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: 1306784
Sex: M
Age: 58
State: IN

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/11/2021
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: pennecillan keflex

Symptom List: Dysphagia, Epiglottitis

Symptoms: 104 temp extreme body aches cough lasted30 hrs

Other Meds: lorstatin 20mg 20mg allegra 1000mg vit c 40mg pepcid multi vit probiotic 80mg asp 10,000mg biotin

Current Illness: none

ID: 1306785
Sex: M
Age: 27
State: CA

Vax Date: 05/10/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Janssen COVID-19 vaccine EUA Woke up around 4:00 am - 4:30 am with a mild head ache with minor pressure around where the nose bridge intersects the eyebrows. Along with some minor nausea.

Other Meds: Melatonin for sleep, 1 x 12oz can of Guinness with dinner.

Current Illness:

ID: 1306786
Sex: F
Age: 60
State: FL

Vax Date: 04/08/2021
Onset Date: 05/04/2021
Rec V Date: 05/11/2021
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:

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

Symptoms: 5/4/21 woke up with L arm pain and numbness and tingling; unable to lift arm above head

Other Meds: fluoxetine oxycarbazepine furosemide oxycodone

Current Illness:

ID: 1306787
Sex: F
Age: 58
State: NY

Vax Date: 03/16/2021
Onset Date: 03/31/2021
Rec V Date: 05/11/2021
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: Urinary tract infection 2 weeks after emergency department visit for backpain, nose ring removal, and COVID vaccination

Other Meds:

Current Illness:

ID: 1306788
Sex: M
Age: 21
State: FL

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/11/2021
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: Syncope, vomiting, fever, chills, loose stools.

Other Meds:

Current Illness:

ID: 1306789
Sex: M
Age: 37
State: CO

Vax Date: 04/18/2021
Onset Date: 04/25/2021
Rec V Date: 05/11/2021
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: None

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

Symptoms: 2 weeks of heart palpitations from 4/25/2021 - 5/09/2021. They seem to have subsided as of 5/10.

Other Meds: Multivitamin

Current Illness: None

ID: 1306790
Sex: F
Age: 37
State: CO

Vax Date: 05/07/2021
Onset Date:
Rec V Date: 05/11/2021
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: There was no adverse event reported.

Other Meds:

Current Illness:

ID: 1306791
Sex: M
Age: 45
State: MA

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 05/11/2021
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: Pharyngeal swelling

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA - late afternoon of the first dose I began having major allergy symptoms - coughing, sneezing, runny nose, fatigue, and began wheezing. These continued for 48 hours despite OTC medications, and I wound up in the ER with difficulty breathing. I received a negative quad swab, negative chest xray, and was given a nebulizer treatment and sent home with an inhaler. Despite f/u with my PCP and aggressive allergy symptom treatment, one week later I returned to the ER with an 88% oxygen level.

Other Meds: Adderall

Current Illness: None

ID: 1306792
Sex: M
Age: 30
State: MD

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/11/2021
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: Severe chills, fatigue, headache, nausea, strong arm pain. Similar sensation to having 40 C fever, but I had 37.

Other Meds: N/A

Current Illness: N/A

ID: 1306793
Sex: F
Age: 54
State: AZ

Vax Date: 05/10/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: beta blockers all heart medicines phinal barbital

Symptom List: Diarrhoea, Nasal congestion

Symptoms: waking up and not being able to breath coughing diizziness diarea weakness, hight high rate, shortness of breath, dehydration, chills, soreness, unable to sleep

Other Meds: xanax clonazapam morphine sulphate

Current Illness: tachachardia recent heart ablation

ID: 1306794
Sex: M
Age: 77
State: NY

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: 45 minutes after administration patient developed signs of a stroke: inability to speak, facial paralysis, inability to move

Other Meds: sertraline 25 mg, motrin 400, multivitamin, nifedical XL 90, ASA 81, HCTZ 12.5, atorvastatin 40, Bactrim 400-80, complera 200-25-300, metoprolol tartrate 12.5, eliquis 5

Current Illness: recently hospitalized for pneumonia

ID: 1306795
Sex: F
Age: 34
State: IN

Vax Date: 05/07/2021
Onset Date: 05/10/2021
Rec V Date: 05/11/2021
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: Nickel

Symptom List: Rash, Urticaria

Symptoms: Headache, nausea, fatigue, diarrhea, vomiting, fever of 102, chills,

Other Meds: None

Current Illness: None

ID: 1306796
Sex: M
Age: 54
State: MD

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 05/11/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Approximately 6 hours after my Shingles shot was administered, my muscles and joints started to ache on top of feeling exhausted. I took 2 Kirtland brand ibuprofens (500mg) and the symptoms subsided temporarily. I went to bed around 10 pm but I was awakened a couple of hours later with extreme body ache, headache, and shiver. I felt warm but no fever. Exhaustion and muscle ache became worst throughout the night. I got up lightheaded around 6 am and took another 2 ibuprofens. A few hours later most symptoms subsided. Throughout the rest of the day, I felt tired but not incapacitated. By the following day, I was back to normal.

Other Meds: Janssen vaccine was given on April 8, 2021, @ 2 pm.

Current Illness: None

ID: 1306797
Sex: F
Age: 52
State: MA

Vax Date: 05/07/2021
Onset Date: 05/08/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: patient received MMR dose 2 weeks early. Patient report dizziness and nausea and felt more thirsty than normal. Patient evaluated in the emergency room on 5/10/2021. Treated for UTI. Does not appear from the MMR vaccine be given too early. Patient reports she felt fine prior to receiving the vaccine

Other Meds:

Current Illness:

ID: 1306798
Sex: F
Age: 71
State: PA

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/11/2021
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: Amoxicillin, Bactrim, Bee stings, IV contrast

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

Symptoms: H/o meningioma and left ICA occlusion w/ prior traumatic ICH sent from outpt clinic s/p 2nd covid vaccine with acute onset slurred speech, facial asymmetry and LUE weakness (?chronic), atraumatic, nml AC, pt HD stable, stroke alert on arrival, symptoms improving

Other Meds: alprazolam, trazodone, sertraline, meloxicam, dicyclomine, gabpentin, omeprazole, ondaseteron

Current Illness: None noted

ID: 1306799
Sex: F
Age: 54
State: VA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/11/2021
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: no known drug allergies

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

Symptoms: On 5/7/2021 about fours after receiving the second shot I began having extreme abdomen pain followed by violent vomiting, diarrhea, disorientation for more than 8 hrs, plus body & muscle pain, hard to get up without assisatance, needed help, I am a very active & mobile person. fatigue, chills, headpain, and more abdomen pain thru the day Sunday May 9th, 2021. On Monday May 10th and Tuesday may 11th stomach is still not feeling normal, still feeling fatigue.

Other Meds: allegra

Current Illness: no

ID: 1306800
Sex: F
Age: 62
State: TX

Vax Date: 05/06/2021
Onset Date: 05/10/2021
Rec V Date: 05/11/2021
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: Septra

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

Symptoms: local reaction to injection site. Large area of diffuse redness , warmth and mild itching. Treated with topical steriod and oral antihistamine

Other Meds: none

Current Illness: none

ID: 1306801
Sex: F
Age: 28
State: VA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 05/11/2021
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 listed

Symptom List: Ear pain, Hypoaesthesia

Symptoms: The interval between her dose was 16 days instead of 28 days.

Other Meds: None listed

Current Illness: None listed

ID: 1306802
Sex: F
Age: 37
State:

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: nausea & burn/tingle at the injection site. Resolved w/o treatment - pt. declined EMS.

Other Meds:

Current Illness:

ID: 1306803
Sex: M
Age: 63
State: CO

Vax Date: 05/07/2021
Onset Date:
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: No adverse event reported.

Other Meds:

Current Illness:

ID: 1306804
Sex: F
Age: 21
State: FL

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/11/2021
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:

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

Symptoms: 21 years old female called to report an adverse reaction after she received her second P-fizer dose on 05/07/2021 @1330. patiet reported that after 2 hour she developed numbness, tingling, loose sensation, and pain in her right arm. patient denies any allergies, patient reported no current medication. patient reported past medical history including: high blood pressure and anemia. patient was instructed to exercise her arm and apply cold compress to help with the symptoms. patient was instructed to seek medical attention if the symptoms got worse. Consulted with doctor

Other Meds: none

Current Illness:

ID: 1306805
Sex: F
Age: 32
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/11/2021
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: Unevaluable event

Symptoms: About 5-10 minutes following first vaccine I started to feel ?funny? my throat felt a little swollen and lips started tingling. I then started to feel hot and sweaty. This lasted about 20-30 minutes then I felt ok to leave. I did get sharp pains in my muscle from shoulder to neck on and off the rest of the day along with waves of nausea and being very tired. No medications were given.

Other Meds: Camila, sertraline, vitamin D, prenatal

Current Illness: Cough and congested 03/22/2021

ID: 1306806
Sex: F
Age: 41
State: FL

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/11/2021
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: Tingling in mouth and L arm/fingertips. BP 113/78, Pox 99%, P 80. Still had slight tingling in mouth. Instructed to follow up with physician, ER/Urgent Care. Verbalized understanding

Other Meds:

Current Illness:

ID: 1306807
Sex: F
Age: 42
State: MN

Vax Date: 05/07/2021
Onset Date: 05/08/2021
Rec V Date: 05/11/2021
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: Vomiting within 3 hours of shot - 1st day 2nd and 3rd day - crippling abdominal pain

Other Meds: Metformin Trulicity Adavan - cholesterol Advil

Current Illness:

ID: 1306808
Sex: M
Age: 44
State:

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Tingle in her mouth. Resolved.

Other Meds:

Current Illness:

ID: 1306809
Sex: F
Age: 51
State: LA

Vax Date: 04/29/2021
Onset Date: 05/03/2021
Rec V Date: 05/11/2021
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: ACE inhibitors.

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

Symptoms: Client reports, "I got my vaccine on the 29th, and on the 3rd I found myself on the floor under my counter with a big bruise on my face. I had blood on my pillow in the other room where I may have bitten my lip, but I don't remember anything about what happened. I'm worried I may have had a seizure, and I've never had seizures." Client denies any event preceding this one, and is unsure of duration of event. Purple and yellow hematoma noted to client's orbit of right eye and to right cheek. Client denies ongoing signs or symptoms, at this time.

Other Meds: Client denies taking prescription medications, over-the-counter medications, dietary supplements, or herbal remedies at time of vaccination.

Current Illness: Client denies the presence of other illnesses at the time of vaccination and up to one month prior.

ID: 1306810
Sex: M
Age: 44
State: NJ

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 05/11/2021
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: Shellfish

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Periodic minor headaches

Other Meds:

Current Illness:

ID: 1306811
Sex: M
Age: 17
State: TX

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient under age 18 was vaccinated with Johnson and Johnson which is a vaccine error. Single vaccine at age 17. Troubleshooting: Scribe and vaccinator did not validate age; screeners at the beginning of the process did not ask or turn away. Parent validated age as 18. Unreported as error, found in data mining.

Other Meds:

Current Illness:

ID: 1306812
Sex: F
Age: 16
State:

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 05/11/2021
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 a syncopal episode after receiving vaccine. Apparently there is a history of anxiety over needles per family on scene.

Other Meds:

Current Illness:

ID: 1306813
Sex: U
Age: 56
State: RI

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

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: pt suffered psychiatric episode and aggressive behavior. pt walked across arena claiming "i cant breath" pt then threw herself to ground and was then placed in ems crew stretcher and secured 5x and taken to ems evaluation room. pt vitals were taken pt bp 179/91 rr 19 spo2 100% ra hr 80. pt became aggressive in ems care and would at times refuse to answer or acknowledge ems crew. pt confirmed psychiatric disorders and medications. pt confirmed HTN. Providence EMS was called and pt was trasnfered to providence ems crew.

Other Meds: lithium, seroquel, klonopin, verafax

Current Illness:

ID: 1306814
Sex: M
Age: 67
State: NY

Vax Date: 03/08/2021
Onset Date: 03/18/2021
Rec V Date: 05/11/2021
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: Hypoxia readmission 1 hour after discharge from initial admission for seizure, hyperglycemia, and trach procedure

Other Meds:

Current Illness:

ID: 1306815
Sex: F
Age: 84
State:

Vax Date: 03/02/2021
Onset Date: 03/16/2021
Rec V Date: 05/11/2021
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 reports development of peroneal vein thrombosis about 1-2 weeks after J&J vaccine. patient was on a flight at this time. she saw her PCP for swollen legs are was diagnosed with superficial thrombophlebitis. patient started asprin 325mg BID. after an ultrasound was done, it was revealed that the patient had right peroneal vein thrombosis as well as superficial thrombophlebitis of the medial right thigh. she was started on Xarelto 10mg daily. since taking Xarelto "tender lumpy spot on right upper thigh has gotten much better". patient has been referred to hematology to follow up.

Other Meds:

Current Illness:

ID: 1306816
Sex: F
Age: 63
State: PA

Vax Date: 03/26/2021
Onset Date: 04/08/2021
Rec V Date: 05/11/2021
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: CefuroximeAnaphylaxis Dextroamphetamine-amphetaminePalpitations Other Acetaminophen-codeineNausea Only LatexRash

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

Symptoms: Cough Nasal Congestion Headache Fatigue Poor Appetite Chills Body Aches

Other Meds: apixaban (ELIQUIS) 5 mg tablet aspirin (ASPIR-81) 81 mg tablet busPIRone (BUSPAR) 10 mg tablet CALCIUM 600 + D,3, 600 mg(1,500mg) -400 unit per tablet clotrimazole-betamethasone (LOTRISONE) cream COMBIVENT RESPIMAT 20-100 mcg/actuation inha

Current Illness: osteoporosis COPD

ID: 1306817
Sex: M
Age: 34
State: AZ

Vax Date: 05/09/2021
Onset Date: 05/10/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Fever of 102.5 severe migraine sweating body aches Nausea blurred vision

Other Meds:

Current Illness:

ID: 1306818
Sex: F
Age: 32
State: AZ

Vax Date: 05/01/2021
Onset Date: 05/02/2021
Rec V Date: 05/11/2021
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: Cold sore appeared on lip by the morning of the second day. Also felt some neck and back pain.

Other Meds: None

Current Illness: None

ID: 1306819
Sex: F
Age: 67
State: FL

Vax Date: 03/01/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: NA

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

Symptoms: diffuse hypopigmentation of the heals and thighs

Other Meds: NA

Current Illness: has history of RA, on kevzara

ID: 1306820
Sex: M
Age: 47
State: MI

Vax Date: 04/29/2021
Onset Date: 05/08/2021
Rec V Date: 05/11/2021
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: OxyContin

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

Symptoms: Tinnitus, and loss of hearing in right ear.

Other Meds: None

Current Illness:

ID: 1306821
Sex: F
Age: 53
State:

Vax Date: 05/02/2021
Onset Date: 05/10/2021
Rec V Date: 05/11/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: DVT and PE Right lower leg pain starting 3 days after vaccine, progressively worsening until time of diagnosis 8 days after dose. Hospitalized and undergoing IV anti coagulation

Other Meds: Multivitamins

Current Illness: None

ID: 1306822
Sex: F
Age: 67
State: IL

Vax Date: 02/22/2021
Onset Date: 02/25/2021
Rec V Date: 05/11/2021
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: Penicillin, Sulfa, Ephedrine

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

Symptoms: Chills, Body Aches, Stomach Cramps, Diarrhea

Other Meds: Omeprazole, Lisinopril, Clonazepam, Rosuvastatin, Omega-3, Probiotic, Turmeric, Glucosamine-Chondroitin, Aleve, Gabapentin, Multi-Vitamin

Current Illness: Osteoarthritis, Pre-Diabetes, Sinusitis, Obesity

ID: 1306823
Sex: M
Age: 47
State: FL

Vax Date: 04/20/2021
Onset Date: 05/08/2021
Rec V Date: 05/11/2021
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: Penicillin, Beestings

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

Symptoms: Immediately following both the first and second jabs the injection site was sore which is understandable and within 1-2 days the arm pain was gone. However, 2.5 weeks after the second jab my injection site has started to hurt and is swollen. It feels like there is a knot in my shoulder muscle where the injection was, and its very painful. No visible rash, just pain and minor swelling. It has not gotten noticeably worse, nor has it gotten any better over the last 4 days.

Other Meds: Buspirone HCL 7.5mg, Sertraline 50mg, Zolpidem 10mg, Vitamin C 1000mg, Rosehips 50mg, L-Lysine 1000mg, Zinc 50mg.

Current Illness: NA

ID: 1306824
Sex: M
Age: 87
State:

Vax Date: 02/26/2021
Onset Date: 03/31/2021
Rec V Date: 05/11/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient was hospitalized within 6 weeks of receiving COVID vaccination. Diagnosis was triple vessel coronary artery disease.

Other Meds:

Current Illness:

ID: 1306825
Sex: F
Age: 47
State: IN

Vax Date: 04/26/2021
Onset Date: 05/04/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: NA

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

Symptoms: Area on upper right arm just below the injection site became red and itchy about 1 week after receiving vaccine. The area at the bottom is slightly raised.

Other Meds: Metformin, trazodone, Fluoxetine, Invokana, Atorvastatin, Dorzolamide, women's multivitamin

Current Illness: NA

ID: 1306826
Sex: F
Age: 60
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: nausea. patient counseled to see PCP. Pt. declined further eval by EMS and hospital transport.

Other Meds:

Current Illness:

ID: 1306827
Sex: F
Age: 17
State: TX

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 05/11/2021
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: Patient under age 18 was vaccinated with Johnson and Johnson which is a vaccine error. Single vaccine at age 17. Troubleshooting: Scribe and vaccinator did not validate age; screeners at the beginning of the process did not ask or turn away. Parent validated age as 18. Unreported as error, found in data mining.

Other Meds:

Current Illness:

ID: 1306828
Sex: M
Age: 30
State: VA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 05/11/2021
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: None listed

Symptom List: Vomiting

Symptoms: He received his 2nd shot after 16 days instead of 28 days.

Other Meds: None listed

Current Illness: None listed

ID: 1306829
Sex: F
Age: 33
State: AZ

Vax Date: 05/09/2021
Onset Date: 05/10/2021
Rec V Date: 05/11/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Swollen lymph in throat /neck area on left side. Shortness of breath

Other Meds: None

Current Illness: None

ID: 1306830
Sex: M
Age: 40
State: AL

Vax Date: 04/22/2021
Onset Date: 04/25/2021
Rec V Date: 05/11/2021
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: He got his vaccine, he had a burning sensation and tingling sensation and broke out really bad on his arms, and the back of his neck and his back. He went to the doctor who send him to the drug store and was given OTC topicals to help with the rash. These medications are helping but it is still not clearing up. He is being sent to the dermatologist for this rash.

Other Meds: None.

Current Illness: None.

ID: 1306831
Sex: M
Age: 18
State: MD

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/11/2021
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: nka

Symptom List: Injection site swelling, Limb discomfort

Symptoms: pt was given wrong 2nd dose of the Moderna Covid Vax at a pharmacy on 5/10/21. His 1st dose was Pfizer given on 4/14/21. The patient completed the consent form correctly but pharmacist gave him the Moderna vax in error. That is the only vaccine they had in the store.

Other Meds:

Current Illness:

ID: 1306832
Sex: F
Age: 54
State: NM

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: 0930: Approximately 20 minutes after vaccine, patient reported hives to chest and right arm. Vaccine administered to left arm. Patient brought to first aid station. Allergies: NKDA PMHx: patient denies Medications: Patient denies Patient reports feeling nervous prior to vaccine. Provider on duty In attendance. VS: SaO2: 98% on RA, b/p: 170/110, HR: 78, RR: 18, Temp: 99.5 0932: Benadryl 50mg Liquid Orally. Pt tolerating water well. 0955: VS Temp: 98.4 B/P: 138/90, HR: 78, RR: 18, O2Sat 98% on RA. Hives present but improved. Continue to monitor for 15 minutes. 1015: Patient cleared by Provider on duty.

Other Meds: None

Current Illness: None

ID: 1306833
Sex: F
Age: 58
State: MA

Vax Date: 04/08/2021
Onset Date: 04/10/2021
Rec V Date: 05/11/2021
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: penicillin

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

Symptoms: vertigo and it has continued for the past month

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm