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: 1376295
Sex: F
Age:
State: MA

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 06/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Get two bumps under each arm pit but they went away a couple days late,wants to report an additional benefit; This is a spontaneous report from a contactable consumer or other health care professional (patient). A 51-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Formulation: Solution for injection; Batch/Lot Number: EL324), via an unspecified route of administration on 01Feb2021 (at the age of 51-years-old) as 1st dose, single case for covid-19 immunisation. Medical history included mammary duct ectasia (clogged breast duct under her right arm pit) from 1999. The patient's concomitant medications were not reported. Consumer stated that she was calling to report not an adverse event, just the opposite, wanted to report an additional benefit to the Pfizer Covid vaccine. Caller was a Pfizer employee and also she wanted to report that after she had her oldest daughter in 1999 she had a clogged breast duct under her right arm pit, and there has been a bump that comes and goes with her period under her right arm pit. Since then, saw a doctor many years ago and did so many tests, CT and ultrasounds, they were not concerned. Caller stated she had the first dose of the Pfizer Covid vaccine on 01Feb2021 and then looking at her past three periods the bump did not bothered her, it has not been an issue since the dose of the vaccine. The outcome of event was recovered in Feb2021.

Other Meds:

Current Illness:

ID: 1376296
Sex: F
Age:
State: IN

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: patient was given the liquid part of Pentacel and not the powder part, no AE; Upon Internal review a signification amendment was performed on 04-Jun-2021, to change the product code of Pentacel from 242 to 520 Initial information was received on 20-Oct-2020 regarding an unsolicited valid non-serious case from other health professional in the United States. This case involves a 10 months and 2 weeks old female patient who was given 0.5 ml liquid part of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(VERO)/HIB(PRP/T) VACCINE [PENTACEL (VERO)] (Batch number: UJ349AAA and expiration date: 22-Jun-2021, DTAP-IPV- Lot: U6841AA, expiry date: 22-Jun-2021, and ActHib- Lot: UJ349AA, expiry: 22-Jun-2021) and not the powder part via intramuscular route in the left thigh for prophylactic vaccination on an unspecified date (PT: product preparation issue). Medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included INFLUENZA VACCINE and PNEUMOCOCCAL VACCINE CONJ 7V (CRM197) (PREVNAR) for prophylactic vaccination. It was an actual medication error case due to inappropriate reconstitution technique (same day latency). No adverse event reported at the time of reporting. The medical assistance (MA) stated the nurse gave the liquid part of Pentacel with the blue top and not the powder part with the green top, the ActHib. The Caller was asking what to do if they only gave the liquid part of Pentacel and not the powder. Can they mix it with anything other than 0.4% NaCl (sodium chloride), what about water or they have 0.7% NaCl, where do they get the 0.4% NaCl. Can Sanofi supply it and how much 0.4% NaCl will they have to use. The caller was told that since the liquid part was 0.5ml they will have to use that much to reconstitute the powder. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds: INFLUENZA VACCINE; PREVNAR

Current Illness:

ID: 1376297
Sex: M
Age: 20
State: MN

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/05/2021
Hospital:

Vax Type:
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Lab Data:

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Symptom List:

Symptoms: administered a booster dose of Menactra that was expired by 5 days with no reported adverse event; Initial information regarding an unsolicited valid non-serious case from other health professional via A (Reference number- 00617105) and transmitted to Sanofi on 26-Apr-2021. This case involves a 20-year old male patient who administered a booster dose of MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE [MENACTRA] that was expired by 5 days (expired product administered) on 26-May-2021 (lot number: U6594AA and expiration date: 21-May-2021] at an booster dose of 0.5 ml once (total) via intramuscular route in the left deltoid for prophylactic vaccination. Medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant vaccination was not reported. It was an actual medication error due to expired vaccine used (latency: same day). At the time of report, no adverse event was reported. It was not reported if the patient received a corrective treatment. Disclaimer: This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 1376298
Sex: F
Age: 24
State: TX

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/05/2021
Hospital:

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

Allergies:

Symptom List:

Symptoms: administered an expired dose of Menactra with no reported adverse event; Initial information regarding an unsolicited valid non-serious case from consumer /non-health professional via Medical Information (Reference number- 00617311) and transmitted to Sanofi on 26-Apr-2021. This case involves a 24-year old female patient who administered an expired dose of MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE [MENACTRA] (expired product administered) on 26-May-2021 (lot number: U6576AA and expiration date: 04-Apr-2021] at an 0.5 ml once (total) dose via intramuscular route in the left deltoid for prophylactic vaccination. Medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant vaccination was not reported. It was an actual medication error due to expired vaccine used (latency: same day). At the time of report, no adverse event was reported. It was not reported if the patient received a corrective treatment. Disclaimer: This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 1376299
Sex: F
Age: 5
State: TX

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 06/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: redness, swelling, hot to touch, the area was 15 cm in diameter at the injection site; a circular bubble in the middle, the area was 15 cm in diameter at the injection site; itching at the injection site, the area was 15 cm in diameter at the injection site; redness, swelling, itching, a circular bubble in the middle, hot to touch, the area was 15 cm in diameter at the injection site; Initial and additional information received on 27-May-2021 regarding an unsolicited valid non-serious case received from a physician (Contact specialty Pediatrics) via Medical Information (Reference number- 00618803). This case involves a five year old female patient who experienced redness, swelling, hot to touch, the area was 15 cm in diameter at the injection site (inflammation), circular bubble in the middle, the area was 15 cm in diameter at the injection site (blister), itching at the injection site, the area was 15 cm in diameter at the injection site (pruritus) and redness, swelling, itching, a circular bubble in the middle, hot to touch, the area was 15 cm in diameter at the injection site (vaccination site reaction), while receiving vaccine DIPHTHERIA-15/TETANUS/5 AC PERTUSSIS VACCINE [DAPTACEL]. The patient's past medical history, medical treatment, vaccination and family history were not provided. Concomitant medications included POLIO VACCINE for prophylactic vaccination on 25-May-2021 at the same visit. On 25-May-2021, the patient received a 0.5 ml dose of suspect DIPHTHERIA-15/TETANUS/5 AC PERTUSSIS VACCINE (lot C5765BA and expiry date: 28-Aug-2022) (Injection) via an unknown route in the left thigh for prophylactic vaccination. On 25-MAY-2021, the patient developed a non-serious redness, swelling, hot to touch, the area was 15 cm in diameter at the injection site (inflammation), circular bubble in the middle, the area was 15 cm in diameter at the injection site (blister), itching at the injection site, the area was 15 cm in diameter at the injection site (pruritus) and redness, swelling, itching, a circular bubble in the middle, hot to touch, the area was 15 cm in diameter at the injection site (vaccination site reaction), on same day following the administration of DIPHTHERIA-15/TETANUS/5 AC PERTUSSIS VACCINE. It was also reported description: Health Care Professional called to report DAPTACEL has been causing chemical reaction in four patients. The caller stated that she has had four patients that developed the same injection site reaction after a vaccination with Daptacel and Doctors nurse called back stating they would like a replacement. Three of the patient received the same lot number for sure, the caller was not sure about the fourth patient. She will send pictures of the reaction areas of all of these patients. Product used, Still using product: No No laboratories details reported. The patient was treated with BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE] and cool compresses for all the events. On an unknown date, the patient recovered from all the events after five days.

Other Meds: POLIO VACCINE

Current Illness:

ID: 1376304
Sex: F
Age: 14
State:

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

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: At 14:13 voiced complaints of Nausea, lightheadedness and dizziness. Then started vomiting. Attendee was pale and clammy. Assisted to the cot after she stopped vomiting. Elevated legs, when stated that she was no longer nauseated. HR: 84 BP 120/68 RR 16 O2sat 95. 14:20 - Attendee stated she felt better, a little pale, denied any dizziness, lightheadedness or nausea. Hr 82 BP 120/68 RR 18 O2Sat 97. 14:36 -No voiced complaints- skin warm and dry. HR 69 BP 118/64 RR 20 O2Sat 98. 14:43 - Care Practitioner educated on home discharge/adverse reaction instructions and she was discharged to home with her mother.

Other Meds:

Current Illness:

ID: 1376305
Sex: F
Age: 19
State: CA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium

Other Meds:

Current Illness:

ID: 1376307
Sex: M
Age: 27
State: CA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Fainting / Unresponsive-Medium, Additional Details: PAIENT GOT PANIC ATTACK AND FAINT BUT RECOVER WITH IN 3-4 M INUTES, CALLED 911, PARAMEDIC HELPED HIM

Other Meds:

Current Illness:

ID: 1376308
Sex: M
Age: 14
State: AZ

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: vaccine was administered outside of storage recommendations. patient returned on 6/6/21 to re-vaccinate

Other Meds: none

Current Illness:

ID: 1376309
Sex: M
Age: 15
State: NY

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Flushed / Sweating-Mild, Additional Details: EMT came to assess and escorted patient out of the pharmacy. Patient was standing up and said he was feeling fine by the time EMT came.

Other Meds:

Current Illness:

ID: 1376310
Sex: F
Age: 37
State: CA

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Systemic: Felt very lightheaded/chills for about 30 minutes. Patient walked out along with her fiancee. she felt back to normal upon getting into they're car.-Mild

Other Meds:

Current Illness:

ID: 1376311
Sex: M
Age: 51
State: CA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Error: Booster Given Too Late

Other Meds:

Current Illness:

ID: 1376312
Sex: M
Age: 55
State: MN

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

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

Lab Data:

Allergies: NA

Symptom List:

Symptoms: Swelling under arm pit, same arm as vaccination, began two days after administration of second dose

Other Meds: NA

Current Illness: NA

ID: 1376313
Sex: F
Age: 36
State:

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

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

Lab Data:

Allergies: Amoxicillin

Symptom List:

Symptoms: Immediate dizziness. Rapid heart beat. Warmth. Sensitivity to light. Discomfort in throat and upper abdomen. Chest tightness. Heaviness in head and eyes. Monitored for 2 hours in clinic. Fatigue, intermittent chest pain and persistent discomfort in head, eyes and abdomin are ongoing now, over 48 hours later.

Other Meds: None

Current Illness: None

ID: 1376314
Sex: F
Age: 70
State: CA

Vax Date: 05/14/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Abdominal Pain-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Chills-Severe, Systemic: Diarrhea-Severe, Systemic: cannot move-Severe, Systemic: Hypertension-Medium, Systemic: Vomiting-Severe, Systemic: Weakness-Severe

Other Meds:

Current Illness:

ID: 1376315
Sex: F
Age: 40
State: IN

Vax Date: 05/15/2021
Onset Date: 05/18/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: Codeine

Symptom List:

Symptoms: Delayed reaction hives 3 days after first dose of vaccine. Took allergy medicine to relieve symptoms.

Other Meds: None

Current Illness:

ID: 1376316
Sex: F
Age: 23
State: MN

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Fainting / Unresponsive-Medium, Systemic: Nausea-Mild, Additional Details: fainted immediately after injection

Other Meds:

Current Illness:

ID: 1376317
Sex: F
Age: 60
State: FL

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List:

Symptoms: Covid arm

Other Meds: Synthroid

Current Illness: None

ID: 1376318
Sex: F
Age: 26
State: MO

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: syncope and tonic presentation for 5-10 seconds, increased pulse and decreased blood pressure-Severe, Systemic: Hypotension-Mild, Systemic: Shakiness-Medium, Systemic: Tachycardia-Mild, Systemic: Weakness-Medium, Additional Details: paramedics called and within 15 minutes patient was able to stand, sit and speak normally and her color had come back. BP and pulse normalized and after 30 minutes of observation by RPh and paramedic was walked out of store by paramedic.

Other Meds:

Current Illness:

ID: 1376319
Sex: F
Age: 12
State: CA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Medium

Other Meds:

Current Illness:

ID: 1376320
Sex: F
Age: 31
State: WI

Vax Date: 01/26/2021
Onset Date: 05/09/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: PENICILLINS, IV CONTRAST

Symptom List:

Symptoms: My menstrual cycle has always been a little irregular but it has gotten substantially worse since the vaccine and I am unsure if it is related so erring on the side of caution and reporting. On may 9th I had profuse mid-cycle bleeding and was going through super tampons every 15 minutes for at least 6 hours. I went to the emergency room and tested negative for pregnancy (thus not a miscarriage) and my IUD was in place so my IUD that I have had for 2 years was not the cause of the bleeding. My period came back 2 weeks after that bleeding episode and has lasted for 13 days.

Other Meds: NONE

Current Illness: NONE

ID: 1376321
Sex: F
Age: 58
State: PA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Swelling of hand on side of injection-Medium

Other Meds:

Current Illness:

ID: 1376322
Sex: F
Age: 44
State: GA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: I went to administer the vaccine, but the needle was not tightly screwed onto the syringe and the patient did not receive the dose (it came out of the syringe at the needle hub). I drew up another dose in a new syringe and administered that dose to the patient.

Other Meds:

Current Illness:

ID: 1376323
Sex: F
Age: 31
State: IN

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: At midnight I woke up with uncontrollable shaky chills and teeth chattering. Was able to fall back asleep after an hour and woke up again at 4 am with a headache and sweats. Took Tylenol at this time and woke up next feeling better

Other Meds: Prenatal vitamin, Lexapro 5 mg

Current Illness: None

ID: 1376324
Sex: M
Age: 56
State: CA

Vax Date: 05/07/2021
Onset Date: 05/16/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: walnuts, dust, mold, pollen.

Symptom List:

Symptoms: Flaking of skin in ear conch area and at least part of the ear canal. tried eucerin cream, aloe vera.

Other Meds: fenofibric acid, atovastatin, lisinopril, aspirin, magnesium, b-complex/b12, COQ10, e, c, glucosamine, chondroitin, d, fish oil, flaxseed oil, Ocuvite, nicotinamide, melatonin

Current Illness: none

ID: 1376325
Sex: M
Age: 17
State: FL

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Error: Wrong Dose of Vaccine-Too Low

Other Meds:

Current Illness:

ID: 1376326
Sex: M
Age: 40
State: FL

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1376327
Sex: F
Age: 24
State: MT

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: None known

Symptom List:

Symptoms: Painful raised/swollen skin on bicep. Burning,, itchy rash that spread over the next day but stayed localized to my upper arm. Extreme muscle weakness in left arm.

Other Meds: Sertraline 100mcg Levothyroxine 100mg Prazosin 2mg Hydroxyzine 25mg (as needed)

Current Illness: None

ID: 1376328
Sex: F
Age: 12
State: FL

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Incorrect dose given, given adult dose instead of pediatric dose

Other Meds:

Current Illness:

ID: 1376329
Sex: M
Age: 29
State: FL

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Fainting / Unresponsive-Medium, Systemic: Seizure-Mild, Additional Details: patient fell down and apper to have seizure , we called emc ,emc take care of the pt, and he was ok,pt refuse to go to er.

Other Meds:

Current Illness:

ID: 1376330
Sex: F
Age: 17
State: OR

Vax Date: 06/01/2021
Onset Date: 06/02/2021
Rec V Date: 06/06/2021
Hospital: Y

Vax Type:
Manufacturer:
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Lab Data:

Allergies: none

Symptom List:

Symptoms: 8 hours post vaccination, developed subjective fever, chills, headache, malaise 6/2: Around 32 hours post vaccination, developed acute chest pain, shortness of breath, difficulty breathing when laying flat. Required ibuprofen. 6/3: felt better, required ibuprofen. Presented to ED on 6/4 with continued symptoms (chest pain, shortness of breath), noted to have elevated troponins. Transferred to Hospital on 6/4 to ICU for monitoring. To the floor on 6/5. Clinically doing well just on NSAIDs with slowly decreasing troponins. Dx: probable acute myocarditis per cardiology based on clinical symptoms and troponin leak

Other Meds: none

Current Illness: None: no cough/cold/URI or other illnesses

ID: 1376331
Sex: F
Age: 28
State: PA

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: none

Symptom List:

Symptoms: many painful blisters on sides, chest, armpits, and stomach

Other Meds: none

Current Illness: none

ID: 1376332
Sex: F
Age: 21
State: WA

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

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: patient became very faint and nauseated. she was seated, i checked her blood pressure (which stayed about 90/60 or higher), and provided water. she also expressed concern over tingling and cramping of hands. she recovered completely in less than 30 minutes.

Other Meds:

Current Illness:

ID: 1376333
Sex: F
Age: 8
State: AZ

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

Vax Type:
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Lab Data:

Allergies: unknown

Symptom List:

Symptoms: The patient received her second Pfizer covid vaccine, then moved on to observation. When a nurse went to fill out the second dose on the child's card, all the personal information was already filled out, including her birthday of 12/06/2012. The patient and her brother (13) had both been vaccinated and were sitting in the second row with the windows up. When asked, the father rolled down the windows so the nurse could observe them and the younger child was clearly wearing a brown, bob wig. The nurse asked her age; when she did not answer, the mother and father both stated clearly that she was 8 years old. The mother then stated that she had signed a consent form for her daughter to receive the first dose, knew that the Pfizer vaccine was not yet approved for EUA for her daughter's age group, and took "full responsibility". On the site's program, the child's birthdate and age had both been entered correctly for both doses. The parents were asked if they would allow us to observe the patient for a total of 30 minutes and they agreed. The patient was released after that time to be driven home by her father with no adverse events noted.

Other Meds: unknown

Current Illness: unknown

ID: 1376334
Sex: F
Age: 36
State: MD

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

Vax Type:
Manufacturer:
Vax Name:
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Lab Data:

Allergies: augmentin, ceclore

Symptom List:

Symptoms: Blisters at site of injection that spread if they are opened. 100.6 degree fever.

Other Meds: Lo loestrin fe, duoloxetine, buspar, synthroid

Current Illness: None

ID: 1376335
Sex: F
Age: 42
State: IN

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

Vax Type:
Manufacturer:
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Lab Data:

Allergies: N/A

Symptom List:

Symptoms: Fever, chills, headache, body aches, skin sensitivity and nausea.

Other Meds: Lisinopril

Current Illness: N/A

ID: 1376336
Sex: M
Age: 12
State: CA

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

Vax Type:
Manufacturer:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1376337
Sex: F
Age: 52
State: CT

Vax Date: 04/06/2021
Onset Date: 04/01/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: Aspirin, Vicodin, Vioxx

Symptom List:

Symptoms: Patient stated approximately 2 day after vaccination maybe up to a week she began to get left leg sensations (nerve pain). She first called an physician 2 to 3 weeks after the vaccination. Her physician told her to go to the E.R.

Other Meds:

Current Illness:

ID: 1376338
Sex: M
Age: 39
State: TN

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 06/06/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: Tightness in chest and shortness of breath. Increase heart rate. Most notice more the day after second shot. Colchicine and 600mg of Ibuprofen

Other Meds: None

Current Illness: None

ID: 1376339
Sex: F
Age: 28
State: CA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1376340
Sex: F
Age: 54
State: CA

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 06/06/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: 104 degree temperature for 6 hours straight. Serious breathing difficulty.

Other Meds: None

Current Illness: None

ID: 1376341
Sex: F
Age: 23
State: KY

Vax Date: 06/02/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
Hospital:

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

Allergies: Latex, Augmentin, Bactrim

Symptom List:

Symptoms: Left eye is swollen and skin around the entire orbital socket, including eyelids, is tender and itchy

Other Meds:

Current Illness:

ID: 1376342
Sex: M
Age: 82
State: GA

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

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

Allergies: N/A

Symptom List:

Symptoms: Patient called today, He stated that 18 hours after his dose of Janssen he had a nose bleed that lasted 8 hours and expeled 2 large blood clots from his nostils. I asked if he had seen a physician and he had only called his friend who was a PA. I encouraged him to contact his physician and inform him/her of the situation.

Other Meds: N/A

Current Illness: N/A

ID: 1376343
Sex: M
Age: 16
State: CA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1376344
Sex: M
Age: 24
State: VA

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List:

Symptoms: Greater than 45 days since 1st dose

Other Meds: Unknown

Current Illness: unknown

ID: 1376345
Sex: F
Age: 77
State: MA

Vax Date: 02/02/2021
Onset Date: 05/23/2021
Rec V Date: 06/06/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: Severe vertigo needing hospitalization Lasting 2 weeks and I still have dizziness

Other Meds: Hydro chlorothiazide

Current Illness: None

ID: 1376346
Sex: M
Age: 30
State: OR

Vax Date: 05/26/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
Hospital:

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

Allergies: bee venom Penicillin TDAP vaccine

Symptom List:

Symptoms: urticarial rash w/ dermatographia, chest pain, SOB. started about 8 days after shot improving on steroids ECG abnormal w/ neg troponins x2. CTA of chest neg for clot or pneumonia was recently started on Buspar and wellbutrin 4 days prior to getting vaccine

Other Meds: Wellbutrin buspar lisinopril

Current Illness: none

ID: 1376347
Sex: F
Age: 41
State: CA

Vax Date: 06/02/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
Hospital:

Vax Type:
Manufacturer:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash Generalized-Medium, Systemic: Lymph Node Swelling-Severe

Other Meds:

Current Illness:

ID: 1376348
Sex: F
Age: 15
State: CA

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

Vax Type:
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Lot:
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Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Site: Pain at Injection Site-Mild, Systemic: Body Aches Generalized-Mild, Systemic: pt was given 0.3ml of sodium chloride instead of pfizer vaccine but was called back to get the correct dose and vaccine from immunizer, no compliants from pt and no visual adverse effect seen-Mild, Error: Diluent Administered Instead of Vaccine, Additional Details: Mother is requesting antibody test for her mother on cvs account to ensure that her daughter did get the second dose of the pfizer vaccine and not just the sodium chloride. spoke to mother around 12:30pm after the call with dr, also called the pharmacy and is aware of the situation. when talk to to mother she was told no follow up is needed per dr but can call for clarification.

Other Meds:

Current Illness:

ID: 1376349
Sex: F
Age: 29
State: NJ

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

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

Lab Data:

Allergies: No

Symptom List:

Symptoms: The night after the second dose of the pfizer, I was sick with flu-like symptoms, a headache, a very sore arm, hot flashes and sweating. Two days later, I got an itchy and sore rash at the injection site, and I am still sweating alot, with a mild headache

Other Meds: Claritin, sertraline 25 mg

Current Illness: None

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm