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: 1330560
Sex: M
Age: 54
State: OR

Vax Date: 05/11/2021
Onset Date: 05/17/2021
Rec V Date: 05/19/2021
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: nkda, no food allergies, past history of seasonal allergies as child

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received Janssen vaccine on 5/11/21 @ Pharmacy, noted 12 hours after the vaccine had headache, body aches, and chills. The on 5/17/21 woke with a head to tow rash. Went to ED and was treated with Prednisone and antihistamines. 5/19/21 noted chest and head congestion, shortness of breath and return of rash on his back only. Patient referred to see provider 5/19/21 to rule out covid infection and discuss the treatment of symptoms.

Other Meds: bupropion 150 mg daily

Current Illness: Patient denied

ID: 1330561
Sex: F
Age: 39
State: OH

Vax Date: 03/31/2021
Onset Date: 04/03/2021
Rec V Date: 05/19/2021
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: Novocain

Symptom List: Anxiety, Dyspnoea

Symptoms: Change in menstrual period - menstrual cycle immediately following dose 1 stopped abruptly several days prior to normal (stopped day 3, normal 6 days), with ovulation following the next day. After second vaccination, menstrual cycle was delayed by 8 days (abnormal, years of history of consistent cycle), followed by a longer period (9 days).

Other Meds: Synthroid

Current Illness: none

ID: 1330562
Sex: M
Age: 17
State: CA

Vax Date: 05/14/2021
Onset Date: 05/16/2021
Rec V Date: 05/19/2021
Hospital: Y

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: NKDA

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

Symptoms: Left sided chest pain few days after second shot. Noted troponin to be elevated. Troponin: 1.27 -> 1.62 -> 1.74 -> 1.62->1.05 -> 1.06 -> 0.99. Normal ECHO. Normal EKG. Dx with myocarditis. Patient's pains symptoms resolved in 1-2 days; observed in hospital until troponin trended down.

Other Meds: None

Current Illness: None

ID: 1330563
Sex: F
Age: 53
State: IN

Vax Date: 05/17/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 48 hours of chills, fever, cough, headache, body ache, nausea

Other Meds: None

Current Illness: None

ID: 1330564
Sex: F
Age: 63
State: NY

Vax Date: 04/13/2021
Onset Date: 04/30/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: Started noticing tinnitus approximately two and a half weeks after the second Pfizer dose.

Other Meds: Estradiol Cream 0.01% twice weekly

Current Illness:

ID: 1330565
Sex: F
Age: 28
State: CA

Vax Date: 04/19/2021
Onset Date: 04/26/2021
Rec V Date: 05/19/2021
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: Seasonal Allergies

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

Symptoms: One week after the vaccine I noticed a red patch like a sunburn on my upper left arm. My arm also hurt like the shot was new. The next day the area was larger and it was itchy. It grew over the next few days to an area of ten inches. The middle was white and it almost looked like Ringworm and the outside area shrank from the outside in. I took Benadryl for the itch. It was better twelve days after the vaccine. I did not receive the second shot yet. Due Date-09/23/2021 Pregnancy- Second

Other Meds: Prenatal Magnesium

Current Illness:

ID: 1330566
Sex: F
Age: 45
State: IL

Vax Date: 05/13/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: Pyrexia, White blood cell count decreased

Symptoms: I have experienced mild dizziness off and on after the shot since about a half hour after first dose. But today, 6 days after first dose, at around Noon, I experienced a stronger episode of dizziness which then progressed to a presyncope feeling (like I might pass out). I also felt flushed and jittery after the presyncope subsided. Now, I still feel dizzy, off balance and jittery.

Other Meds: Sertraline 50mg; Metoprolol 25mg; Loratidine 5mg

Current Illness: None.

ID: 1330567
Sex: M
Age: 29
State: WI

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: Per patient, no known allergies.

Symptom List: Pharyngeal swelling

Symptoms: Patient received COVID 19 vaccine and was in the waiting room sitting for 15 minutes before he could leave. After about 7 minutes, the patient passed out and fell on the floor. He caught his arm on the chair when falling and it is unknown if he hit his head. He almost immediately regained consciousness and we kept him laying down on the floor until 911 arrived. Patient was still light headed, felt tingly, and was hot (sweating profusely). Patient was taken away by 911 to be locally evaluated.

Other Meds: Per patient, no medications were taken before or during the time of the vaccination.

Current Illness: Per patient, no known illnesses.

ID: 1330568
Sex: F
Age: 63
State: FL

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/19/2021
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: About 6 minutes post vaccination, patient reported that her feet felt tingly, no other reaction reported. Patient was given 50mg dose of diphenhydramine and decided to stay 20 minutes post vaccination for observation, but the reaction subsided. 24 & 48 hours post vaccination patient the patient did not report any other reaction.

Other Meds:

Current Illness:

ID: 1330569
Sex: F
Age: 50
State: OH

Vax Date: 03/10/2021
Onset Date: 03/12/2021
Rec V Date: 05/19/2021
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: Yes allergic and known at the time of vaccination because provided a list.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I got a severe stomach flu and joint elbow pain and went behind my knee, lesions started on lower leg with red bumps and went across ankles and feet but still experiencing lesions which are extremely painful, feet are swollen and tingling and numbness of pain. I've been to ER and had an EKG and ultrasound performed.

Other Meds: Yes I'm taking medications.

Current Illness: None

ID: 1330570
Sex: M
Age: 69
State: FL

Vax Date: 01/06/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: On12/17/20 staff member received 1 st dose of Pfizer vaccine / 2nd dose received 1/6/21 staff member 5/17 tested - 5/19 POSITIVE result with no symptoms *staff member had the virus back in April of 2020

Other Meds: simvastatin lisinopril metformin

Current Illness: N/A

ID: 1330571
Sex: F
Age: 36
State: VA

Vax Date: 05/07/2021
Onset Date: 05/08/2021
Rec V Date: 05/19/2021
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: unknown allergies

Symptom List: Rash, Urticaria

Symptoms: The night of or next morning of receiving the shot. The injection site was swollen and painful. It was painful to raise my arm above my head. That went away within 24-30 hrs. 11 days after receiving the vaccine I noticed I had a rash 5 inches long and about 3 inches wide. I could have had the rash earlier, but did notice it until I subconsciously started scratching it. After realizing what it is, I have stopped myself from itching it further. It is now 12 days since taking the vaccine and I still have the rash-- it has not completely gone away as of 5/19/2021.

Other Meds: Protein Shakes

Current Illness: none

ID: 1330572
Sex: F
Age: 64
State: FL

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: morphine analogues

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

Symptoms: cellulitis in the right arm. Pain intensified after receiving the injection.

Other Meds: no medications were taken at the time.

Current Illness: no illnesses

ID: 1330573
Sex: F
Age: 33
State: OK

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
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: Sulfa

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

Symptoms: Syncope 5 minutes post vaccine. Increased headache and fever up to 102.4 degrees for 15 hours

Other Meds: Multivitamin

Current Illness: None

ID: 1330574
Sex: F
Age: 35
State: WY

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 05/19/2021
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: Penicillin

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

Symptoms: Extreme discomfort and pain at injection site. Followed by rash that covered left arm, left breast and side, extremely itchy. Rash remained and finally was relieved with two doses of Benedryl and ice compress. Left arm remains sore after one week.

Other Meds: None

Current Illness: None

ID: 1330575
Sex: F
Age: 27
State: NY

Vax Date: 02/09/2021
Onset Date: 03/02/2021
Rec V Date: 05/19/2021
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: na

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

Symptoms: The night following my first dose, I experienced the worst mentrual cramping I have ever had in my life, so much so that it felt like I was having contractions. As I have an IUD, I have not had a period for over two years now, though I do experience cramps during the time in my cycle where I should bleed. The cramps experienced were nothing like my normal menstrual cramps, I was doubled over in pain. And on the third day after the shot, I bled for the first time in 2 years (since getting an IUD). My breasts also doubled in size and extremely painful.

Other Meds: na

Current Illness: na

ID: 1330576
Sex: F
Age: 52
State: MS

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 05/19/2021
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: pt says next day after taking the vax she started having a burning joint pain in her left shoulder and the arm pit lymph node is swollen. The joint pain went across to the other shoulder joint. The pain went from her right shoulder down to her elbow, to her wrist down to her hip, knee and ankle. The pain moved to all of the joints on the right side of her body. Her blood pressure was going up. It went from 110/70 to 149/89. She gets a severe pain on the right side of her head like a headache. She has a constant ringing in her head. She has short term memory loss and expressive aphasia. She went to OB/GYN on 3/3/21. He sent her to see her PCP NP on 3/7/21. She was given a Medrol dose pack and antibiotics. Pt had lab work. She wasn't getting better so went back about a week later and saw Dr. She was prescribed 40 mg of prednisone. She was referred to Neurologist. He ordered her an MRI and EEG. The MRI showed 3 spots on it which doctor want overly concerned about but the EEG was abnormal so she was rescheduled for further testing on 9/28/21.

Other Meds: levothyroxine, estrogen, progesterone, lithothyroxine, vitamins C, D3, B12, Zinc

Current Illness:

ID: 1330577
Sex: F
Age: 38
State: NV

Vax Date: 03/06/2021
Onset Date: 05/11/2021
Rec V Date: 05/19/2021
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: 1st menstrual cycle after vaccine was light. 2nd menstrual cycle is missing

Other Meds: Tri lo Sprintec, Claritin, Vitamin D3

Current Illness: none

ID: 1330578
Sex: M
Age: 51
State: CA

Vax Date: 05/01/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: Bee Stings, MMR vaccine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Chills and tremors two weeks after vaccination. Possible aggravation of underlying psychiatric disorder including anxiety, desire for a drink and additional anxiolytics medication, suicidal ideation. Sleeplessness. Not absolutely certain these were related to the vaccine although I was doing well before it. Dr. suggested it might be an allergic reaction or unspecified cause.

Other Meds: Geodon, Klonopin, gabapentin, naltrexone, atorvadtatin, nexium, Lexapro, BuSpar, Lamictal, nicotine gum, caffeine, multivitamin

Current Illness: Bipolar disorder, substance abuse disorder (alcoholism), GERD, high cholesterol, obesity

ID: 1330579
Sex: M
Age: 34
State: MD

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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

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

Symptoms: Sore arm. Violent shakes and chills in the middle of the night. Fever (highest recorded 100.3F, but likely higher during the night). Back soreness, eye pressure, headache, short bursts of nerve pain in hands and feet

Other Meds: N/A

Current Illness: NOne

ID: 1330580
Sex: F
Age: 34
State: IN

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/19/2021
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: Penicillin

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

Symptoms: Joint pain (particularly leg/knee), inflammation, extremely heavy (and early) period passing blood clots. Three weeks (and continuing) for inflammation, two days for period symptoms.

Other Meds: Beachbody Energize, Beachbody Recover, collagen

Current Illness: Stomach/GI issues

ID: 1330581
Sex: F
Age: 71
State: NY

Vax Date: 04/28/2021
Onset Date: 04/30/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs, bee stings, raw tomatoes

Symptom List: Unevaluable event

Symptoms: Lightheadedness, dizziness and fainting

Other Meds: Baby aspirin, verapamil ER 180 MG tablet, low Sartain potassium 100 MG tab, Chlorthalidone 25 MG tablet, probiotics, biotin, vitamin D three, Citracal slow release.

Current Illness: No other illnesses

ID: 1330582
Sex: M
Age: 17
State: CA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 05/19/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Moderna administered to 17 year old.

Other Meds:

Current Illness:

ID: 1330583
Sex: M
Age: 28
State:

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: Ten minutes after receiving his vaccine I went to check on the patient knowing he had had a previous fainting experience with injections. I offered him water and he accepted stated he was ok. 15 minutes after receiving his vaccine the patient started to feel dizzy and raised his arm to alert me. I went to his side and asked if he was ok and he stated that "it's happening". His head started to fall back and body started to slump to the side. I supported his head and called for the other pharmacist who came over and we were able successfully get the patient to the floor in the supine position. I left the patient with the other pharmacist and called 911. By the time I came back he was awake and talking . He remained in the supine position until the medic came and took vitals. We had him sit up and within a few minutes back into his chair where I remained with him until his wife arrived. I gave him a water and approximately 1 hour after the incident the patient left with his wife.

Other Meds:

Current Illness:

ID: 1330585
Sex: F
Age: 12
State:

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: An incomplete Vaers report was previously submitted for this patient. Please reference Report. Please disregard previous report. Adverse Event At 10:10am, patient was sitting with her mother when she started to convulse while sitting upright in a chair and vomited as well. This episode lasted for about 15seconds. Past medical Hx Patient reported one syncope episode after receiving a shot in the past, blood was drawn. No Hx of seizure disorder Treatment Patient was given crackers, juice, water EMS called at 10:31am for patient to have further evaluation. Patient was in stable condition prior to transport to ER A translator used, parent consent was provided.

Other Meds:

Current Illness:

ID: 1330586
Sex: M
Age: 42
State: VA

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 05/19/2021
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:

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

Symptoms: Syncopal episode about 15 minutes post vaccination. BP was 76/44. IV fluids started and patient transported to ER by EMS.

Other Meds:

Current Illness:

ID: 1330587
Sex: F
Age: 16
State: NY

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: no adverse event as of this time wrong dilution of vaccine (1.3 ml vs 1.8 ml) monitor only, no treatment at this time. reported to Health office

Other Meds:

Current Illness: none

ID: 1330588
Sex: M
Age: 62
State: ID

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: Atorpin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I experienced day after vaccine, really horrible chest pains. I went to ER after 8 hours, and had blood pressure 160/100 and pulse of 120. They did x-rays, treated like a heart attack and gave me medicine for an ulcer and some other type of injection placed in IV line. On Sunday I have breathing issues, wheezing and could not catch my breath.

Other Meds: Thyroid medication

Current Illness:

ID: 1330589
Sex: F
Age: 17
State: ME

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/19/2021
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:

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

Symptoms: Pfizer vaccine mixed incorrectly (used sterile water).

Other Meds:

Current Illness:

ID: 1330590
Sex: F
Age: 28
State: CA

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

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

Lab Data:

Allergies: Keflex, cats, dogs, pollen, dust mites

Symptom List: Nausea

Symptoms: I had nervous sweats, I felt that my throat was closing. Once I got home, I had body aches, fever, and chills. It lasted about three days. I took Dayquil and nightquil

Other Meds: Sulfasalazine, Tamsulosin, Ibuprofen

Current Illness: No

ID: 1330591
Sex: M
Age: 24
State: IL

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

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

Lab Data:

Allergies: Amoxicillin- Headaches

Symptom List: Injection site pain

Symptoms: Patient received the J&J vaccine on 5/18/21. 12 hours later, he developed nausea, vomiting, cough, weakness, headaches, sweats, and chills. On 5/19/21, he came to the emergency department. He received 1L of NS, ketorolac 30 mg, ondansetron 4 mg, and orphenadrine 60 mg.

Other Meds: loratadine as needed for allergies and sumatriptan as needed for headaches

Current Illness: None

ID: 1330592
Sex: F
Age: 63
State: OR

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 05/19/2021
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: latex

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

Symptoms: Woke up in the middle of the night and couldn't breathe. Couldn't walk and talk at the same time for 3 days. Had no energy because it was too hard to breathe. Was put in the hospital for 3 days, checking on lungs and heart. Had chest X-rays etc. Could not come up with definite reason, but my condition did not improve. I was put on 2 liter of oxygen (which I was never on prior to shot), and told to see doctor in 7 days.

Other Meds: Wellbutrin, Lisiniprol, Morphine, Gabapentin, probiotic, vit D, Atorvastitin

Current Illness: high blood pressure, high cholesterol, chronic low back pain

ID: 1330593
Sex: F
Age: 43
State: NJ

Vax Date: 03/08/2021
Onset Date: 03/26/2021
Rec V Date: 05/19/2021
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: Dust, pet dander, pollen

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

Symptoms: Missed menstrual cycle - so far 2 Lump under left armpit

Other Meds: Amlodopine and iron

Current Illness: None

ID: 1330594
Sex: M
Age: 72
State: NY

Vax Date: 03/16/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
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: Severe Tinnitus

Other Meds: Tamsulosin 0.4mg capsule daily

Current Illness:

ID: 1330595
Sex: M
Age: 13
State: NY

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: At 1:03 pm, patient went over to father shortly after being vaccinated and stated "I do not feel well." He sat down and briefly for <1 second became unresponsive. Upon arousing, he was pale in color and clammy to touch. RN (school nurse was at pt. side). Dad and pt. stated he was worked up and nervous before vaccine. Dr. also at pt. side. 1:15pm: Pt. drank 2 juice boxes and color improved to pink, and conversing without problem. Dr. suggested to pt. and father to have pt. lie down when he returns for his 2nd dose in 3 weeks.

Other Meds: none

Current Illness: none

ID: 1330596
Sex: F
Age: 57
State: PA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/19/2021
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: milk allergy

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

Symptoms: Gall bladder inflammation the evening after vaccine. Abdominal pain that prevented sleeping and did not seem allayed by Tylenol. I am prone to gall bladder problems because of gall stones, but I have only had two major incidents in the last year, and both were the evening after my Moderna vaccine. This was the second. I reported the first incident in a separate report. Other adverse events: headache, single blotchy, warm-to-touch rash on arm about five inches below injection site.

Other Meds: omeprazole, famotidine, digestive enzymes, Allegra D

Current Illness:

ID: 1330597
Sex: M
Age: 16
State:

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/19/2021
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: c/o feet and toes tingling 15 minutes after vaccine. States tingling had happen before but cannot remember when or what he was doing. P66 strong & regular BP126/88. EMS evaluated student. Student went to nurse office to wait for his mother to take him home.

Other Meds:

Current Illness:

ID: 1330598
Sex: F
Age: 30
State: WA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/19/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: First dose was just cathartic roughly three hours after shot. Second shot starting again 3-4 hours after injection developed itchy hives purple in color on face and around injection site. Fever of 99.8 degrees Farhat and flu like symptoms that lasted for four days.

Other Meds: Adult multi-vitamin supplement with vitamin E and Saw palmetto supplement and vitamin B12

Current Illness: none

ID: 1330599
Sex: F
Age: 44
State: WI

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/19/2021
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: Patient had received her 2nd COVID vaccine and was about 10 minutes into her post vaccination waiting when she began feeling lightheaded, clammy, and nauseated. She got up and walked over to the staff desk where she continued to feel lightheaded and developed tunnel vision. Staff got her into a wheelchair and she subsequently lost consciousness. They noticed brief arm and leg jerking motions. She had no bowel or bladder incontinence or tongue bite. There was no postictal period. She is brought to the ED. She has had minimal to eat or drink today. She does note that she has had multiple syncopal episodes in the past including with blood draws and at the dentist. She currently feels fatigued and slightly nauseated. She was lightheaded and had difficulty standing after the episode so she was brought to the ED The episode sounds more consistent with syncope than seizure given the lack of postictal period, no tongue bite, bowel or bladder incontinence. She likely had some myoclonic jerks due to syncope in an upright position. EKG shows normal sinus rhythm without evidence acute ischemia or infarct, low suspicion for ACS or malignant dysrhythmia as cause for syncope, particularly since she had a clear prodrome prior to syncope. Symptoms appear most consistent with vasovagal syncope related to vaccination. Patient feeling improved after rest and p.o. intake. Able to ambulate steadily in ED. Appears appropriate for outpatient follow-up.

Other Meds:

Current Illness:

ID: 1330600
Sex: M
Age: 59
State: MD

Vax Date: 03/22/2021
Onset Date: 05/04/2021
Rec V Date: 05/19/2021
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: None

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

Symptoms: Patient developed renal infarct May 4, 2021. No previous history of thromboembolic disease. He subsequently developed severe upper chest pain and fatigue with an elevated high-sensitivity troponin I greater than 1000. He had cardiac catheterization on May 17,2021 which revealed nonobstructive coronary artery disease. His inflammatory markers are elevated (CRP, sed rate). He is scheduled for cardiac MRI to look for inflammatory disease of the heart. The patient himself is wondering if these events could be triggered by the COVID-19 vaccine he received.

Other Meds: None

Current Illness: Previous successful treatment of HCV 10 yrs ago.

ID: 1330601
Sex: F
Age: 101
State: PA

Vax Date: 03/03/2021
Onset Date: 04/13/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: Atarax [Hydroxyzine Hcl]Hallucinations Fluconazole LisinoprilOther (document details in comments)

Symptom List: Pain in extremity

Symptoms: UNKNOWN

Other Meds: amLODIPine (NORVASC) 10 mg tablet apixaban (ELIQUIS) 5 mg tablet(Expired) ascorbic acid, vitamin C, (VITAMIN C) 500 mg tablet aspirin 81 mg tablet betamethasone valerate (VALISONE) 0.1 % cream calcium carbonate-vitamin D3 500 mg(1,250mg) -4

Current Illness:

ID: 1330602
Sex: F
Age: 46
State: OH

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/19/2021
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: Day 2 - muscle aches and swelling at injection site. Day 3 & 4 - rash on front and back of torso.

Other Meds:

Current Illness:

ID: 1330603
Sex: F
Age: 48
State: CO

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/19/2021
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 Allergies

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

Symptoms: Pt received first Pfizer COVID-19 vaccine on 5/14. Pt was COVID positive three weeks prior to receiving the vaccine. Pt went to the ED on 5/15, c/o of chest pain. See below from initial consultation in the ED: 48-year-old female with a history of recently diagnosed COVID-19 approximately 3 weeks ago and subsequent COVID-19 vaccination yesterday presenting with chest pain. EKG reassuring and troponin negative. Chest x-ray without mediastinal widening or pneumothorax but with persistent bilateral pneumonia consistent with COVID-19. Considered PE but patient chest pain resolved following GI cocktail therefore less likely. No tachycardia or hypoxia. Plan for ACS rule out given HEART score 2. Patient signed out to the oncoming attending at shift change disposition pending repeat Trop/EKG but patient to continue to be primarily managed by PA. Pt was prescribed famotidine and MOM and told to F/U with their PCP.

Other Meds:

Current Illness:

ID: 1330604
Sex: F
Age: 52
State: ME

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/19/2021
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: Pfizer vaccine mixed incorrectly (used sterile water)

Other Meds:

Current Illness:

ID: 1330605
Sex: F
Age: 12
State: AZ

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/19/2021
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: penicillins

Symptom List: Vomiting

Symptoms: headache, lightheadedness, fatigue, and a fever of 100.4 - site of vaccine has a slight redness/tenderness (mom reports mild - consistent with vaccine localized reaction). Sxs have persistent through from 5/16/2021 to 5/18/2021, temperature has slightly improved at 99 with Motrin, but headache/fatigue persisting, and then patient woke 5/18/2021and vomited x 1. day 3 with slightly elevated temp, persisting headache, fatigue, and new onset sx of vomiting today. Motrin for fever, fluids, rest, and monitoring at home.

Other Meds: n/a

Current Illness: none

ID: 1330606
Sex: F
Age: 31
State:

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 05/19/2021
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: nkda

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient developed low grade fever, chest pain, breast pain, skin "on fire" sensation, and elevated blood pressure.

Other Meds: Xanax, lisinopril, zoloft, labetalol

Current Illness: Sore throat

ID: 1330607
Sex: F
Age: 59
State: NJ

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 05/19/2021
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: nkda, nor food allergies

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

Symptoms: right arm swelling and hand swelling

Other Meds: valsartan-hctz,

Current Illness: none

ID: 1330608
Sex: F
Age: 55
State: CA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/19/2021
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: Client was vaccinated with Moderna on 4/21/2021. Client was then vaccinated with Pfizer on 5/18/2021.

Other Meds:

Current Illness:

ID: 1330609
Sex: M
Age: 60
State: NJ

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 05/19/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: leg cramping and weakness, tingling and pins-needles head and face

Other Meds: no

Current Illness: no

ID: 1330610
Sex: M
Age: 39
State: VA

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 05/19/2021
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: Patient felt left arm tingling and dizzy within 15 minutes of vaccination. He slumped to the floor (syncopal episode). He felt better after resting and drinking some water, and was released to home.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm