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: 1323527
Sex: F
Age: 52
State: TX

Vax Date: 04/10/2021
Onset Date: 04/18/2021
Rec V Date: 05/17/2021
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: Vicodin

Symptom List: Dysphagia, Epiglottitis

Symptoms: I started feeling pain in my arm and shoulder, but I didn't pay much attention to it. The next day, the area above my breast was hurting and tight. My husband took me to a healthcare facility and they took xrays and blood. They wanted to admit me, but I didn't want to stay. They gave me Tramadol for pain and told me to relax when I got home and to see my PCP. I was eventually able to get in about a week later and he did an ultrasound of my heart, an EKG and last week I took a stress test--which was abnormal and I have to go get my results today. I feel a lot better, but I still have pain in my chest area occasionally.

Other Meds: Xarelto Cholesterol meds

Current Illness:

ID: 1323528
Sex: M
Age: 39
State: FL

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
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: Benadryl

Symptom List: Anxiety, Dyspnoea

Symptoms: Client stated feeling dizzy and wanted to vomit. Observation nurse first attended. Client was held for further observation. He was released to home at 8:55am

Other Meds: n/a

Current Illness: n/a

ID: 1323529
Sex: M
Age: 12
State: IL

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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: DIZZY BLURRED VISION

Other Meds: none

Current Illness: none

ID: 1323530
Sex: F
Age: 25
State:

Vax Date: 05/16/2021
Onset Date: 05/17/2021
Rec V Date: 05/17/2021
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: Random sharp pains throughout body

Other Meds:

Current Illness:

ID: 1323532
Sex: F
Age: 43
State: NJ

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

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

Lab Data:

Allergies: lactose intolerant

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

Symptoms: Patient began to feel itchy beginning in left upper arm at approximately 4:00PM on 5/8/2021. throughout the next several days the itchiness was accompanied by small hives and has progressed through patients arms, legs, torso , neck, and now head including ears. the skin is affected in red patched and has caused the psoriasis patient had to flair up dramatically throughout her body. there is swelling in patient's forearms and she sought the medical care of a physician who did not alleviate or even look at the affected areas and tried to prescribe patient a steroid which she refused (prednisone) as she had violent reactions to it as well. patient is on her way to see her Dermotologist tp seek relief and better medical care.

Other Meds: Tylenol, Aleve

Current Illness: None

ID: 1323533
Sex: M
Age: 14
State: CA

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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:

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

Symptoms: Pt reported muffled hearing, nausea, dizziness BP 117/59; HR 86; RR 20. Pt reported resolved sx after rehydration. Pt advised to get rest & increase fluid intake, advised to f/u w/PCP if other delayed s/sx. Pt stable & d/c'd from vaccination site

Other Meds:

Current Illness:

ID: 1323534
Sex: F
Age: 27
State: DC

Vax Date: 05/02/2021
Onset Date: 05/03/2021
Rec V Date: 05/17/2021
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: Pineapple, nickel

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I had COVID for the first week of December of 2020 and around the fourth day of being symptomatic, I developed tinnitus, which I continued to experience as a low-grade, high-pitched ringing in my ears in the months following. I reported this to a PCP . Immediately after getting my second dose of the Pfizer COVID vaccine, I began experiencing some of the symptoms I had when I had COVID (migraine, low-grade fever) and my tinnitus got much worse. It is now significantly louder and makes it difficult to focus or sleep at night. Nobody seems to know whether or not this will be permanent. If it is, I don?t know what I?m going to do.

Other Meds: Levothyroxine, isotretinoin, vitamins B12 & D, fish oil, selenium, curcumin

Current Illness: None

ID: 1323535
Sex: F
Age: 59
State: WI

Vax Date: 05/08/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
Hospital: Y

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

Lab Data:

Allergies: Sertraline, ciprofloxacin

Symptom List: Pharyngeal swelling

Symptoms: Pt received first Pfizer COVID 19 vaccine on 5/8/2021. Pt became ill with COVID and was admitted to the hospital for treatment on 5/15/2021.

Other Meds: fluoxetine, glipizide, lisinopril, oxybutynin, potassium, risperidone, simvastatin, sitagliptin, vitamin D

Current Illness:

ID: 1323536
Sex: F
Age: 68
State: WA

Vax Date: 03/27/2021
Onset Date: 04/26/2021
Rec V Date: 05/17/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Bilateral Pulmonary Emboli

Other Meds:

Current Illness:

ID: 1323537
Sex: F
Age: 29
State: PA

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

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

Lab Data:

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: redness and swelling to injection site, itchy and painful, bandage was removed leaving skin under red, hydrocortisone was giving to patient and a Benadryl.

Other Meds: hydroxyzine HC< 50mg, fluticasone propionate 50mcg, meclizine hc. 25mg

Current Illness: anxiety

ID: 1323538
Sex: F
Age: 51
State: OR

Vax Date: 04/17/2021
Onset Date: 04/01/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: "Anesthesia tray" pineapple codeine ketorolac morphine nsaids

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

Symptoms: The patient is perimenopausal and had amenorrhea x 4months prior to receiving first Moderna vaccine. She has had spotting x3 weeks since receiving first dose of Moderna vaccine.

Other Meds: Hydrochlorothiazide 25mg tablet, take 1 tab PO daily

Current Illness: n/a

ID: 1323540
Sex: F
Age: 52
State: WA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Fatigue, headache, chills, fever, pain at injection site, nausea, joint pain, muscle pain

Other Meds:

Current Illness:

ID: 1323541
Sex: F
Age: 41
State: NC

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: Fever after 12h, redness, heat and swollen in the arm where the vaccine was inoculated after 72 h

Other Meds: No

Current Illness: No

ID: 1323542
Sex: M
Age: 52
State: OH

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 05/17/2021
Hospital: Y

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: statins, Lisinopril

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

Symptoms: Patient developed frequent headaches starting a day after receiving first dose of vaccine. Patient then developed daily headaches after he got the second dose. Patient was hospitalized for his headaches and had to be started on medication.

Other Meds: Vitamin D3, Trazodone, Amlodipine, Losartan, Loratadine, Singulair, Meloxicam, Testosterone, Arimidex, Fenofibrate, Omeprazole, Metformin

Current Illness: None

ID: 1323543
Sex: M
Age: 20
State: MS

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 05/17/2021
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: n/a

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

Symptoms: Patient stated he " blacked out after vaccine"RN spoke with Dr. and advised that patient receive second dose of vaccine in physicians office. Patient verbalized understanding. Patient declined ED services.

Other Meds: no

Current Illness: n/a

ID: 1323544
Sex: F
Age: 30
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/17/2021
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: Patient friend called out the nurse, upon the nurse arrival patient was already unconscious. Ammonia placed under the nose by the nurse and patient regained consciousness. Paramedic is assessing patient at this time. Patient is now alert and oriented.

Other Meds:

Current Illness:

ID: 1323545
Sex: F
Age: 19
State: MA

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

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

Lab Data:

Allergies:

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

Symptoms: After receiving the vaccine the patient reported feeling light headed. I (the pharmacy manager) was called over. I witnessed the patient have a near fainting episode (diagnosis). The patient shook, and was guided from the chair to the ground. she did not hit her head. someone remained with patient the entire time. Patient was given water while waiting for EMT to arrive. EMT evaluated patient, diagnosed with near-fainting episode related to anxiety. EMTs do not believe response was vaccine related. BP, sugars, and all other tests within normal limits. Mom arrived and patient left pharmacy once she calmed down.

Other Meds:

Current Illness:

ID: 1323546
Sex: F
Age: 28
State: MO

Vax Date: 05/11/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: Peanut, tree-nut, shell-fish, fish, seasonal allergies.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Fatigue the evening after and for 2 days following the 2nd dose. Rash around injection site noticed 5/16/2021 (5 days after the 2nd dose). Rash feels bruised below injection site.

Other Meds: Vitamin D3, Creatine Supplement, Claritin, and Flonase.

Current Illness:

ID: 1323547
Sex: F
Age: 21
State: CA

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
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: Dizziness; Nausea. BP 96/58; HR 69; RR 18. Pt has history of anxiety with blood draws & shots. Pt feeling better BP 101/60; HR 70; RR 18

Other Meds:

Current Illness:

ID: 1323548
Sex: F
Age: 47
State: MD

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/17/2021
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: patient got hot flash and tongue felt like she ate a hot pepper, reaction stopped than happened again in around a minute. observing patient for 30 minutes following vaccine

Other Meds:

Current Illness:

ID: 1323549
Sex: F
Age: 37
State: FL

Vax Date: 04/13/2021
Onset Date: 04/14/2021
Rec V Date: 05/17/2021
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: Pt reports next day after her 1st vaccine she felt fatigue, lethargic and her whole body was burning up - by 3rd day the the symptoms cleared up. With 2nd vaccine, pt reports the next day she felt the same way as the 1st dose symptoms along with having congestion, coughs and mucus production. Pt reports feeling better on 5/15/2021, but today she is still congested, coughing, producing mucus and when she blew her nose her ears popped. Pt reports she took Tylenol and took off her clothes and that helped with the burning sensations.

Other Meds: Wellbutrin Trileptal Clonazepam 0.5 mg Lasix 40 mg

Current Illness:

Date Died: 05/16/2021

ID: 1323550
Sex: F
Age: 87
State: OH

Vax Date: 02/22/2021
Onset Date: 05/02/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Unevaluable event

Symptoms: Patient received Moderna COVID vaccine on 2/1/2021 and 2/22/2021. Pt. presented to Medical center within Health system with weakness and arm and leg swelling on 3/4/2021. Admitted for observation, tested negative for COVID and discharged on 3/5. Pt. presented to Medical Center, also within Health system on 5/2/2021 complaining of SOB. Stated that she has had non-productive cough for months, but felt it had worsened lately. Pt. found to be COVID positive with bilateral infiltrates. Pt. required 6L O2. Pt. was DNRCCA. Pt. not intubated but expired from cardiac arrest/COVID on 5/16/2021.

Other Meds: allopurinol, aspirin, calcium acetate, losartan, parvastatin,

Current Illness: ESRD, AFib, CAD, HTN, DVT, CVA, PVD, gout, anxiety

ID: 1323551
Sex: F
Age: 77
State:

Vax Date: 03/05/2021
Onset Date: 04/15/2021
Rec V Date: 05/17/2021
Hospital: Y

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: N17.9 - Acute kidney failure, unspecified

Other Meds:

Current Illness:

ID: 1323552
Sex: F
Age: 56
State: IA

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/17/2021
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: Reglan Augmentin Bee venom

Symptom List: Injection site pain, Pain

Symptoms: Approximately 20 minutes after receiving her second Pfizer vaccine patient began feeling numbness/tingling of lips and "itching everywhere". Noted to have edema under eyes bilaterally. Gave Benadryl 25mg orally at 1408 and shortly after moved patient to a private area to monitor and have her lay down. While ambulating pt began to feel dizzy, wobbly and her feet became numb. Pt . began talking as if her tongue was thick and swollen. Laid pt on couch with feet elevated. Administered Epi Pen autoinjector into rt. lateral thigh at 1415. Called 911 EMS. Lip swelling, eye edema and tongue edema began decreasing. Pt never felt short of breath. Feet remained feeling numb. Vitals: 1410 BP: 160/100 Pulse: 74 Oxygen sat: 98%. 1418 BP: 172/102 Pulse:84 O2 Sat: 97% 1424 BP: 174/100 Pulse: 83 O2 Sat: 98%. Pt transported by ambulance with paramedics at 1432.

Other Meds: Levothyroxine Norvasc Losartan Crestor ASA Celexa

Current Illness:

ID: 1323553
Sex: M
Age: 42
State: FL

Vax Date: 04/14/2021
Onset Date: 04/17/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: Cipro

Symptom List: Injection site pain, Menorrhagia

Symptoms: At first it was a lot of joint and muscle pain all over, and then I got shingles by the weekend. I thought they were bug bites and I wasn't sure where all the pain was coming from and I ended up in the emergency room where I was diagnosed with shingles. After my second shot I started getting shingles by laterally on my right side, but I was already on medication so it didn't get that bad. I also have a lot of joint pain and burning pain in my hands and wrists that shoot up my arms and haven't stopped since the symptoms started. It's much worse at night and keeps me up from sleeping. I have also have been very forgetful and my mind is always cloudy.

Other Meds: Ozempic

Current Illness: None

ID: 1323554
Sex: F
Age: 23
State: MA

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
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: Thought to have no allergies until second dose of vaccine.

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

Symptoms: Three hours after the second vaccine there was a soreness in my left arm, followed by a headache. The next day around 12:00pm, I started to experience swelling in my throat. The swelling made it difficult to breathe. About an hour later I experienced tightness in my chest, making it difficult to breathe again. I experienced shortness of breath and the tightening in my chest did not leave. I was able to make it more bearable by taking my inhaler, used for my asthma. Today (5/17), I am still experiencing tightness in my chest, although it is not as severe as it was yesterday. The swelling in my throat as disappeared today (5/17).

Other Meds: Montelukast for allergies, xhance nasal spray for allergies, sprintec for birth control.

Current Illness: N/A

ID: 1323555
Sex: F
Age: 19
State: IA

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 05/17/2021
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: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient was sitting in the post vaccination monitoring area after her 2nd dose of Moderna COVID-19 vaccine on May 12. She was with her brother and another male. Pt came up to the hostess to let her know the patient was having a seizure. I was called to the waiting area. The patient was sitting with head hung down and hands were moving involuntarily. She was not responding when calling her name. Her brother informed me that she does this at times and has a somatic seizure disorder. I asked how I could help and he asked that we get her outside in the fresh air. Got a wheel chair and by the time we started to put her in the wheel chair she was becoming more awake. We took her outside and she was more awake but tired. She told me that she did not do this with her 1st COVID vaccine but she has done after other vaccines.

Other Meds: Medication list was not updated at vaccine appointment. She is not our patient so unsure of medication she is taking.

Current Illness: None known

ID: 1323556
Sex: F
Age: 64
State: CO

Vax Date: 04/14/2021
Onset Date: 04/16/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: Aleve, Duracef, seasonal allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: two to three days after vaccination, when I got out of bed the room was spinning and I've not had that type of episode for years. I do have MS and have experienced vertigo years past.

Other Meds: Benefiber, Benedryl

Current Illness: No

ID: 1323557
Sex: F
Age: 39
State: IL

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/17/2021
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: Penicillin

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

Symptoms: Diarrhea, fatigue, severe headache lasting several days, severe muscle cramps lasting several days

Other Meds: Asthma medication

Current Illness: No

ID: 1323558
Sex: M
Age: 43
State: IN

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: Percocet - Full body rash, shortness of breath

Symptom List: Nausea

Symptoms: 18 hours after receiving the vaccine, passed out while walking in my house. No signs of dizziness or nausea preceded the episode. Lost consciousness for about 10 seconds, then was disoriented for about 2 minutes before being able to get up with assistance and move to my bed.

Other Meds: Viibryd - 10mg

Current Illness: None

ID: 1323559
Sex: M
Age: 36
State: KY

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: allergic to PNC and eggs

Symptom List: Injection site pain

Symptoms: Patient given vaccine. Patient reported he had not been given a Covid-19 vaccine in the past, when in it shows he has had 2 Moderna Shots administered. 02/09/2021 and 3/09/2021. After Janssen vaccine administered. Patient was monitored and had no adverse reactions. Thank you

Other Meds:

Current Illness:

ID: 1323560
Sex: F
Age: 18
State: CA

Vax Date: 05/07/2021
Onset Date: 05/09/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: cats

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

Symptoms: Rash over left arm, neck, and face as well as ear swelling in both ears. After taking Allegra ear swelling and much of rash on neck has dissipated, but face and arm still have rash/getting more red.

Other Meds:

Current Illness:

ID: 1323561
Sex: M
Age: 71
State:

Vax Date: 03/15/2021
Onset Date: 04/17/2021
Rec V Date: 05/17/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: N17.9 - Acute kidney failure, unspecified

Other Meds:

Current Illness:

ID: 1323562
Sex: F
Age: 56
State: TN

Vax Date: 05/01/2021
Onset Date: 05/03/2021
Rec V Date: 05/17/2021
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: sulfa, cefdinir

Symptom List: Tremor

Symptoms: Patient reports after initial 2 days of fever and body aches subsided following second dose, fatigue remained and she has since then, noticed an irregular heartbeat that she had not been diagnosed with prior or ever noticed prior to the second moderna vaccination. Patient reports irregular heartbeat is more noticeable when lying down and describes it as a"fluttering" and occasional very "hard" heartbeat.

Other Meds:

Current Illness: none

ID: 1323563
Sex: M
Age: 29
State:

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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: Pt found vomiting in observation area, RN present. Noted 5-10mL clear content emesis. Pt denied experiencing any other abnormal sx. Per pt, reported drinking 3-4 alcoholic drinks plus 3-4 tequila shots last night. He is likely having emesis related to alcohol consumption. Monitored for a total of 45mins. BP 141/82, HR 98, RR 16, T 96.8. Patient stable and released from the vaccination site.

Other Meds:

Current Illness:

ID: 1323564
Sex: M
Age: 17
State: MD

Vax Date: 05/08/2021
Onset Date: 05/09/2021
Rec V Date: 05/17/2021
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: tree nut allergy

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

Symptoms: Painful mouth sores erupted on back of throat 2 days after vaccine. Extreme sore throat. Sores and fatigue lasted for 10 days after shot.

Other Meds: None

Current Illness: None

ID: 1323565
Sex: F
Age: 54
State: WA

Vax Date: 04/09/2021
Onset Date: 04/22/2021
Rec V Date: 05/17/2021
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: Bactrim Penicillin Anaphylaxis

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

Symptoms: Thirteen days after the vaccine I got a sudden sharp pain in my right leg after the vaccine. I am predisposed to blood clots and the staff could not find pulses in my foot. The pain started in my groin area where the femoral artery is located. I have been diagnosed with Raynaud's Syndrome which could have caused the lack of pulse. I was observed for six hours and all tests were negative. The pain did not happens again since then and no other side effects besides initial flu like reaction.

Other Meds:

Current Illness:

ID: 1323566
Sex: M
Age: 23
State: FL

Vax Date: 05/08/2021
Onset Date: 05/10/2021
Rec V Date: 05/17/2021
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: Penecillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Chest pains and high blood pressure. Dramatical increase of Troponin levels

Other Meds: Melatonin- 10mg

Current Illness: None

ID: 1323567
Sex: F
Age: 57
State: CA

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/17/2021
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: FEVER CHILLS

Other Meds:

Current Illness: NONE

ID: 1323568
Sex: M
Age: 48
State: MD

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/17/2021
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: Bee stings and poison ivy.

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

Symptoms: Fever, chills, weakness general malaise. Persisted for ~24 hours - relieved to come extent by high dose Tylenol

Other Meds: Omeprazole (40 mg orally daily), loratidine (10 mg daily).

Current Illness: GERD

ID: 1323569
Sex: M
Age: 14
State: ID

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Pain in extremity

Symptoms: Dose given to minor

Other Meds: unknown

Current Illness: unknown

ID: 1323570
Sex: F
Age: 64
State: AZ

Vax Date: 12/26/2020
Onset Date: 12/27/2020
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, Robaxin

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

Symptoms: After receiving my 1st vaccine at noon, I experienced a slight headache and fatigue. Later that afternoon, I started to experience some GI discomfort and woke up during the night with severe diarrhea that continued daily for a total of 7 weeks. After 3 weeks of treating the symptoms on my own with diet & Pepto Diarrhea without resolution. On 1/14/21 I saw NP Family Practice. She ran extensive testing and couldn't identify the issue. Diarrhea continued daily so on 2/19/21, I saw ANP-C at Health facility who suspected microscopic colitis. I had a colonoscopy performed on 3/8/2021 by Dr. that confirmed the diagnosis of microscopic colitis.

Other Meds: Armor thyroid, Valsartan/HCTZ, Low-dose naltrexone, C-testosterone in HRT cream, Vitamin D-3, vitamin K2-MK-7, DHEA, NAC, Vital Nutrients Multi-Nutrients 5, Alpha Lipoic Acid, Red Yeast Rice, COQ-10, Fish Oil, Lifewave X39 photo-therapy pat

Current Illness: 12/01/2020-Percutaneous tenotomy (Tenex) procedure performed for left hip tendonitis/bursitis

ID: 1323571
Sex: M
Age: 57
State: OH

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 05/17/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Patient came to hospital 6 days after vaccination on 4/19/2021. He was diagnosed with cryptogenic stroke. Patient was on anticoagulation at the time of his stroke. Thought that patient was non-compliant with his medications but patient and family insist he took his Xarelto consistently.

Other Meds: Fish oil, Xarelto, Metoprolol, Lisinopril, Metformin, Atorvastatin

Current Illness: None

ID: 1323572
Sex: F
Age: 17
State: IL

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 05/17/2021
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: NO ADVERSE EFFECTS ADMINISTRATION DEVIATION: UNAUTHORIZED AGE GROUP

Other Meds:

Current Illness:

ID: 1323573
Sex: F
Age: 76
State: IL

Vax Date: 04/16/2021
Onset Date: 04/30/2021
Rec V Date: 05/17/2021
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: no known allergies

Symptom List: Vomiting

Symptoms: PAINFUL RASH AT INJECT SITE. STARTED 2 WEEKS AFTER INJECTION LASTING 10 DAYS AFTER ON SET.

Other Meds: NONE

Current Illness: NONE

ID: 1323574
Sex: M
Age: 12
State: CA

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
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: Pt reported sweating & nausea. BP 101/74; HR 93; RR 24. 30 min post vaccination. Pt feeling much better. Advised pt to get rest, rehydrate & what to do in case of emergency. Released in stable condition

Other Meds:

Current Illness:

ID: 1323575
Sex: M
Age: 19
State: OH

Vax Date: 05/16/2021
Onset Date: 05/17/2021
Rec V Date: 05/17/2021
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: hayfever

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

Symptoms: full body ache, and vomiting, joint pain, fever, chills

Other Meds:

Current Illness:

ID: 1323576
Sex: M
Age: 81
State:

Vax Date: 03/28/2021
Onset Date: 03/31/2021
Rec V Date: 05/17/2021
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: nkda

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Muscle aches and weakness progressing over several months since vaccination. Patient is undergoing extensive workup to determine if symptoms are related to myasthenia gravis or polymyalgia rheumatica.

Other Meds: atorvastatin, aspirin, sildenafil

Current Illness:

ID: 1323577
Sex: M
Age: 24
State: CO

Vax Date: 03/10/2021
Onset Date: 04/30/2021
Rec V Date: 05/17/2021
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: Patient completed two shot series of Moderna COVID-19 vaccine 10 Feb and 10 March and tested positive for COVID-19 30 April.

Other Meds:

Current Illness:

ID: 1323578
Sex: F
Age: 58
State: CA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/17/2021
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: tetracyclines, prednisone, iodinated contrast media, linzess

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

Symptoms: significant, working memory disruption, fatigue, muscle weakness

Other Meds: amitiza,

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm