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: 1323733
Sex: F
Age: 43
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Syncope, Flushing/sweating. Post vaccination pt had a vaso vagal/syncopal episode in her seat in observation. Pt did not fall. Pt was wheeled back in supine position. VS stable. Patient recovered, drank juice. When stable, patient was released from the vaccination site.

Other Meds:

Current Illness:

ID: 1323734
Sex: F
Age: 22
State: WI

Vax Date: 04/12/2021
Onset Date: 05/09/2021
Rec V Date: 05/17/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient admitted for left flank pain. Was treated for urinary tract infection, although never had symptoms of a UTI. No dysuria, frequency or urgency. Urine is dark. Irregular menses. Has had cough, sore throat, vomiting, headache over past week. Mild epistaxis and heavy menses last month. CBC shows anemia and thrombocytopenia. Imaging showed splenomegaly with small acute splenic infarct. Hematology/oncology consulted and TTP ruled out.

Other Meds: Bupropion XL 300mg daily, venlafaxine XR 150mg daily, nexplanon implant

Current Illness: none

ID: 1323735
Sex: M
Age: 18
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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:

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

Symptoms: received the second dose of COVID vaccine Pfizer lot # ER2613(expiration date 7/30/2021) at 1306. Client reported to EMT table that he felt "cold and lightheaded". EMT and RN responded to client. @1313 Patient reported feeling cold and light headed after his first dose. Patient was sat in a zero gravity chair where an EMT applied ice packs to the posterior neck and left side. This was done after patient reported ice packs being helpful the "last time he experienced the same feelings". The last time the client experienced similar symptoms was "over two months ago" while his blood was being drawn. At this time the patient's vitals were BP: 154/100 P: 113 RR: 22. At 1321 Client reported feeling okay and vitals were BP: 144/94, P:99, RR:20. @1326 Vitals BP: 130/80, P: 94, RR: 16. Another set of vials were taken at 1331 Vitals BP: 130/90 P: 102 RR: 8 Patient was still in gravity chair and taking long and deep breaths. @1338 Vitals BP: 124/90 P: 115 RR: 10. Patient reported symptoms have resolved and is ready to leave. Pt was educated to observe for signs of allergic reactions and informed to call emergency medical services, as well as following up with his healthcare provider. No s/sx of allergic reactions were observed and patient denied EMS. Patient left site at 1341 with an observed steady gait and drove himself home.

Other Meds:

Current Illness:

ID: 1323736
Sex: F
Age: 64
State: GA

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: Penicillin, mango

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Vomiting, fever 102.6, heart rate 140.

Other Meds: Atorvastatin, zertech

Current Illness: None

ID: 1323737
Sex: M
Age: 41
State: IL

Vax Date: 05/09/2021
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:

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

Symptoms: Janssen vial diluted and given to patient. Vial mix up. vial was mistaken to be Pfizer by tech

Other Meds:

Current Illness:

ID: 1323738
Sex: U
Age: 73
State: MI

Vax Date: 01/20/2021
Onset Date: 02/28/2021
Rec V Date: 05/17/2021
Hospital: Y

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 presented to the ED with complaints of SOB. Pt was found to be COVID positive post vaccination. Pt required supplemental oxygen and was hospitalized for COVID.

Other Meds:

Current Illness:

ID: 1323739
Sex: F
Age: 61
State: IN

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: EFFEXOR

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: FATIGUE, SEVERE BODY ACHES, INCREASED PAIN IN AREAS WITH PROBLEMS, FREEZING COLD WITH 4 THICK BLANKETS ON, WEAK, UP TO 36 HOURS IN BED CONTINUALLY. BAD DREAMS CONSTANT THEN OUT OF BALANCE NAUSEATED, OUT OF SORTS, ACHY FOR THE SECOND COMPLETE DAY, BAD DREAMS . LIGHT HEADACHE ALL DAY THIRD DAY (I DONT USUALLY GET HEADACHES . FOURTH DAY I NOTICE MY HEART BEAT SEEMS A BIT ERRATIC. I CAN FEEL IT MORE THAN NORMAL AT TIMES.TODAY SOME RACING HEART BEATS NOT TERRIBLE BUT DIFFERENT

Other Meds: LISINOPRIL, LEVOTHYROXINE, CITALPROLAM ,VITAMIN D3 , BIOTIN, MESALAMINE,

Current Illness: NONE

ID: 1323740
Sex: F
Age: 46
State: MO

Vax Date: 05/09/2021
Onset Date: 05/10/2021
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:

Symptom List: Pharyngeal swelling

Symptoms: Palms, skin around nails, back of hands are hot and at same time, palms and skin around finger nails are very red. Accompanying feeling feels like how face feels when running fever. Fingernails feel very warm to touch. Face feels hot and same burning feeling also to eyes, neck, chest, back of upper arms. Rash. Filled out vsafe form this morning but forgot to add these.

Other Meds:

Current Illness:

ID: 1323741
Sex: F
Age: 22
State: WA

Vax Date: 05/12/2021
Onset Date: 05/13/2021
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: Amoxicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Diarrhea, vomiting on third day after vaccine, nausea, light-headedness, foggy brain, given Zofran for nausea

Other Meds: Birth Control

Current Illness: N/A

ID: 1323742
Sex: F
Age: 41
State: OH

Vax Date: 04/23/2021
Onset Date: 04/25/2021
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: Vicodin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Felt very warm/hot within a few hours after the shot followed by chills at night and general body aches without a fever. Since Sunday April 25 to date I have kept on feeling an itch (without rash or hives) underneath my skin, mostly in between fingers and toes but also in stomach, back, chest. There's nothing visible in my skin, just this itchy sensation.

Other Meds: Probiotic 10 Eye Promise Restore

Current Illness: No

ID: 1323743
Sex: F
Age: 66
State: IL

Vax Date: 02/14/2021
Onset Date: 02/16/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer-BioNTech Covid-19 Vaccine EUA. On the evening of 2/16/21 I started itching on my hips. I noticed the following morning I had welts on my hips and it continued to spread that day and for the next 3 days to my trunk, arms, face, chest, thighs and my upper lip swelled the evening of 2/19/21. I started taking Benadryl on 2/17/21 and discontinued it 2/19/21. I started a Medrol Dose Pak on 2/18/21. The steroids started clearing up the welts on 2/19/21 and they were totally gone on 2/21/21.

Other Meds: 81 mg ASA, Levothyroxine Sodium 75mcg, Rosuvastatin calcium 5 mg, Vitamin D, Hydrocortisone 2.5% ointment ??

Current Illness:

ID: 1323744
Sex: M
Age: 24
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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Advil - unknown reaction

Symptom List: Rash, Urticaria

Symptoms: Pt w/ a hx of unknown Advil reaction. Flushing/sweating, dizziness, vasovagal episode. Pt had a vasovagal reaction from fear of needles/anxiety. Placed patient in Trendelenburg position and felt normal/baseline. OJ given. BP 103/61, HR 102, RR 18 -- > 115/63, 89, 18. Pt stable and released from vaccination site.

Other Meds:

Current Illness:

ID: 1323745
Sex: M
Age: 64
State: IN

Vax Date: 04/17/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Shot site pain, Low fever ,diarrhea, headache, shivering, bad general body aching, fatique All gone in about 24 hours

Other Meds: None

Current Illness: None

ID: 1323746
Sex: F
Age: 43
State: CA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Valium

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

Symptoms: By 7:30, I felt drunk. My brain was not functioning normally and had a fever all night. By 7:15 I felt fine, with the exception for random joint pain. The following Friday, April 9th, I had bloodwork done. It felt like I had hit my funny bone. I had shooting pain up my arm and into my neck and down my spine. I thought it was just the blood draw, so I suffered all weekend. My husband made me go to the doctor on Monday. My doctor said I had the same symptoms of a blood clot. They sent me to the hospital for an ultrasound and blood tests recommended, but everything was negative. She told me to just watch out for any changes and it went away after a few days.

Other Meds: Synthroid - 120 mcg 5 days a week, 1 day I take half of that Singular Probiotic every day

Current Illness:

ID: 1323747
Sex: F
Age: 22
State: MI

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: 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: She was unresponsive for 10 to 15 seconds. Once she became responsive, she laid on the floor and we waited for EMS to arrive. She had no other reaction and refused further care after EMS checked on her.

Other Meds:

Current Illness:

ID: 1323748
Sex: F
Age: 41
State: CA

Vax Date: 01/27/2021
Onset Date: 05/01/2021
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: Avocados

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

Symptoms: At the time I received my 1st Pfizer vaccine I was pregnant. I recently found out my unborn child has a birth defect called spina bifida. I am 18 weeks pregnant and my due date is 10/18/2021.

Other Meds: Prenatal vitamins

Current Illness: None

ID: 1323749
Sex: M
Age: 89
State: OH

Vax Date: 04/23/2021
Onset Date: 05/02/2021
Rec V Date: 05/17/2021
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: adenosine amlodipine-atorvastatin ASA codeine iodinated contrast

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

Symptoms: 5/2/21 Pt was hospitalized for 2 days for COVID is a 89 y.o. male patient of , MD with history of steroid and oxygen dependent COPD with chronic hypoxic respiratory failure on 6 L, coronary artery disease, gout, hypertension, hyperlipidemia, BPH, and recent exacerbation of his COPD who presents with fevers, body aches, generalized weakness for 5 days found to have COVID-19 infection Acute on chronic hypoxic respiratory failure Due to COVID-19 infection. On home requirement of 6L NC. Expect he may have a milder course given vaccinated status (though not fully vaccinated until 5/7/21). Update 05/4/2021 Patient stated that he feels that he is back to his baseline Currently on 6 L nasal cannula oxygen His sats was~98 %t rest, with no evidence of respiratory distress Covid-19 Virus Infection Date of onset of symptoms: 4/28/21, Symptoms present on admission: fevers, myalgias, dyspnea, weakness Date of covid positive test: 5/2/21 Vaccination status: vaccinated on 4/1 and 4/23/21 but had exposure on 4/22/21 Imaging: CXR with low lung volumes with bronchovascular crowing and strandy bibasilar pneumonia with small pleural effusions Oxygen requirements on admission: 6L Current oxygen requirements: 6L Medical therapy: Received x3 doses of remdesivir while in the hospital, will complete total 10 days of dexamethasone treatment Consultants following: pulmonary Anticipated special isolation end date: 5/8/21 Generalized weakness Due to above issues -PT/OT consults COPD with chronic hypoxic respiratory failure GOLD grade 3, group D, follows with Dr. as an outpatient and recently completed a course of prednisone taper and augmentin on 5/1/21.Chronically declines PFTs in the past. He is on chronic prednisone at 5mg daily and uses 4-6L NC continuously at home. Pneumovax 2010, prevnar 2015. -Continue home spiriva, symbicort, singulair, and albuterol MDI 4x daily -ST consulted, recommended chopped/NDD 3, thin liquids -Discharge home to complete total 10 days of dexamethasone -Can restart his home prednisone afterwards

Other Meds: acetaminophen 650mg BID albuterol MDI or med neb QID allopurinol 100mg QD clopidogrel 75mg QD fluticasone propionate/salmeterol 500-50mg 1 puff BID furosemide 20mg daily montelukast 10mg daily pravastatin 80mg daily prednisone 30mg QD x3, 2

Current Illness: 4/22/21 Pt was seen by his pulmonologist for a COPD flare and was treated with Augmentin prednisone taper. On 4/29, daughter-in-law called pulmonologist reporting that pt was having fever to 102.7, malaise, anorexia with a known COVID exposure. Pulmonologist urged family to have pt tested so he could be treated with mAB. Pt felt better on 4/30 and declined testing.

ID: 1323750
Sex: M
Age: 24
State: IL

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received moderna vaccine at 12:45 pm and at 12:47 after he went to sit down in the observation chair he passed out. Patient fell to the ground on his stomach and I rushed over to turn him on his back. He tried getting up and looked like he had no strength and kept falling back and trying again. The other pharmacist raised his legs while I supported his neck and checked for pulse. Initially we thought it was a seizure but patient was saying he just could not raise his head up and kept going in and out of consciousness. We stayed with the patient for 30 minutes and he felt perfectly fine. Gave him an ice pack for his forehead, but the shoulder took the brunt of the impact.

Other Meds: None

Current Illness: None

ID: 1323751
Sex: F
Age: 32
State: IN

Vax Date: 05/03/2021
Onset Date: 05/07/2021
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: Menstrual cycle altered. Late by 12 days (uaul cycle: 26-32 days).

Other Meds: Metformin, Jardiance 25, Spironolactone, Cabergoline, Folic Acid

Current Illness:

Date Died: 05/09/2021

ID: 1323752
Sex: F
Age: 69
State: KY

Vax Date: 05/05/2021
Onset Date: 05/09/2021
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: none listed

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

Symptoms: Clinic contacted patient date of death: 05/09/2021. No other information on symptoms, signs experienced prior to time of death.

Other Meds: Tizanidine 2mg, Nystatin cream, Amlodipine 5mg tablet, Eliquis 5mg Tablet, Atorvastatin 40mg tablet, Melatonin 3mg

Current Illness: Pre-DM, HTN, Dermatitis, Elevated Creatinine

ID: 1323753
Sex: F
Age: 16
State: CA

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Patient under age of 18 years old received Moderna COVID-19 Vaccine. 1st dose given mistakenly at this age. 2nd dose was given in this instance after guidance from CDC to continue with 2nd dose.

Other Meds:

Current Illness:

ID: 1323754
Sex: M
Age: 19
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: Post vaccine pt became dizzy and lightheaded. Pt transferred to med obs via wc. Pt reports immediately feeling better after sitting down on litter. Vitals obtained and monitored. Pt had no complaint of chest pain. Pt had no complaint of SOB. Pt released at 14:01. Vitals as follows: 1349 SITTING BP 126/84 HR 70 RR 16 SpO2 98% 1400 STANDING BP 110/76 HR 71 RR 16 SpO2 98%

Other Meds: N/A

Current Illness: N/A

ID: 1323755
Sex: F
Age: 38
State: FL

Vax Date: 05/14/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Allergies to shrimp and some plants that I don?t know what they are

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: I have rash all over my body, redness and itches

Other Meds:

Current Illness:

ID: 1323756
Sex: F
Age: 11
State: OR

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Pt was 11 years old at time of vaccination. Her mother falsified her age information on the consent form.

Other Meds: None

Current Illness: None

ID: 1323757
Sex: F
Age: 32
State: IL

Vax Date: 05/09/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Janssen vial diluted and given to patient. Vial mix up. vial was mistaken to be Pfizer by tech

Other Meds:

Current Illness:

ID: 1323758
Sex: M
Age: 48
State: MS

Vax Date: 04/26/2021
Onset Date: 04/26/2021
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: denied

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

Symptoms: C/O throat closing "like an egg in my throat" clearing thraot -- no c/o SOB, HA, itching, swelling externally. 25mg Diphenhydramine PO w/ effect after 10 minutes

Other Meds: denied

Current Illness: denied

ID: 1323759
Sex: M
Age: 70
State: WA

Vax Date: 02/09/2021
Onset Date: 02/10/2021
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: avocado

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: my tinnitus elevated to a high level the next day and now 3 months later has not come down or diminished .

Other Meds: trazadone

Current Illness: none

ID: 1323760
Sex: F
Age: 40
State: WA

Vax Date: 04/06/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Nuts and asprin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pregnancy that ended in blighted ovum. Vaccine given right about time of fertilization.

Other Meds: Labetalol

Current Illness: None

ID: 1323761
Sex: M
Age: 13
State: PA

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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None known

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

Symptoms: Pfizer- right lymph node behind ear become red and swollen; hot to the touch

Other Meds: Guanfacine Vyvanse

Current Illness: No

ID: 1323762
Sex: F
Age: 39
State: CT

Vax Date: 04/19/2021
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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: When patient came for her second dose of her Moderna shot today, she reported that she got a rash from her first dose. The rash occurred 1 week after her first dose. She stated the rash was around the injection site and progressed around her deltoid muscle. She said the rash was red and painful to the touch. She said she put Hydrocortisone cream around the area and took one dose of Benadryl. The rash lasted 1 week per the patient. She did not seek any medical attention after she noticed the rash. This reaction seems like common reaction referred to as "Covid arm." The CDC still recommends that patients should get the second dose of the Covid shot even if they had this reaction. The patient received the second dose of the vaccine and was told that if she did get a reaction to let us know and to report it to VSAFE.

Other Meds:

Current Illness:

ID: 1323763
Sex: F
Age: 45
State: OR

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: Medications: Septra, codeine Foods: corn, soy, rice, gluten, nightshade vegetables

Symptom List: Injection site pain

Symptoms: About 2 hours after receiving shot, I was feeling very run-down and sore. My neck had pressure building at the base. Left work early to get rest. My next day entire head and shoulders were pressurized and shooting pains down neck, through arms, numbing left side of body cramping feet and arms, all triggering anxiety /panic attacks. By Friday I sought help. Urgent care sent me ER because they?d be able to run better tests. ER gave me an Ativan and sent me mental health referral. After a couple more days of trying to rest and get ease, went to different urgent care. Received muscle relaxer for cramping, and appointment for primary care provider. Saw ENT dr for throat, referred to neurologist, had MRI for neck pressure and painful spinal release sensation I feel every morning. Follow-up is end of June. Brain in fog, pressure in head building still daily. Acupuncturist gave me info for this Reporting. Been to acupuncture twice, not improving yet.

Other Meds: Daily vitamins, pea protein, mineral drops, stress tincture

Current Illness:

ID: 1323764
Sex: F
Age: 43
State: WA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 05/17/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Received the Pfizer 2nd dose on 9th April. Following day (04/10), I had body ache, fatigue, mild temperature 99.8, back neck and upper arm/shoulder pain. While I recovered from the ache and fatigue the next day (04/11), the neck pain continued for a couple of weeks. On 23rd April, the pain aggravated and I took a 2 Advil's (2 tablets of 200mg each) which made the overall pain extremely critical. The pain was mainly in the neck, upper arm, tingling in the fingers, grinding jaw pain, all symptomatic to a cardiac pain. I visited the Urgent care and they suggested I rush to Emergency care. See the notes attached. I was detected with Myocardial infraction or Heart Inflammation (as there was an increasing Troponin). They did an Angiogram to detect any blockages but was cleared of all blockages or major heart conditions. Was hospitalized for 2 days and was on observation for any new pains, repeat or increase in symptoms. Heart inflammation continues to be there and I am unable to take any anti inflammatory as that aggravates the cardiac/ MI pain. No prior history of heart disease etc. Will be visiting for repeat tests with the Cardiologist in coming weeks. Since there were no prior heart condition and since this initiated day after the 2nd vaccine, i strongly believe this is a side effect from the vaccine dose.

Other Meds: One a day womens multi-mineral and vitamin supplements, Vitamin D3, Symbicort inhaler 160/4.5 2 puffs twice a day

Current Illness: Asthma ongoing condition

ID: 1323765
Sex: F
Age: 60
State: PA

Vax Date: 05/10/2021
Onset Date: 05/10/2021
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: RA

Lab Data:

Allergies: None

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

Symptoms: Tinnitus, ringing in my left started 6 hours after the first dose and has continued non-stop for a week.

Other Meds: Multi-vitamin and D3 2,000 IU

Current Illness: None

ID: 1323766
Sex: F
Age: 73
State: VT

Vax Date: 03/08/2021
Onset Date: 03/22/2021
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: No

Symptom List: Tremor

Symptoms: Extreme fatigue, short of breath, light headed, irregular heart beats Started 3/22. ER 4/2-4/3. Extensive testing. D-Dimer 2,121 no blood clot. Zio Patch places. All tests were basically in normal range. Started to feel better early May

Other Meds: No

Current Illness: None

ID: 1323767
Sex: F
Age: 62
State: WV

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: topamax and protonix

Symptom List: Erythema, Pruritus

Symptoms: Patient was walking in the store, said she started feeling anxious and light headed and began to feel like she was going to pass out. The manager came and got me and we went to her. She was seated and I gave her water. After about 10 minutes she said she felt better and said she wanted to leave. I walked her to her car, helped her load her groceries in the car and she left with her sister. An incident report was written by store management

Other Meds: n/a

Current Illness: n/a

ID: 1323768
Sex: M
Age: 12
State: OK

Vax Date: 05/16/2021
Onset Date: 05/17/2021
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: None known

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

Symptoms: Woke up and said it felt like an elephant on his chest, still had heavy pressure at 11.. Went to pediatrician - spirometry and heart basics, BP and pulse ox okay. Prescribed albuterol in hopes it would help in a few days. Took first dose at 1pm and feels slightly better.

Other Meds: Cymbalta 30mg, Flonase OTC

Current Illness: Inpatient treatment for mental health - depression/anxiety/suicidal ideation

ID: 1323769
Sex: F
Age: 16
State: IL

Vax Date: 03/30/2021
Onset Date: 03/30/2021
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:

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

Symptoms: NO ADVERSE EFFECTS ADMINISTRATION DEVIATION: UNAUTHORIZED AGE GROUP

Other Meds:

Current Illness:

ID: 1323770
Sex: M
Age: 16
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Within 30 seconds passed out. Woke up and about 5 minutes later passed out again, with eyes open and could hear but couldn't talk. Epi Pen administered by Pharmacist around 8 minutes after shot. Taken by ambulance to ER

Other Meds: NA

Current Illness: None

ID: 1323771
Sex: F
Age: 38
State: CA

Vax Date: 03/27/2021
Onset Date: 03/27/2021
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: The vaccine has effected my menstrual cycle. My cycle was delayed until the beginning of May 2021. Once my cycle started it has not stopped. It has now been almost 3 weeks. The flow is very light almost non existent at times. This is not typical for me.

Other Meds:

Current Illness:

ID: 1323772
Sex: F
Age: 51
State: MD

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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: AMOXICILLIN AND PRILOSEC

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

Symptoms: WITHIN 4 HOURS OF RECIEVING THE VACCINE, I BROKE OUT IN A RASH ON MY ENTIRE BODY THAT WAS ITCHY FOR OVER 2 WEEKS.

Other Meds: SYNTHROID, VITAMIN D, ROVASTIN, PREVACID,ADDERALL,

Current Illness: NONE

ID: 1323773
Sex: F
Age: 46
State: TX

Vax Date: 04/10/2021
Onset Date: 04/16/2021
Rec V Date: 05/17/2021
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: Tramadol

Symptom List: Pain in extremity

Symptoms: Admitted with bilateral pulmonary emboli. Treated with anticoagulation via pulmonary catheter

Other Meds: unknown

Current Illness: unknown

ID: 1323774
Sex: F
Age: 43
State: VA

Vax Date: 04/29/2021
Onset Date: 04/29/2021
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:

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

Symptoms: Patient c/o feeling throat tightening and had difficulty breathing and chest tightness.

Other Meds:

Current Illness:

ID: 1323775
Sex: F
Age: 34
State: IN

Vax Date: 04/20/2021
Onset Date: 04/25/2021
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: none

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

Symptoms: Developed ear pain evening of 4/21/2021 (side unknown), ear pain continued and worsened. Early AM on 04/25/2021, developed facial drooping on same side as ear pain. Medical exam consistent with Bell Palsy. Grade !!!.Valtrex was prescribed along with eye drops.

Other Meds: None

Current Illness: none

ID: 1323776
Sex: M
Age: 66
State: SC

Vax Date: 05/07/2021
Onset Date: 05/13/2021
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: none

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Large swelling and Rash patch on right arm. Sore arm. Weakness and dizziness.

Other Meds: none

Current Illness: none

ID: 1323777
Sex: F
Age: 17
State: CA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
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: None

Symptom List: Vomiting

Symptoms: Daughter was administered the wrong vaccine. She is only 17 years old.

Other Meds: None

Current Illness: None

ID: 1323779
Sex: F
Age: 17
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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: chest and throat tightness

Other Meds: none

Current Illness:

ID: 1323780
Sex: F
Age: 38
State: PA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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: Tylenol

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

Symptoms: The patient presented over 2 weeks after onset of symptoms. She reported developing a constant, pruritic, erythematous, raised rash after receiving her vaccine that did not resolve with antihistamines at home. She was concerned it was an allergic reaction.

Other Meds: Patient denied any

Current Illness: Patient denies any

ID: 1323781
Sex: F
Age: 23
State: CA

Vax Date: 02/16/2021
Onset Date: 05/13/2021
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: Sulfa drugs

Symptom List: Injection site swelling, Limb discomfort

Symptoms: On May 17, 2021, I tested positive for COVID-19 despite being fully vaccinated back in February. It started with a runny/stuffy nose, tiredness, sore throat on May 13 and I lost my taste on May 17.

Other Meds:

Current Illness:

ID: 1323782
Sex: F
Age: 53
State: IL

Vax Date: 05/09/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Janssen vial diluted and given to patient. Vial mix up. vial was mistaken to be Pfizer by tech

Other Meds:

Current Illness:

ID: 1323783
Sex: F
Age: 16
State: IL

Vax Date: 04/13/2021
Onset Date: 04/13/2021
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:

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

Symptoms: NO ADVERSE EFFECTS ADMINISTRATION DEVIATION: UNAUTHORIZED AGE GROUP

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm