Symptoms: Client came in to receive their second f dose of the covid vaccine, The first dose was received at Medical Center on 4/22/21. They are no longer administering the vaccine so he was instructed to come to hospital to receive his second dose. During the screening process and vaccine administration it wasn't noticed that it was two days too early to be received so it was given.

Other Meds: none known

Current Illness: none known

ID: 1327036
Sex: M
Age: 64
State: TX

Vax Date: 05/13/2021
Onset Date: 05/15/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: BOTH OF PATIENT HANDS HAD CHEMICAL EXPOSURE APPROXIMATELY 8 YEARS, THERE WAS SCAR TISSURE ON HIS HANDS, HE EXPERIENCED FREEZING IN HIS HANDS AND THEY WERE COLD TO THE TOUCH WITH PAIN CONCENTRACTING IN HIS FINGER TIPS, HE WAS HAVING DIFFICULTY GRIPPING AND THINGS WITH HIS HANDS.

Other Meds:

Current Illness:

ID: 1327037
Sex: F
Age: 15
State: IL

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: not applicable

Symptom List:

Symptoms: Patient exhibited signs of paleness, dizziness and nausea during the 15 minute post-vaccination observation.

Other Meds: not applicable

Current Illness: not applicable

ID: 1327038
Sex: F
Age: 39
State: OK

Vax Date: 12/18/2020
Onset Date: 05/02/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: She had no adverse events after her Pfizer Covid vaccine on 12/18/20 or 1/8/21. She did become pregnant with a LMP of 1/10/21 and a confirmed EDC of 10/17/21. She had symptoms and tested positive for Covid on 5/2/21. She states that her test was a rapid test that was done with her employee health. She had mild symptoms with congestion, loss of taste and smell. She has recovered and fetus is doing well as of 5/18/21.

Other Meds:

Current Illness: none

ID: 1327039
Sex: F
Age: 46
State: NJ

Vax Date: 04/08/2021
Onset Date: 05/13/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: I menstruated a full week earlier than expected after having the second dose of the vaccine. (I have been like clockwork for years). Both anemia and thrombocytopenia run in my family and I am going to follow up with my physician to see if bloodwork is recommended-- I don't think he will know the answer and would like assistance from CDC to understand any connection between vaccine and menstruation and the extent to which that suggests an issue with clotting or any other disorder. I am happy to participate in any studies on this and am eager for follow up. I think the menstruation angle needs to be addressed to bolster public confidence-- am hearing reports of menstrual changes frequently. Thank you. Also noting that 14 year old daughter started spotting three days after receiving her first Pfizer vaccine.

Other Meds: none

Current Illness: none

ID: 1327040
Sex: F
Age: 69
State: NY

Vax Date: 03/03/2021
Onset Date: 03/10/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Cold sore for 1 week Exhaustion still ongoing Exacerbated Fibro symptoms

Other Meds: Savella Levothyroxine Calcium B6 Methyl folate

Current Illness: Fibromyalgia Hypothyroid

ID: 1327041
Sex: F
Age: 40
State: CA

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: pistachio

Symptom List:

Symptoms: 5/15/2021: Pain around the injection site. Chills, muscle pain, and fever over 101 degree . Taken acetaminophen twice. 5/16/2021: Urinary tract infection. Healthcare provider prescribed nitrofurantoin for 5 days.

Other Meds: NA

Current Illness: NA

ID: 1327042
Sex: F
Age: 18
State: NY

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No known medication, food, or environmental allergies.

Symptom List:

Symptoms: Prior to vaccination, the patient reported a history of feeling light headed during and immediately after procedures involving needles. Patient completed pre-screening checklist for Pfizer COVID-19 vaccine and was administered 0.3mL of Pfizer BioNTech vaccine IM in left deltoid at 3:28pm. At 3:30pm patient began to appear pale and lethargic. Patient reported that she felt light headed and dizzy. Patient's mother encouraged her to drink water. Patient was assisted to lie down on ground. The first set of vital signs were taken at 3:34pm. Pulse was 68, regular and thready. Respiratory rate was 12 breaths per minute and unlabored. Blood pressure 73/43. Oxygen saturation 98%. Pt reported soreness in left arm and no other pain. An ambulance was called. At 3:40pm, vital signs were PR 71, RR 12, BP 86/59, O2 Sat 98%. Patient reported minor nausea. At 3:45pm vital signs were PR 71, RR, 14, BP 106/70, O2 Sat 96%. Patient reported a headache. Ambulance arrived at 3:48pm. Patient was assisted to stand and walk 10 feet to stretcher. Ambulance Unit transported patient to Hospital.

Other Meds: None.

Current Illness: None.

ID: 1327043
Sex: M
Age: 14
State: CA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: PENICILLIN

Symptom List:

Symptoms: Pt receive the vaccination at 1147, immediately after administration pt has syncopal episode where patient was able to regain consciousness within 30 seconds. Pt able to answer questions appropriately. Vital signs were taken - WNL, STAT RN was called, ice pack applied behind neck, apple juice and granola bar given to pt. Pt assessed and was a&0x4. Pt states he was very anxious about vaccine. Pt transferred to gurney and taken to treatment room for further observation due to pt sweating perfusely a few minutes after syncopal episode. Report given to RN in treatment room at 1210. Pt's mother at bedside and even at all times:

Other Meds: N/A

Current Illness: N/A

ID: 1327044
Sex: F
Age: 29
State:

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: n/a

Symptom List:

Symptoms: None stated.

Other Meds: 25 mg diphenhydramine

Current Illness: n/a

ID: 1327045
Sex: M
Age: 54
State: IA

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Unknown

Symptom List:

Symptoms: Reports his throat was swelled, he had chest pain in which he took nitro for, tired, sweating both morning and night, and had an upset stomach.

Other Meds: Unknown

Current Illness: Unknown

ID: 1327046
Sex: F
Age: 65
State:

Vax Date: 02/27/2021
Onset Date: 05/11/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Pt completed 2 dose course of COVID Pfizer Vaccine on 02/06/2021 and 02/27/2021. Pt tested positive for COVID on 05/12/2021, with symptoms beginning on 5/11/2021 (sneezing, runny nose). Does not endorse any COVID + contacts, although lives with 4 other people who have not yet been tested.

Other Meds: Unknown

Current Illness: Unknown

ID: 1327047
Sex: F
Age: 16
State: CA

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/18/2021
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Allergies: Penicillins

Symptom List:

Symptoms: Lightheadedness & ringing in ears. BP 95/60; HR 89; RR 16. Pt AOx4; VS stable; pt escorted home with mother

Other Meds:

Current Illness:

ID: 1327048
Sex: F
Age: 14
State: OK

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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Allergies: None

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Symptoms: Patient received Pfizer COVID19 vaccine at 03:50 PM to left deltoid by EMT. Patients skin began to become pale. Patient reported nausea. Her eyes closed and her head went limp for approximately 10 seconds or less. Patient remained upright in chair with support from this RN. Patient was moved to cot with assistance from EMT and placed in prone position with feet elevated. Blood pressure, pulse oximetry and pulse obtained by this RN. Initial blood pressure of 90/58, heart rate 71, and oxygen saturation of 98% on room air at 03:52 PM. At 04:00 patient reported she began to feel better. Patient was assisted to sitting position. Patient denied dizziness or nausea upon rising to sitting position. Vital signs at 04:00 PM blood pressure 102/68, heart rate of 81, and oxygen saturation of 98% on room air. Patient stated she was feeling much better. Patient left building with her mother accompanied by this RN.

Other Meds: None

Current Illness: None

ID: 1327049
Sex: F
Age: 51
State: MA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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Allergies: not known

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Symptoms: patient sat down after the vaccine and about 5 minutes later passed out for about 30 seconds. EMS came out and checked her out. She refused to come with ambulance and stayed in the store until a relative came in to pick her up because she was afraid to drive. She left the store thereafter.

Other Meds: not known

Current Illness: not known

ID: 1327050
Sex: F
Age: 58
State: PA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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Allergies: Sulfa

Symptom List:

Symptoms: Patient had a rash on her right arm

Other Meds: Synthroid, Lowsartin, Symbicourt

Current Illness: none

ID: 1327051
Sex: M
Age: 47
State: NC

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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Symptoms: Administered Moderna vaccine. Patient was sitting in observation and fell face forward out of the chair. Patient hit head and chipped tooth. Pt was unconsciousness for less than 10 seconds. Patients glasses cut his forehead. Called management and 911 immediately. 911 arrived and examined and patient refused to go to ER. Said he was okay to drive home. Patient did ask for me to schedule second dose in 4 weeks.

Other Meds:

Current Illness:

ID: 1327052
Sex: F
Age: 28
State: NY

Vax Date: 04/18/2021
Onset Date: 04/25/2021
Rec V Date: 05/18/2021
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Allergies: None

Symptom List:

Symptoms: I had an extremely heavy period after my first moderna vaccine. My period was earlier than expected and I passed larger clots than normal.

Other Meds: Venlafaxine

Current Illness: None

ID: 1327053
Sex: F
Age: 15
State: IN

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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Symptoms: Patient received the vaccine with no issues. Approximately 5 minutes after the vaccine the patient fainted. They were seated on a chair and had multiple instances of syncope.

Other Meds:

Current Illness:

ID: 1327054
Sex: F
Age: 91
State: IA

Vax Date: 02/24/2021
Onset Date: 02/27/2021
Rec V Date: 05/18/2021
Hospital: Y

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Allergies: No known allergies per client.

Symptom List:

Symptoms: Reports about 3 days after the shot she developed a headache, was cold, felt like a "dishrag", tired. She went to her family physician. He sent her to the hospital as she said he told her that her heart was hardly beating. At the hospital she had to have a pacemaker placed. She had no history of any heart issues. She reports being healthy before the vaccine.

Other Meds: Unknown

Current Illness: None.

ID: 1327055
Sex: F
Age: 56
State: IL

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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Allergies: none

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Symptoms: The Pt went to to get their first dose of covid vaccine. They have received moderna for the first dose. When they came to she has received Pfizer second dose in error. No adverse events were reported by the pt.

Other Meds: none that I know of

Current Illness: none that I know of

ID: 1327056
Sex: M
Age: 70
State:

Vax Date: 03/20/2021
Onset Date: 03/21/2021
Rec V Date: 05/18/2021
Hospital: Y

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Symptoms: 3/21, admitted day after covid vaccine. Presented with shortness of breath, cough, but guarding on abd exam/wincing with moderate palpation. Reports he is making urine, denies dysuria frequency. Urine culture grew contaminating flora. Abscess culture growing heavy MRSA. Recommended IV vancomycin inpatient and then can transition to oral doxycycline 100 mg twice daily for least 2 to 4 weeks. Follow-up with Dr. in neurology clinic after discharge.

Other Meds:

Current Illness:

ID: 1327057
Sex: F
Age: 46
State: CA

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 05/18/2021
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Allergies: None

Symptom List:

Symptoms: Immediate sensation radiating down the left arm into the hands and fingers. Immediate cold hands and feet which resolved after one day. A month later still has some numbness and tingling in the fingers of the left hand.

Other Meds:

Current Illness: None

ID: 1327058
Sex: M
Age: 23
State: CA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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Symptoms: In a few minutes after vaccine administration , pt vomited a small amount and felt hot for few minutes. pt started feeling better after few minutes and was monitored for at least for 15 minutes.

Other Meds:

Current Illness:

ID: 1327059
Sex: M
Age: 29
State: MN

Vax Date: 05/11/2021
Onset Date: 05/12/2021
Rec V Date: 05/18/2021
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Allergies: Cefprozil

Symptom List:

Symptoms: I had a fever (100.6) and body aches. Missed one day of work. Symptoms lasted for one day and were managed with ibuprofen.

Other Meds: Ibuprofen, multivitamin, fiber supplement

Current Illness: none

ID: 1327060
Sex: F
Age: 37
State: ME

Vax Date: 05/17/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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Allergies: Massive list of anti psychotics, Bactrim, doxycycline, penicillin, morphine, scallops, influenza vaccine.

Symptom List:

Symptoms: Heart racing nausea sweating, fever, muscle aches and spasms

Other Meds: Gabapentin ( 1800 mg/ day) kava root ( 1mL tincture in shake daily), visteril (25mg), Tylenol (1g x4 daily) ibuprofen 600 mg x 4 daily), capsaicin cream, ginger candies, certirazine, vitamin D 3 (1,000iu).

Current Illness: Nausea, head ache, generally unwell, back pain, muscle spasms, bi polar 2, poly cystic ovary syndrome, ptsd, anxiety, vitamin d deficiency, stress incontinence. And have a fever as of 4pm today

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm