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: 1328025
Sex: M
Age: 69
State: NC

Vax Date: 01/26/2021
Onset Date: 03/09/2021
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: Omeprazole, Cipro, Levofloxacin, Sulfa antibiotics

Symptom List: Dysphagia, Epiglottitis

Symptoms: Exactly 3 weeks to the day of the second shot I lost all hearing in my left ear. Ear had been perfect until this day. 2 ear tests have revealed that the ear is useless.

Other Meds: Atenolol, Synthroid, Ecotrin, Spiriva, Ondansetron, Famotidine, Tramadol, Resuvastatin,

Current Illness: Stage 4 Kidney disease

ID: 1328026
Sex: F
Age: 15
State: CA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Gluten

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt reported lightheadedness and was found to be diaphoretic and pale after vaccine administration. She was laid down on a gurney with legs elevated, V/S monitored for 45 minutes and given apple juice po.

Other Meds: None

Current Illness: None

ID: 1328028
Sex: F
Age: 15
State: AL

Vax Date: 05/18/2021
Onset Date: 05/18/2021
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: none

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

Symptoms: Patient is 15 instead of approved age of 18.

Other Meds: none

Current Illness: none

ID: 1328029
Sex: M
Age: 38
State: MA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: No known

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Head achrs fever chill fatiques thirsty,

Other Meds: Eggs , coffee

Current Illness: Non

ID: 1328030
Sex: M
Age: 18
State:

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:

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

Symptoms: Patient received the Pfizer vaccine 28 days following the administration of the Moderna vaccine. The Moderna vaccine was given at a different location than this dose of Pfizer. Patient sat for the recommended 15 minutes for observation. He stated that he felt fine and left for home with his father. Both the patient and his father were told that getting one dose of each is not ideal but that there is no medical concerns associated with this. Told the potential side effects are the same for both vaccines. Told that there is no need for a second Pfizer. Will still be considered fully vaccinated in 2 weeks.

Other Meds:

Current Illness:

ID: 1328031
Sex: F
Age: 40
State: MD

Vax Date: 05/17/2021
Onset Date: 05/18/2021
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: Shellfish (mild nausea allergy)

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

Symptoms: Extreme fatigue (falling asleep sitting still), headache, sore arm. Fatigue was equivalent to that when actually having the flu. Extreme difficulty staying awake, ended up falling asleep mid-sentence while sitting on the couch. After nap, low-level fatigue and sleepiness remained. Would not consider self safe to drive. Mild headache, responded well to over the counter medication (ibuprofen and acetaminophen). Arm soreness began earlier (immediately after vaccination) and increased in stiffness and soreness with reducing range of motion over time. Pain medication helps but still very sore. Pain seems to be affecting a nerve, as tingling radiates down the arm to the little finger in the hand, and all along the side of the arm.

Other Meds: None

Current Illness: None

ID: 1328033
Sex: M
Age: 71
State: CO

Vax Date: 04/13/2021
Onset Date: 04/13/2021
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: No known drug allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Within a few hours of receiving the 2nd Moderna vaccine, patient had severe body aches, fatigue and a severe headache. Fatigue lasted for 10 days. The severe body aches, and severe headaches have not subsided (he's on day 35). It is decreasing his quality of life. He is not able to go and do things he used to be able to do.

Other Meds: rosuvastatin, furosemide, omeprazole, magnesium oxide, azithromycin, acyclovir, alendronate, bactrim ds, montelukast, tamsulosin, eliquis, tacrolimus, mycophenolate mofetil,

Current Illness:

ID: 1328034
Sex: M
Age: 61
State: NY

Vax Date: 05/15/2021
Onset Date: 05/16/2021
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: none

Symptom List: Pharyngeal swelling

Symptoms: muscle pain in my left leg for the last three days unable to sit or use my leg to stand up pain meds do not work

Other Meds: ibuprofin

Current Illness: none

ID: 1328035
Sex: M
Age: 29
State: MO

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: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Extreme fatigue, loss of appetite, vomiting, inability to keep down any substantial of liquid, severe headache, sweats and chills. Patient began developing systems roughly 16 hours after injection . Symptoms are less problematic 24-25 hours later but still actively exist to a certain extent including fatigue, loss of appetite, and chills . Patient was treated at home through self-care and assistance from non-medical professionals.

Other Meds:

Current Illness:

ID: 1328036
Sex: F
Age: 24
State: NY

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: patient had an anxiety attack related to vaccine administration (needles) and potential side effects after administration. vitals : hr 50, r 30, BP 140/100,m o2 sat 88%. EMS was called due to dropping o2 sat and HR. vitals reached normal range after EMS arrived. final vitals upon leaving facility: HR 56, R 25, BP 138/90, O2SAT 99%. EMS took patient to mt sinai west in NYC for further observation.

Other Meds: none

Current Illness:

ID: 1328037
Sex: M
Age: 28
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: None

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

Symptoms: 5/17/21 Patient given Janssen vaccine at 1859. 1905 : patient had an episode of syncope. BP:90/55, pulse: 50 1906: patient awake , alert and oriented.x4 1910: BP: 114/71, pulse 57. Alert and oriented x4 Patient reports a history of syncope and fear of needles. 1930: patient reports doing well. Vital signs stable, alert and oriented x4

Other Meds: None

Current Illness: History of syncope

ID: 1328038
Sex: F
Age: 14
State: NJ

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:

Symptom List: Rash, Urticaria

Symptoms: Patient received vaccine and within 5 minutes was not feeling well. Patient fainted and then when conscious began vomiting. Patient also became very pale and clammy. Patient has experienced vasovagal symptoms before when having blood work done but not during vaccination. Patient also stated afterwards that she had not eaten any food all morning prior to receiving the vaccine.

Other Meds:

Current Illness:

ID: 1328039
Sex: F
Age: 22
State: KY

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: No allergies listed

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

Symptoms: Patient received first moderna vaccine and was sitting in the waiting area for her after shot evaluation. After about 5-7 minutes patient came up to the counter and stated that she felt her throat was closing. Pharmacist went out and had patient sit in shot booth. He called 911, administered oral benadryl and asked patient how she felt. She stated she still felt that her throat was closing so pharmacist administered epi-pen. Pharmacist stayed with patient until EMS arrived. At no time did patient lose consciousness or show any outward signs of allergic reaction

Other Meds: No other medications to my knowledge

Current Illness: None known

ID: 1328041
Sex: F
Age: 42
State: UT

Vax Date: 05/12/2021
Onset Date: 05/13/2021
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: Caine Family, Penicillin

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

Symptoms: Client reports starting 05/13/2021 she experienced burning, aching in injection site, difficult to move; chills, fever, headache, fatigue, and muscle aches which are still ongoing. Client had 2 seizures today, previously seizures were well controlled and client reports these seizures today were not like previous seizures as she did not have aura prior to them. Client reports she did call neurologist who told her stay hydrated, not drive, and call the health department. Recommended to client to be seen by physician today as symptoms are progressing and vaccination was ~ 6 days ago.

Other Meds: Trokendi XR, Leflunomide, Gabapentin, Nifedipine ER, Rinvoq,

Current Illness: None

ID: 1328042
Sex: M
Age: 68
State: AZ

Vax Date: 03/15/2021
Onset Date: 03/25/2021
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

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

Symptoms: Approximately two weeks after receiving my second COVID vaccination on March 15, I developed tinnitus in both ears. I experience a constant, high-pitched ringing in both ears. Now, two months later, the condition has not changed.

Other Meds: Atorvastatin 40 mg Aspirin 81 mg Vegan multivitamin and mineral supplement Vegan omega-3 DHA-EPA supplement

Current Illness: Mild case of bacterial pneumonia from November 2010 to mid-March 2021. Diagnosed by x-ray on January 21; resolved by March 18.

ID: 1328043
Sex: F
Age: 25
State: CA

Vax Date: 05/11/2021
Onset Date: 05/12/2021
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: Penicillins

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

Symptoms: Chills within 24 hours of 2nd dose. Hives to bilateral thighs within 72hrs, resolved with Benadryl. Occipital headache, dizziness, sweats, nausea, anorexia, ear pressure within 72 hours after 2nd dose.

Other Meds: None

Current Illness:

ID: 1328044
Sex: M
Age: 24
State: FL

Vax Date: 05/17/2021
Onset Date: 05/18/2021
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: NKA

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

Symptoms: Nausea and vomiting for 1 day. Prescription provided today for Zofran (4mg) 2 tablets by mouth 2 times a day as needed up to 4 doses

Other Meds: nothing

Current Illness: Denies

ID: 1328045
Sex: F
Age: 22
State: AL

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: dizzy, lightheaded, nauseated, hot flashes. checked patient's blood pressure which was normal gave her a water and an ice pack and asked her to sit longer until she felt better patient came up to counter, said she felt a lot better and left the store 30 min after administration

Other Meds:

Current Illness:

ID: 1328046
Sex: F
Age: 63
State: OH

Vax Date: 04/02/2021
Onset Date: 04/23/2021
Rec V Date: 05/18/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin Actos IVP Dye Latex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Had an Ischemic Stroke. Hospitalized via ambulance 4/23-4/29/2021.

Other Meds: Metformin Hydrochloride 1000mg (x2) Synthroid 75mcg Bisoprolol Fumarate 5mg Lisinopril 40mg Vitamin D-50 50,000 unit cap (once a week) Bydureon B12 1000mcg Biotin 20;000mcg B6 200mg Centrum Silver

Current Illness: 13 month COVID Longhauler

ID: 1328047
Sex: F
Age: 37
State: NY

Vax Date: 05/12/2021
Onset Date: 05/15/2021
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: Pt experienced hives and red papules on her face, cheeks and chin bilaterally. Describes them as itching and mild burning sensation. Pt states it happened 24 hours after receiving second dose of covid vaccine. Pt came to urgent care and was treated with oral prednisone and hydrocortisone.

Other Meds:

Current Illness:

ID: 1328048
Sex: M
Age: 32
State: HI

Vax Date: 03/16/2021
Onset Date: 05/10/2021
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: SHELLFISH, BACTRIM

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

Symptoms: PT RECIEVED 2 DOSES OF JANSSEN VACCINATION 3/16/2021 AND 5/10/2021. NO ADVERSE EVENTS/REACTIONS REPORTED

Other Meds: N/A

Current Illness: NONE

ID: 1328049
Sex: M
Age: 95
State: IA

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 05/18/2021
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: NSAIDs, Statins

Symptom List: Unevaluable event

Symptoms: Patient continued to deteriorate after second dose of vaccine with progressive weakness and shortness of breath. When he presented to the emergency room he had new onset cardiomegaly and heart failure. Patient also developed new onset atrial flutter but had bradycardia due to AV heart block.

Other Meds: Norvasc 5 mg daily, Proscar 5 mg daily, calcium with vitamin D daily, fish oil 4000 mg daily, Cozaar 100 mg daily, AcipHex 40 mg daily, Requip 2.5 mg nightly, tramadol 50 mg as needed, Tylenol 500 mg as needed, Tessalon Perles 100 mg as nee

Current Illness: none reported

ID: 1328051
Sex: M
Age: 44
State: MN

Vax Date: 03/24/2021
Onset Date: 03/25/2021
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: chills, since March 25

Other Meds: Xiidra, Clindamycin, Fluoxetine

Current Illness: none

ID: 1328052
Sex: M
Age: 57
State: ID

Vax Date: 03/15/2021
Onset Date: 03/18/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: 10 mins after injection became very faint and broke out in cold sweat. Pharmacy gave me oral Benadryl. For the next three days i was very fatigues and slept 60% of the time. Starting on day 4 my upper back and neck started to very pain like a sunburn feeling, but the skin was not red and there was no rash and did not hurt when touched. The sunburn feeling was constant and annoying from day 4-14, then it started to become more intermittent. I decided to get the second vaccine shot(Pfizer ER8734) on 4/5/21. Since that time the sunburn feeling has spread to my shoulders and arms and the inside of my legs. As of this date it is pretty much a constant pain. In the last couple of weeks I have also started feeling random nerve pain on all different parts of my body.

Other Meds: All of the following are taken once per day at night: Alfuzosin 10 mg; Tadalafil 5 mg; Lansoprazole 30 mg; Beta-sitosterol 120 mg; Vitamin D3 4000 IU; Lutein & Zeaxanthin 25mg/5mg; Kirkland Multi-Vitamin

Current Illness: None

ID: 1328053
Sex: F
Age: 59
State: VA

Vax Date: 04/20/2021
Onset Date: 04/27/2021
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: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient says a week after her dose 1 she developed some swelling in her armpits on her left arm.

Other Meds: N/A

Current Illness: None

ID: 1328054
Sex: F
Age: 15
State: IL

Vax Date: 05/15/2021
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: NA

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

Symptoms: Massive nose bleeds from left nostril on 5.17.21 and 5.18.21

Other Meds: Spiranolactone 50MG 2x Daily

Current Illness: NA

ID: 1328055
Sex: F
Age: 16
State: MD

Vax Date: 05/13/2021
Onset Date: 05/16/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: vomiting began 3 days after vaccination fever up to 102 began 4 days after vaccination sore throat, congestion, body aches persist 5 days after

Other Meds: none

Current Illness: none

ID: 1328056
Sex: F
Age: 57
State: NJ

Vax Date: 05/06/2021
Onset Date: 05/11/2021
Rec V Date: 05/18/2021
Hospital: Y

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

Lab Data:

Allergies: Ketorolac, Toradol

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Vaccine on 5/5/2021 on 5/11/2021 the patient went into cardiac arrest. The patient has a history of Acute respiratory failure with hypoxia, on O2

Other Meds:

Current Illness:

ID: 1328057
Sex: M
Age: 22
State: MI

Vax Date: 05/18/2021
Onset Date: 05/18/2021
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: NKA

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

Symptoms: Approximately 5-10 minutes after receiving injection patient became faint and collapsed while browsing store. Did not appear to hit his head or significantly injure himself in any way but reported headache and some confusion on regaining consciousness. Slowly moved to sitting position and allowed to recover.

Other Meds: Unknown

Current Illness: No reported medical conditions

ID: 1328058
Sex: M
Age: 18
State: CA

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: RA

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Patient was given injection with no issues; spent a few minutes post injection speaking to patient about the potential side effects. Encouraged him to stay hydrated and to utilize Tylenol if fever, pain, or aches. Patient was alert and oriented when he left the vaccination room. After sanitizing the room for the next member, preparing the next member's shot, came out of the room to announce the next member and found the original patient face down on the floor of the warehouse. Witnesses stated he had fell to his knees from a sitting position and then hit his head on the floor with no more then 2 minutes going by (most likely less then 1 minute). Had the patient lay on the ground with legs elevated while he came to. Offered patient water and ice pack. Patient was able to call his parents, which I stayed by his side, until they arrived.

Other Meds: None stated except for 2nd dose of Moderna Covid-19 vaccine (lot 038C21A, exp 10/27/21)

Current Illness: Lack of sleep and hydration.

ID: 1328059
Sex: M
Age: 12
State: TX

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Patient appear to have a mild seizure (faint, stiffness on the arm that got the vaccine injection, eye rolled) about less than 5 seconds. Patient became fully awake as being put to laying down on the floor. Patient was able to answer to all questions was asked. Patient stated that he was nervous and scared of getting the vaccine. Patient's mother stated that he had fainting history of seeing cut or bleeding. The event occur 30 seconds after received that vaccine.

Other Meds: none

Current Illness: none

ID: 1328061
Sex: M
Age: 40
State: KY

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: None

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

Symptoms: Pt. received his 2nd Covid vaccine on 5/18/2021 at approximately 4:30pm. He stated in the informed consent form that he felt really dizzy on his 1st Moderna vaccine. I administered his 2nd vaccine and told him to wait in front of the pharmacy for 30 minutes. Approximately 30 minutes later one of the pharmacy technicians stated that the patient did not look like he was feeling well. I imediately went out as asked how the patient felt, and he stated that he was feeling really dizzy, had fatigue land a little tingley with a mild headache, nausea and some muscle aches. I offered to get him a wet towel and some water or anything he might like to drink. He stated he would like some water to drink. I asked him if he needed someone to come and get him. He called his mother and she came to pick him up at 6:35pm. I told him and her we would follow up with the patient tomorrow 5/19/2021 at the earliest possible time.

Other Meds: None

Current Illness: None

ID: 1328062
Sex: M
Age: 52
State: WA

Vax Date: 05/14/2021
Onset Date: 05/15/2021
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: gluten, egg, opiods

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

Symptoms: Fever (102) for over 48 hours; muscle aches; chills; headache; nausea; lethargy; joint pain; dry cough

Other Meds: Flonase, singular, multi-vitamin, zyrtex

Current Illness: None

ID: 1328063
Sex: F
Age: 41
State: CT

Vax Date: 05/14/2021
Onset Date: 05/15/2021
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 and its derivatives

Symptom List: Tremor

Symptoms: About 25 hours after receiving the vaccination, I felt rather intoxicated, though I do not drink alcohol or use any sort of illegal drugs. I also felt a little nauseous as well as extremely tired. I slept for several hours in the middle of the day. I felt better a few hours after waking up. I did not report these symptoms to my physician.

Other Meds: Synthroid and liothyronine

Current Illness: none

ID: 1328064
Sex: F
Age: 11
State: WA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: MOTHER STATED PATIENT WAS 12 YEARS OLD AND ELIGIBLE FOR VACCINATION. PATIENT IS ONLY 11 YEARS OLD AND NOT ELIGIBLE FOR VACCINATION

Other Meds:

Current Illness:

ID: 1328065
Sex: M
Age: 58
State: ME

Vax Date: 04/27/2021
Onset Date: 05/07/2021
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: None

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

Symptoms: Headache, Muscle Pain, Chills, Fever, Nausea, Diarrhea, Tiredness

Other Meds: None

Current Illness: None

ID: 1328066
Sex: F
Age: 60
State: SC

Vax Date: 05/14/2021
Onset Date: 05/15/2021
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: Biaxin. Causes rash with blisters.

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

Symptoms: Malaise, pain at the injection site, fever, and sore throat. The fever and sore arm lasted about 24 hours, and the malaise about 48 hours. I am STILL experiencing the sore throat. I took tylenol alternated with advil for the fever and made sure to stay hydrated.

Other Meds: none

Current Illness: none.

ID: 1328067
Sex: F
Age: 37
State: NC

Vax Date: 05/15/2021
Onset Date: 05/17/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Mastitis (I am breastfeeding a 3 month old)

Other Meds:

Current Illness:

ID: 1328068
Sex: F
Age: 0
State: NY

Vax Date: 04/15/2021
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 THAT WE ARE AWARE OF

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

Symptoms: HARD LUMP AT INJECTION SITE THAT IS STILL THERE AT PRESENT (OVER 1 MONTH SINCE SHOT)

Other Meds: NONE

Current Illness: N/A

ID: 1328069
Sex: F
Age: 65
State: CA

Vax Date: 02/11/2021
Onset Date: 02/16/2021
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: Sulfa drugs

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

Symptoms: Limited mobility and Weakness in left arm that is still an issue three months later. Discussed first time with PC doctor on 5/18/2021. Shoulder X-ray taken on 5/18, but no issues detected in any area of the shoulder.

Other Meds: Atorvastatin, vitamins B12 and D3, melatonin

Current Illness: None

ID: 1328071
Sex: F
Age: 29
State: IL

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: None

Symptom List: Pain in extremity

Symptoms: Patient received dose 2 of Moderna COVID vaccine. After administration patient saw blood and passed out while seated. Pharmacy staff noticed body twitching and called EMS. Patient had a pulse and was breathing. Patient returned to consciousness prior to arrival of EMS. Was given water. EMS checked patient vitals, vitals were normal. Patient declined to be taken to hospital. Remained seated for about 20 minutes after incident. Husband picked her up. Patient was awake and alert on leaving pharmacy

Other Meds: Venlafaxine XR, Montelukast, Levocetirizine

Current Illness: None

ID: 1328072
Sex: M
Age: 37
State: PA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
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: none

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

Symptoms: Patient in chair sitting position at time of vaccination, minutes later fell out of chair face forward and on carpet floor lying on left side breathing hard. Patient had rug burns on face. Patient lost consciousness for about 1 to 1 and a half minute patient snapped back immediately and slowly came back to being oriented. EMS arrived to check over patient, patient was nauseated and vomited. Patient complained of neck discomfort, EMS pressed on patients neck and EMS felt it was muscle related. Patient refused additional service from EMS. EMS advised patient to seek additional services from hospital if symptoms worsen.

Other Meds:

Current Illness: none

ID: 1328074
Sex: F
Age: 59
State: AZ

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known

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

Symptoms: Not in left arm at injection site light pink rash approximately 2? x 3? sensitive to touch warm to touch: Taking Tylenol 500 mg Q4 hours

Other Meds: Oxycodone 10 mg four times a day Levothyroxine 150 ?g once daily

Current Illness: None

ID: 1328075
Sex: U
Age:
State:

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

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: Moderna COVID-19 Vaccine EUA I had to have an appendectomy due to an acute appendicitis. I became very ill about 9 hours after receiving the second Moderna COVID-19 vaccine, then three days later I got very sick ended up in the ER with an acute appendicitis and having an appendectomy the following morning (4th day after the vaccine)

Other Meds:

Current Illness:

ID: 1328076
Sex: F
Age: 33
State: AZ

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: FAUX LEATHER PRODUCTS

Symptom List: Vomiting

Symptoms: WITHIN A COUPLE MINUTES OF RECEIVING MODERNA VACCINATION IN HER LEFT ARM, PATIENT APPEARED TO SEIZE ON THE SAME SIDE OF HER BODY AS THE SHOT WAS GIVEN (LEFT). SHE APPEARED TO GO PALE AND STATED SHE WANTED TO LAY DOWN. SHE WAS LOWERED TO THE GROUND, 911 CALLED AND ADMINISTERED 50 MG DOSE OF BENADRYL IM. WITHIN A FEW MINUTES PATIENT APPEARED TO LOOK BETTER. CHECKED BLOOD PRESSURE 119/80 HR 142. PARAMEDICS CAME AND SHE STATED SHE WAS FINE. THE DID NOT STAY LONG TO EVALUATE HER. PATIENT CALLED FRIEND TO PICK HER UP AS WE DID NOT FEEL COMFORTABLE WITH HER DRIVING.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1328078
Sex: M
Age: 25
State: TX

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient felt dizzy after getting the shot. As he walked to the chair and fell down as he was about the sit on the chair. He got up and sat on the chair with help of his Dad. He also got sweaty and pale. After he sat for a while and got some water he said he felt better. He waited for 30 minutes and felt better and went home.

Other Meds:

Current Illness:

ID: 1328079
Sex: M
Age: 83
State: CA

Vax Date: 05/11/2021
Onset Date: 05/12/2021
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: N/A

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

Symptoms: Patient reports daily headaches after second Pfizer vaccine 1 day after second vaccine for the past 2 months. His headache is stable and controlled with daily acetaminophen.

Other Meds: ? apixaban 5 mg tablet, Take 1 tablet (5 mg total) by mouth 2 (two) times a day., Disp: 180 tablet, Rfl: 3 ? atorvastatin 20 mg tablet, Take 1 tablet (20 mg total) by mouth 1 (one) time each day., Disp: 90 tablet, Rfl: 3 ? cholecalcifero

Current Illness: N/A

ID: 1328080
Sex: M
Age: 34
State: CA

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Near syncopal episode approximately 15 minutes after vaccine administration. Pt became cool, clammy and diaphoretic. Complained of feeling dizziness. Pt was ambulated to Urgent Care.

Other Meds: Lamictal

Current Illness: None

ID: 1328081
Sex: F
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Moderna COVID?19 Vaccine EUA. Fatigue, extreme body aches, nausea, vomiting, chills, fever, headache and sore throat.

Other Meds:

Current Illness:

ID: 1328082
Sex: F
Age: 63
State: CA

Vax Date: 04/20/2021
Onset Date: 04/28/2021
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: UNKNOWN

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

Symptoms: 9 DAYS AFTER VACCINATION PATIENT GOT "COVID ARM" RED, PAIN, INFLAMMATION, ACHING ARM. OTHER SX INCLUDED HA/MIGRAINE, ACHING LOW BACK. TODAY WHEN SHE PRESENTED FOR SECOND SHOT SHE FELT ALMOST FULLY RECOVERED.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm