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: 1326610
Sex: M
Age: 48
State: CA

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 05/18/2021
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: Chronic fatigue, severe pain on shoulder when lifting left arm up.

Other Meds:

Current Illness:

Date Died: 02/15/2021

ID: 1326611
Sex: F
Age: 82
State: LA

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Systemic: patient died-Severe, Additional Details: patient expired at the hospital not in the nursing home per, director of nursing, at Nursing Home.

Other Meds:

Current Illness:

ID: 1326612
Sex: M
Age: 36
State: OH

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Systemic: Abdominal Pain-Medium, Systemic: Body Aches Generalized-Severe, Systemic: Chills-Severe, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Hypotension-Medium, Systemic: Nausea-Medium, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Shakiness-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Visual Changes/Disturbances-Severe, Additional Details: tingling in arms - numbness in arms as well. called 911 - they checked everything, gave the ok for patient to go home with someone picking him up.

Other Meds:

Current Illness:

ID: 1326613
Sex: M
Age: 19
State: VA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Systemic: Dizziness / Lightheadness-Medium

Other Meds:

Current Illness:

ID: 1326614
Sex: F
Age: 24
State: IN

Vax Date: 05/16/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Nausea, puking, fever, aches for the entire second day after shot

Other Meds: Pill birth control taytulla

Current Illness:

ID: 1326615
Sex: F
Age: 41
State: IN

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/18/2021
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: Headaches, body aches, chills, rash at sight of injection

Other Meds: Birth control

Current Illness: None

ID: 1326616
Sex: M
Age: 20
State: NY

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Seizure-Medium

Other Meds:

Current Illness:

ID: 1326617
Sex: M
Age: 28
State: NY

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Systemic: Fainting / Unresponsive-Severe

Other Meds:

Current Illness:

ID: 1326618
Sex: F
Age: 52
State: TX

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 05/18/2021
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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)

Other Meds:

Current Illness:

ID: 1326619
Sex: M
Age: 24
State: CA

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/18/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Systemic: Fainting / Unresponsive-Mild

Other Meds:

Current Illness:

ID: 1326620
Sex: M
Age: 17
State: VT

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

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

Symptoms: Soreness at injection site; extreme dizziness (cannot move head without disorienting dizziness).

Other Meds: None

Current Illness: None

ID: 1326621
Sex: F
Age: 36
State: IN

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/18/2021
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: A lot of plant based foods, trees, molds

Symptom List: Rash, Urticaria

Symptoms: Severe joint pain, cold sweats, feverish

Other Meds: Sulfasalazine, bupropion, spironolactone, dht blocker, allegra, monoleukAst, aleve, ibuprofen

Current Illness: None

ID: 1326622
Sex: F
Age: 39
State: TX

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies: Iodine and shellfish

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

Symptoms: Myelitis transverse. Paralyzed for at least 2 days

Other Meds: N/A

Current Illness: N/A

ID: 1326623
Sex: F
Age: 14
State: OH

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Site: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: Immediately after administering vaccine, patient bled quite a lot. I wiped the area 2 times times and applied pressure for ~1 minutes. Applied a cotton ball under a band-aid. Within 1 min of the vaccine, the pt developed a pump that appeared to be filled with blood under the surface. She stated that the site felt like "when you initially get poked with a needle". I recommended to take ibuprofen 200-400mg q4-6 hours until the swelling decreases, to apply a cold compress, and call md if worsens.

Other Meds:

Current Illness:

ID: 1326624
Sex: M
Age: 50
State: AL

Vax Date: 05/16/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: none known

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

Symptoms: Profound headache, muscle soreness, lethargy and chills

Other Meds: none

Current Illness: none, felt healthy prior

ID: 1326625
Sex: M
Age: 55
State: PA

Vax Date: 04/01/2021
Onset Date: 05/14/2021
Rec V Date: 05/18/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Dizziness and Vertigo like symptoms

Other Meds: Lisinopril, Ezetimibe, Aspirin, multi vitamin, CoQ10, Fish Oil, Biotin

Current Illness: None

ID: 1326626
Sex: M
Age: 16
State: CA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Shakiness-Mild, Additional Details: 911 was called for vitals after patient passed out. Paramedics stated that patient experienced syncope when standing up. also has history of anxiety.

Other Meds:

Current Illness:

ID: 1326627
Sex: F
Age: 62
State:

Vax Date: 03/14/2021
Onset Date: 03/14/2021
Rec V Date: 05/18/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient presented to the ED on 3/14/21 with anxiety. Patient presented to the ED and was subsequently admitted on 4/6/21.

Other Meds:

Current Illness:

ID: 1326628
Sex: M
Age: 22
State: WI

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt states the day after first dose of Pfizer COVID vaccine, throat "felt swollen on and off for a few days". Denies any difficulty breathing, rash, cold s/s, or other allergies. Denies interruption of ADLs. Denies difficulty swallowing. Did not seek medical care, did not take any OTCs for s/s relief. Presented for 2nd dose on 5/12/21. Writer discussed pt's reports with Medical Advisor. Recommended pt receive education regarding anything can happen with next dose and s/s allergic reaction/anaphylaxis. Discussed with patient. States he understands and would like to receive the next injection. Discussed waiting 30 min instead of 15 min for observation. Agrees. Received 2nd injection without difficulty.

Other Meds: Unknown

Current Illness: Unknown

ID: 1326629
Sex: M
Age: 15
State: MI

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Hypotension-Severe, Additional Details: sweating profusely, EMS called and came to pharmacy, checked on pt and all clear for him to leave, parents had no problem and said they didnt need anything before they leave

Other Meds:

Current Illness:

ID: 1326630
Sex: F
Age: 39
State: NY

Vax Date: 04/26/2021
Onset Date: 05/15/2021
Rec V Date: 05/18/2021
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: Site: Pain at Injection Site-Medium, Systemic: Magnet was sticking to arm-Mild, Additional Details: Pt produced a magnet and demonstrated it sticking to her left deltoid, the site of her 1st COVID vaccine dose. Pt demonstrated this was indeed a real magnet as it stuck to a piece of metal in the store. The magnet did not stick to her other arm. Pt reported she had arm pain for the first 48 hours after the dose, and no other adverse reactions. Pt tested positive for COVID in January 2021.

Other Meds:

Current Illness:

ID: 1326631
Sex: F
Age: 22
State: SC

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

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

Lab Data:

Allergies: na

Symptom List: Unevaluable event

Symptoms: VOMITING WITHIN 5-10 AFTER SHOT

Other Meds: Sprintec

Current Illness: na

ID: 1326632
Sex: M
Age: 48
State: MI

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/18/2021
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: None

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

Symptoms: Tinnitus in both ears.

Other Meds: Testosterone, Cabergoline

Current Illness: None

ID: 1326633
Sex: M
Age: 16
State: NY

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Systemic: Allergic: Rash Generalized-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild

Other Meds:

Current Illness:

ID: 1326634
Sex: F
Age: 53
State: CA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Headache-Mild

Other Meds:

Current Illness:

ID: 1326635
Sex: M
Age: 36
State: LA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Penicillin

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

Symptoms: Blood pressure elevated 178/107

Other Meds:

Current Illness:

ID: 1326636
Sex: F
Age: 27
State: IL

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Systemic: Confusion-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Mild, Additional Details: Pt was okay for 2 minutes and then fainted. LOC for 10-15 seconds, woken up to sniffing alcohol swab, CapriSun provided to raise blood sugar and cool her off. Another one was provided to use as an icepack as she was very hot. She recovered after 5 mins, refused medical attention.

Other Meds:

Current Illness:

ID: 1326637
Sex: F
Age: 41
State: NJ

Vax Date: 04/19/2021
Onset Date: 04/26/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Really bad anxiety and now insomnia. I conceived week of vaccine. Exact date unknown. I miscarried Jan 25,2021 and got pregnant again week of this vaccine

Other Meds: None I conceived week of second vaccine

Current Illness: None

ID: 1326638
Sex: M
Age: 66
State: TN

Vax Date: 05/06/2021
Onset Date: 05/09/2021
Rec V Date: 05/18/2021
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

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

Symptoms: On 5/8/2021 I was stung by a wasp. I have always had a very mild response to bee/wasp or other insect bites. This was initially the same with little or no swelling or redness at the site (my left index finger). However, the next day I noticed red bumps on my arms. The rash continued to develop spreading across my entire body including palms and bottom of feet. It persisted for six days before resolving. I took benedryl and it had an effect on the itching but no impact on reducing the rash. As this is a significant change in immune response from historical, and it was within 2days of the second Covid shot, this potential to increased immune activity to wasp venom should be considered. What if I was already sensitive? Would it move to anaphylaxis?

Other Meds: None

Current Illness: None

ID: 1326639
Sex: M
Age: 13
State: OH

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Mild, Additional Details: administered vaccine at 2:56 pm. within 5 minutes patient had loss of color, sweating and felt dizzy. Patient laid on the bench and was responsive the entire time. Called EMS at mother's request. Patient walked out of the store with mom and EMS and seemed fine. Spoke with father about 20 minutes after patient left and he said he was ok. He said he will follow up with us if anything changes.

Other Meds:

Current Illness:

ID: 1326640
Sex: M
Age: 71
State: TX

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1326641
Sex: F
Age: 52
State: VA

Vax Date: 04/20/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies: Ambien

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

Symptoms: Woke up with vertigo on 5/17 and 5/18.

Other Meds: 200 mg gabapentin at bedtime iron, magnesium, vitamin C, Colace at bedtime Note: have been taking this combination for years, but increased the gabapentin from 100 mg to 200 mg since receiving the vaccine.

Current Illness: None

ID: 1326642
Sex: F
Age: 32
State: WI

Vax Date: 04/20/2021
Onset Date: 04/22/2021
Rec V Date: 05/18/2021
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: Pt received 1st dose Pfizer COVID vaccine on 4/20/21. Presented for 2nd dose on 5/12/21. Reports that 2 days after 1st dose, she developed a "fine, red, itchy rash on both arms". Reports she also had "swelling around the face and some rash". Denies any SOB or difficulty breathing or swallowing. Reports s/s lasted about 4 days and she did not seek medical care or take any OTC medications for s/s. Discussed risks of receiving 2nd dose. Advised to seek evaluation and discuss with PCP. Note requesting provider evaluation given to patient to bring to her PCP. Pt left facility on 5/12/21 without receiving 2nd injection.

Other Meds: Unknown

Current Illness: Unknown

ID: 1326643
Sex: M
Age: 69
State: NY

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Site: Redness at Injection Site-Mild, Additional Details: RPh received fax from VAERS , but is unaware of the reaction patient had to the vaccine. RPh tried to call patient but the phone number is invalid. RPh only filled out the information required, but cannot verify if that is the reaction that the patient had. can only verify lot number , exp date, date of administartion. do not have any further information to verify reaction

Other Meds:

Current Illness:

ID: 1326644
Sex: M
Age: 19
State: VA

Vax Date: 05/04/2021
Onset Date: 05/05/2021
Rec V Date: 05/18/2021
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: Erythema, Pruritus

Symptoms: Eruption of erythemic plaque over injection site of Varicella vaccine - lateral aspect of R deltoid. Lesion is ~3.5cmx5.5cm diameter, ovoid shape, discrete borders. Lesion is non-tender, warm to touch. Erythema localized to lesion, surrounding skin unaffected. Lesion began to gradually decrease in size and color after one day, and resolved completely after two days. No treatment administered.

Other Meds: None.

Current Illness: None.

ID: 1326645
Sex: M
Age: 48
State: TX

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1326646
Sex: M
Age: 16
State: CT

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 05/18/2021
Hospital: Y

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

Lab Data:

Allergies: No known

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

Symptoms: Received second Pfizer Covid-19 vaccine on Thursday 5/13 without acute adverse events. The following day he developed substernal non radiating pleuritic chest pain that kept him awake all night. The following morning pain progressively worsened so he went to the emergency room.

Other Meds: None

Current Illness: None

ID: 1326647
Sex: F
Age: 50
State: SC

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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: PENICILLIN

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: VOMITING WITHIN 5-10 MIN AFTER SHOT, ABOUT 5 MIN AFTER DAUGHTER VOMITED.. MOM GOT VACCINATION FIRST, DAUGHTER SECOND, DAUGHTER VOMITED FIRST.

Other Meds: Vit D2 50,000, pravachol, lisin/hctz, buspirone

Current Illness: N/A

ID: 1326648
Sex: F
Age: 55
State:

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/18/2021
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: None

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: A few hours after my 2nd dose of the Moderna vaccine, I began to experience significant fatigue, headache, joint and muscle pain, heat flashes, brain fog. I began taking OTC ibuprofen/acetaminophen but they didn't have any impact. The side effects started to diminish about 24 hours later, and now at 36 hours they are almost gone.

Other Meds: Effexor and Zoloft (generic versions)

Current Illness: None

ID: 1326649
Sex: M
Age: 15
State: CA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium

Other Meds:

Current Illness:

ID: 1326650
Sex: F
Age: 43
State:

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 05/18/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Pain in extremity

Symptoms: Chills, fever, body aches, swelling of left arm, swelling of lymph nodes, muscle soreness in left arm. Symptoms started approximately 2-3 hours after shot and persisted for 48 hours.

Other Meds: Relpax as needed

Current Illness: None

ID: 1326651
Sex: F
Age: 15
State: OH

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1326652
Sex: F
Age: 26
State: IL

Vax Date: 02/01/2021
Onset Date: 03/01/2021
Rec V Date: 05/18/2021
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 drugs

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

Symptoms: Approx a month after receiving the vaccine, I developed shingles on my left side. Could be be coincidental, but wanted to report. Received an antiviral from a clinic and was treated in time before shingles got worse.

Other Meds: Sertraline, 200mg Nexplanon birth control

Current Illness: N/A

ID: 1326653
Sex: F
Age: 15
State: OH

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1326654
Sex: M
Age: 15
State: PR

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Systemic: Seizure-Mild, Additional Details: AFTER 5 MINUTES OF ADMINISTARTION VACCINE PATIENT BEGIN A SEIZURE OF LESS 1 MINUTE MOTHER DESCRIBED TONIC SEIZURE PATIENT NOT HAD PAST HISTORY OF SEIZURE

Other Meds:

Current Illness:

ID: 1326655
Sex: F
Age: 16
State: MD

Vax Date: 05/17/2021
Onset Date: 05/18/2021
Rec V Date: 05/18/2021
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: chills, body muscle aches, arm is sore, fatigue

Other Meds: none

Current Illness: none

ID: 1326656
Sex: M
Age: 22
State: IN

Vax Date: 05/11/2021
Onset Date: 05/13/2021
Rec V Date: 05/18/2021
Hospital: Y

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

Symptoms: Tightness in chest, pain in chest, and shortness of breath. Started late May 13, subsided enough to get some sleep. Awakened by the pain and shortness of breath around 7:30 am May 14. Unable to get out of bed. Called 911 for ambulance. Patient was taken to Hospital Cardiac. EKG showed ST elevation, thus L & R Catheterization was performed. Negative for MI, but diagnosed with Pericarditis, kept overnight in hospital and prescribed Indomethacin (Indocin) 3 times daily for 14 days. Released from hospital May 15. Recovery continues at home.

Other Meds: Motrin as needed for occasional headaches/pain.

Current Illness: None.

ID: 1326657
Sex: F
Age: 15
State: TX

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Site: Pain at Injection Site-Medium, Additional Details: Patient was given one dose of Pfizer vaccine in two separate injections. Needle and Syringe failed to administer dose during first injection. Patient was stuck again to administer dose. Magellan 25G 1" hypodermic safety needle was used.

Other Meds:

Current Illness:

ID: 1326658
Sex: F
Age: 32
State: PA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/18/2021
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: Systemic: Allergic: Anaphylaxis-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Itch Generalized-Mild, Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Systemic: Allergic: Rash Generalized-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Swelling and tingling occured in tongue, lips and throat. Symptoms began to abate 3-4 minutes after administration of epinepherine (Epineperine 0.3 mg via autoinjector to the pt's left thigh at approximately 1730). Patient was taken to ER by EMS. EMS arrived at approximately 1737.

Other Meds:

Current Illness:

ID: 1326659
Sex: F
Age: 33
State: PR

Vax Date: 05/07/2021
Onset Date: 05/14/2021
Rec V Date: 05/18/2021
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: None

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

Symptoms: Shingles: painful itchy rash on back of neck, and right arm.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm