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: 1300385
Sex: F
Age: 43
State: NY

Vax Date: 04/29/2021
Onset Date: 05/06/2021
Rec V Date: 05/08/2021
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: Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Shingles developed May 6, 2021

Other Meds: Synthroid, lo loestrin

Current Illness: None

ID: 1300387
Sex: F
Age: 38
State: MA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
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 Celebrex - hives

Symptom List: Anxiety, Dyspnoea

Symptoms: Left upper arm - red rash that is painful to the touch, located on anterior portion of deltoid. Rash is not raised, nor does it contain bumps.

Other Meds: Spironolactone 75 mg Verapamil 120 mg Ginger 500 mg Maxalt Loestrin Elavil 75 mg

Current Illness: Chronic migraine vertigo hypertension arthritis

ID: 1300388
Sex: M
Age: 58
State: TX

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/08/2021
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: No Known Drug Allergy

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

Symptoms: The patient was given the Pfizer BioNTech COVID vaccine - incorrect diluent type was used (sterile water for injection) instead of preservative-free normal saline. MD was notified, Patient had no symptoms and monitored the patient.

Other Meds: Catapres 0.1 mg 1 tab prn C-PC B12 1000 mcg/ml bimonthly Flonase 50 mcg puffs 2 apply prn Levemir 100U/ml 25 units BID metoprolol succinate 50 mg 1 tab QD Renvela 800 mg 2 tab TID Tylenol 325 mg 1 tab Prn Vitamin C 500 mg daily Zofran 4mg

Current Illness: No illnesses in the past 30 days

ID: 1300389
Sex: M
Age: 22
State: IN

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

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

Lab Data:

Allergies: None, NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: According to the nurse from the Clinic, patient fell and hit his head while sitting after the vaccination. When I saw the patient again, he was conscious and drinking water. Nurse note: fell hit head, lightheadness, ringing in ears, reported history of syncope as teen. Nurse took vitals at210pm on 5/8 HR46 BP 92/52 O2: 98% Respiration: 22 Blood glucose 2:25pm-109 EMS was called by the Clinic, patient refused to go to the hospital. Patient went home

Other Meds: Unknown

Current Illness: Unknown

ID: 1300391
Sex: M
Age: 53
State: AR

Vax Date: 12/16/2020
Onset Date: 12/18/2020
Rec V Date: 05/08/2021
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

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

Symptoms: Nausea and fatigue, symptoms faded before 2nd shot

Other Meds: none

Current Illness: none

ID: 1300392
Sex: M
Age: 82
State:

Vax Date: 01/21/2021
Onset Date: 02/13/2021
Rec V Date: 05/08/2021
Hospital: Y

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: This 82 year old male received the Moderna Covid shot on 1/21/21 and went to the ED on 2/13/21 and was admitted on2/16/21 with the following diagnoses listed below. I63.9 - CVA (cerebral vascular accident) (CMS/HCC) R29.90 - Stroke-like symptoms I63.9 - Cerebral infarction, unspecified

Other Meds:

Current Illness:

ID: 1300393
Sex: M
Age: 65
State: OR

Vax Date: 12/23/2020
Onset Date: 12/28/2020
Rec V Date: 05/08/2021
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: I had severe pain in the entire both legs and pain in the trochanteric bursa at 4:00 AM with a fever. It resolved quickly with over-the-counter naproxen 440 mg

Other Meds: None

Current Illness: None

ID: 1300394
Sex: F
Age: 79
State:

Vax Date: 02/11/2021
Onset Date: 02/24/2021
Rec V Date: 05/08/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: This 79 year old white female received the Pfizer Covid shot on 2/11/21 and went to the ED on 2/24/21 and was admitted on 2/24/21 with the following diagnoses listed below. I63.9 - CVA (cerebral vascular accident) (CMS/HCC)

Other Meds:

Current Illness:

ID: 1300395
Sex: F
Age: 16
State: MI

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

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

Lab Data:

Allergies: No allergies listed

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received Pfizer vaccination at 04:55 pm. Her father accompanied her. A few minutes after receiving the vaccination, she passed out. Her father shook her arm and she became cognizant again. She did not remember passing out and has never passed out in the past. I monitored her for 30 minutes and gave her bottled water to stay hydrated. After 30 minutes she was feeling well and I observed her as she stood up. She had no further problems.

Other Meds: None

Current Illness: None

ID: 1300396
Sex: M
Age: 62
State: WA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
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: unknown

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt. arrived for second Pfizer vaccine on day 13 after first dose requesting an exception for travel plans. Medical Site supervisor is informed and placed call to Dr. (Name) to confirm dosing schedule for Pfizer. After updated Dr. (Name) approves vaccination with education of pt. on risks of early vaccination. immunization registry at checkout discovers pt. had full Moderna series in late Jan/early Feb. Dr. (Name) is notified. Pt. left clinic before education could be given

Other Meds: unknown

Current Illness: unknown

ID: 1300397
Sex: M
Age: 36
State: UT

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

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

Lab Data:

Allergies: sulfa, erythromycin

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

Symptoms: patient began feeling light headed 5 minutes after being given the vaccine, then feeling tingling in hands then in body, he then started feeling tightness in stomach area then in arms. Patient was instructed to take deep breaths and was able to speak in full sentences when he was asked about his address and if he's had a reaction to vaccines in the past. He responded that he felt lightheaded after his Tetanus vaccine in the past but never severe reactions. EMS was called and he was take to hospital by ambulance.

Other Meds:

Current Illness: n/a

ID: 1300398
Sex: F
Age: 59
State:

Vax Date: 01/26/2021
Onset Date: 02/04/2021
Rec V Date: 05/08/2021
Hospital: Y

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: This 59 year old female received the Pfizer Covid shot on 1/26/21 and went to the ED on 2/4/21 and was admitted on 2/4/21 with the following diagnoses listed below. I63.9 - CVA (cerebral vascular accident) I63.9 - Cerebral infarction, unspecified R29.810 - Facial weakness

Other Meds:

Current Illness:

ID: 1300399
Sex: M
Age: 51
State: OR

Vax Date: 05/07/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

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

Lab Data:

Allergies: sulfa drugs

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

Symptoms: woke up to severe chills and body aches, headache and extreme pain at both injection sites. fatigue.

Other Meds: vitamin d, 5000 i.u./day prenatal vitamin

Current Illness: none

ID: 1300400
Sex: M
Age: 81
State: TX

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

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

Lab Data:

Allergies:

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

Symptoms: Patient reports pain in left arm and shoulder since time of injection three weeks ago.

Other Meds:

Current Illness:

ID: 1300401
Sex: M
Age: 60
State: FL

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
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: flu virus vaccine (anaphylaxis), penicillin (rash), contrast (fever)

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

Symptoms: patient received second moderna covid-19 vaccine on 5/8/21, lot number 037B21A. patient reported to the ED with blistering at the injection site (right arm) one day later. patient did not have this reaction after the first vaccine in the left arm but reports still being sore from the injection 4 weeks ago. patient was discharged with clindamycin for possible secondary infection.

Other Meds: patient received second moderna covid-19 vaccine on 5/8/21, lot number 037B21A. patient reported to the ED with significant blistering at the injection site (right arm) one day later. patient did not have this reaction after the first vacc

Current Illness:

ID: 1300402
Sex: F
Age: 24
State: TX

Vax Date: 03/06/2021
Onset Date: 04/27/2021
Rec V Date: 05/08/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient symptoms interscapular back pain started 04/27/2021 upper extremeties weakness started late 4/27/2021 presented to ER on 4/28/2021 developed upper and lower extremeties weakness, urinary retention, multople imaging studies done, including MRI cervical and Thoracic spine, consistent with Transverse Myelitis

Other Meds:

Current Illness:

ID: 1300403
Sex: F
Age: 74
State: VA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 05/08/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Headaches in eyes and head, extreme sensitivity to light non-stop!!! since April 12, PM until today May 8th. Just starting to diminish a little bit.

Other Meds: Estradot Patch

Current Illness: None

ID: 1300404
Sex: M
Age: 63
State:

Vax Date: 03/26/2021
Onset Date: 04/05/2021
Rec V Date: 05/08/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: This 63 year old male received the Moderna Covid shot on 3/26/21 and went to the ED on 4/5/21 and was admitted on 4/5/21 with the following diagnoses listed below. I63.9 - CVA (cerebral vascular accident)

Other Meds:

Current Illness:

ID: 1300405
Sex: F
Age: 24
State: IN

Vax Date: 04/06/2021
Onset Date: 04/24/2021
Rec V Date: 05/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Certain foods/drinks/tastes now taste like metal. So far the specific tastes are: hazelnut, peppermint, and Gatorade. There are others that I can?t pin point as the cause of the taste. I got COVID in February and lost my taste and smell for around a month.

Other Meds: Viibryd Amitriptyline Montelukast

Current Illness:

ID: 1300406
Sex: F
Age: 74
State:

Vax Date: 02/26/2021
Onset Date: 04/18/2021
Rec V Date: 05/08/2021
Hospital: Y

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: This 74 year old female received the Moderna Covid shot on 2/26/21 and went to the ED on 4/18/21 and was admitted on 4/18/21 with the following diagnoses listed below. I63.9 - CVA (cerebral vascular accident) I63.9 - Stroke determined by clinical assessment R29.810 - Facial weakness

Other Meds:

Current Illness:

ID: 1300407
Sex: M
Age: 67
State: OR

Vax Date: 04/30/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
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: Buspirone

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

Symptoms: About 8 days after vaccine patient noticed a red patch at vaccine site that is swollen and itchy. He was not concerned enough to seek medical attention. Ice and topical medication seemed to be helping with the itching. Patient will continue to monitor and let us know of any differences in condition

Other Meds:

Current Illness:

ID: 1300408
Sex: M
Age: 25
State: TX

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

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

Lab Data:

Allergies: No Known Allergies

Symptom List: Unevaluable event

Symptoms: COVID-19 Pfizer BioNTech vaccine was administered to the patient on 05/05/2021 (incorrect diluent- sterile water for injection was used as diluent instead of preservative-free normal saline). The patient had no symptoms. MD was notified of the error and the patient was monitored. The patient did not have any adverse event from receiving the vaccine.

Other Meds: ADALAT CC 60MG TABS 1 TABS BID ORAL(po) APRESOLINE 25MG TABS 2 TABS BID ORAL(po) CALCIFEROL 50000 UNITMG TABS 1 TABS EVERY WEEK ORAL(po) METOPROLOL TARTRATE 25 MG TABS 1.5 TABS BID ORAL(po) CALCITRIOL 0.5MCGMG CAPS 1 CAPS QTX ORAL(po) CATAP

Current Illness: None

ID: 1300409
Sex: M
Age: 29
State: IA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
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: Within 5 minutes post-administration the patient reported dizziness, sweating, vision disturbances (blotchy vision), shaking hands. Over the next few minutes it appeared to worsen. EMS was called and by the time they arrived 10 minutes later he was feeling better. He was released from the their care and claims he is fully recovered. It is suspected that it could be a panic attack, but he is not sure.

Other Meds: None

Current Illness: none

ID: 1300410
Sex: F
Age: 44
State: WV

Vax Date: 05/06/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
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: no known allergies

Symptom List: Injection site pain, Pain

Symptoms: Patient called into pharmacy on 05/08/2021 @ 1:15 pm stating that upon going into work this morning around 8:00 am and starting her shift that she had weakness and tingling in the arm (left) that her injection was given. She had burning and it hurt just from the injection itself but understood that to be normal. She was concerned about the burning and tingling that was present. She also stated that it as she tried to use the arm at work ( she is a groomer ) that a weird tingling sensation traveled up to her neck and to the middle of her index finger. She had to leave work because she could not use her arm to do her job. I advised the patient to seek medical attention. I called the patient back @ 6:58 pm on 05/08/2021 and she stated that she was feeling better but has not had time to seek medical attention and was going to wait until Monday.

Other Meds:

Current Illness:

ID: 1300411
Sex: M
Age: 59
State: WI

Vax Date: 04/22/2021
Onset Date: 05/02/2021
Rec V Date: 05/08/2021
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: laytex, narcotic pain meds, gabapentin,

Symptom List: Injection site pain, Menorrhagia

Symptoms: stroke on 5/2 8:45 am hospitalized 5 days no physiologiical explanation. 3/4 of right cerebellum is dead. at onset nausea vomiting vision loss, loss of balance and coordination BP bottomed out low heartrate while sleepiing

Other Meds: Famotidine tums tumeric garlic C50 Vitamin B multivitamin

Current Illness: none

ID: 1300412
Sex: F
Age: 44
State: FL

Vax Date: 04/26/2021
Onset Date: 04/29/2021
Rec V Date: 05/08/2021
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: Erythromycin

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

Symptoms: I had the somewhat expected fever and flu like aches for 2 days after vaccine but on the third day, The lymph node on the left side by the collar bone was quite enlarged. The right followed and over the next day or so, the headache started. By day 5 the headaches were so severe I was waking up in agony during the night and on the first night of headache I was nauseated but did not vomit. At this point, almost 2 weeks since vaccine, armpit, side of neck and back of neck lymph nodes are all enlarged and the headaches continue. They are not quite as severe. I have used hydrocodone and prescription ibuprofen for pain. I started a 6 day cycle of steroids yesterday, May 7.

Other Meds: Premarin -Estrogen Amlodipine Claritin

Current Illness: N/A

ID: 1300413
Sex: F
Age: 66
State: MD

Vax Date: 05/01/2021
Onset Date: 05/03/2021
Rec V Date: 05/08/2021
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: Ibuprofen, naxoprine, iodine, gapbapen Allergic to shellfish.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I believe on 5/4/2021 I noticed my mouth my tongue felt numb when I ate or drank. I could taste but numbness was noticeable. Wednesday, May 5 it was still numb and I had a headache. Thursday, numbness remains headache is worsening. . On Friday, May 7, same but my right was watery. May 8, right side of my face is numb to the point that eating or drinking is difficult. Went to the Emergency Room because I thought I was having a stroke.

Other Meds: Lexapro, pravaststin, buspirone,omeprazole, loratadine, vagefem Fish oil, ginger, turmeric, CbD oil, cranberry capsules, probiotic, CoQ10, calcium, ocuvite for healthy eyes,

Current Illness: None

ID: 1300414
Sex: M
Age: 80
State: ID

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 05/08/2021
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: Patient stated he could not walk in the morning and this lasted for about 12 hours after the second dose of Moderna.

Other Meds:

Current Illness:

ID: 1300415
Sex: F
Age: 32
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: At 15:45 pt reported heat sensation in her chest radiating across her chest and into her L arm. Vitals at 15:45 are: T:98.1 P: 107 RR: 17 BP:145/100 O2: 98%. Pt encourgaed to take deep breaths and offered cold pack. Cold pack placed on back of pt's neck. Vitals at 15:55 are: T:98.1 P:102 RR: 18 BP:130/100 O2: 97%. Pt states ice pack helped releive the heat sensation. Pt monitored for an additional 10 minutes. Pt reports symptoms have subsided. Last set of vitals at 16:10 are: T:98 P: 100 RR:16 BP:125/90 O2:99%

Other Meds:

Current Illness:

ID: 1300416
Sex: F
Age: 44
State: MA

Vax Date: 04/23/2021
Onset Date: 04/27/2021
Rec V Date: 05/08/2021
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: Started with a couple of hives on my back around 8pm. In a few hours it progressed to a rash and hives all over the torso. The next day there were additional hives on the elbows, knees, and thighs. The rash had also spread to the scalp. The rash and hives began to fade the third day but came back that evening. On the fourth day the hives were gone but there was still a rash in the morning. By the mid afternoon the rash was also completely gone. I took 2 benadryl every 6 hours while awake and that helped with the itching. I did not take any medication between bedtime and waking in the morning. There were times I felt a lump in my throat, but breathing was never restricted or a problem. I did call my doctor on the second day and was told to take benadryl and call 911 if I had any issues breathing.

Other Meds: None

Current Illness: None

ID: 1300417
Sex: M
Age: 31
State: FL

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

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

Lab Data:

Allergies: penicilins

Symptom List: Injection site pain

Symptoms: vasovagal syncope

Other Meds: unknown

Current Illness: unknown

ID: 1300418
Sex: F
Age: 33
State: GA

Vax Date: 05/07/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
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: Patient called in the morning saying she is experiencing possible adverse reaction from vaccine she received yesterday. She said she is having two bumps on the same arm where received vaccine. It's not at the injection site but slighlty below. One bump was small while other one was pea-sized. She put cortisone cream and cleaned it with alcohol. I suggested her to apply ice also and see if swelling goes down. She said she will do it. She called back again in afternoon and told me she has been doing combination of ice and steroid and redness and itchiness is going down but now there is a ring around the bumps. I told her to keep doing that combination and in case if it gets wrose then seek medical attention.

Other Meds:

Current Illness:

ID: 1300420
Sex: F
Age: 33
State: OR

Vax Date: 04/24/2021
Onset Date: 04/26/2021
Rec V Date: 05/08/2021
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: Apple, peaches, pears, cherries, plums

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

Symptoms: About 36 hours after vaccine, I had a severe tremor episode that lasted for about 45 minutes. Since then, I?ve had muscle weakness, fatigue, and tremors in my arms and hands. It?s been 2 weeks now. Not sure if it?s vaccine related or not.

Other Meds: Prozac, 40 mg Loestrin birth control

Current Illness: None that I can remember.

ID: 1300422
Sex: M
Age: 29
State: IN

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
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: Fatigue, chills, fever, muscle soreness, and joint pain all over for 24 hours, starting 24 hours after second injection. Laying down was painful due to serve joint and muscle pain in my neck and arms in the last 8 hours. I sat or stood to relieve the neck pain. I took 2 ibuprofen at 9am Saturday to help with the pain. I had fully recovered by 1pm Saturday, the 8th.

Other Meds:

Current Illness:

ID: 1300423
Sex: F
Age: 23
State: TX

Vax Date: 04/12/2021
Onset Date: 04/21/2021
Rec V Date: 05/08/2021
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: patient developed a rash about 9-10 days after initial vaccination around the area of the injection site . she stated this went away in a couple of days

Other Meds:

Current Illness:

ID: 1300424
Sex: M
Age: 52
State: AL

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

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

Symptoms: Patient experienced nausea, paleness, and sweating. Used an ice pack. Called 911. Paramedics arrived and assessed patient inside and then moved patient outside for further assessment. Called patient after leaving the pharmacy and his wife stated that he was doing fine and back to normal.

Other Meds: Unknown

Current Illness: None known

ID: 1300425
Sex: M
Age: 33
State: NC

Vax Date: 04/30/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Itchy lump at injection site one week after injection

Other Meds: Effexor, Testosterone Cypionate, Trazadone, Klonopin, Vitamin D, Vitamin B12

Current Illness: None

ID: 1300426
Sex: M
Age: 47
State: PA

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 05/08/2021
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: No immediate effects other than soreness at the injection site on Wed 4/28. Upon waking on Thurs 4/29, I had a fever of approximately 99.5F. Took acetaminophen afterwards for the next 24/48 hours as the fever steadily rose throughout the day peaking at approx 102F around 5 pm. Also developed chills, fatigue, all over muscle soreness, a headache, and nausea. Overnight 4/29 into 4/30 was pure misery but by 4/30 a.m. the fever starting to break. Took pain relievers and antacids(for the nausea) through Sat 5/1.

Other Meds:

Current Illness:

ID: 1300427
Sex: M
Age: 72
State: NM

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
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: N/A

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

Symptoms: Patient reports 27 hours feeling fatigued after vaccine yesterday but unable to sleep. Said could not sleep "not a single minute" last night even though tired. Could not sleep at all today and feeling racy and anxious like he does if he were to go without his clonazepam but insists he has taken it properly. Note, patient didn't experience any of this with his first dose. But also came into his second vaccine asking about if this would interact with his lamictal. Patient seems convinced the vaccine is interacting with his medications. After discussion he is going to be seen at an urgent care for how to proceed.

Other Meds: Lamictal, clonazepam

Current Illness: N/A

ID: 1300428
Sex: M
Age: 31
State: KS

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

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

Lab Data:

Allergies: NONE

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

Symptoms: PATIENT RECEIVED MODERNA COVID19 VACCINE. AFTER IT WAS ADMINISTERED HE WAS ABLE TO GET UP AND WALK OVER TO THE DESIGNATED WAITING AREA APPROXIMATELY 5 MINUTES AFTER HE FAINTED AND FELL TO THE GROUND FROM A SEATED POSITION IN THE CHAIR. WHEN I GOT TO HIS SIDE I WAS UNABLE TO TURN OVER DO TO HIS SIZE BUT LESS THAN 30 SEC HE CAME TO AND WAS ABLE TO PICK HIMSELF UP BACK TO SEATED POSITION. PATIENT REPORTED NO INJURIES DUE TO THE INCIDENT.

Other Meds: UNKNOWN

Current Illness: NONE REPORTED

ID: 1300429
Sex: F
Age: 64
State:

Vax Date: 04/06/2021
Onset Date: 04/20/2021
Rec V Date: 05/08/2021
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:

Symptom List: Pain in extremity

Symptoms: This 64 year old female received the Pfizer Covid shot on 4/6/21 and went to the ED on 4/20 /21 and was admitted on4/20/21 with the following diagnoses listed below. I63.9 - Cerebrovascular accident (CVA), unspecified mechanism (CMS/HCC) I63.9 - Cerebral infarction, unspecified R29.810 - Facial weakness

Other Meds:

Current Illness:

ID: 1300430
Sex: F
Age: 46
State: WA

Vax Date: 04/19/2021
Onset Date: 04/26/2021
Rec V Date: 05/08/2021
Hospital: Y

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

Lab Data:

Allergies: no

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

Symptoms: Blood Clot in right shoulder VAS Upper Extremity Venous Right

Other Meds:

Current Illness: no

ID: 1300431
Sex: F
Age: 41
State: CA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 05/08/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Chills/ hot flashes 2 days Metallic taste in mouth 3 weeks Muscle cramps ongoing since 4/14 Muscle burning ongoing since 4/14 Headaches 2 weeks Dizziness ongoing since 4/14 Numbness in left hand ongoing since 4/14 Fatigue ongoing since 4/14 Muscle weakness ongoing since 4/14 Back pain ongoing since 4/14 Pain in left arm / shoulder started last night Unable to sleep. Ongoing since 4/14 Nausea 2 days Pain in calves 1 day Cough 1 week

Other Meds: Birth control pills Biotin Multivitamin

Current Illness: None

ID: 1300432
Sex: F
Age: 82
State:

Vax Date: 01/28/2021
Onset Date: 02/24/2021
Rec V Date: 05/08/2021
Hospital: Y

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

Symptoms: This 82 year old female received the Moderna Covid shot on 1/28/21 and went to the ED on 2/24/21 and was admitted on 2/24/21 with the following diagnoses listed below. CVA (cerebral vascular accident) Cerebral infarction, unspecified Facial weakness

Other Meds:

Current Illness:

ID: 1300433
Sex: F
Age: 40
State: IN

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
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: Mangos

Symptom List: Vomiting

Symptoms: Fatigue, body aches, low grade fever

Other Meds: Flexeril, Meloxicam, Tramadol

Current Illness: None

ID: 1300434
Sex: M
Age: 51
State: CA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
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: Pharmacist came to observation area noticed MD and EMT with client. Client reportedly per OBservation Lead was complaining of not feeling well, feeling dizzy and having blurred vision. Client was intially refusing to provide us with his information. Per EMT clients BP 202/127 oxygenation 97% HR 85, client declined Blood Sugar check. MD advised client to go to ER due to BP, EMT called paramedics at approx 350pm. Paramedics arrived at 4pm repeat BP 200/130 agreed to transport to hospital. TRansferred to doctors hospital at 0405pm

Other Meds:

Current Illness:

ID: 1300435
Sex: F
Age: 60
State: NJ

Vax Date: 03/19/2021
Onset Date: 04/20/2021
Rec V Date: 05/08/2021
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: None

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

Symptoms: Shingles.

Other Meds: None

Current Illness: None

ID: 1300437
Sex: M
Age: 89
State:

Vax Date: 01/20/2021
Onset Date: 04/16/2021
Rec V Date: 05/08/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: This 89 year old white male received the Pfizer Covid shot on 1/20/21 and went to the ED on 4/16/21 and was admitted on 4/16/21 with the following diagnoses listed below. I63.9 - Acute CVA (cerebrovascular accident) R29.810 - Facial weakness

Other Meds:

Current Illness:

ID: 1300438
Sex: M
Age: 27
State: CA

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

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

Lab Data:

Allergies: N/A

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

Symptoms: PATIENT IS AFRAID OF NEEDLES AND WAS DIZZY AFTER INJECTION. PATIENT HAD TO BE LAID DOWN FOR 30 MINUTES AND FIRST RESPONDERS CAME TO ASSESS PATIENT'S CONDITION. WAS TOLD PATIENT IS FINE AND PATIENT LEFT WHEN HE NO LONGER EXPERIENCED DIZZINESS

Other Meds: N/A

Current Illness: N/A

ID: 1300439
Sex: F
Age: 49
State: CA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
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: Sulfa drugs, environmental allergies

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

Symptoms: I received my first dose of Pfizer vaccine on 4/17/21 at a super pod site but decided to get my second dose at a retail pharmacy close to my home. Despite filling out a form online, handing in a paper form and showing my vaccine card, the pharmacy gave me a a Moderna vaccine.

Other Meds: Synthroid, once daily

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm