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: 1302504
Sex: M
Age: 30
State: CO

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/10/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Immediate stinging and numbing feeling in index finger that lasted about a week

Other Meds: None

Current Illness: None

ID: 1302505
Sex: F
Age: 53
State: SC

Vax Date: 01/18/2021
Onset Date: 02/06/2021
Rec V Date: 05/10/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Shortness of breath. Ongoing. Requires regular doses of OTC inhaler

Other Meds: Parnate

Current Illness: None

ID: 1302506
Sex: M
Age: 37
State: KY

Vax Date: 01/19/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: n/a

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

Symptoms: Seizure like activity without any personal or family history. All vitals and tests were normal when taken by EMT and RN at the hospital.

Other Meds: n/a

Current Illness: n/a

ID: 1302507
Sex: F
Age: 45
State: NH

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: Yes, many.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Within minutes, I experienced tachycardia and syncope with weakness. After 30+ minutes, they cleared me to go home with no intervention. My heart rate had come down and though still weak they felt I was ok. Hives began within this period and worsened after my release. Nausea and dizziness within the hour which persisted for 5 days with fevers, chills and sweats, until diarrhea became the predominant stomach ache. Through the first three days, chest pain and weakness continued with the dizziness, fevers and nausea. Metallic taste in mouth. Blister on roof of mouth. Lymph node swelling under arm within a day or so, and into the neck by day 6. Very tender. Fevers continue but low grade and without chills or sweats. Right eye pain beginning first night -continuing still. Episodic hives first several days. Joint pain, nerve pain, muscle pain. Bright red joints and tendons episodically.

Other Meds: None at time.

Current Illness: N/A

ID: 1302508
Sex: M
Age: 73
State: FL

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 05/10/2021
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, novacaine

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

Symptoms: Lightheadedness, "brain fog", large drop in bp down to 94/58, heart rate dropped from 82 to 62, difficulty focusing eyes, nystagmus in left eye, unsteady balance. Events were present for over 3 weeks before beginning to fade.

Other Meds: Olmesartan 10mg, Verapimil 180mg, Triamterene HCT 37.5 mg, Provachol 80mg, Breo 100mcg Vitamin D3, B12, Super Beta Prostate Advanced, aspirin 81mg

Current Illness: BPH

ID: 1302509
Sex: F
Age: 87
State: GA

Vax Date: 02/15/2021
Onset Date: 04/27/2021
Rec V Date: 05/10/2021
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: Hospitalized due to COVID-19 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1302510
Sex: M
Age: 76
State: CO

Vax Date: 12/31/2020
Onset Date: 01/14/2021
Rec V Date: 05/10/2021
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: Tussinex

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I have had neurological problems since December of 2019. I had problems after an episode of water in my ear. I have had lightheadedness and near fainting episodes since then. Since I got the first dose of the vaccine my problems have gotten worse. My episodes of Dizziness and near fainting have become more severe. It had seemed to improve before I got the vaccine. I am lightheaded every day and I see a doctor every week. Vestibular Rehab Training, Neurology, Physical Therapist and other professional. Dose 2 # 007M20A

Other Meds: Armor thyroid

Current Illness:

ID: 1302511
Sex: M
Age: 38
State: FL

Vax Date: 03/11/2021
Onset Date: 04/30/2021
Rec V Date: 05/10/2021
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: No known allergies

Symptom List: Pharyngeal swelling

Symptoms: ED notes: 39 y.o. male with no significant medical history brought by EMS for dysarthria, RT arm weakness, and RT facial droop beginning at 2:05pm today. Sx acute onset, severe, constant, and have not occurred previously. Pt was driving just prior to symptom onset when he called his mother stating he did not feel well at 2:05pm. Upon arriving home, mother noticed he was dysarthric and called 911. EMS noted facial droop, arm weakness, dysarthria, and gaze palsy and transported him to the hospital. Initial glucose by EMS 110. Pt denies headache, recent head trauma, history of brain hemorrhages or prior stroke. PMH: None, PSH: None, Allergies: NKDA, Tobacco: Denies, ETOH: Social, Drugs: Denies Pt AAOx3, bib from home for weakness and facial droop. Stroke alert called en route. As per report, pt was driving home at 2 pm when he started to feel ""weird"". Pt called his wife and was able to drive himself home. Upon arrival at his house he ""collapsed"" on the couch and his wife noticed right-sided facial droop and weakness, more prominent on the right side. Upon arrival to ED pt appears pale and weak. R sided facial droop and right arm and right leg weakness noted. Dr. at bedside. Stroke alert called in ED. Hr noted to be in the 40s. As per wife, pt is an athlete 5/4/21 Critical Care Notes: Neurology- No hx of neurological disease but does have family history of blood clotting disorder in maternal uncles and cousins (factor 2 and factor 5 but unclear specific diagnosis)- Patient presented with R sided weakness, R facial droop, dysarthria, double vision, R CN 6 palsy; no prior history of similar events- CT brain negative for acute abnormaility - CTA brain/perfusion showed no significant stenosis, occlusion, aneurysm, no perfusion abnormality- MRI brain showed small acute ischemic infarct in ventromedial L thalamus and chronic bilateral cerebellar lacunar infarcts- Patient showing improvement in symptoms s/p tPA- Repeat CT showed new mild hypoattenuation suggesting evolving acute infarction with no bleed, herniation, mass effect, or midline shift- Echo with bubble study revealed patient PFO, No DVT on LE US- Lipid profile WNL, tox screen neg, RPR neg- Neuro checks per unit protocol- Check ANCA, Anti cardiolipin, anti thrombin III, antiphospholipid Ab, Factor V Leiden, Protein C and S, ANA, FTA, A1c; Dr. (H/O) consulted- ESR elevated- DAPT per neuro- DSA with NIR today Cardiology- Hx of sinus bradycardia: Patient is athletic, works out regularly. Had previous cardiac evaluation with no significant findings- EKG showing borderline 1st degree AV block- Troponin neg- BP well controlled - MAP goal >65mmHg- 2D echo with bubble study revealed patent PFO, No DVT on LE US Heme/Onc- CBC unremarkable - No active bleeding- Transfuse if Hgb < 7- DVT prophylaxis SCDs, patient ambulatory- No DVT on LE US- Workup as above for blood clotting disorders given stroke in otherwise young healthy patient with family history of clotting disorders- H/O consulted, pending eval 5/9/21 Neurology Note: Overall neurological assessment remains stable and unchanged overnight. Double vision on the right eye stable, improving as per patient's report. Will recommend to continue with DAPT as ordered. Follow up with neurology as an outpatient in 2-4 weeks. Follow up with Cardio as well. Ok to discharge patient home as per Neurolgy standpoint. 1. Left ventromedial thalamic CVA. 2. PFO - S/P closure 5/7/2021. 3. Congenital hypoplastic left VA, basilar trunk. 4. Remote cerebellar lacunar infarcts. 5. Family history of Factor V Leiden, factor II. PLAN: 1. Ok to discharge patient home as per neurology standpoint. 2. Continue ASA 81 mg and Plavix 75 mg Daily. 3. Follow up with neurology as an outpatient in 2- 4 weeks. 4. Follow up with Cardio as per their recommendations. 5. Medical management as per IM.

Other Meds: Unknown

Current Illness: None

ID: 1302512
Sex: F
Age: 72
State: GA

Vax Date: 02/11/2021
Onset Date: 03/31/2021
Rec V Date: 05/10/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Hospitalization t did not eat/ drink anything for 72 hours before going into the hospital on 3/31. Pt began feeling unwell on 3/27 and has been digressing until hospitalization. Pt was noticeably confused and unable to carry a conversation. Pt did not mention change in taste or smell. Pt was warm to the touch but no temperature taken. Pt also complained of chills but this is typical for the pt. Pt had body aches. From Saturday on she was essentially bed ridden. Nausea but no vomiting. Pt rep spoke with the pt this morning and reports the pt is less confused and able to communicate. Pt and pt rep received second dose of Pfizer on 3/3. Pt rep their son-in-law and granddaughter visited around 3/25 and tested (+) on 3/29 or 3/30. Pt rep states the pt has had no other contacts. Pt rep denies travel and congregate settings. Pt rep verbally confirmed guidelines.

Other Meds:

Current Illness:

Date Died: 03/02/2021

ID: 1302513
Sex: M
Age: 87
State: AZ

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 05/10/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Death listed as a heart attack. No symptoms, but took an abnormally long nap just prior to the attack.

Other Meds: Losartan, Metformin, Nexium, Levothyroxine, Simvastan, Calcium 500+D, Vitamin B complex plus B12.

Current Illness: None

ID: 1302516
Sex: F
Age: 51
State: NC

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: penicillin, erythromycin, clindamycin, clarithromycin, percocet

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

Symptoms: about 4 minutes after vaccination: blurred vision, fast heart beat, shaking, high blood increased, throat was itchy, started coughing, voice went hoarse, headache, legs felt heavy. put in a room and monitored for about an hour, glucose test done. took Benadryl when I got home. felt like extremely fatigued/weak for 4 days.

Other Meds: none

Current Illness: none

ID: 1302517
Sex: F
Age: 20
State: IL

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Injection site is very swollen, sore, red, and itchy. About the size of a golf ball.

Other Meds: Junel-Fe 24 Birth Control

Current Illness: None

ID: 1302518
Sex: M
Age: 42
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Patient fainted after vaccine but was assisted to the floor. States that he has anxiety. Patient carefully watched in observation and did deep breathing exercises. He stated he felt better and vitals were within normal limits

Other Meds:

Current Illness:

ID: 1302519
Sex: M
Age: 63
State: IL

Vax Date: 04/18/2021
Onset Date: 04/22/2021
Rec V Date: 05/10/2021
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: 3 days after receiving the first dose I was hospitalized with Pericarditis.

Other Meds: None

Current Illness: None

ID: 1302520
Sex: F
Age: 59
State: CA

Vax Date: 04/19/2021
Onset Date: 04/28/2021
Rec V Date: 05/10/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NA

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

Symptoms: developed abd pain days after 2nd dose of Pfizer vaccine, came in 3 wk later for PEA arrest with dead gut secondary to extensive bud chiari syndrome w thrombosis of the portal vein, splenic vein, and superior mesenteric vein. Admitted to ICU/OR for ischemic small bowel removal.

Other Meds: aspirin 81 mg daily

Current Illness: JAK2 positive myeloproliferative disorder (with essential thrombocytosis and pre-fibrotic myelofibrosis) on ASA 81mg daily, h/o coagulopathy with elevated PTT. No inhibitor found.

ID: 1302521
Sex: F
Age: 40
State: VA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 05/10/2021
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: Allergic to the flu shot and to levaquin

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

Symptoms: Following the 2nd shot I had rapid heart beats and high fever. Within 48 hours the heartbeats and chest pain continued to intensify. In 2.26.2021 I went to the ER and my heartrate was in the 150s/160s and my heart presented to be in failure. I was admitted to the hospital for 2 days because my troponin level was high and indicated heart issues. I had mulitple EKGs and other tests as well as a heart catheterization. The catheterization showed no blockages. My heart continued to have an arithmyia and PVCs as well as chest pain. I was diagnosed with myocarditis or periocarditis due to the effects of the vaccine and referred to a cardiologists. I have been seeing the cardiologist for 6 weeks. I had to wear a heart monitor, have an echo cardio gram and many EKGs. I have never had any heart issues prior to this vaccine. I am still under the care of the cardiologist and on heart anti-inflammatory medications due to the myocarditis. I have rapid, irregulary heart beats and am unable to do any physical activity.

Other Meds: none

Current Illness: none

ID: 1302522
Sex: M
Age: 80
State: TX

Vax Date: 04/01/2021
Onset Date: 05/05/2021
Rec V Date: 05/10/2021
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: I woke up on May 5th with a woosh sound in my left ear and impaired hearing in the ear.

Other Meds: Hydrochlorothiazide TAB 25mg Rosuvastatin Calcium TAB 10mg Carvedilol Phosphate CAP 80mg Tolterodine Tartrate ER CAP 4mg Dutasteride CAP 0.5mg Vitamins

Current Illness: None

ID: 1302523
Sex: F
Age: 25
State: TX

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/10/2021
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: Tramadol

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Night of vaccine had severe body aches, back pain, leg pain severe until legs went numb, then arm pain severe until also numb, chest pains/ trouble breathing. Following days had pains in arms and legs as if a tourniquet was left on and I cycled through severe pain and being numb. 5 days in I lost my vision (super blurry and seeing double) and lost complete control of arms and legs on top of headache and chest pains. Vision came back a couple hours later but the leg pains/ numbness continued even now. It feels as if my circulation has been cut off.

Other Meds: Benadryl, Zyrtec, naproxen

Current Illness: None

ID: 1302524
Sex: M
Age: 65
State: OR

Vax Date: 05/05/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
Hospital: Y

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

Lab Data:

Allergies: Allergies Allergen Reactions ? Cephalexin Urticaria, Hives and Rash rash, hives,vomiting, diarrhea ? Lovastatin Myalgia myalgia myalgias ? Penicillin V Rash ? Simvastatin Myalgia myalgia myalgias

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: From Discharge summary Covid vaccine 05-05-2021; stroke about 05-07/2021

Other Meds: HOME MEDICATIONS: To the best of my knowledge are as follows: 1. Carvedilol 12.5 mg twice daily with meals. 2. Glipizide 5 mg twice daily with meals. 3. Lisinopril 5 mg at bedtime. 4. Terazosin 10 mg every morning. 5. Aspirin 81

Current Illness: Patient Active Problem List: Anemia [D64.9] Atherosclerosis of aorta [I70.0] Benign prostatic hyperplasia [N40.0] Family history of malignant neoplasm [Z80.9] Fracture, pelvis closed [S32.9XXA] GERD (gastroesophageal reflux disease) [K21.9] Homonymous bilateral field defects of right side [H53.461] Hx of splenectomy [Z90.81] Hx of traumatic brain injury [Z87.820] Hypercholesterolemia [E78.00] Hypertension [I10] Low back pain [M54.5] Microalbuminuria [R80.9] Migraine with aura [G43.109] Mild cognitive impairment [G31.84] Nevus of choroid of right eye [D31.31] Old myocardial infarction [I25.2] Pain in joint of left shoulder [M25.512] Personal history of other drug therapy [Z92.29] Presence of stent in anterior descending branch of left coronary artery [Z95.5] Rectal bleeding [K62.5] Screening for colon cancer [Z12.11] Sensory disorder as late effect of cerebrovascular disease [I69.998, R20.9] Spleen laceration extending into parenchyma w/open wound into cavity [S36.039A] Thrombocythemia [D47.3] Type 2 diabetes mellitus without complication, without long-term current use of insulin [E11.9] POLST (Physician Orders for Life-Sustaining Treatment) [Z78.9] Monoplegia of upper extremity following cerebral infarction affecting left dominant side [I69.332] Vascular dementia with behavior disturbance [F01.51] Dementia with behavioral disturbance, unspecified dementia type [F03.91] Essential hypertension, benign [I10] Chronic left shoulder pain [M25.512

ID: 1302525
Sex: M
Age: 35
State: ME

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: None that I am aware of

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

Symptoms: Roughly 30 minutes after receiving the shot, I developed a small rash on my forearm, on the same arm that I got the shot in. It was not itchy and only slightly raised in a couple spots.

Other Meds: None

Current Illness: None

ID: 1302526
Sex: M
Age: 55
State: MN

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 05/10/2021
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: None Seasonal Allergies

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

Symptoms: Fatigue, Chills, Fever

Other Meds: Astorvastatin 40 mg

Current Illness: Had Covid 19 on March 19, Low level sysmptoms until March 27th, Chills, Fatigue, sore muscles, body aches

ID: 1302527
Sex: F
Age: 17
State: VA

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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: Patient presented for second dose of Pfizer COVID vaccine. Per mom, patient had anxiety attack after first dose last approximately 45-60 minutes. Patient transferred from vaccine clinic to private room with stretcher prior to vaccine administration. Post vaccine administration, patient exhibiting typical symptoms of panic attack per mom (seizure-like activity, unable to respond to verbal stimuli, sternal rub or fingernail pressure). EMS arrived at 0925. Patient regained consciousness after EMS arrived, back to baseline at 0940. Patient and mother declined EMS transfer to ED for further evaluation. Patient and mother informed to seek medical attention immediately for any worsening/concerning symptoms. Patient discharged via wheelchair with mother.

Other Meds:

Current Illness:

ID: 1302528
Sex: F
Age: 54
State: TX

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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:

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

Symptoms: Patient complaining of hoarseness. Assessed and monitored for 30 minutes. symptoms subsided on site.

Other Meds: Lyrica, propranolol, topiramate, ibuprofen 400 mg

Current Illness:

ID: 1302529
Sex: F
Age: 45
State: NY

Vax Date: 05/02/2021
Onset Date: 05/03/2021
Rec V Date: 05/10/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Experienced fever of 104.2; 103.5; 101.3 with headaches and weakness.

Other Meds:

Current Illness:

ID: 1302530
Sex: F
Age: 33
State: VT

Vax Date: 05/06/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: Penacillin Omaxacillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Just over 48 hours after the vaccine, I got a sunburn-like rash on both triceps that hurt and have a burning sensation. The rash and burning sensation remain.

Other Meds: Sertraline 100 mg Nexplanon

Current Illness:

ID: 1302531
Sex: F
Age: 58
State: IN

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Fever, headache, chills, fatigue

Other Meds: Tylenol, Zyrtec, Atorvastatin

Current Illness: Sinusitis, high cholesterol

ID: 1302532
Sex: F
Age: 42
State: CA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient developed hives on the face and neck only, minor lip swelling. Denies SOB, Dizziness. Pt given Benadryl 25mg PO. VSS. Patient stable and released from the vaccination site. Recommended that the patient F/u with their healthcare provider, f/u instructions provided. 2nd dose appointment was canceled and scheduled J&J dose in 28 days. Pt has hx of PCN (hives), Sulfa (hives), morphine (swelling) allergies.

Other Meds:

Current Illness:

ID: 1302534
Sex: M
Age: 66
State: NY

Vax Date: 03/12/2021
Onset Date: 03/01/2021
Rec V Date: 05/10/2021
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 known

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: aphthous ulcers

Other Meds: metformin, benazepril, allopurinol, aspirin, gemfibrozil, vitamin D

Current Illness: none

ID: 1302536
Sex: F
Age: 49
State: FL

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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: Patient had swelling of throat and palpitations

Other Meds:

Current Illness:

ID: 1302537
Sex: F
Age: 47
State: MI

Vax Date: 04/26/2021
Onset Date: 04/27/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: Cadexomer Iodine, Doxycycline

Symptom List: Nausea

Symptoms: Nauseous after receiving vaccine; but then the feeling went away after about an hour Restlessness Irritability Hallucinations - seeing people that are no longer living (grandparents) I have reached out to (and will be seeing) my neurologist on Friday, May 14th. She put me on Clonazepam (.50 mg) - with instructions to take either a half or full tablet nightly. They are helping, as I have had my second night's dose and was able to sleep through the night without being restless and without the hallucinations. While I miss my grandparents, I don't wish to see them this way.

Other Meds: Lidocaine (preservative free) 2% Soln Injection: Inject 2.5 mL into the skin once for 1 dose. Triamcinolone Acetonide 40mg/mL Injection: Inject 1 mL (40 mg total) into the muscle once for 1 dose. Eliquis 5 mg Tablet: Take 1 tablet by mou

Current Illness:

ID: 1302538
Sex: M
Age: 36
State: CT

Vax Date: 05/08/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: Shrimp

Symptom List: Injection site pain

Symptoms: Body aches, low grade head ache, 102 fever, swollen and tender lymph node in left armpit. Lasting over 24hrs

Other Meds: Multi vitamin, vitamin D supplement

Current Illness: N/a

ID: 1302539
Sex: F
Age: 16
State:

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 05/10/2021
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 was 16 and received the Moderna vaccine on 4/18/21, called clinic to schedule second vaccine. no A/E

Other Meds:

Current Illness:

ID: 1302540
Sex: M
Age: 64
State: NY

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 05/10/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: I felt dizzy and had problems with breathing right away after the injection. A doctor from that site who checked my vitals wanted to call an ambulance to take me to a hospital. I couldn't let this happen as I was 120 miles away from my apartment, where two dogs were left unattended. I decided to come back home and monitor my vital signs. Since that time, I had almost every other day a chest pain and high blood pressure and low level of O2 but was too busy at work to care of myself. On 04.30.2021 around 3am I decided to drive into ER at where I was admitted and had CABG surgery on Tuesday 05/04/2021.

Other Meds:

Current Illness:

ID: 1302541
Sex: M
Age: 43
State: NJ

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: Johnson and Johnson vaccine. I have been experiencing ringing in the ears .. coming and going .. sometimes mild , sometimes more intense . I still have the ringing as of today , one week after . I am certain it is due to the vaccine as I have never experienced this before

Other Meds: None

Current Illness: None

ID: 1302542
Sex: F
Age: 42
State: NE

Vax Date: 04/07/2021
Onset Date: 04/12/2021
Rec V Date: 05/10/2021
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: None

Symptom List: Erythema, Pruritus

Symptoms: Tinnitus. Fairly constant from April 12th thru today (May 10th). Right ear. Fullness April 12th thru doctor visit later that week.

Other Meds: Levothyroxine

Current Illness: None

ID: 1302543
Sex: M
Age: 45
State: NJ

Vax Date: 04/06/2021
Onset Date: 04/10/2021
Rec V Date: 05/10/2021
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: no

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

Symptoms: Developed and still have severe ringing in the ears or tinnitus several days after vaccine. I never had any symptoms of tinnitus before the vaccine. It is completely disrupting quality of life,

Other Meds: Vitamin D and Vitamin B. Allergy generic Flonase nose spray

Current Illness: no

ID: 1302544
Sex: F
Age: 48
State:

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 05/10/2021
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: Amoxicillin

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

Symptoms: Moderna COVID-19 Vaccine EUA Symptoms started 12 hours after injection: muscle aches, fever, chills, headache, fatigue, and nausea for roughly 36 hours

Other Meds: Levothyroxine 25 mcg; Zyrtec 10 mg; Vitamin D3 2000 IU; OTC Probiotic

Current Illness:

ID: 1302545
Sex: F
Age: 42
State: AZ

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: NKDA Pepper

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fever/Severe Joint Pain/Headache

Other Meds: Birth Control

Current Illness: None

ID: 1302546
Sex: F
Age: 61
State: CA

Vax Date: 04/08/2021
Onset Date: 04/10/2021
Rec V Date: 05/10/2021
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: Eye infection started 2 days after the shot - 4/10/21. Stye developed and continued for over 2 weeks. Infection resolved without medication but small redness still present 5/10/21. Eye infection may not have been related to the vaccine but it was unusual. I have not had a stye for over 10 years.

Other Meds:

Current Illness:

ID: 1302547
Sex: F
Age: 54
State: NY

Vax Date: 04/30/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
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: DAY 9 POST INJECTION LARGE HARD LUMP AT INJECTION SITE THAT ENLARGED OVER THE NEXT 24 HOURS AND SKIN RED SWOLLEN AND ITCHY WATCHED OVER NIGHT ARE GOT LARGER CONTACTED primary DR OFFICE TO SCHDULE APT TO LOOK AT .

Other Meds: ESTRIDOL DOTTIE PATCH

Current Illness:

ID: 1302548
Sex: M
Age: 45
State: CO

Vax Date: 05/01/2021
Onset Date: 05/05/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Deep vein thrombosis (DVT). Woke up on 4th day after vaccine (May 5, 2021) with pain in calf. Swelling continued to get worse. Went to an emergency room just over one week after vaccine (May 8, 2021) and was diagnosed with DVT in the lower left calf (after D Dimer test and ultrasound). No family history of clotting issues. And no personal history of clotting issues. Currently on Rivaroxaban (Xarelto), 15 mg twice per day. Will be on for at least 3 months (moving to 20 mg once per day after the first 21 days).

Other Meds: Levothyroxine, prilosec

Current Illness: Gout

ID: 1302550
Sex: M
Age: 69
State: TX

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: patient received 1st Moderna dose on 4/30/21. The next morning on 5/1 he felt pain on his left leg. He waited to see if would get better or worse. On the afternoon at an unknown time, his leg had gotten worse. He had severe pain on his left leg; it was painful to the touch; it was swollen and was hard as a rock. He called 911. He was taken to Hospital. Pt wanted me to report that he did not receive any treatment for his blood clot. He received a Lidocaine patch on his knee and was given a prescription for Voltaren Gel. (he was expecting to receive TPA to dissolve the clot like a few times before when he had blood clots but this particular time he did not)

Other Meds: ATORVASTATIN, HUMULIN 70/30, TORSEMIDE, ELIQUIS, LEVOTHYROXINE

Current Illness:

ID: 1302551
Sex: M
Age: 58
State: GA

Vax Date: 01/16/2021
Onset Date: 04/03/2021
Rec V Date: 05/10/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Hospitalized due to COVID-19 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1302552
Sex: M
Age: 17
State: IL

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 05/10/2021
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: Unknown

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

Symptoms: Unknown

Other Meds: Unknown

Current Illness: Unknown

ID: 1302553
Sex: F
Age: 83
State: FL

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 05/10/2021
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: Penicillin, fish

Symptom List: Vomiting

Symptoms: Severe L. arm pain and swelling, L. neck, L. face and head severe pain w/headache; chest pain w/malaise and felt sick. Incapacitated for 5-6 days . Symptoms lasted for over a week

Other Meds: Various

Current Illness: None

ID: 1302554
Sex: F
Age: 16
State: GA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/10/2021
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: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Moderna COVID-19 vaccine administered to a 16 year old. No adverse reactions noted.

Other Meds:

Current Illness:

ID: 1302555
Sex: M
Age: 54
State: AL

Vax Date: 04/27/2021
Onset Date: 04/29/2021
Rec V Date: 05/10/2021
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: 1. Tinnitus in left ear, constant high pitch humming 2. Constant itching on chest, stomach, back, arms

Other Meds: none

Current Illness: none

ID: 1302556
Sex: F
Age: 17
State: IL

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

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

Lab Data:

Allergies: NONE

Symptom List: Injection site swelling, Limb discomfort

Symptoms: NO ADVERSE EVENT; PT RECEIVED VACCINE UNDER THE RECOMMEND AGE. PATIENT IS 17 YEARS OLD.

Other Meds: PATIENT RECEIVED JOHNSON AND JOHNSON VACCINE UNDER THE AGE OF 18. PATIENT IS 17. NO ADVERSE EVENT REPORTED.

Current Illness: NONE

ID: 1302557
Sex: F
Age: 37
State: MA

Vax Date: 04/14/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: gluten - celiac

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

Symptoms: Same night after the shot, I noticed a small, raised, red bump below injection site. Nothing at actual injection site, but likely where the syringe was inserted and vaccine entered body. That went away within a day or so. Some site soreness, but similar to other vaccines like Tetanus. A day or so after the vaccine, I developed a rash about the size of a silver dollar pancake. The rash was red, but not raised. The rash was itchy occasionally. The rash remained for about 10-14 days after vaccination. It gradually faded in redness and itchiness. It was not very bothersome and topical creams helped, but I wanted to report.

Other Meds: birth control, flonase, probiotics, vitamins regularly: multi, iron, D, B, occasionally: magnesium, herbal sleep aid

Current Illness: none

ID: 1302558
Sex: F
Age: 65
State: OH

Vax Date: 03/24/2021
Onset Date: 03/30/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Extremely itchy rash on Left arm that subsequently spread to my chest, front torso & back.

Other Meds: Lisinopril 5 mg daily Vitamin D 2000 units daily Potassium Citrate ER 10mEq twice daily CoQ10 30 mg daily Research Drug Trial - Empagliflozin 10mg vs placebo Take 1 tab daily

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm