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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1302664
Sex: M
Age: 34
State: DC

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient experienced light headedness, dizziness and passed out for about 2-3 seconds. Minor convulsions during unconsciousness.

Other Meds: Valium 5mg

Current Illness:

ID: 1302665
Sex: M
Age: 72
State: IN

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/10/2021
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: sulfa, pcn, rocephin,

Symptom List: Anxiety, Dyspnoea

Symptoms: Got up in the middle of the night and passed out. EMS called and taken to hospital. Was there for 1 week and then transferred to another hospital facility nearby.

Other Meds: Eliquis bid, metropolar, bumatine bid, oxycodone up to tid, allopril qd escfillar predinisone, potassium. trapasone

Current Illness: rheumatoid arthritis, stage 3 kidney failure, CHF,

ID: 1302666
Sex: M
Age: 56
State: MI

Vax Date: 04/12/2021
Onset Date: 05/03/2021
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: penicilin

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

Symptoms: Herpes Zoster

Other Meds: nop

Current Illness: tooth infection

Date Died: 05/09/2021

ID: 1302667
Sex: U
Age: 82
State:

Vax Date: 03/31/2021
Onset Date: 04/08/2021
Rec V Date: 05/10/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: This 82 year old female received the Covid shot on 3/31/21 and went to the ED on 4/8 /21 and again to the ED and admitted on 5/7/21 with the diagnoses listed below and died on 5/9/21. J90 - Pleural effusion, not elsewhere classified N18.6 - ESRD (end stage renal disease) D61.818 - Pancytopenia A41.9, R65.20 - Severe sepsis

Other Meds:

Current Illness:

ID: 1302668
Sex: F
Age: 39
State: FL

Vax Date: 04/08/2021
Onset Date: 04/17/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Injection site swelling and itching one week post vaccine

Other Meds:

Current Illness:

ID: 1302670
Sex: F
Age: 64
State: GA

Vax Date: 03/24/2021
Onset Date: 04/06/2021
Rec V Date: 05/10/2021
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: Penicillin

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: Itching with maybe minor rash, starting 2 weeks after shot. Itching started at site of shot, and moved to different places, back, side, shoulders, arms, head, legs. Regularly at first, then gradually subsided for 2 weeks and then no more.

Other Meds: lamotrigine Levothyroxine simvastatin Trazodone

Current Illness: None

ID: 1302671
Sex: M
Age: 36
State: GA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Dose administered at 12:30, pt.complained at 12:40 of "itchy mouth and tongue". MD on site administered Benadryl 25 mg p.o. and instructed pt. to wait an additional 15 minutes. 1:00, pt stated "no worsening of symptoms", no changes observed. Pt. was dismissed and verbalized understanding of emergency instructions.

Other Meds:

Current Illness:

ID: 1302672
Sex: M
Age: 60
State: CA

Vax Date: 04/09/2021
Onset Date: 04/30/2021
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: unknown

Symptom List: Pharyngeal swelling

Symptoms: received Pfizer instead of Moderna for second dose of COVID vaccine

Other Meds: unknown

Current Illness: unknown

ID: 1302673
Sex: F
Age: 36
State: TX

Vax Date: 04/30/2021
Onset Date: 05/03/2021
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: N/a

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Whooshing/ringing/machine noise in left ear that is persistent and has not faded

Other Meds: Prenatal vitamin, vitamin b12, vitamin d

Current Illness: N/a

ID: 1302674
Sex: M
Age: 41
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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: ORIGINAL ON FILE AT FACILITY

Symptom List: Diarrhoea, Nasal congestion

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: 1302675
Sex: M
Age: 63
State: SC

Vax Date: 01/12/2021
Onset Date: 01/24/2021
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: None

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

Symptoms: Kidney stone

Other Meds: Low dose aspirin, vitamin B, vitamin D

Current Illness: None

Date Died: 05/06/2021

ID: 1302677
Sex: M
Age: 71
State:

Vax Date: 03/29/2021
Onset Date: 05/06/2021
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:

Symptom List: Rash, Urticaria

Symptoms: This 71 year old male received the Covid shot on 3/29/21 and died on 5/6/21 with the diagnoses listed below Covid-19

Other Meds:

Current Illness:

ID: 1302678
Sex: F
Age: 51
State: IN

Vax Date: 04/19/2021
Onset Date: 04/19/2021
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: codine, morphine, sulfas, sulfites, bee/hornet/wasp/yello jackets

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

Symptoms: waited 30 minutes before leaving per instructions, by the 40 minute mark I began to itch all over. No rash/hives/trouble breathing, just itching. Called dr office and they said to try OTC allergy medicine (ie alegra) and if that didn't work within an hour to try benedryl. that did not really help, still itching all over just not as severe. Friday 4/23/2021 had a dr appt already set up and was prescribed hydroxyzine to help with itching. Has controlled severity of itching but not relieved. Still itching as of today.

Other Meds: metformin, janumet,crestor,singular

Current Illness:

ID: 1302679
Sex: F
Age:
State: OH

Vax Date:
Onset Date:
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: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Intense, heavy bleeding one week exactly after second Moderna dose. My period is not due for 2.5 more weeks. I had JUST finished a period right before receiving 2nd shot.

Other Meds: None

Current Illness: None

ID: 1302680
Sex: M
Age: 64
State: IN

Vax Date: 05/05/2021
Onset Date: 05/06/2021
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:

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

Symptoms: The next morning (exact time was estimated) patient complained he didn't feel good. His symptoms increased to the point of his believing he has Covid again (with the exception of taste and smell); ie: restlessness; fever (off and on); extreme fatigue; coughing; labored breathing; loss of appetite; and difficulty sleeping. He already had Covid-19 and was hospilized over a week and returned home with oxygen and at-home treatment.

Other Meds:

Current Illness:

ID: 1302681
Sex: F
Age: 17
State: NY

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

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

Lab Data:

Allergies: None

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

Symptoms: Rash all over patient's body

Other Meds: Vimpat, epidiolex

Current Illness: none

ID: 1302682
Sex: F
Age: 34
State: CA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
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: N/A

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

Symptoms: Dizziness and shaking fainted - Physician called to evaluate the patient. Patient transferred to gurney from chair. Vitals checked BP:95/60 Pulse: 70 o2:99% After few minutes patient responds and stoked she fells better now. Patient stated she usually fainted whenever any blood was done on her. Patient had sips of water and said she is normal now. Suggest her to stay for more 30 minutes for evaluation. BP: 98/65 Pulse: 74 Advice her to consult her primary physician about adverse reaction. Patient left for home with husband. #21 Went home

Other Meds:

Current Illness:

ID: 1302683
Sex: F
Age: 70
State:

Vax Date: 03/17/2021
Onset Date: 05/01/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: This 70 year old female received the Covid shot on 3/17/21 and died on 5/1/21.

Other Meds:

Current Illness:

ID: 1302684
Sex: F
Age: 71
State: NY

Vax Date: 02/01/2021
Onset Date: 03/01/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Taste of foods has changed. Very strange. And I have not had Covid virus.

Other Meds: Escatilopram Blood pressure med

Current Illness: None

ID: 1302685
Sex: F
Age: 83
State: MI

Vax Date: 02/27/2021
Onset Date: 05/04/2021
Rec V Date: 05/10/2021
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: Hospital admission STEMI 5/4/21

Other Meds:

Current Illness:

ID: 1302686
Sex: M
Age: 41
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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: ORIGINAL ON FILE AT FACILITY

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

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: 1302687
Sex: M
Age: 42
State: AR

Vax Date: 04/16/2021
Onset Date: 04/18/2021
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: NO ALLERGIES

Symptom List: Unevaluable event

Symptoms: patient reported intermittent blurred vision

Other Meds: N/A

Current Illness: NONE

ID: 1302688
Sex: M
Age: 52
State: PA

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: LA

Lab Data:

Allergies:

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

Symptoms: Defective syringe. Hub came off during administration in left arm. Partial dose administered. Unable to determine how much. Per CDC guidelines, gave full dose in the right arm.

Other Meds:

Current Illness:

ID: 1302689
Sex: M
Age: 87
State:

Vax Date: 02/16/2021
Onset Date: 05/04/2021
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: This 87 year old male hospice received the Covid shot on 2/16/21 and died on 5/4/21.

Other Meds:

Current Illness:

ID: 1302690
Sex: M
Age: 44
State: AZ

Vax Date: 05/09/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever, Aches

Other Meds: None

Current Illness: None

ID: 1302691
Sex: F
Age: 38
State: IL

Vax Date: 03/03/2021
Onset Date: 03/08/2021
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: unknown

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

Symptoms: Client states right shoulder pain MD and MRI obtained injection into tendon complains unable to use had physical therapy and steroidal injections much better now

Other Meds: unknown

Current Illness: unknown

ID: 1302692
Sex: M
Age: 59
State: NV

Vax Date: 04/23/2021
Onset Date: 04/26/2021
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: NKDA, but had severe myalgias to Pravastatin and had gingival hyperplasia due to a CCB (calcium channel blocker)

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: He reported a GBS-type reaction where his tingling in his legs got worse and he was paralyzed from the waist down to the point that he couldn't walk. These symptoms lasted about a week. He brought this up later after the side effects had resolved. He also reported a transient amnesia episode where he forgot where he was driving locally and had to have some one come pick him up 2 weeks after the 2nd vaccine. Both of these side effects occurred after the second vaccine.

Other Meds: Lantus, Januvia, Novolog, potassium, torsemide, HCTZ, rosuvastatin, nortriptyline, gabapentin

Current Illness:

ID: 1302693
Sex: F
Age: 36
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: No known allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Approximately 1 hour after receiving first dose of the COVID 19 Vaccine the member began feeling shaky and itchy around neck and chest area and then spread to arms and hands. Member was given 50 mg oral benadryl. Member had elevated BP upon arrival, 181/118. Member was then given 60 mg oral prednisone and started on an IV of .9%sodium chloride, 1000ml. Member began feeling better and symptoms subsided. She was sent home with benadryl and prednisone and informed that if symptoms return to return to the hospital.

Other Meds: None

Current Illness: Minor cold about 1 month prior (negative for COVID)

ID: 1302695
Sex: M
Age: 70
State: OH

Vax Date: 03/14/2021
Onset Date: 03/19/2021
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: Penicillin-rash

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

Symptoms: Zoster rash

Other Meds: ASA, MV, Omeprazole, Metamucil, Bisacodyl, Metformin, Pravastatin,

Current Illness:

ID: 1302696
Sex: F
Age: 37
State: MI

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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: ASA

Symptom List: Nausea

Symptoms: Patient complained of a tight throat onsite EMS was called vitals BP 133/87 HR 87 99% 02. 25mg Benadryl was given and she said this had happen with other vaccines. She was release to go home.

Other Meds:

Current Illness:

ID: 1302697
Sex: F
Age: 63
State: MI

Vax Date: 04/09/2021
Onset Date: 05/04/2021
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:

Symptom List: Injection site pain

Symptoms: Hospital admission 05/04/21

Other Meds:

Current Illness:

ID: 1302698
Sex: M
Age: 38
State:

Vax Date: 05/03/2021
Onset Date: 05/03/2021
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: Covid vaccine was given to 6 patients including this patient using a vial that had been in the refrigerator for 32. This is two days past the manufacturer recommended storage of 30 days. Nurses in the clinic did not realize this until a day after administration. We did contact the manufacturer for guidance.

Other Meds:

Current Illness:

ID: 1302699
Sex: M
Age: 28
State: WA

Vax Date: 05/07/2021
Onset Date: 05/08/2021
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: RA

Lab Data:

Allergies: amoxicillin

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

Symptoms: Fever, chills, body ache, head ache

Other Meds: none

Current Illness: none

ID: 1302700
Sex: F
Age: 43
State: GA

Vax Date: 05/07/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Tomatoes (nausea)

Symptom List: Tremor

Symptoms: diarrhea, vomiting, headache, chills, sweating profusely, hot flashes, and lack of appetite - started on Saturday and continues to have the same symptoms today (05/10/2021). Pt was given number to contact to receive authorization code to be seen at her nearest Urgent Care facility.

Other Meds: Atorvastatin, Benazepril, Vitamin D2, HCTZ, Insulin Degludec and Semaglutide, Metformin, Metoprolol, Montelukast, Multivitamin, Omeprazole, and Rivaroxaban,

Current Illness: Not that she is aware of.

ID: 1302701
Sex: M
Age: 26
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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: ORIGINAL ON FILE AT FACILITY

Symptom List: Erythema, Pruritus

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: 1302702
Sex: F
Age: 34
State: MI

Vax Date: 05/07/2021
Onset Date: 05/07/2021
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:

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

Symptoms: SHE RECEIVED HER 2ND DOSE 1 WEEK EARLY. SHE UNDERSTANDS HER SERIERS IS COMPLETE

Other Meds:

Current Illness:

ID: 1302703
Sex: F
Age: 16
State: MI

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: 16 YEAR OLD FEMALE RECEIVED MODERNA BRAND VACCINE TODAY AS HER FIRST DOSE. PER GUIDANCE HER 2ND VACCINE IN 4 WEEKS SHOULD ALSO BE MODERNA

Other Meds:

Current Illness:

ID: 1302704
Sex: F
Age: 58
State: VA

Vax Date: 05/07/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: codeine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: pt states she went down hill once she got home after taking vax. She felt nauseous but no vomiting, had diarhea, had chills, fever, joint pain, exploding headache and was dizzy. Her left arm is sore. She has had these symptoms almost 3 days. She is feeling better as of today.

Other Meds: sertraline, ibuprofen 800,

Current Illness: Covid Virus on 4/10/2021 @ 6:00 PM

Date Died: 05/05/2021

ID: 1302705
Sex: U
Age: 49
State:

Vax Date: 04/06/2021
Onset Date: 05/05/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: This 49 year old female received the Covid shot on 4/6 /21 and went to the ED on 5/5 /21 with the following diagnoses listed below and died on 5/5/21.

Other Meds:

Current Illness:

ID: 1302706
Sex: F
Age: 70
State: IN

Vax Date: 02/01/2021
Onset Date: 02/03/2021
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: allergic to something but not sure what

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

Symptoms: Client called office on 2/22/2021 to report chills with COVID vaccine given on 2/1/2021. On 2/3/2021 she experienced extreme exhaustion. From 2/6/2021 to 2/8/2021 her legs were weak and shakey. On about 2/15/2021 she developed a large patch of redness to her arm where the injection was given that measured about 6" x 3" and still has this as of 2/22/2021. No symptoms within 4hrs. of shot per client. These reactions were reported to our county health officer Dr

Other Meds: Bydurean 2mg

Current Illness: non reported at time of vaccination

ID: 1302707
Sex: F
Age: 44
State: IL

Vax Date: 05/03/2021
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: Pain in extremity

Symptoms: I had chills and body aches and headache the night after getting my vaccine, I took Tylenol which helped but felt very lethargic the next day. Then, on May 8th, I woke up with ringing in my right ear and it has not gone away. The other symptoms have gone away.

Other Meds:

Current Illness:

ID: 1302708
Sex: F
Age: 57
State: IL

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

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

Symptoms: Patient had vaccine at aproximately 940 m. She came back into walk in clinic around 1 pm stating she had developed total body rigors, slurred speech, gait disturbance and left sided chest pain. Patient was sent to ER for further evaluation

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1302709
Sex: F
Age: 46
State: CA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
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: seafood, haladol, giadome, flu shot, chocolate, penicillin

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

Symptoms: A couple hours after the vaccine my BS went up to 274 so I called my PCP. After about 5hrs I went to my PCP but it had gone down to like 130 something and was advised to sign up for the vsafe. After a few days I did begin to feel a little better. I was very tired, groggy and sore for a few days and after that all symptoms subsided

Other Meds: Ezetimibe, Atorvastatin, Montelukast, Iron, Oxcarbazepine, Dicyclomine, Pantoprazole, Topiramate, Oyster Calcium, Glipizide, Jardiance, Estradiol, levothyroxine, Vit D3, vit B2, linzess, neproxin, cardizem, magnesuium, meclizine, mesalamine

Current Illness: no

ID: 1302710
Sex: M
Age: 28
State: MI

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NA

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

Symptoms: Chills, body ache, fever, cold sweat

Other Meds: NA

Current Illness: NA

ID: 1302711
Sex: F
Age: 32
State: CO

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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, sulfa

Symptom List: Vomiting

Symptoms: Severe depression - ongoing

Other Meds: Sertaline, buspirone, gabapentin, N-Acetylcysteine, multivitamin, fish oil, b complex, d3, vit c, liver care supplement, magnesium

Current Illness:

Date Died: 05/05/2021

ID: 1302712
Sex: F
Age: 70
State:

Vax Date: 04/09/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: This 70 year old female received the Covid shot on 4/9/21 and went to the ED on 5/5/21 died on 5/5/21.

Other Meds:

Current Illness:

ID: 1302713
Sex: F
Age: 26
State:

Vax Date: 04/28/2021
Onset Date: 05/03/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Swollen lymph nodes on left side neck and in left armpit

Other Meds:

Current Illness:

ID: 1302714
Sex: M
Age: 29
State: NY

Vax Date: 04/10/2021
Onset Date: 05/04/2021
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: Developed shingles about 3 weeks after first dose of Moderna vaccine.

Other Meds: ClomiPhene, multivitamin, vitamin D

Current Illness: None

ID: 1302715
Sex: M
Age: 55
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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: ORIGINAL ON FILE AT FACILITY

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

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: 1302716
Sex: F
Age: 54
State: TN

Vax Date: 04/13/2021
Onset Date: 04/19/2021
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: Extreme itch began by April 19; exact date of start not noted. Noticed the rash the following Saturday, already fully established; it had probably been present for several days. The rash is consistent with Shingles. It progressed from itching, to later pain, and is still present now (5/10/21) but is beginning to clear up.

Other Meds: Multivitamin, calcium supplement, glucosamine, ibuprofen

Current Illness: None.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm