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: 1293013
Sex: F
Age: 38
State: FL

Vax Date: 05/02/2021
Onset Date: 05/02/2021
Rec V Date: 05/06/2021
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: Error: Diluent Administered Instead of Vaccine

Other Meds:

Current Illness:

ID: 1293015
Sex: M
Age: 80
State: IN

Vax Date: 02/12/2021
Onset Date: 02/15/2021
Rec V Date: 05/06/2021
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: Alopurinol, Neurontin, Bactrim, losartan

Symptom List: Anxiety, Dyspnoea

Symptoms: 3 days post vaccination resident had increase confusion, new hallucinations, combative behavior. UA, blood work, CT of head, negative for acute findings, Hospital stay x 2 occurrences, including psychiatric evaluation. Follow up with neurologist pending .

Other Meds: Carbidopa/levodopa, Lasix, calcium, Pepcid, oxybutynin, finasteride

Current Illness: Parkinson's, PVD, CAD, Dermatitis, Chronic kidney disease non dialysis, BPH, OSA

ID: 1293016
Sex: F
Age: 50
State: MA

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 05/06/2021
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: None

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

Symptoms: Patient was treated on 3/10/21 w/ 3 days of Bactrim for UTI. First COVID vaccine 3/18/21, that day developed redness and swelling of face, low back, chest, feet. Rash is persistent to this date with no imprvovement. She had bloodwork to rule out, RA, Lyme, thyroid disease all within normal limits. Skin biopsy was done 4/1/21 which showed likely hypersensitivity reaction to drug or ssytemic allergic versus a connective tissue disease. Stains that were done argue against Lupus.

Other Meds: Flexeril, Mirena IUD, Ativan. Bactrim x 3 days on 3/10/21.

Current Illness: n/a

ID: 1293017
Sex: F
Age: 39
State: MI

Vax Date: 04/08/2021
Onset Date: 04/15/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: Allergic to Sulfa (mild, break out in hives).

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Experienced the arm pain around the injection site for about 4-5 days. By day 7, a lump formed at the injection site and it was itchy. By day 8, my arm broke out in a itchy rash from my shoulder bone down my arm to just above my elbow. I used over the counter hydrocortisone topical cream to stop the itchiness. The rash went away in 5 days.

Other Meds: Multivitamin, coenzyme Q10- 200mg, Chaste Tree fruit 6:1 extract 83.3 mg, E-Manganese (Vitamin E 5.1mg, Calcium 30 mg, Manganese 8 mg).

Current Illness: None

ID: 1293018
Sex: F
Age: 74
State: OH

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

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

Lab Data:

Allergies: Iodine, Sulfa

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

Symptoms: Pt had dose 1 Moderna on 5/3 within 24 hours had back pain and urinary incontinence unable to ambulate. Hospitalized overnight.

Other Meds: tylenol, tylenol with codeine, lipitor, vitamin d, restasis, trulicity, diflucan, lasix, gabapentin, synthroid, metformin, toprol xl, prilosec, potasium, zanaflex

Current Illness: Diabetes, hyperlipidemia, GERD, hypothyroidism

ID: 1293019
Sex: F
Age: 46
State: FL

Vax Date: 05/02/2021
Onset Date: 05/02/2021
Rec V Date: 05/06/2021
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: Error: Diluent Administered Instead of Vaccine

Other Meds:

Current Illness:

ID: 1293020
Sex: F
Age: 50
State: OR

Vax Date: 03/29/2021
Onset Date: 03/31/2021
Rec V Date: 05/06/2021
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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Gradual onset tinnitus in left ear over the following 48 hours after the vaccine, worsening to current level over about 7 days. Has been constant since then. The level is moderate and interferes somewhat with sleep and quality of life. Also headaches on that side. No treatment has been attempted as of yet.

Other Meds: Ventolin inhaler for asthma

Current Illness: None

ID: 1293021
Sex: F
Age: 17
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient was underage when we gave her Covid 19 Moderna dose 2. She received dose 1 in center

Other Meds:

Current Illness:

ID: 1293022
Sex: F
Age: 32
State: GA

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

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

Lab Data:

Allergies: fruits kiwi, orange,pineapple

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: after the second covid dose, patient reported that she felt that her throat is closing. observed her for a few minutes and called 911. Emergency management services examined her and told her that her breathing is ok and heartrate little high because she was looking anxious . but she insisted her throat is closing. Ambulance took her to the emergency room . She called the pharmacy after 4 hours and said that she was treated with allergy medication in the ER.

Other Meds: none

Current Illness: none

ID: 1293023
Sex: F
Age: 37
State: PA

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 05/06/2021
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: Tree Nut

Symptom List: Diarrhoea, Nasal congestion

Symptoms: nose bleed for 45 minutes day of (25 minutes after shot) fatigue brain fog Bad headache that lasted days (still have it while filling out this report 3 days later) rashes in random places all over my body develped 2 days later

Other Meds: Flonase, One a day Women's daily vitamin

Current Illness: n/a

ID: 1293024
Sex: U
Age: 74
State: AZ

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 05/06/2021
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: None

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

Symptoms: Patient is a 74 y/o female with PMH significant for meningitis at age 2 resulting in developmental delay (non-verbal at baseline and seizure disorder) who presented for poor oral intake, dysphagia, and inability walk due to increased lower extremity weakness that has been occurring since April 9th. The patient is typically ambulatory but needs significant assistance with ADLs. She is able to feed herself (tends to eat baby food). Eventually, the patient was admitted for sepsis 2/2 UTI and now with concerns for remote stroke with persistent dysphagia and acute encephalopathy. Since April 9th, the family has noted that the patient has had difficulty swallowing baby food and seems to be uncomfortable; she is able to make a couple of audible sounds or gestures that suggest pain and that is why they brought her. The family also reports that the patient received her second dose of the Pfizer-BioNTech COVID-19 vaccine on 04/07/2021. On 04/08/2021, the patient had one staring episode, but then returned to baseline. She was at baseline during breakfast on the morning on 04/09/2021, but around lunchtime, she had another staring spell and was unable to swallow food as well as unable to walk, stand, or move her lower extremities. The patient has limited language at baseline but also has not been able to say the few words she used to communicate with her family, only moaning and grunting since that time. Since 04/09, she has not been able to consume any solid foods, only eating a very small amount of smashed/liquified fruit and drinking Pedialyte. Sister has been massaging her legs regularly in hopes of re-establishing movement but saw nothing until yesterday (05/05/2021) when the patient moved toes bilaterally and briefly lifted her right leg. Neurology Consult on 05/05/2021: The patient had mildly bradycardiac and hypertensive (170s/80s). Labs reviewed and showed mildly elevated WBC (i.e., 12.9 K/MM3) and urinalysis was consistent with UTI. Imaging was reviewed and consistent with chronic CVA, likely occurring on 04/09/2021 while the patient was in hypercoagulable post-COVID vaccine state. Neurology recommends CT angio head and neck, TTE w/ bubble, A1c, fasting lipid panel, DVT prophylaxis via lovenox 40mg SC daily, D-dimer levels, EKG, PT/OT?Speech therapy evals, BP control via lisinopril 10mg daily w/ goal of < 140/90, and ASA 81mg daily

Other Meds: Phenytoin 125 mg/5mL oral suspension, 250mg = 10mL, oral, BID Primidone 250mg PO BID

Current Illness: Sepsis secondary to UTI with WBC of 12 (leukocytosis), HR > 90, and urine culture positive for pseudomonas as the primary source of infection. The patient also displays hypokalemia with concern for refeeding syndrome due to low oral intake as well as an anion gap metabolic acidosis (AGMA), potentially due to starvation ketoacidosis.

ID: 1293025
Sex: F
Age: 30
State: AZ

Vax Date: 12/18/2020
Onset Date: 05/05/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Received Dose 1 on 12/18/2020 and Dose 2 on 1/8/2021 tested positive for COVID on 5/5/2021 with positive symptoms

Other Meds:

Current Illness:

ID: 1293026
Sex: F
Age: 56
State: FL

Vax Date: 04/23/2021
Onset Date: 04/25/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: bandaide tape, polysporin

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

Symptoms: fever, chills, aches lasted until 04/25/2021, then went away. reporting this because of tinnitus that started 04/25/2021. I had tinnitus before, but it went to a level 10 that day, subsided to level 7 where it remains as of 5/6/2021

Other Meds: Atorvastatin 10mg, Zyrtec 10mg

Current Illness: after vaccine fever, chills, aches, pain injection site

ID: 1293027
Sex: F
Age: 56
State: CA

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 05/06/2021
Hospital: Y

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: Went to the Emergency Room, Not breathing, CPR and Difibrilation performed. Cardiac Heart Attack. Hospitalized for 11 days 4 intensive care.

Other Meds: None

Current Illness: None

ID: 1293028
Sex: M
Age: 66
State: MI

Vax Date: 02/04/2021
Onset Date: 04/28/2021
Rec V Date: 05/06/2021
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: nkda

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

Symptoms: positive covid 04-28-2021, febrial

Other Meds: oxycontin 10 mg 1 bid, oxycodone 5 mg 1 q6, lisinopril 5 mg 1 qd, pepcid ac 20 mg 1 bid, levothroxine 100 mcg 1 qd, vitamin b 1 qd, mtv 1 qd, folfiri

Current Illness:

ID: 1293029
Sex: M
Age: 59
State: NJ

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 05/06/2021
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: NKDA

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

Symptoms: Patient received the 2nd Moderna dose 3 days early. No adverse events.

Other Meds:

Current Illness:

ID: 1293030
Sex: F
Age: 47
State: PA

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 05/06/2021
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: OndansetronShortness of breath / Dyspnea, Itching, Rash Sulfamethoxazole-trimethoprimHives / Urticaria Oxycodone-acetaminophenNausea Only

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

Symptoms: Cough Shortness of Breath Fatigue Muscle or body aches Headache New loss of taste or smell Congestion or running nose

Other Meds: cinnamon bark 500 mg capsule cyanocobalamin, vitamin B-12, (VITAMIN B-12 ORAL) ferrous sulfate 325 mg (65 mg iron) tablet ginkgo biloba 40 mg tablet lisinopriL (ZESTRIL) 5 mg tablet melatonin 10 mg capsule multivitamin 400 mcg tablet traMAD

Current Illness:

ID: 1293031
Sex: M
Age: 45
State: NY

Vax Date: 04/15/2021
Onset Date: 05/04/2021
Rec V Date: 05/06/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pericarditis Medication Treatment ongoing

Other Meds: Allergy medication

Current Illness:

ID: 1293032
Sex: F
Age: 68
State: OR

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: pt came in for immunization and was asked 3 times if this was her first covid shot, she repeatedly said yes. The shot was administered. It was not until afterwards that she explained that she wanted a hepatitis B shot and that she had already had her 2 Pfizer vaccines.

Other Meds: no

Current Illness: possible lymphoma

ID: 1293034
Sex: F
Age: 54
State: MA

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Fainting / Unresponsive-Mild

Other Meds:

Current Illness:

ID: 1293035
Sex: F
Age: 29
State: MO

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 05/06/2021
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: Tramadol

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

Symptoms: On my forehead, something strange appeared in a circle shape. Determined as granuolma annulare by my doc. Also weeks after 2nd stop got a staph infection not sure if related.

Other Meds: None

Current Illness: None

ID: 1293036
Sex: M
Age: 43
State: MA

Vax Date: 05/06/2021
Onset Date:
Rec V Date: 05/06/2021
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: None stated.

Other Meds:

Current Illness:

ID: 1293037
Sex: F
Age: 30
State: PA

Vax Date: 04/05/2021
Onset Date: 04/16/2021
Rec V Date: 05/06/2021
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: DimenhydrinateAnaphylaxis PenicillinsHives / Urticaria, Nausea Only

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

Symptoms: sinus drainage OTC meds for symptoms.

Other Meds: aspirin 81 mg tablet cholecalciferol, vitamin D3, 50 mcg (2,000 unit) tablet tablet escitalopram (LEXAPRO) 20 mg tablet fluticasone (FLONASE) 50 mcg/actuation nasal spray folic acid (FOLVITE) 1 mg tablet hydroCHLOROthiazide (MICROZIDE) 12.5

Current Illness: None

ID: 1293038
Sex: M
Age: 63
State: CA

Vax Date: 02/25/2021
Onset Date: 03/31/2021
Rec V Date: 05/06/2021
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: NKDA

Symptom List: Injection site pain, Pain

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA NEW diagnosis and onset of Type II Diabetes Mellitus, symptoms started approximately 10-14 days after 2nd vaccination. Ongoing problem, started on Metformin.

Other Meds: Levoxyl, Prednisone, omeprazole

Current Illness: Hashimoto's Thyroiditis, Occular Myasthenia Gravis

ID: 1293039
Sex: M
Age: 17
State: MN

Vax Date: 04/23/2021
Onset Date: 04/01/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient vaccinated at age 17. No adverse effects were reported back from patient or mom.

Other Meds:

Current Illness:

ID: 1293040
Sex: M
Age: 43
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/06/2021
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: ORIGINAL ON FILE AT FACILITY

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

Symptoms: PREPARATION AND ADMINISTRATION ERROR. PATIENT RECEIVED 180 MCG OF PFIZER COVID 19 VACCINE IMx1.

Other Meds: ORIGINAL ON FILE AT FACILITY

Current Illness: ORIGINAL ON FILE AT FACILITY

ID: 1293041
Sex: M
Age: 78
State: NJ

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 05/06/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received the 2nd Moderna dose 3 days early. No adverse events.

Other Meds:

Current Illness:

ID: 1293042
Sex: F
Age: 59
State: WV

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 05/06/2021
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: Widespread flu like symptons. Extreme tireness the day of second doe of COVID vaccination. Second and third day no appetitie. Second day extremely achy kees. Around fourth day back muscle requiring 1/2 tablet of vicodin in order to sleep. Also, slight headach after about 5 days.

Other Meds: MegaFoods vitamins and supplements

Current Illness: none

ID: 1293043
Sex: F
Age: 50
State: SC

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/06/2021
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: sulfa containing drugs

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

Symptoms: pt reported immediate sore throat and neck pain she stated that her jaw went numb and during the course of questioning to ensure no airway issues she states the numbness moved up her cheek and onto her nose- EMS as called. The determined all vitals were good. Feeling/ tingling began to return to her face after 15 mins and the patient went home

Other Meds: cymbalta levothyroxine

Current Illness:

ID: 1293044
Sex: F
Age: 41
State: CA

Vax Date: 04/14/2021
Onset Date: 04/16/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: 2 days after shot I developed a brain fog feeling. Felt disconnected from world. Unable to focus and concentrate. Concerned for my safety driving. This continued for 2 weeks. Saw a doctor to check bloodwork and make sure nothing else was wrong. After 2 weeks the symptoms transitioned from fogginess to dizziness. This has continued till now (at 3 weeks post Moderna shot number one). Room seems to spin when sitting still or closing eyes. Dizziness occurs throughout day, although not consistent. Bloodwork results all came back normal. Physical exam normal.

Other Meds: multi vitamin, calcium supplement, omega 3 supplement, probiotics

Current Illness: none

ID: 1293045
Sex: F
Age: 28
State:

Vax Date: 04/19/2021
Onset Date: 04/28/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: Peanuts, soy

Symptom List: Injection site pain

Symptoms: 9 days after injection: Skin reaction (rash) on hands, feet, and face. Most severe on right hand. Swelling where rash was present, pain, and severe itch - Rash peaked at day 2 or 3 and by day 7 mostly subsided. Treated with regular allergy medication (Allegra) supplemented with maximum recommended dose of Benadryl throughout the day; Cortizone cream applied at maximum recommended dose throughout the day; Ice; Hot water baths to stop itching. Outcome: Symptoms persisted for about a week, peaking on the second or third day and subsiding steadily with treatment - Was able to cut back on antihistamines and Cortizone after the first few days. As I write this it is the 8th day since symptoms appeared - Still very minor itch in a couple of spots but swelling is gone. Skin is splotchy where rash is healing but fading by the day.

Other Meds: Birth control pill (Estarylla), Allegra, Women's multivitamin, Calcium supplement, Vitamin C supplement

Current Illness:

ID: 1293046
Sex: F
Age: 34
State: CA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild, Additional Details: Within a minute or so of receiving her vaccine, patients became sweaty, dizzy, and had to put head between her knees. After that initial reaction, patient had initial signs and symptoms of nausea (described nausea, cheek bloated intermittently as if to vomit). Side effects resolved within a 15 minute period. Patient sat for a total of 30 minutes, and left pharmacy with no apparent lingering effects.

Other Meds:

Current Illness:

ID: 1293047
Sex: F
Age: 79
State: FL

Vax Date: 03/26/2021
Onset Date:
Rec V Date: 05/06/2021
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: Statins: insids; Talwin: Macradantin; celebrex; mobic,

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

Symptoms: April 6 giant hives covering entire body. Extdreme itching, Sores of the lips,,

Other Meds: Centrum Silver 1/day; Baby asprin 81 mg 1/day: Vitamin E 1000 1 /day; Akegra 180 mg 1 /day: sertraline 50 mg 1/day

Current Illness: Urinitary track infection

ID: 1293048
Sex: F
Age: 17
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient was under age when she received covid 19 moderna dose 1. Parents want patient to get dose 2

Other Meds:

Current Illness:

ID: 1293049
Sex: F
Age: 26
State: MD

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Nausea - No vomitting Seen by EMT. Discharged home at 1230pm

Other Meds:

Current Illness:

ID: 1293050
Sex: F
Age: 32
State: IN

Vax Date: 05/04/2021
Onset Date: 05/05/2021
Rec V Date: 05/06/2021
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: N/a

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

Symptoms: Chills, body aches - - took ibuprofen and rested

Other Meds: Losartan, seroquil, Cymbalta, prazosin, buspirone, hydroxyzine pamoate

Current Illness: N/a

ID: 1293051
Sex: F
Age: 74
State: NY

Vax Date: 02/05/2021
Onset Date: 04/13/2021
Rec V Date: 05/06/2021
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: sulfa

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

Symptoms: shingles

Other Meds:

Current Illness:

ID: 1293052
Sex: F
Age: 93
State: HI

Vax Date: 04/15/2021
Onset Date: 05/01/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: The patient presents with generalized weakness and fever. She has been feeling weak in general for past 2 days. She developed fever (103F) today. She also has a decrease appetite. She does not have any pain. She denies any chest pain, headache, sore throat, abdominal pain. She denies any cough, shortness of breath, vomiting, diarrhea, or dysuria. She does not have any sick contact. She received Pfizer COVID-19 vaccination about a week ago. Since then, she has been feeling slightly weak and fatigued.. Given fluids and discharged to home stable.

Other Meds:

Current Illness:

ID: 1293053
Sex: F
Age: 24
State: TX

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/06/2021
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: Aproximately 7 minutes after receiving vaccine patient began experiencing right arm pain that travelled to her forearm. She described it as dull and 2/10.

Other Meds:

Current Illness:

ID: 1293054
Sex: M
Age: 22
State: NC

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/06/2021
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: Site: Pain at Injection Site-Mild, Systemic: Body Aches Generalized-Mild, Systemic: Chills-Mild, Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Visual Changes/Disturbances-Mild, Additional Details: pt had tunnel vison and lost his vision for a split second, he could not remmember me asking if he was okay. I gave his benadryl and checked bp that was 95/65, Encoraged pt to drink water and got a sucker for him. He was clammy and seemed worried. His bp started coming up within 5 minutes and was 105/80. His bp was 120/80 in 5min later, asked pt to get a ride and his wife came and got him. It had happened to him one time giving blood. pt had chills and ackes last night and is fatigued

Other Meds:

Current Illness:

ID: 1293055
Sex: M
Age: 47
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: ORIGINAL ON FILE AT FACILITY

Symptom List: Pain in extremity

Symptoms: PREPARATION AND ADMINISTRATION ERROR. PATIENT RECEIVED 180 MCG OF PFIZER COVID 19 VACCINE IMx1.

Other Meds: ORIGINAL ON FILE AT FACILITY

Current Illness: ORIGINAL ON FILE AT FACILITY

ID: 1293056
Sex: M
Age: 55
State: NJ

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient received the 2nd Moderna dose 3 days early. No adverse events.

Other Meds:

Current Illness:

ID: 1293057
Sex: M
Age: 36
State: MI

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/06/2021
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: NKA, NKDA

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

Symptoms: Patient became diaphoretic and light headed 6 minutes after being injected. Patient was 'dazed'. States that he has done this before with normal venipunctures.

Other Meds: Unknown

Current Illness: none

ID: 1293058
Sex: F
Age: 18
State: DE

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 05/06/2021
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: unknow

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

Symptoms: Immediately upon receiving vaccine, patient complained of dizziness and request an ambulance. Ambulance arrived within a few minutes. patient vitals were obtained and was asked if she'd like to go to the hospital. Patient decline additional care as she was feeling fine and not dizzy anymore

Other Meds: unknow

Current Illness:

ID: 1293059
Sex: F
Age: 33
State: CA

Vax Date: 04/08/2021
Onset Date: 04/17/2021
Rec V Date: 05/06/2021
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: nope

Symptom List: Vomiting

Symptoms: Tinitus, Vertigo, Fatigue (headache sometimes of the day). And all these have been last for 3 weeks now (they started 1 week after the shot) I went to earing doctor, they said nothing wrong with my ears

Other Meds: nope

Current Illness: nope

ID: 1293060
Sex: F
Age: 41
State: MN

Vax Date: 02/22/2021
Onset Date: 04/30/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Tested positive for covid-19 after completing vaccine series.

Other Meds:

Current Illness:

ID: 1293061
Sex: F
Age: 36
State: MI

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/06/2021
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: Nione

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

Symptoms: Patient received the COVID 19 vaccine and was being monitored for 15 minutes post-vaccination. Approximately 10 minutes after receiving the vaccine patient stated that she felt dizzy and her throat was scratchy. Pharmacist went to assist patient and noted that patient had yellow facial coloring and appeared disoriented. Patient was not responding when pharmacist was speaking to her. Patient was seated in a chair and her eyes were noted to roll back in her head and her body was convulsing. Patient was not conscious. Patient was assisted to floor by staff and assessed by pharmacist and technician. Approximately 5 to 10 seconds after being set on ground, patient stopped convulsing and regained consciousness. Patient stated she was not having difficulty breathing but was confused, shaking, light-headed and nauseous. A nurse who happened to be on site assisted with treatment. An ambulance was called for the patient and treatment was triaged to emergency responders. Patient was assessed and observed by EMT's and was discharged to home.

Other Meds:

Current Illness: None known

ID: 1293062
Sex: M
Age: 32
State: WI

Vax Date: 04/10/2021
Onset Date: 04/15/2021
Rec V Date: 05/06/2021
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: Konsyl Sugar-free aspartame, penicillins

Symptom List: Injection site swelling, Limb discomfort

Symptoms: patient lightheaded, dizzy, winded, fatigue, chest pressure, diaphoresis, sense of fogginess in his thinking.

Other Meds: none

Current Illness: none

ID: 1293063
Sex: M
Age: 67
State: PA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Medium, Systemic: Nausea-Severe, Systemic: Tingling (specify: facial area, extemities)-Severe, Systemic: Visual Changes/Disturbances-Severe, Systemic: Weakness-Severe

Other Meds:

Current Illness:

ID: 1293064
Sex: M
Age: 17
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: patient was underage when he got covid 19 moderna vaccine. Patients parents want him to receive second dose

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm