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: 1330611
Sex: M
Age: 61
State: WA

Vax Date: 01/08/2021
Onset Date: 01/12/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Sudden sensorineural hearing loss in left ear noted Jan 12 2021 (4 days after 1st dose). Spontaneous recovery of some hearing within 48 hours. High-pitched tinnitus in both ears. another episode of sudden hearing loss noted Jan 31 2021 (5 days after second dose), with spontaneous recovery. Residual low frequency hearing loss in left hear; High frequency tinnitus remains in both ears as of reporting date (5/19/2021)

Other Meds: Losartan 50 mg QD

Current Illness: None

ID: 1330612
Sex: F
Age: 60
State: TN

Vax Date: 05/10/2021
Onset Date: 05/18/2021
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: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: Severe redness and Minor swelling at the vaccine site that will not go away. At the time of swelling (05/18/2021) the site became itchy

Other Meds: Metformin 500mg , Potassium CL ER 10MEQ, Telmisartan 80mg, Rosuvastatin Calcium 10mg, Pantoprazole SOD DR 40MG, Hydrochlorothiazide 12.5mg, Glimepiride 1mg, Amlodepine Besylate 5mg, Ibuprofen 800mg.

Current Illness: N/A

ID: 1330613
Sex: M
Age: 54
State: OH

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: 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: Pt received second Moderna vaccine today. During the 15 minute waiting period after the vaccine; he reported that his chest, back and torso felt tight and almost felt if he were having muscle spasms. We called the squad and had him sit down to rest. He said it felt better to stand and he tried relieving the discomfort by stretching his lower back. We checked his blood pressure (131/90) and asked if he wanted a bottle of water. He said that the feeling was beginning to fade and by the time the squad arrived; he said the felling had passed and he felt fine.

Other Meds: None reported

Current Illness: None

ID: 1330614
Sex: U
Age:
State:

Vax Date:
Onset Date:
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient diagnosed with dural sinus thrombosis, our stroke team believes this to be an incidental finding, as this was ordered for initial work-up of new onset headache. However, symptoms had resolved completely by time of COVID vaccination on 3/14/21.

Other Meds:

Current Illness:

ID: 1330615
Sex: F
Age: 64
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:
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: Pfizer vaccine mixed incorrectly (used sterile water)

Other Meds:

Current Illness:

ID: 1330616
Sex: F
Age: 38
State: MD

Vax Date: 05/14/2021
Onset Date: 05/18/2021
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: Ceftin

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

Symptoms: Early menstration. 6 days early in a regular cycle.

Other Meds: Claritin over the counter allergy medicine

Current Illness:

ID: 1330617
Sex: F
Age: 60
State: CO

Vax Date: 04/20/2021
Onset Date: 04/24/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Patient noticed itching that started the Saturday following the shot. On Monday night at 3AM she had a hard lump, swelling, and the injection site was hot. She took Benadryl and when she woke up at 9AM the swelling and itching had gone down. She took more Benadryl and the reaction was gone by the end of the day on Tuesday.

Other Meds:

Current Illness:

ID: 1330618
Sex: F
Age: 15
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Almost passed out BP 102/70 pulsestrong and regular. Pick up by mom.

Other Meds:

Current Illness:

ID: 1330619
Sex: F
Age: 82
State: OK

Vax Date: 05/12/2021
Onset Date: 05/15/2021
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: Penicillin - itching, hives

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 2-3 days following the 1 Pfizer dose, she notice brown spots on her left arm and her right elbow was itching. Since then, the spots are nearly faded away and her elbow has stopped itching.

Other Meds: Metroprolol Clonidine NSAID Potassium, D3

Current Illness: None

ID: 1330620
Sex: M
Age: 73
State: AZ

Vax Date: 05/04/2021
Onset Date: 05/12/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Developed pharyngeal candidiasis, treated with fluconazole, with resolution.

Other Meds:

Current Illness:

ID: 1330621
Sex: F
Age: 26
State: MD

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Erythematous, pruritic rash on bilateral ventral surfaces of arms. No dyspnea, no palpitations, no chest pain, no wheezing. No desquamation. The patient's mother had the same reaction after the 1st vaccine. Benadryl advised. The pt will go to the ER with severe symptoms. I called in the afternoon and the patient's pruritis had resolved with Benadryl. Rash was still present. They will call back if symptoms change and go to ER for any severe changes.

Other Meds: Unknown

Current Illness: Unknown

ID: 1330622
Sex: M
Age: 45
State: TX

Vax Date: 05/06/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Still having soreness in both upper arms, feel tired and yawning a lot, high or increased heart beat that comes and goes without physical exertion, some chest tightness, left leg cramping, occasional pale face that comes and goes as well.

Other Meds: Wellbutrin, Propanolol, Atorvastatin, Low dose Asprin

Current Illness: None

ID: 1330623
Sex: F
Age: 15
State: IN

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient was given more Pfizer vaccine, intern pulled up 1.8 mls of sodium chloride and then pulled up in same syringe about 0.2 ml from Pfizer vial that was not reconstituted and injected into patient's arm. The error was realized after the patient had already left. We called patient multiple times and had to leave a message to call us back. We left message with dr office as well and we will keep trying to get a hold of patient. We are not aware of adverse events occurring, but will make patient aware that they are more likely to have flu like symptoms because of the error. I have spoken to my intern and trained even more about the process of giving and have reported error.

Other Meds:

Current Illness:

ID: 1330624
Sex: M
Age: 25
State: FL

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Within 5 min of administration, pt states ge felt lightheaded and passed out. Pt was seated and under care of RN. RN secured pt's airway and applied sternal rub to which the pt quickly revived. VS were normal. EMS was called and pt refused to go. Pt felt much improved within 45 min of the event and left the clinic w/o further incident.

Other Meds: unknown

Current Illness: unknown

ID: 1330625
Sex: M
Age: 16
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine mixed incorrectly (used sterile water)

Other Meds:

Current Illness:

ID: 1330626
Sex: F
Age: 52
State: MO

Vax Date: 12/28/2020
Onset Date: 12/28/2020
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: Penicillin anaphylaxis reaction and difficulty breathing

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

Symptoms: 12/28/2020 patient received the 1st dose of the vaccine and had a fever, fatigue and lethargy. She took ibuprofen and Tylenol to help with the fever. She normally takes these medications as needed since she gets headaches and pain on a regular basis. By 1/3/2021, she developed a cough. On 1/6/2021, she went to see the doctor and was prescribed OTC cough drops and OTC Robitussin. On 2/2/2021, she went back to the doctor for the cough and was prescribed Tessalon Perles 200mg three times a day. A chest X-ray was done which showed left side infiltrate. On 3/2/2021, she went back to the doctor and was prescribed an Albuterol Inhaler. Coughing still not resolved and she called the doctor on 3/30/2021 for a phone consult. The doctor prescribed Singulair 10mg daily to help with the cough. On 5/10/2021, patient went to see the doctor again for a routine yearly checkup. Patient stopped Singulair since it wasn't helping much and patient is still complaining of coughing. On 5/17/2021, the doctor called in a prescription for Medrol Dose Pack to be taken for 6 days to help with her cough. She is currently still taking Medrol and cough has not resolved.

Other Meds: Dyazide; Norvasc; Potassium chloride; Protonix; Lexapro; Omega 3; Turmeric; Vitamin D2

Current Illness: None

ID: 1330627
Sex: F
Age: 18
State: FL

Vax Date: 04/28/2021
Onset Date: 05/01/2021
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: None

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

Symptoms: After the second shot, she has had ongoing headaches and painful swelling in her extremities that comes and goes. For instance, one day her entire palm of her hand, the next day her fingers, the next day the sole of her foot, a few days later it will be just one finger. It is very odd, but she has never had this issue. Also, she has never suffered from headaches until after this second shot. This has been going on for almost a month. We don't know what to do about it.

Other Meds: None

Current Illness: None

ID: 1330628
Sex: F
Age: 70
State: PA

Vax Date: 05/05/2021
Onset Date: 05/06/2021
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: Every inch of my body was so sore (but no fever or other symptoms) I didn't want to even turn over or move in any way in bed. Lasted two days.

Other Meds: none

Current Illness: none

ID: 1330629
Sex: M
Age: 24
State: NJ

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

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Systemic: patient felt lightheaded. Pt thought he wa going to faint. Pt never fainted but we called 911. They said his vitals were fine. Pt and EMT both agreed he should go to ER for observation.-Mild

Other Meds:

Current Illness:

ID: 1330630
Sex: F
Age: 23
State: MA

Vax Date: 05/19/2021
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:

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

Symptoms: Patient had a near syncopal episode

Other Meds:

Current Illness:

ID: 1330631
Sex: M
Age: 20
State: WI

Vax Date: 04/13/2021
Onset Date: 04/20/2021
Rec V Date: 05/19/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Pt is an otherwise healthy 20 year old male who presents with 2 weeks of blurred vision in R eye. The blurry vision developed suddenly 1 week after getting 1st dose of covid vaccine (moderna). He was seen in ophthalmology clinic on 04/29 and diagnosed with R optic neuritis; The patient reports that his blurred vision has not improved or worsened since onset. It affects both his near and far vision in the right eye only. He denies double vision, eye pain, headaches, nausea, vomiting, numbness, tingling, or weakness. This has never happened before. No recent illness including fever, chills, runny nose, cough, or sore throat. Pt admitted to hospital. Etiology of his optic neuritis is unclear, but possibility include demyelinating etiology (like clinically isolated syndrome). Infectious etiology was thought to be unlikely given no signs/symptoms of infection and reassuring lab workup. No family history of similar symptoms reported, making hereditary optic neuritis less likely. Other considerations included other primary ophthalmological disease, although otherwise reassuring ophthalmological exam makes that less likely. Unclear association with COVID vaccination.

Other Meds:

Current Illness:

ID: 1330632
Sex: M
Age: 35
State: UT

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Lip started to tingle at 6 pm after vaccine. Felt feverish and had soreness in left arm and left leg over night. Woke up unable to control left side of Face including lips. Also had left eye irritation. Went to ER, doctor is rolling out Bells Palsy. Treatment with steroid, anti viral, eyes drops, and eye ointment.

Other Meds: None

Current Illness: None

ID: 1330633
Sex: F
Age: 41
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
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: Patient has had an all over body rash since the first vaccine. She has self treated with benadryl and hydrocortisone and it has not gone away. RPH advised her not to receive dose #2 and to seek medical attention

Other Meds:

Current Illness:

ID: 1330634
Sex: F
Age: 49
State: VA

Vax Date: 04/24/2021
Onset Date: 05/13/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: On May 13th patient awoke with acute left shoudler/chest pain which progressed to pleuritic pain. Pain and pressure worse when lying down. Went to ED 5/14/21 and received labs includind d-dimer/trop and EKG with Echo. Given aspirin and NTG. Studies were normal and she was diagnosed with acute idiopathic pericarditis

Other Meds: Collagen, miralax, bactrim

Current Illness: NA

ID: 1330635
Sex: F
Age: 62
State: CA

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: antibiotics in general - penicillin; cestin; Biaxin; Cipro; Doxycycline; Azithromycin; sulfa - all these itching or rash morphine -throw up/vomiting; codeine - heart palpitations; Corn - shortness of breath

Symptom List: Injection site pain, Menorrhagia

Symptoms: First I had the itching and I came home and took a Benadryl and it subsided. The next day, I woke up stiff as a board. Everything hurt. Like I remember having the flu - feeling you get when joints etc. hurts all over. I took Tylenol - maybe took 1000 mg twice in that day. I have fibromyalgia and this was over and above that. The third day, the injection site on arm really hurt. The fourth or fifth day, the cough started - first a little irritation and then I started coughing and rattling and I have had the cough ever since. I have seen my doctor four times in the last month to get medications that work. I had to go to the walk in (Urgent Care at the clinic on Weekends) this Saturday (5/15/2021) and get this new medication that seems to be working - it's a steroid - it's Levaquin . Although, yesterday, I still had that overall body hurt (I was in bed all day) - could have been side affect of medication but today (after two doses) seems to be better and I'm not coughing as much.

Other Meds: no

Current Illness: no

ID: 1330636
Sex: F
Age: 40
State: NY

Vax Date: 04/17/2021
Onset Date: 05/08/2021
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: Systemic: Blood Disorder (diagnosed by MD)-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Headache-Medium, Systemic: Tachycardia-Severe, Additional Details: Pt presented to the ER complaining of racing heart, chest tightness, and uneasiness. Pt was sent home without dx. Pt returned to ER and insisted to be seen and that something was wrong. MD diagnosed pt with 2 blood clots in lungs, Causality was not confirmed, but relation to vaccine was not ruled out. Pt has been on blood thinner and did not receive 2nd dose.

Other Meds:

Current Illness:

ID: 1330637
Sex: M
Age: 55
State: TN

Vax Date: 02/03/2021
Onset Date: 02/05/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Having nerve/muscle pain in right upper arm. Pain with certain movements of arm and difficulty using arm due to pain with use. Awaiting appointment with VA to have issue evaluated.

Other Meds: Metformin, Pravastatin, Fish Oil, One a Day Vit, Vit D supplement

Current Illness: None

ID: 1330638
Sex: F
Age: 59
State: NH

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pfizer vaccine mixed incorrectly (used sterile water)

Other Meds:

Current Illness:

ID: 1330639
Sex: F
Age: 25
State: IL

Vax Date: 04/30/2021
Onset Date: 05/01/2021
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: RA

Lab Data:

Allergies: none

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

Symptoms: Patient is a Gravida 2, Para 1001, with a due date of 7/2021. She received the first dose of the vaccine when she was 29 0/7 weeks gestation. She experienced chest pain and shortness of breath and at 10:00 PM she was admitted to \HOSPITAL EMERGENCY ROOM. Her heart rate was 122, Temp 99.1 ?F (37.3 ?C) (Oral) | Resp 19 | SpO2 97% She was given IV fluids and Acetaminophen Tab 1,000 mg.

Other Meds: prenatal vitamin, docusate sodium

Current Illness: none

ID: 1330640
Sex: F
Age: 71
State: TN

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: IM
Vax Site: RA

Lab Data:

Allergies: NONE

Symptom List: Nausea

Symptoms: PATIENT GOT DIZZY WITHIN 5 MINUTES OF RECEIVING VACCINE-BECAME UNRESPONSIVE FOR ABOUT 30 SECONDS. SHE CONTINUED TO BE DIZZY/FAINT AND HAD A COLD SWEAT. PT WAS NOT INJURED WITH LOSS OF CONSIOUSNESS. CALLED 911, EMS ARRIVED AND TOOK PATIENT TO THE HOSPITAL. WHILE WAITING FOR EMS BLOOD PRESSURE AND HR CHECKS WERE PERFORMED WHILE PATIENT WAS IN LAYING DOWN POSITION.

Other Meds: NOT AVAILABLE

Current Illness: NONE

ID: 1330641
Sex: M
Age: 20
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Systemic: Fainting / Unresponsive-Mild

Other Meds:

Current Illness:

ID: 1330642
Sex: F
Age: 73
State: MD

Vax Date: 03/03/2021
Onset Date: 03/03/2021
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: none

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

Symptoms: Severe shoulder pain. unable to lift left arm. cant sleep on left side,

Other Meds: vitamin D, Lisinopril, Lasix, Lipitor, Amlodipine, Benadryl

Current Illness: none

ID: 1330643
Sex: F
Age: 71
State: WI

Vax Date: 04/22/2021
Onset Date: 04/28/2021
Rec V Date: 05/19/2021
Hospital: Y

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

Lab Data:

Allergies: sulfa, amoxicillin, erythromycin, ciprofloxacin, metronidazole, vilazodone

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

Symptoms: Headache, vomiting so severe it was associated with a troponin elevation despite coronary arteries having no significant coronary artery disease on cardiac catheterization.

Other Meds: various herbal supplements and nutritional supplements Docusate, miralax, bupropion, levothyroxine

Current Illness: NA

ID: 1330645
Sex: M
Age: 47
State: CA

Vax Date: 04/22/2021
Onset Date: 04/24/2021
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: Site: Pain at Injection Site-Mild, Systemic: Allergic: Rash Generalized-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Fever-Severe, Systemic: testicle swelling/lymphnodes groing swelling-Severe, Systemic: Headache-Severe, Systemic: Lymph Node Swelling-Severe, Systemic: Weakness-Severe, Additional Details: fever for 2 weeks, blister, rash all over body. drained and body felt beat up, fever of 102.4 for 2 weeks

Other Meds:

Current Illness:

ID: 1330646
Sex: F
Age: 23
State: WA

Vax Date: 01/02/2021
Onset Date: 01/22/2021
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 reported

Symptom List: Erythema, Pruritus

Symptoms: I experienced bad chest pains, flu like symptoms and was really hard to take my daily activities. I had a telehealth appointment the day I went to the ER to check my heart. They performed EKG, chest x-rays and everything was normal. They could not explain to me why I had those symptoms. I was told to take Ibuprofen 400mg a daily for about one week to help relieve the pain. I also got an inhaler of albuterol that I now use intermittently if I get chest pain. I do not have my lot number to provide

Other Meds: Anxiety medication

Current Illness: None reported

ID: 1330647
Sex: F
Age: 37
State: PA

Vax Date: 04/12/2021
Onset Date: 04/28/2021
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: None

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

Symptoms: 1. One week after injection: Site was bright red, and hot to the touch, with a small pus-filled lesion (3mm in diameter). As of 5/19/21, a small hard lump remains under the skin. 2. Despite a very consistent 27-29 day menstrual cycle, I have had no menses since receiving the vaccination.

Other Meds: None

Current Illness: None

ID: 1330648
Sex: F
Age: 40
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin, gluten

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

Symptoms: Flu like symptoms. Hugh fever 102. Headache, body aches, chills, extreme dizziness, lightheadedness

Other Meds: Iron, Blisovi FE, prebiotic

Current Illness: None

ID: 1330649
Sex: F
Age: 14
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pfizer vaccine mixed incorrectly (used sterile water)

Other Meds:

Current Illness:

ID: 1330650
Sex: M
Age: 36
State: WA

Vax Date: 04/24/2021
Onset Date: 05/15/2021
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: erythymican

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

Symptoms: pt says he developed a rash on both legs that looks like chicken pox. The rash is on the front and back of both legs below the knees. Pt says it is not spreading and has not seen a health care provider yet.

Other Meds:

Current Illness:

ID: 1330651
Sex: F
Age: 34
State: OH

Vax Date: 04/13/2021
Onset Date: 04/13/2021
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: Egg, latex, yellow jacket sting

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

Symptoms: Throat swelling, face swelling and numbness, rash on legs and arm 30 minutes to an hour after vaccination, numb/tingling face still a month later Treatment: Benadryl and then steroids and antihistamines at ER

Other Meds: None

Current Illness: None

ID: 1330652
Sex: F
Age: 27
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Pain in extremity

Symptoms: body aches that affected sleep and day to day activity. body aches affected the entire body including hands & feet & went into joints. skin felt like pins & needles. headache that is similar to a headache you would get with the flu. chills that are similar to chills with the flu. fever as high as 101.5 that went down with tylenol every 4 hours but did not fully go away until 24 hours later. all symptoms began 9 hours after shot & lasted until the following morning.

Other Meds: none

Current Illness: common cold 3 weeks prior to vaccine

ID: 1330654
Sex: M
Age: 70
State: MI

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: As I injected the patient with the dose, the needle was loose on the syringe and the vaccine had leaked out and patient was not given full dose and no was to tell how much actually went in the patients left arm. I was instructed to give a full dose in the patients right arm.

Other Meds:

Current Illness:

ID: 1330655
Sex: M
Age: 67
State: PA

Vax Date: 03/03/2021
Onset Date: 03/12/2021
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: NKA

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

Symptoms: UNKNOWN - Exposure to SARS-associated coronavirus

Other Meds: aspirin 81 mg chewable tablet atorvastatin (LIPITOR) 20 mg tablet lisinopriL (ZESTRIL) 5 mg tablet metoprolol succinate XL (TOPROL-XL) 25 mg 24 hr tabl

Current Illness:

ID: 1330656
Sex: M
Age: 26
State: NE

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

Symptoms: Gave patient vaccine at 9:55 AM. Patient was instructed to hang out seated in the pharmacy department for 15 minutes. Patient was feeling fine and proceeded to head to customer service counter in store where he lost consciousness falling forward hitting his face on the counter, and then fell back hitting the back of his head on the floor.

Other Meds: NONE

Current Illness: NONE

ID: 1330657
Sex: M
Age: 32
State: AR

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: none reported

Symptom List: Vomiting

Symptoms: Patient received 0.5ml of Janssen in right deltoid on 5/16/21. He experienced side effects (fever, chills and joint pain) starting that night at 8pm. He reports that his knees hurt so bad that he could not walk. He is treating with tylenol and ibuprofen and side effects have improved

Other Meds: none reported

Current Illness: none reported

ID: 1330658
Sex: M
Age: 47
State: ME

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pfizer vaccine mixed incorrectly (used sterile water)

Other Meds:

Current Illness:

ID: 1330659
Sex: M
Age: 45
State: LA

Vax Date: 05/17/2021
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: RA

Lab Data:

Allergies: Latex, strawberries

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

Symptoms: The patient did not report he had a latex allergy on the immunization screening questionnaire. Was given single dose TD vaccine that contained latex. Reported to clinic today with red raised rash to arms, legs, back, chest and forehead.

Other Meds: n/a

Current Illness: none

ID: 1330660
Sex: M
Age: 13
State: NV

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient is 13yoa and was administered the Janssen vaccine instead of Pfizer. Reporting due to patient age. Per mom no adverse effects have been experienced at this time.

Other Meds:

Current Illness:

ID: 1330661
Sex: F
Age: 42
State: CA

Vax Date: 04/09/2021
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: RA

Lab Data:

Allergies: none

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

Symptoms: Developed Pulsatile Tinnitus

Other Meds: none

Current Illness: none

ID: 1330662
Sex: F
Age: 46
State: ME

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine mixed incorrectly (used sterile water)

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm