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: 1303236
Sex: F
Age: 37
State: TX

Vax Date: 03/30/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Report HA, body ache, fatigue, and chills day started day 1 that continued for 4 days with no improvement. Treatment: Emergency room Outcome: diagnosed with pneumonia and +COVID-19.

Other Meds:

Current Illness:

ID: 1303237
Sex: F
Age: 31
State: OH

Vax Date: 03/06/2021
Onset Date: 03/13/2021
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: Covid vaccine red rash on arm

Symptom List: Anxiety, Dyspnoea

Symptoms: Sore arm, 4 inch diameter rash on arm, chills fatigue dizziness 15 min after.

Other Meds: 5+ meds

Current Illness: Chronic medical condition/autoimmune

ID: 1303238
Sex: F
Age: 50
State: NY

Vax Date: 04/23/2021
Onset Date: 04/23/2021
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: None

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

Symptoms: Approximately after 2-3 hours of getting the 2nd dose of the Moderna Covid-19 vaccine, I experienced moderate side effects which included chills, body aches, headache, tiredness, nausea. It lasted about 28 hours.

Other Meds: None

Current Illness: None

ID: 1303239
Sex: F
Age: 76
State:

Vax Date: 02/27/2021
Onset Date: 03/17/2021
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 76 year old black female received the Covid shot on 2/27/21 and went to the ED and was admitted on 3/17/21 and again to the ED and admitted on 4/7/21 with the diagnoses listed below. Systemic inflammatory response syndrome (sirs) of non-infectious origin without acute organ dysfunction Non-ST elevation (NSTEMI) myocardial infarction Epistaxis

Other Meds:

Current Illness:

ID: 1303240
Sex: M
Age: 66
State: MI

Vax Date: 05/05/2021
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: penicillins

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

Symptoms: Developed a large papular raised rash on back, shoulder and bi-lateral medial thighs

Other Meds: Metformin 1000mg

Current Illness:

ID: 1303241
Sex: F
Age: 91
State: MI

Vax Date: 03/20/2021
Onset Date: 04/10/2021
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: No medication allergies, dairy, flour products, sugar, chemicals and preservatives

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

Symptoms: I had 2 1/2 weeks of eye swelling, watering and swelling of my eyes.

Other Meds: I'm taking a lot of things for nutritional balance, B vitamin and calcium

Current Illness: No

ID: 1303242
Sex: F
Age: 35
State: AZ

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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Swelling of throat, dizziness, confusion, light headed, blurry vision, rash & hives around neck and cheeks. Itchiness and hot feeling around neck and face.

Other Meds: Elderberry multi vitamins, Adzenys XR ODT

Current Illness: None

ID: 1303243
Sex: M
Age: 28
State: MI

Vax Date: 05/07/2021
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: LA

Lab Data:

Allergies: none known

Symptom List: Pharyngeal swelling

Symptoms: Jaw Pain and mild sore throat

Other Meds: 55mg naproxen

Current Illness: none

ID: 1303244
Sex: M
Age: 24
State: MA

Vax Date: 04/24/2021
Onset Date: 04/25/2021
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: None.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Extreme skin hypersensitivity. Became overwhelming for any sort of tactile stimulation on skin, such as showering, toweling off, and wearing a shirt. It lasted roughly 6 hours and then subsided. I also felt extreme fatigue.

Other Meds: 2 pills tylenol at 5pm after vaccination.

Current Illness: None.

ID: 1303245
Sex: F
Age: 17
State: WA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Administered 0.5 mL of vaccine instead of 0.3 mL

Other Meds:

Current Illness:

ID: 1303246
Sex: M
Age: 54
State: MI

Vax Date: 04/22/2021
Onset Date: 04/22/2021
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: iodine, Seafood

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

Symptoms: 5 mins after initial shot, rapid heart rate that subdued in approximately 15 min. About 12 hours after the shot, experienced swelling in face and closure of throat, excessive sweating, fatigue and disorientation/dizziness and muscle paralysis/weakness in the back of neck, needing to use my hand to lift my head up.

Other Meds: Lisinopril, pravastatin, coq10,magnesium, vitamin d, multi vitamin

Current Illness:

ID: 1303247
Sex: F
Age: 35
State: CA

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: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Pain in armpit near injection site. Worse with movement. Has lasted 3 full days. Full center of armpit.

Other Meds: Levothyroxine,

Current Illness: None

ID: 1303248
Sex: M
Age: 32
State: NJ

Vax Date: 04/09/2021
Onset Date: 05/02/2021
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: NONE

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

Symptoms: FIRST DOSE ADMINISTERED 3/22/21. SECOND DOSE ADMINISTERED 4/9/21. DIAGNOSED WITH APPENDICITIS 5/6/21 WITH ONSET OF SYMPTOMS 5/2/21. LAPAROSCOPIC APPENDECTOMY PERFORMED 5/6/21.

Other Meds: NONE

Current Illness: NONE

ID: 1303249
Sex: F
Age: 55
State: CT

Vax Date: 05/01/2021
Onset Date: 05/06/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa,pcn

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

Symptoms: Approx 4 days later feel fatigue, malaise, body aches and still feel same as if I have a low grade flu of sorts

Other Meds: Butrans dermal patch

Current Illness: N/a

ID: 1303250
Sex: F
Age: 64
State: OR

Vax Date: 05/07/2021
Onset Date: 05/09/2021
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: Allergies Allergen Reactions Chlorthalidone Other (See Comments) Syncope Amlodipine Swelling Fluconazole Itching Suspected allergy to diflucan -- had itching and rash Macrobid (Nitrofurantoin) Diarrhea Prochlorperazine Other (See Comments) "crawling out of my skin" Sulfa Antibiotics Other (See Comments) Pt gets flushed. Intolerance No active intolerances/contraindications

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

Symptoms: Presented to hospital with 1-2 days of fever, fatigue, confusion, and generalized weakness on 5/9/21. Primary diagnosis is acute encephalopathy.

Other Meds: Medications Prior to Admission Medication Sig Dispense Refill ? albuterol 90 mcg/puff inhaler Inhale 2 puffs into the lungs every 4 hours as needed for Wheezing or Shortness of Breath (please dispense with spacer and teach patient how to us

Current Illness: NONE

ID: 1303251
Sex: M
Age: 68
State: GA

Vax Date: 03/26/2021
Onset Date: 04/17/2021
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: N/A

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

Symptoms: He was having stroke symptoms. He was having trouble moving his arm, and his speech was slurred.

Other Meds: Multi Vitamin Vitamin C

Current Illness: N/A

ID: 1303252
Sex: F
Age: 60
State: PA

Vax Date: 01/21/2021
Onset Date: 01/28/2021
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: Penicillin, Iodine, Erythromycin, Macrodantin. Trees and things that grow on them, almonds, raw apples, plums, nectarines, peaches.

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

Symptoms: She got her vaccine, she had no symptoms at all. The next day she had some body aches and fatigue, a headache that lasted for about a week. Then on day #8 she started with a low grade fever that lasted for 8/9 days. The highest temp was 101.3. Most of the time went from 99.9 to 100.6. Two of those days also had night sweats, headache for a few of those days, body aches and fatigue. Then week #3 was mostly fatigue, a rash started on her buttocks and was covered, not itchy, but raised in nature that lasted for about #2 weeks. Then she got a fever back again for a day. On week 4 she got left lower quadrant pain that lasted for a week. Then that was end of her symptoms. She had a telehealth APT for her to return to work, this was during the low grade fever time. She was then told to come in for blood work. She had raised eosinophils which they were not concerned about. They then sent her to hospital and gave her a COVID test, urinalysis, more blood work, chest x-ray. She had two COVID and flu tests which were all negative. The eosinophils were raised again during this visit. She also had a positive Lyme test and then was told that she had either recovered from Lyme disease or that she was fighting something else. She had a telehealth visit, two hospital visits and also sent for an ultrasound of her left lower quadrant which was negative.

Other Meds: 81 mg aspirin, multivitamin.

Current Illness: None.

ID: 1303253
Sex: F
Age: 49
State: TX

Vax Date: 05/10/2021
Onset Date: 05/10/2021
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: None - Seasonal allergies only

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient called 911 for difficulty breathing and chest pressure approximately 30 minutes after vaccination. During evaluation, patient began hyperventilating which resulted in additional symptoms which were managed once the breathing was controlled. Patient was administered Diphenhydramine 50mg IM with improvement of symptoms.

Other Meds: Zyrtec

Current Illness: None

ID: 1303254
Sex: F
Age: 80
State:

Vax Date: 03/10/2021
Onset Date: 03/15/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: This 80 year old white female received the Covid shot on 3/10/21 and went to the ED and was admitted on 3/15/21 with the following diagnoses listed below. Pneumonia Pulmonary embolism

Other Meds:

Current Illness:

ID: 1303255
Sex: M
Age: 70
State: KS

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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

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

Symptoms: Scheduled for second COVID 19 dose. Pfizer Lot # EW0153 vial was reconstituted with .8 mL 0.9% sodium chloride instead of 1.8 mL. RN withdrew 0.3 mL diluent and administered IM to left deltoid. Pt remained for 15 minutes post injection. Arm pain at injection site, no other reaction noted or reported.

Other Meds:

Current Illness:

ID: 1303256
Sex: F
Age: 38
State: TX

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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: NKA

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

Symptoms: RED CHEEKS, UNABLE TO SPEAK EMS TRANSPORT AFTER EPINEPHREN ADMINISTERED ON SITE. PARAMEDIC ADVISE POSSIBLE TIA/STROKE VS. VACCINE RXN.

Other Meds: NONE REPORTED

Current Illness: NONE REPORTED

ID: 1303257
Sex: M
Age: 38
State: WA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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: Unevaluable event

Symptoms: Administered 0.5 mL of vaccine, not 0.3 mL

Other Meds:

Current Illness:

ID: 1303258
Sex: F
Age: 33
State: MN

Vax Date: 04/19/2021
Onset Date: 04/19/2021
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: LA

Lab Data:

Allergies: Dairy, Sulfa, Augmentin

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

Symptoms: Swelling in arm, redness, itchiness. Facial flushing and puffiness.

Other Meds:

Current Illness: Seasonal Allergies

ID: 1303259
Sex: M
Age: 70
State: TX

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: induration, warmth, erythema, pruritis to right upper arm area, treated w topical hydrocortisone

Other Meds: albuterol, ergocalciferol, loratadine, meloxicam, omega-3, simvastatin, diclofenac B6

Current Illness: none

ID: 1303261
Sex: F
Age: 41
State: UT

Vax Date: 03/31/2021
Onset Date: 04/07/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: None known

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reports that she has not had a menstrual cycle since her 2nd dose.

Other Meds: Unknown

Current Illness: Unknown

ID: 1303262
Sex: F
Age: 45
State: MI

Vax Date: 05/06/2021
Onset Date: 05/09/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa drugs

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

Symptoms: Pt presented to Urgent Care on the third day after vaccine (5/9) with chest pain, left arm pain, nausea and vomiting. EKG showed T-wave inversion on V2 and pt was sent to the ED for further evaluation. At the ED, bloodwork showed a significantly elevated troponin level. Pt was admitted for a possible NSTEMI and placed on a heparin gtt, diagnosis changed to myocardial injury within the setting of myo/pericarditis.

Other Meds: Balziva, cetirizine

Current Illness:

ID: 1303263
Sex: M
Age: 19
State: KY

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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fatigue, Fever.

Other Meds: None

Current Illness: None

ID: 1303264
Sex: M
Age: 54
State: MI

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

Lab Data:

Allergies: Patient states no history of severe allergic reactions

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: The following are descriptions is a synopsis of information provided over the phone by the patient's wife on 5/10: At time of second dose patient was fatigued, lethargic, hyperglycemic, and experiencing brain fog. She states some of the symptoms started some time after his first dose but couldn't provide a time frame. On 5/6 he answered the Vaccine Questionnaire question of "are you sick today?" as "unsure" and further discussion was had with a pharmacist to verify he was eligible to receive vaccine. Neither the pharmacist or patient remember the details of this discussion. Patient and wife have belief that his ethnicity contributed to dismissing of possible illness during the vaccine screening process, but due to the patient's lethargy and brain fog at the time, he could not provide specifics of the conversation. His wife was not with him during the screening process with the pharmacist or during vaccine administration. The appointment time was 4:55pm. The wife states the patient was so fatigued after the shot was administered on 5/6 that he was asleep in his chair in the observation area. Later that day fever of 100.5 was noted and controlled by OTC ibuprofen 2 hours after the ibuprofen was administered. The wife states that he rapidly declined over the 3 days after second Pfizer vaccine and she called an ambulance on Sunday 5/9. From the ER he was admitted to the ICU with the primary reason for admission listed as hyperglycemia but a COVID was listed as a contributing factor. The COVID test administered Sunday was positive. He had high blood pressure, heart rate, blood sugar, and sodium. Patients vitals have since stabilized other than the sodium is still high. He is in ICU at hospital still very lethargic as of today 5/10.

Other Meds: Not provided by patient

Current Illness: Patient's wife states that at some point after his first vaccination on 4/15/21 he started having some fatigue and higher than normal blood sugar levels.

ID: 1303265
Sex: F
Age: 16
State: CA

Vax Date: 04/12/2021
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: None

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

Symptoms: Patient was administered dose #1 of Moderna on 4/12/21. Upon dose #2, discovered patient DOB at 4/24/04, which places her at 17 years of age. Parent and adolescent counseled by physician regarding age at injection. Parent indicated wish to have daughter complete series. No adverse signs/symptoms on dose #1, nor on dose #2. Reported to medical director at Hospital, which oversees health center. Advised to counsel parent/child and staff involved. Correction plan in place to ensure no repeat of age error.

Other Meds: None

Current Illness: None

ID: 1303266
Sex: F
Age: 57
State: VA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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: RA

Lab Data:

Allergies: NKA

Symptom List: Nausea

Symptoms: Received vaccine on 4/8/21 and states reacting to vaccine. States severe dizziness within 3 hours of receiving vaccine and lasted for a couple of minutes, severe headache, and nausea. Sx resolved within a few minutes. Denies home tx. Denies fever. Denies any other episodes

Other Meds: Lidoderm patches 5 % PRN Tramadol 50mg prn 1/2 Tab PO PRN Albuterol Inhaler prn Asthma b12 1 tab daily ( holistic Dr. ) Vit D ( holistic Dr. ) Vit C ( holistic Dr) Probiotic ( holistic Dr. ) Zince acetaminophen 500 mg PO PRN TENS U

Current Illness: tendon rupture

ID: 1303267
Sex: M
Age: 27
State: CA

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: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Individual felt dizzy and nausea

Other Meds: none

Current Illness: none

ID: 1303268
Sex: F
Age: 20
State: CT

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

Symptoms: Patient passed out and body started to shake. within less than a minute patient regain consciousness.

Other Meds:

Current Illness:

ID: 1303269
Sex: F
Age: 74
State:

Vax Date: 02/20/2021
Onset Date: 03/22/2021
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: This 74 year old female received the Covid shot on 2/20/21 and went to the ED and was admitted on 3/22/21 with the following diagnoses listed below. I63.9 - Cerebral infarction, unspecified I63.9 - Ischemic stroke

Other Meds:

Current Illness:

ID: 1303270
Sex: M
Age: 69
State: NJ

Vax Date: 04/02/2021
Onset Date: 04/14/2021
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: no known allergies

Symptom List: Tremor

Symptoms: Persistently intermittent high-grade fevers with associated chills since 4/14/2021. On 4/20/2021, patient reported to his PCP for further management, and blood workup did not show any acute abnormalities. On the morning of 5/5/2021, patient woke up with a 101F fever and appeared to be confused as per wife and niece, which prompted ED visit.

Other Meds: none

Current Illness: none

ID: 1303271
Sex: M
Age: 50
State: PA

Vax Date: 04/24/2021
Onset Date: 05/07/2021
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: none

Symptom List: Erythema, Pruritus

Symptoms: Acute ST-elevation myocardial infarction; highly unusual dual artery occlusion including acute proximal occlusion of the RCA and simultaneous proximal LAD occlusion. At 24 hours later, both arteries re-occluded and required repeat stenting. Patient has critically low platelets and a positive PR4 antibody. Physicians seeing pt feel this is most consistent with vaccine-induced thrombotic thrombocytopenia.

Other Meds: none

Current Illness: none

ID: 1303272
Sex: U
Age: 29
State: VA

Vax Date: 01/15/2021
Onset Date: 02/07/2021
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: NKDA

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

Symptoms: *See continuous page*

Other Meds: Prozac, Vyvanse, Vitamin D supplement,

Current Illness: None

ID: 1303273
Sex: M
Age: 39
State: CO

Vax Date: 04/19/2021
Onset Date: 04/20/2021
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: none.

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

Symptoms: Had COVID-19 in July 2019. Afternoon of the second day after my first dose of Pfizer vaccine, developed minor chills/fatigue. Arm soreness persisted for several days, including swollen lymph node in my left armpit.

Other Meds: Melatonin, 1 mg, nightly

Current Illness: none.

ID: 1303274
Sex: F
Age: 43
State: GA

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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fever started about 12 hours after the shot at 99 degrees. Fever peaked at 101 and ended about 36 hours after the injection with maximum doses of Tylenol starting right at the first sign of fever. Rash and swelling around the injection site, as well as pain in armpit on that side. Pain lasted for 12 hours, rash is still there 3 days later. Body aches and fatigue while the fever was present.

Other Meds: Pill form Birth control, Crestor, Vitamin D.

Current Illness: COVID illness April6-April 17

ID: 1303275
Sex: M
Age: 27
State: WA

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

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

Lab Data:

Allergies:

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

Symptoms: Administered 0.5 mL of vaccine, not 0.3 mL

Other Meds:

Current Illness:

ID: 1303276
Sex: F
Age: 68
State: OH

Vax Date: 04/12/2021
Onset Date: 04/19/2021
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: acetaminophen

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

Symptoms: Redness, swelling, hardness at the injection site [possible Covid-rash] occurred approx. 7 days after the initial injection.

Other Meds: none reported

Current Illness: unknown

ID: 1303277
Sex: M
Age: 43
State: IN

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: LA

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Patient reports he started having a headache since 3hrs after vaccine, he had 24hours of chills and myalgias but the headache has persisted. Patient tried tylenol and migraine tylenol. Headache is nagging persistent since second injection Counseled patient to schedule NSAID (take with food), stay hydrated, rest.

Other Meds: None

Current Illness: None

ID: 1303278
Sex: F
Age: 61
State: WI

Vax Date: 04/30/2021
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: none

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

Symptoms: late local reaction of erythema and itching that began 10 days post vaccine. Area measures 8 cm x 5 cm. Non tender. Firm. Warm. treatment with ice, tylenol and anti itch cream.

Other Meds: calcium carbonate-vitamin D (CALCIUM ) Cholecalciferol (VITAMIN D) ipratropium magnesium oxide melatonin Omega-3 Fatty Acids (OMEGA 3 ) PARoxetine probiotic capsule thyroid (NP THYROID) Turmeric (CURCUMIN ) vitamin B

Current Illness: unknown

ID: 1303279
Sex: F
Age: 71
State: IN

Vax Date: 03/19/2021
Onset Date: 03/19/2021
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: n/a

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

Symptoms: pt reported that her tongue was numb and blurred vision. vss at 175/89 then 5 min. post recovery room at 1215 155/89 hr 91. Pt stated this happened on the first vaccine as well, but she took Benadryl at home and that resolved the issue. 25mg benadryl po. and at 1230 pt d/c home "feeling better" 142/76 HR89

Other Meds: n/a

Current Illness: n/a

ID: 1303280
Sex: F
Age: 24
State: NE

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

Lab Data:

Allergies:

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

Symptoms: 15 min after receiving vaccination patient became nauseous and became pale. She then became overcome with dizziness and had to immediately sit down for 30 minutes. After sitting her nausea and dizziness had improved enough to stand up and she was feeling better again.

Other Meds:

Current Illness:

ID: 1303281
Sex: F
Age: 49
State: LA

Vax Date: 04/27/2021
Onset Date: 05/03/2021
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:

Symptom List: Vomiting

Symptoms: Staff member reports hives to entire body (which I visualized) and chest pains

Other Meds:

Current Illness:

ID: 1303283
Sex: M
Age: 28
State: FL

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received vaccination and immediately sat down to wait for the 15 minutes. He started to sweat and was feeling nauseous. We gave the patient ice water which he drank. He continued feeling nauseous and did vomit once. Once he vomited, he started to feel better but was sweating. He had no symptoms of dizziness or lightheadedness like he was going to faint.

Other Meds:

Current Illness:

ID: 1303284
Sex: M
Age: 17
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: RA

Lab Data:

Allergies: none

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

Symptoms: Patient did not have any symptoms but patient was administered dose even though patient is 17 years old (not 18) , he is 1 month shy of being 18 years old.

Other Meds: none

Current Illness: none

ID: 1303285
Sex: M
Age: 75
State: IL

Vax Date: 04/09/2021
Onset Date: 05/03/2021
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: Norflex Ibuprofen

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 24 days after vaccine ringing in both ears. No treatment, still having ringing in both ears

Other Meds:

Current Illness: None

ID: 1303286
Sex: F
Age: 40
State: TX

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: RA

Lab Data:

Allergies: latex and nuts

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

Symptoms: a few minutes later she had tickling in throat after shot. told her to wait around pharmacy for 15 minutes after the shot and then husband came up and asked me which Benadryl was best...liquid or capsule. I asked for allergies? and that's when she told me she was having the same reaction she has when she eats nuts...throat swelling shut. administered one dose of adult epi-pen and called 911. the epi-pen took effect within a couple minutes and pt got better. advised her to see whoever her PCP was to get an epi-pen to have on her due to the nut allergy even though this was unrelated to the nut allergy. paramedics came and she was feeling much better by that time. they walked out of the store with her.

Other Meds:

Current Illness:

ID: 1303287
Sex: M
Age: 54
State: KS

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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:

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

Symptoms: Scheduled for second COVID 19 dose. Pfizer Lot # EW0153 vial was reconstituted with .8 mL 0.9% sodium chloride instead of 1.8 mL. RN withdrew 0.3 mL diluent and administered IM to left deltoid. Pt remained for 15 minutes post injection. Patient reported arm pain at injection site and general tired feeling. Symptoms were resolved within 24 hours. No hospitalization required.

Other Meds:

Current Illness: Percocet

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm