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: 1318905
Sex: M
Age: 12
State: CO

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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: Patient received their first Pfizer Covid vaccine and while his sibling was receiving her vaccine approximately two minutes later the patient fainted and fell on the floor and hit his head.

Other Meds:

Current Illness:

ID: 1318906
Sex: M
Age: 20
State: TX

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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: Patient came to received his Covid-19 shot. After the shot, he was instructed to wait 15 minutes nearby for observation. The patient was standing up reading the EUA given to him, felt dizzy, and fell to the ground. This happened approximately 5 minutes after the shot. He was able to get up by himself and sit down to a chair, where he requested water. He proceeded to vomited as he was sitting down.

Other Meds:

Current Illness:

ID: 1318907
Sex: F
Age: 30
State: DC

Vax Date: 04/20/2021
Onset Date: 05/03/2021
Rec V Date: 05/14/2021
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: A skin rash originating under breasts with red skin lesions spreading all over torso very similar to pityriasis rosea without a herald patch and minimal itching. Continuing to spread even after 2 weeks

Other Meds: None

Current Illness: None

ID: 1318908
Sex: M
Age: 32
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
Hospital:

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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318909
Sex: M
Age: 45
State: OK

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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: Decrease/ loss of taste

Other Meds: Metformin

Current Illness:

ID: 1318911
Sex: F
Age: 56
State: NH

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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: Latex Bananas

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

Symptoms: Patient had received their first dose of their Covid-19 vaccine. They were sitting in our waiting area like they were asked. Patient states that she started to feel lightheaded and dizzy. She then starts to walk up to the counseling window to notify the pharmacist, even after being advised to not leave her chair, when she fainted. The patient may have hit her head on the floor when she fainted, unknow to the pharmacist. Patient came to in less than 2 seconds from fainting with complete consciousness. Patients feet were elevated for a few moments and bp was checked while in this position with a bp of 161/101 and a pulse of 89. Patient was then moved back to the chair where she remained until EMS arrived. Patient was also given a snack and water to make sure that her blood sugars were not part of the cause of the fainting. Once EMS arrived they assumed controls of the situation and the patients health. We both were assuming it to be a vagovasal response.

Other Meds: Patient is taking high blood pressure medication, but unsure of what at the moment.

Current Illness: None

ID: 1318912
Sex: M
Age: 12
State: ID

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/14/2021
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: unknown

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: patient given Janssen instead of Pfizer; vaccine not approved for patient age

Other Meds: unknown

Current Illness: unknown

ID: 1318913
Sex: M
Age: 27
State: CA

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

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

Lab Data:

Allergies: Milk Macadamia nuts

Symptom List: Pharyngeal swelling

Symptoms: Strong metallic taste in mouth within an hour after receiving the vaccine and remains after over 6 hours so far.

Other Meds: Testosterone cypionate Multivitamin

Current Illness: None

ID: 1318914
Sex: F
Age: 33
State: MS

Vax Date: 04/30/2021
Onset Date: 05/13/2021
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies: Na

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Immediately following vaccine for 2 days after I experienced severe muscle pain- full body and headache. The side effects subsided after 2 days but has returned now 2 weeks after vaccination and are gradually increasing in severity.

Other Meds: Wellbutrin XL, Trazadone, Xanax

Current Illness: Post op from endoscopic sinus surgery. Surgery date 4/7/2021.

ID: 1318915
Sex: F
Age: 40
State: FL

Vax Date: 04/16/2021
Onset Date: 04/18/2021
Rec V Date: 05/14/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no known allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt experienced a breakthrough seizure requiring hospitalization ( pt had been seizure free for 20 years). Also experienced vertigo. Pt did not have any fever or other systemic side effects, only a sore arm after receiving the shot till the seizure occurred. Pt also reports no alcohol consummation or change in diet.

Other Meds: Keppra, baclofen, asa 81mg and multivitamin

Current Illness:

ID: 1318917
Sex: F
Age: 58
State: OH

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

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

Lab Data:

Allergies: None

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

Symptoms: Became lightheaded , sweating, faint, about 10 min after shot. EMS called

Other Meds: 10mg atorvastatin Raloxifene 60mg Vit D 5000 IU CoQ10 300mg Loratidine 10mg

Current Illness: None

ID: 1318918
Sex: F
Age: 62
State: CA

Vax Date: 04/06/2021
Onset Date: 04/20/2021
Rec V Date: 05/14/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin.

Symptom List: Rash, Urticaria

Symptoms: Developed a rare blood disorder known as TTP (Thrombotic thrombocytopenic purpura). Suffered various strokes. Outcome is pending but doctors are predicting permeant right side paralysis and inability to communicate.

Other Meds: Prescription for hypertension.

Current Illness: None.

ID: 1318919
Sex: M
Age: 15
State: CA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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 INDICATED

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

Symptoms: PATIENT RECEIVED PFIZER COVID VACCINE AND WENT TO WAITING AREA. PATIENT COMPLAINED THAT HE FELT FAINT. PATIENT DIAPHORETIC AND SHAKING. CLOSED EYES. APPEARED TO LOSE CONSCIOUSNESS FOR ABOU A MINUTE. GAVE PATIENT COLD WATER. PATIENT REVIVED QUICKLY. MOVED HIM FROM CHAIR TO WAITING AREA TO LAY FLAT. HE WANTED TO RISE TO HIS FEET WITHIN MINUTES. PATIENT'S MOTHER IS PHYSICIAN AND WAS ON PHONE WITH FATHER ACCOMPANYING HIM.

Other Meds: UNKNOWN

Current Illness: NONE INDICATED

ID: 1318920
Sex: M
Age: 37
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318921
Sex: M
Age: 37
State:

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

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

Lab Data:

Allergies:

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

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318922
Sex: M
Age: 38
State:

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/14/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318924
Sex: F
Age: 46
State: TN

Vax Date: 03/28/2021
Onset Date: 04/09/2021
Rec V Date: 05/14/2021
Hospital: Y

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: unknown

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

Symptoms: patient called and said 10 days post she had a heart attack and was hospitalized. no further information given

Other Meds: unknown

Current Illness: unknown

ID: 1318925
Sex: F
Age: 38
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1318926
Sex: M
Age: 39
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318927
Sex: F
Age: 42
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318928
Sex: M
Age: 48
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318929
Sex: F
Age: 48
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318930
Sex: M
Age: 49
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318931
Sex: M
Age: 23
State: DE

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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: Pt reports that he is allergic to pollen and pet dander

Symptom List: Injection site pain, Pain

Symptoms: Pt scheduled and appt for J&J vaccine and it was administered by LPN in his left arm. Pt waited in observation for 5 minutes and reported he felt dizzy. Pt loss consciousness while sitting in his chair. Nurse repeatedly called patients name with no response . Charge Nurse was called for assistance . Charge Nurse administered a sternal rub and patient woke up . Pt was able to state his name , DOB and location . Pt reported that he lost his vision , with a headache and everything was black. Laid patient in first aid area on a cot and took patients vitals which were WNL. After lying down for 15 min patients vision returned. Pt stated he walked 25 min in the sun to the vaccination clinic and only had 1 meal for the whole day. Pt was monitored for an additional 30 minutes , drank water and was provided some crackers. Pt refused EMS services and just wanted to lie down . medial director was notified immediately of the incident and felt comfortable releasing the patient to walk back home on his own . Patients Vitals were rechecked and within normal limits . Pt left after 45 minutes

Other Meds: Pt reports no medications or supplements

Current Illness: Pt reports no past medical history or illness.

ID: 1318933
Sex: M
Age: 50
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1318934
Sex: F
Age: 22
State: KY

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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: None

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

Symptoms: Nausea and vomiting (not experienced with first dose or during Covid in January 2021) Muscle weakness Joint pain Headache

Other Meds: Pristiq 100 mg Birth control

Current Illness: none

ID: 1318935
Sex: F
Age: 51
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318936
Sex: M
Age: 56
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318937
Sex: F
Age: 56
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318938
Sex: F
Age: 56
State:

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318940
Sex: M
Age: 59
State:

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318941
Sex: F
Age: 71
State: FL

Vax Date: 03/17/2021
Onset Date: 04/01/2021
Rec V Date: 05/14/2021
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: Codeine, hydrocodone, indomethacin, meperine, morphine

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

Symptoms: On 4/1/2021 Patient had at least one seizure at home and upon arriving at the ER/hospital had a severe seizure. She was admitted to the hospital for treatment and was in the intensive care unit for about 9 days. She was given seizure medicine along with other fluids to keep her hydrated and fed. Multiple EEGs were taken to track the electrical activity within her brain - which even with high doses of medication was very active. A spinal tap was done to test for infection and no viruses were found. An MRI was completed to identify what part of the brain was being impacted. The area of the brain that was impacted was the side and the images showed it was very inflamed. She has since been moved to a physical therapy facility to try to help her improve. At this time, she still needs assistance for all activities and would not be able to return home due to the level of care she needs. Her current diagnosis is autoimmune encephalitis. She has never had seizures before and this one began about two weeks after receiving her first dose of the COVID-19 shot. She has been unable to receive her second shot due to being in the hospital and physical therapy facility. Due to the timing of the seizure event, we are very concerned with her receiving her second shot as well.

Other Meds: Metoprolol succinate ER, Hydralazinie HCI, Losartan potassium, Omeprazole Dr, Folbic, Seroquel

Current Illness: N/A

ID: 1318942
Sex: F
Age: 60
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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:

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

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318943
Sex: M
Age: 16
State: OR

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 05/14/2021
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: THIS VACCINE IS ONLY FOR 18 YEARS OR OLDER. HOWEVER, THIS PATIENT IS ONLY 16 AND GOT THIS SHOT ON 04/05

Other Meds:

Current Illness:

ID: 1318944
Sex: M
Age: 60
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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: Erythema, Pruritus

Symptoms: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1318945
Sex: F
Age: 61
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318946
Sex: M
Age: 62
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318947
Sex: F
Age: 59
State: CA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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: Chills, mild fever, aches, loss of taste, I feel like I have the flu. Extremely sore arm

Other Meds: None

Current Illness: None

ID: 1318948
Sex: M
Age: 63
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318949
Sex: M
Age: 63
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318950
Sex: F
Age: 68
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318951
Sex: F
Age: 17
State: CO

Vax Date: 04/20/2021
Onset Date: 04/22/2021
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient presented for second dose vaccination. Patient reported seeking medical attention for adverse effects. Patient sought medical attention due to swollen lymph nodes on neck (superficial cervical) and flu-like symptoms (fever, body aches, fatigue, nausea) following first dose vaccination. Lymph nodes prompted CT scan when checked at medical facility. Patient was not admitted as inpatient, no antibiotics were prescriber following encounter but anti-nausea medication was prescribed.

Other Meds:

Current Illness:

ID: 1318952
Sex: F
Age: 68
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1318953
Sex: F
Age: 17
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318954
Sex: M
Age: 19
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318956
Sex: F
Age: 19
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318957
Sex: F
Age: 16
State: KY

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 05/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Within 5-10 mins post-injection pt became pallor, sweaty, dizzy and had a vasovagal episode while sitting in her chair. Pt exhibited jerking motions and then quickly had a syncope episode lasting <1 min. Pt was lowered to the ground during the episode. No trauma occurred. Pt mother beside pt entire time. During this time a pulse ox was put on pt and her legs were elevated. Pulse ox remained 96-98%. After waking, water and wet rag was given to pt and pt moved to reclined chair after 5 mins. Pt remained pallor and dizzy x15mins, after 40 mins pt was able to walk and leave the clinic. Mother stated in past that pt had a vasovagal episode after the Gardasil vaccine.

Other Meds:

Current Illness:

ID: 1318958
Sex: M
Age: 45
State: TX

Vax Date: 05/05/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient stated arm felt sore with mild pain. He explained the injection site felt as if he had a "knot" or "pimple" under the injection site reaction. There is nothing noticeable or visible to the naked eye but stated that as he felt around the injection site there was soreness or pain

Other Meds: N/A

Current Illness: N/A

ID: 1318959
Sex: F
Age: 22
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1318960
Sex: F
Age: 24
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm