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

Incidents per State

State Total
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 1357952
Sex: F
Age: 16
State: WA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NONE KNOWN

Symptom List:

Symptoms: NO ADVERSE EVENT AT TIME OF VACCINE REPORT DUE TO PATIENT AGE

Other Meds: NONE KNOWN

Current Illness: NONE KNOWN

ID: 1357953
Sex: F
Age: 63
State: MN

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: 100 degree fever, nausea, aches Still have hardened circle on my left arm from 1st shot

Other Meds: Wellbutrin, HCTZ, Atenolol, Vitamin D

Current Illness: none

ID: 1357954
Sex: M
Age: 49
State: IN

Vax Date: 05/26/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: idoeine in the dye in x-rays when I was a child

Symptom List:

Symptoms: Fever, chills, fatigue, headache

Other Meds: Tyneol and ibuprofren. Sudafed and benaydrl.

Current Illness: none

ID: 1357955
Sex: F
Age: 62
State: PA

Vax Date: 05/16/2021
Onset Date: 05/17/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: sulfa; codeine; seasonal allergies

Symptom List:

Symptoms: 1st shot: severe left arm pain and shoulder pain-improved but not resolved on 5/28/21 fatigue for 2 weeks resolved Increased Inflammation of arthritis in many joints that were not previously affected-has not resolved headache

Other Meds: Vit D; Vit C, multivitamin; essential oils

Current Illness: none

ID: 1357956
Sex: F
Age: 73
State: MO

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Emergency Room Visit, Specialist, Family Practice Visits Severe pain, legs arms, face, neck, trouble walking, rising from sitting, fatigue, Prednisone

Other Meds: Potassium Citrate 10 m Extended Release Multiple Vitamins Calcium

Current Illness: none

ID: 1357957
Sex: F
Age: 67
State: AZ

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies: Levaquin, Quinolones

Symptom List:

Symptoms: Moderate to extensive Orticaria to Trunk, Axillary, and thigh.

Other Meds: Omeprazole 20mg 1 qd

Current Illness: None

ID: 1357958
Sex: M
Age: 66
State: FL

Vax Date: 03/14/2021
Onset Date: 03/21/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
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Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Very, very Severe pain in right leg upper leg near hip area. - never had this pain before. Nothing has relieved the pain for him. He went to Primary care and urgent. Still having very severe pain in the same leg. waiting to see pain management doctor.

Other Meds: None - regular medications, also takes Advair

Current Illness: None

ID: 1357959
Sex: M
Age: 62
State: WI

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
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Lot:
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Lab Data:

Allergies: Neosporin, atorvastatin, fluoxetine

Symptom List:

Symptoms: 3/26/21 After Pfizer vaccine noticing hives on chest and left arm as well as facial tingling and slightly left eye itchiness. Received 2 dose of Epinephrine during ED visit. 5/13/21 After Janssen vaccine he received at this morning around 8:10 AM. After that he had almost the exact same symptoms with a shooting pain in the left arm and neck some left hand tingling and swelling to the point where he can't get his wedding ring off and a sensation of pressure/tingling/fullness in the left side. Given Benadryl and steroids, initially there is no airway concerns or compromise. However after a period of time, he thought his voice was different. He did sound just slightly raspy, though I did question whether this could be related to dryness from the Benadryl. Regardless given that he did note a change, we opted to go ahead and give a dose of epinephrine, which did resolve his symptoms

Other Meds: None

Current Illness: Balanitis

ID: 1357960
Sex: F
Age: 94
State:

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Patient received a 3rd dose of Moderna. 1st dose on 1/25/21, 2nd dose on 2/22/21, 3rd dose on 5/12/21.

Other Meds:

Current Illness:

ID: 1357961
Sex: F
Age: 30
State: OH

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
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Lot:
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Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Patient has large (approximately 4 in diameter) raised surface with bright red ring around vaccination site. Skin was elevated ~1/2 in above surface was taunt/ inflamed. Patient reported that reaction was not painful. She also reported no difficulty breathing, hives, or other indications of allergic reaction. She called her PCP the day after the vaccination clinic (04/23/21), they determined no emergent response was necessary. Watchful waiting was adapted. Upon return for second vaccine dose no sign of ADE was present. Vaccinating pharmacist was made aware of the ADE for the first time at second dose clinic (05/20/21). Patient declined second dose of vaccine.

Other Meds: None reported by patient

Current Illness: None reported by patient

ID: 1357962
Sex: F
Age: 60
State: TX

Vax Date: 01/25/2021
Onset Date: 01/28/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Vax Site:

Lab Data:

Allergies: None.

Symptom List:

Symptoms: The symptoms began at about 8 PM on 1/28/2021. I was very congested. I had a stopped up nose. When I woke up on 1/29, I was really dizzy and had a sore throat, and my nose was still stopped up. I decided not to go to work. I went to the doctor to get it checked. The doctor asked a lot of questions and said that it was an allergy. They gave me a prescription for Zyzal. They concluded it was seasonal rhinitis due to pollen.

Other Meds: None.

Current Illness: None.

ID: 1357963
Sex: F
Age: 11
State: OR

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
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Vax Route:
Vax Site:

Lab Data:

Allergies: Answered "No" to vaccine screening question "Have you had a serious or life-threatening allergic reaction, such as hives, or difficulty breathing to any vaccine shot?" Any other specific allergies unknown.

Symptom List:

Symptoms: Pfizer Vaccine administered to individual under 12 years old; vaccine is only authorized for 12+. No adverse event/outcomes noted. Parents of children misrepresented their age when making the children appointments to get the vaccine. Registration noticed the children were under 12 years old when they were looking at second dose scheduling and noticed duplicate accounts with same info but different ages.

Other Meds: Unknown

Current Illness: Unknown

ID: 1357964
Sex: M
Age:
State: FL

Vax Date: 05/26/2021
Onset Date:
Rec V Date: 05/28/2021
Hospital:

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Lab Data:

Allergies:

Symptom List:

Symptoms: muscle aches...all over, the more he moves the more it hurts he has mental illness that makes him pace. he stated he feels a lot better after taking his anxiety med, a warm bath and some aspirin all his symptoms subsided.

Other Meds: psych meds, lisinopril, Prilosec omeprazole, atorvastatin, Ativan

Current Illness:

ID: 1357965
Sex: F
Age: 43
State: VA

Vax Date: 01/21/2021
Onset Date: 01/27/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Allergic to shellfish

Symptom List:

Symptoms: Swollen lymph node above right clavicle

Other Meds: Paroxetine 10 mg/day Zyrtec 10 mg/day Multivitamin

Current Illness: none

ID: 1357966
Sex: M
Age: 19
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
Hospital:

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Allergies:

Symptom List:

Symptoms: Patient is a 19yo male who experienced a near syncopal episode immediately after receiving his first dose of Pfzier covid 19 vaccine. Patient c/o dizziness and tinnitus, patient then noted altered level of conciousness, w/o complete loss of consciousness. Upon assessment patient noted with significant diaphoresis, noted generalized clammy skin, no skin lesions, rash or hives noted. respiratory rate WNL, respirations even and unlabored. Within less that 60 seconds patient started to regain alertness and was able to respond and answer questions appropriately. Reported feeling some anxiety prior to getting vaccine but denied being diagnosed or treated with anxiety. reported prior episode with similar less severe symptoms associated with "shots" within >2 minutes patient was A&O x4, verbal and able to make needs known. Respiration remained even and unlabored. Skin pink warm and intact with significantly decreased clamminess and diaphoresis. No sx/sx of allergic reaction. Chest is non-tender, initially bradycardia @ 43 BPM, noted irregular heart rhythm, no murmur or extra sounds noted. Pt reports playing football with practicing at least 4 days weekly. Denies significant past medical HX. No HX of allergies. Patient was assisted to yoga mat on ground, in supine position with lower extremities elevated. Physical assessment completed then past medical HX obtained from PT. Initial VS 100/50. HR 43, o2 96% ECG obtained by EMTS WNL. Spontaneous resolution of symptoms after 1-2 minutes. Patient was assisted to sitting position, then standing w/o return of symptoms. VS @ 5 mins 114/63 HR 63 RR 18 o2 98%. Patient escorted to observation area and sitting in chair. Patient was observed for 30 mins in observation area. After 30 minutes no acute distresss noted, pt denied pain, dizziness, tinnitus or other symptoms. Advised patient to abstain from strenuous activity for the rest of the day and advised against football practice today and against being alone today. Advised patient to seek emergency treatment by calling 911 should symptoms return, experience SOB, or any sx/sx of an allergic reaction. Patient verbalized understanding before leaving vaccine site @ 1610

Other Meds:

Current Illness:

ID: 1357967
Sex: F
Age: 41
State: MD

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: pt fainted after vaccination and recovered right away

Other Meds:

Current Illness:

ID: 1357968
Sex: F
Age: 43
State: FL

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No

Symptom List:

Symptoms: The night I got the second dose my feet started tingling. Five days later my legs and hands started tingling. I went to the urgent care and they told me to wait. Today I still felling my right hand and my left foot tingling.

Other Meds: No

Current Illness: No

ID: 1357969
Sex: F
Age: 52
State: MA

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Nonemiled allergies

Symptom List:

Symptoms: My temp is normally low.. between 96.7 and 97.6 (temp takin at work every day) We?d 5/26/21 Shot at 9:15am Fatugue & diarrhea started around 4pm Headache and hot cold flashes begins around 7pm Vomiting with major chills and fever of 100.01 begins around 11pm Thurs 5/26/21 Vomiting continues til 7am Headache continues as well Temp down to 99.4 around 4pm Finally ate soup Headache continues throughout Thursday night Friday 5/28/21 Headache and body really really tired

Other Meds: Imitrex, Sumatriptan

Current Illness: None

ID: 1357970
Sex: M
Age: 26
State: PA

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Latex

Symptom List:

Symptoms: I was very nauseated, shortness of breath, vertigo, tachycardia, body aches. I went to ER the following morning after my vaccine.

Other Meds:

Current Illness:

ID: 1357971
Sex: M
Age: 26
State:

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Intermittent urticaria and palmar irritation since vaccination.

Other Meds: none

Current Illness: None

ID: 1357972
Sex: M
Age: 55
State: PA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: Patient experienced acute pulmonary embolism approximately 8 days after administration of the J&J vaccine. He did not have low platelets. No clear cause of the PE was found. It was thought to be possibly related to superficial thrombosis of his upper extremity secondary to IV that was placed 2 days prior when he was briefly admitted for workup of heavy hematocheiza, at which time he was found to have a mild anemia and discharged. He was treated inpatient at Hospital. I am not sure of the where he obtained the vaccine or the exact date.

Other Meds: abilify, tylenol, amitriptyline, aspirin, atorvastatin, lantus, insulin lispro, lisinopril, metformin, nifedipine, sertraline, singulair, spiriva, albuterol, victoza

Current Illness: none known

ID: 1357973
Sex: M
Age: 51
State: VA

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NA

Symptom List:

Symptoms: Patient without shot card on second dose clinic. Dose of Pfizer given while researching shot #1. Subsequently found on master computer syatem to have had J&J on 05/09/21 by FEMA-- second shot not indicated.

Other Meds: NA

Current Illness: NA

ID: 1357974
Sex: F
Age: 62
State: FL

Vax Date: 05/22/2021
Onset Date: 05/23/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: aches, pain, low grade fever started on 5/23/2021 and responded to APAP; sneezing, postnasal drip, cough started on 5/24/2021 and is still ongoing

Other Meds: ventolin hfa prn

Current Illness:

ID: 1357976
Sex: F
Age: 33
State: CT

Vax Date: 05/18/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: allergy to Penicillin

Symptom List:

Symptoms: mild pericarditis

Other Meds:

Current Illness:

ID: 1357977
Sex: F
Age: 33
State: CA

Vax Date: 02/05/2021
Onset Date: 02/09/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

Symptom List:

Symptoms: Six hours after vaccination, patient developed palpitations and dizziness. Presented to ER and EKG completed, which came back normal. Four days post vaccination, patient developed sudden onset dizziness/lightheadedness, imbalance with walking, and brain fog. Symptoms were intermittent and continue to be present to date (5/28/2021). Patient was treated with meclizine without relief.

Other Meds: N/A

Current Illness: N/A

ID: 1357978
Sex: M
Age: 75
State:

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Patient received a 3rd dose of Moderna. 1st dose on 1/22/21, 2nd dose on 2/19/21, 3rd dose on 5/12/21.

Other Meds:

Current Illness:

ID: 1357979
Sex: M
Age: 22
State: CA

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Client received his first dose of the Pfizer Covid-19 vaccine (Lot # EW0185 Exp. 08/2021) on 5/27/21 at 1036 AM. At approximately 1045 the client walked up to the EMT asking for water and stating that he felt lightheaded. " Client was a 22-year-old male alert and tracking with his eyes and beginning to stumble. The client had a chief complaint of syncope. EMT managed to assist the client to the observation bed while an additional EMT and RN arrived for further assistance. The client was positioned supine on the cot and proceeded to lose consciousness. The client did not fall or injure himself in any way. He regained consciousness after approximately 15 seconds. He was alert and oriented to person, place, time, and situation immediately upon regaining consciousness. Client stated that he did not have anything to eat or drink before arriving at the vaccination site. The client had no known allergies and denied any medical history. The client was negative for hives, swelling, discoloration, signs or symptoms of shortness of breath, or other signs of anaphylaxis. The client's airway, breathing, and circulation were intact. The first set of vital signs were taken at 1045 and are as follows: blood pressure 110/76, pulse 52, O2 saturation 96%, skin pale, sweaty and hot. The client consented to stay an additional 30 minutes after his initial vitals were taken and his vitals were reassessed every five minutes until his symptoms resolved. After approximately 10 minutes, the client was fully pink in his face and denied any further lightheadedness. At 1051 the second set of vital signs were: bp 122/82, p 56, O2 96%, skins pink, normal, and warm. Client was assisted to an upright seated position and was given Pringles and juice. At 1059 clients vitals were - 124/84 BP, 74HR O2 99%, Resp 16. At 1109 vitals: bp 122/82, p 68, O2 97%, skins pink, normal and warm. At the completion of his additional 30-minute observation, the client stated that he was feeling better. All pertinent information was given to client by EMT and RN and he was encouraged to follow up with his primary before his next dose. The client was also instructed to call 911 if a severe allergic reaction occurred later in the evening and was reminded to eat before his next vaccination. RN educated client about the possible signs and symptoms of an allergic reaction. The client at 1115 in positive disposition with his mother.

Other Meds: None

Current Illness: None

ID: 1357980
Sex: F
Age: 45
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Lightheadedness; Patient felt light headed and weak, EMS called, patient recovered within 5 minutes. Will keep in observation for 20 more minutes.

Other Meds:

Current Illness:

ID: 1357981
Sex: F
Age: 23
State:

Vax Date: 05/06/2021
Onset Date: 05/13/2021
Rec V Date: 05/28/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient is a 23-year-old female with past medical history significant for epilepsy, presenting for four days of generalized arthralgias. Patient received the Johnson and Johnson COVID-19 vaccine on 5/6/2021. Two days later she was feeling well and did her usual workout. On 5/9, patient awoke with pain in all of her joints excluding her ankles. She has continued to experience these pains through today. This is abnormal for her as she is typically active. She has been taking Ibuprofen, Tylenol, and Flexeril without relief. She denies any fevers, chest pain, shortness of breath, nausea, vomiting, diarrhea, sore throat, or rashes. No prior similar experiences. Of note, patient had strep pharyngitis 4/6/2021, and she finished the prescribed course of antibiotics. She follows with Dr. from neurology. LMP unknown as patient has birth control implant. Denies vaginal bleeding or discharge. No past surgical history. Medications reviewed. Currently on Lamotrigine. Allergies noted. Patient is a nonsmoker, occasional drinker, uses marijuana recreationally. Family history includes hypertension and diabetes.

Other Meds:

Current Illness:

ID: 1357982
Sex: F
Age: 64
State: WV

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: Symptoms started within first 45 mins of receiving vaccine. Pt states that her left side of her face started to feel numb, appeared to be droopy. Pt states she went to work after leaving the clinic, employer made her go to the ER. At the ER, pt states that they performed CT on brain with and without contrast, MRI on brain with contrast, EKG, chest x-ray, and bloodwork. ER doctors consulted with a specialist via telehealth and asked pt to perfom many skills and dx her with Bells Palsy. Pt was prescribed Valtrex and Prednisone upon discharge from ER. Pt states that Bells Palsy resolved in about 2 weeks.

Other Meds: Indapamide, Enalapril, Naproxen, Omeprazole, Loratadine, Ferrous sulfate, doxycycline, trazodone, flonase

Current Illness: Feb 2021- pt states she had a dizzy spell

ID: 1357983
Sex: F
Age: 45
State: CA

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Pt experienced headache and dizziness post vaccination. Pt has Hx of HA on & off, possible migraine per PCP. Pt also did not have breakfast and has hx of anxiety. (BP 112/63; HR 82; RR 18; T 97.3; AOx3). 10 min later pt denied dizziness & HA had improved (BP 102/59; HR 78; RR 18; T 97.4). Pt was stable & released from vaccination site.

Other Meds:

Current Illness:

ID: 1357984
Sex: F
Age: 10
State: OR

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
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Lab Data:

Allergies: Answered "No" to "Have you had a serious or life-threatening allergic reaction, such as hives, or difficulty breathing to any vaccine shot?" Any other allergies unknown.

Symptom List:

Symptoms: Pfizer Vaccine administered to individual under 12 years old; vaccine is only authorized for 12+. No adverse event/outcomes noted. Parents of children misrepresented their age when making the children appointments to get the vaccine. Registration noticed the children were under 12 years old when they were looking at second dose scheduling and noticed duplicate accounts with same info but different ages. Per CDC and OHA guidance, second dose will not be administered.

Other Meds: Unknown

Current Illness: Unknown

ID: 1357985
Sex: F
Age: 81
State: NY

Vax Date: 03/02/2021
Onset Date: 03/03/2021
Rec V Date: 05/28/2021
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Symptom List:

Symptoms: Injection pain and headache patient took some of Tylenol. This pain lasted for a few days. On the second shot patient was fatigued and slept all day. Only fatigued for one day and went back to normal

Other Meds:

Current Illness:

ID: 1357986
Sex: F
Age: 39
State: IL

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 05/28/2021
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Lab Data:

Allergies: Salento, Mice, Mole

Symptom List:

Symptoms: After 5-10 minutes. I started to feel tingling around my mouth and throat. Tingling in my chest, trouble breathing. After sitting there for an hour my heart rate was evaluated 100 beats/min. My temperature and blood pressure was high. I started to feel dizzy. I felt I was having an allergic reaction. My oxygen was low.

Other Meds: Levothyroxine, Clardine D, Flonasz , Ibuprofen, Vitamin D, Multi-Viatmin, Excedrin

Current Illness: No

ID: 1357987
Sex: F
Age: 58
State: MA

Vax Date: 05/05/2021
Onset Date: 05/15/2021
Rec V Date: 05/28/2021
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Allergies: none

Symptom List:

Symptoms: Tinnitus in both ears

Other Meds: Levothyroxine 75mg

Current Illness: none

ID: 1357988
Sex: F
Age: 81
State:

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 05/28/2021
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Symptoms: Patient received a completed series of Pfizer and then received a dose of Janssen. 1st dose of Pfizer on 12/21/20, 2nd dose of Pfizer on 1/11/21, 3rd dose of Janssen on 3/30/21.

Other Meds:

Current Illness:

ID: 1357989
Sex: M
Age: 32
State: PA

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 05/28/2021
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Allergies: N/A

Symptom List:

Symptoms: Pt reported dizziness following injection. Pt brought to Med Obs 1 at 11:03. Pt reported not eating breakfast but consuming an energy drink. Vital signs taken. BP elevated but all other VSS. Following administration of oral fluids and crackers, pt reported no more dizziness with standing and ready to go home. Repeat VSS, BP at 160/97. Pt escorted to exit and encouraged to follow up with PCP about BP.

Other Meds: N/A

Current Illness: N/A

Date Died: 04/29/2021

ID: 1357990
Sex: M
Age: 82
State: GA

Vax Date: 03/11/2021
Onset Date: 04/01/2021
Rec V Date: 05/28/2021
Hospital: Y

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Symptom List:

Symptoms: Patient hospitalized. Patient died after testing positive for COVID-19. Admitted to hospital 4/2/2021 for right flank pain. Tested positive on 4/1/2021. Died 4/29/2021

Other Meds:

Current Illness:

ID: 1357991
Sex: U
Age: 27
State:

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/28/2021
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Symptom List:

Symptoms: Lightheadedness; Patient stated " I don't feel ok' EMS came by patient side. Lead staff been aware of it. Patient vitals took by EMS BP 118/86, HR 61, O2 96. After 10 minutes lay flat and vitals taken. Patient Stated I feel good. Patient refused to go to the hospital.

Other Meds:

Current Illness:

ID: 1357992
Sex: F
Age: 36
State: FL

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/28/2021
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Lab Data:

Allergies: penicillin, sulfa drugs, dust, cats

Symptom List:

Symptoms: "The person giving the vaccine did not pay attention while administering the vaccine and may have given the vaccine too high." The administration hurt a lot, unusual compared to the 1st dose; it also bled a lot. Within a day or 2, started having a tingling sensation; effects have lasted for the past 4 weeks, not subsiding. Frontal area of shoulder and elbow and upper arm have paresthesia.

Other Meds: OCP, asthma inhaler

Current Illness:

ID: 1357994
Sex: M
Age: 44
State: WI

Vax Date: 12/19/2020
Onset Date: 12/19/2020
Rec V Date: 05/28/2021
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Allergies: NKA

Symptom List:

Symptoms: 3/12/21 persistent pain in the right shoulder since receiving his vaccine in December. History and physical exam are most consistent with post vaccination subacromial bursitis. Given lack of response to conservative therapy, I recommended subacromial bursa injection today. Patient experienced immediate relief following procedure.

Other Meds: None

Current Illness: None

ID: 1357995
Sex: F
Age: 55
State: AZ

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 05/28/2021
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Lab Data:

Allergies: sensativities, no allergies

Symptom List:

Symptoms: Moderna COVID-19 Vaccine EUA First Shot - minimal symptoms as with other vaccines (headache, upset stomach for 30 minutes) Second Shot - had to sleep the rest of the same day. Day two (6 hours of diarehea), stomach and throat ulcers, black stool for three days, headache, fever (>102), joints aching, hard to move joints at times, back hurting, soar throat, allergy like symptoms (swelling, tight chest, etc.), excessive weight gain. Weeks 2 to present (continuing still at ONE month since second shot) - joints aching (hard to walk at times), back hurting, soar throat, allergy like symptoms (general joint and body swelling, tight chest, etc.). Not sure is related to COVID Shot, just started at second shot.

Other Meds: Liothyronine (10mcg/day), prebiotic/probiotic/ D3/

Current Illness: none

ID: 1357996
Sex: F
Age: 40
State: IN

Vax Date: 01/02/2021
Onset Date: 01/06/2021
Rec V Date: 05/28/2021
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Allergies: penicillin sulfa

Symptom List:

Symptoms: Started experiencing irregular heartbeat 1-6-21. Went to PCP for EKG 1-8-21. EKG was normal but I continued to experience palpitations intermittently for months.

Other Meds: oral birth control pill sertraline

Current Illness: n/a

ID: 1357997
Sex: F
Age: 60
State: GA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 05/28/2021
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Lab Data:

Allergies: Erythromycin gives me the shakes, and metronidazole gives me hives.

Symptom List:

Symptoms: Five hours after vaccine around 8 PM I started with chills and shakes and then fever. I think I had a fever of over 100. No body aches or anything like that, of coarse there was a little bit of soreness in arm but it wasn't so bad. 3 weeks later is when I started with headache which I recognized as sinus so I started medical treatment I went to see a doctor about a month later on 05/03/2021 and that is when I was put on antibiotics for 10 days and steroids. It ended up going away maybe halfway through taking the antibiotics, about 5 days in using antibiotics around 05/08/2021 I started feeling better.

Other Meds: Thyroid levothyroxine and Amlodipine and over the counter Vitamin C, B Complex, Vitamin D, Loratadine, and supplements for menopause.

Current Illness: None.

ID: 1357998
Sex: F
Age: 58
State:

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 05/28/2021
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Symptom List:

Symptoms: Difficulty breathing; Nausea; Vomiting; Lightheadedness; Patient feel nausea, lightheadneness. EMS was at patient side for 10 min .Water given. After the 30 minute patient stated " I feel ok now". Patient left to go home.

Other Meds:

Current Illness:

ID: 1357999
Sex: U
Age: 59
State: SC

Vax Date: 04/09/2021
Onset Date: 04/16/2021
Rec V Date: 05/28/2021
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Allergies: None.

Symptom List:

Symptoms: Extreme ringing in ears.

Other Meds: Lisinopril, Pravastatin

Current Illness: None.

ID: 1358000
Sex: M
Age: 17
State: OR

Vax Date: 05/21/2021
Onset Date: 05/22/2021
Rec V Date: 05/28/2021
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Lab Data:

Allergies: Poison oak

Symptom List:

Symptoms: Patient experienced fatigue, malaise and rash within 24 hours of second COVID vaccine. Then reported feeling short of breath with exertion while at wrestling practice on 5th day following COVID vaccine.

Other Meds: Vitamin C

Current Illness: no known illnesses

ID: 1358002
Sex: F
Age: 56
State: CA

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/28/2021
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Allergies: Penicillin, Cefzil

Symptom List:

Symptoms: Day after injection developed small, itchy water blisters behind knees. About 10 blisters behind each knee. They dried up and scabbed -over within about 3-4 days.

Other Meds:

Current Illness:

ID: 1358003
Sex: M
Age: 66
State:

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type:
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Allergies:

Symptom List:

Symptoms: Patient received a completed series of Pfizer and then received a dose of Janssen. 1st dose of Pfizer on 1/11/21, 2nd dose of Pfizer on 2/1/21, 3rd dose of Janssen on 3/30/21.

Other Meds:

Current Illness:

ID: 1358004
Sex: M
Age: 26
State: MD

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 05/28/2021
Hospital:

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Lab Data:

Allergies: pollen- mild

Symptom List:

Symptoms: Patient experienced vagal reaction to the vaccine. He states that this is due to the fear of needles.

Other Meds: Not taking any meds

Current Illness: no

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm