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: 1333362
Sex: F
Age: 80
State:

Vax Date: 03/07/2021
Onset Date: 04/06/2021
Rec V Date: 05/20/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient hospitalized within 6 weeks of receiving COVID vaccination for stenosis of right carotid artery.

Other Meds:

Current Illness:

ID: 1333363
Sex: F
Age: 64
State: CA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt received Pfizer for dose 2 instead of Moderna.

Other Meds:

Current Illness:

ID: 1333364
Sex: F
Age: 32
State: AL

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: non stated

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

Symptoms: 11:50 am Moderna administered 11:53 and @ 30 seconds am it was noted that patient had multiple small red dots all over her arms and hands. No apparent respiratory distress or difficulty, no nausea, no dizziness. Patient stated they felt " normal" other than the spots. The RN who administered the vaccine did not recall noting the red dots on the patient prior to vaccine administration. At 11:55 am out of caution, the patient was transferred via wheelchair with two registered nurse escorts' to the facility emergency room. Clinical assessment did not indicate the need for administration of injectable epinephrine nor Benadryl ( but these were sent with escorting RN's).

Other Meds: unknown

Current Illness: unknown, non stated.

ID: 1333365
Sex: F
Age: 42
State: MD

Vax Date: 04/16/2021
Onset Date: 04/23/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: none known

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Developed sores (Ulcer) in both nostrils, mouth and lip exactly 1 week after receiving first shot.

Other Meds: Developed Sores (Ulcers) In both nostrils, in mouth and lip

Current Illness: none

ID: 1333367
Sex: F
Age: 29
State: TX

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

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

Lab Data:

Allergies: NKA

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

Symptoms: DID NOT EAT

Other Meds: NONE REPORTED

Current Illness: NONE REPORTED

ID: 1333368
Sex: M
Age: 21
State: CA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
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: NKA

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

Symptoms: at 2:55pm pt. c/o dizziness and lightheadedness. pt assisted to gurney and placed in supine position with BLE elevated. pt offered fluids vs monitored vitals t-97.7 BP: 93/68 RR-17 o2 SAT 99%RA. pt reported hx of dizziness with needlestick. vitals- BP: 90/68 P-73 RR-19 o2 SAT 99%RA patient verbalized relief from symptoms noted with no dizziness an light headedness as reported by pt. zero change LOC Zero SOB alert and verbally responsive.

Other Meds:

Current Illness:

ID: 1333369
Sex: F
Age: 76
State: CO

Vax Date: 01/09/2021
Onset Date: 01/10/2021
Rec V Date: 05/20/2021
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; sulfa

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fever was the main thing. I developed a rash on the arm - on the left arm - on the 19th of January with a fever. Doctor's visit on 21st. Treatment was ice. The fever went away. The rash was all the way down to my elbow and it lasted four days- through the weekend. It itchy and hot.

Other Meds: Irbesartan; Crestor; Cosamin; 1 a day vitamin; 81 afa aspirin; Vit C

Current Illness: no

ID: 1333370
Sex: M
Age: 27
State: GA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/20/2021
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: Disclaimer: I was diagnosed with COVID in December 2020. This may be the reason why my symptoms were out of the ordinary. The first shot gave me a mild chills and pretty bad body pain, however, the second shot gave me a sore throat, nasal congestion, chest congestion, wet cough, body pain, and shortness of breath. In order to tally out a second exposure to Coronavirus, I got tested twice and was negative. These adverse symptoms started 4 hours after the 2nd vaccine and are still the same intensity. I?m taking mucinex and anti histamines but nothing has been helping much. I?m on my 6th day now.

Other Meds: None

Current Illness: None.

ID: 1333371
Sex: F
Age: 47
State: WA

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/20/2021
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: There is no adverse event. This is reported due to administration error. First dose Moderna COVID vaccine was given on 4/17/21, but the 2nd dose Moderna COVID vaccine was given 1 day too early on 5/10/21 (i.e. 23 days after 1st dose). Minimum frequency between 1st and 2nd Moderna dose is 24 days.

Other Meds:

Current Illness:

ID: 1333372
Sex: F
Age: 48
State: CA

Vax Date: 04/04/2021
Onset Date: 04/26/2021
Rec V Date: 05/20/2021
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: Bee Stings

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Tinnitus - constant ringing in ears

Other Meds: Multi Vitamin

Current Illness: None

ID: 1333373
Sex: F
Age: 24
State: CA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt received Pfizer for dose 2 instead of Moderna.

Other Meds:

Current Illness:

ID: 1333375
Sex: F
Age: 16
State: PA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: NKDA

Symptom List: Rash, Urticaria

Symptoms: pt began to fill light headed about 5 minutes after vaccination. She then had some vomiting. The room was very warm. She was a little diaphoretic. The vomiting happened about 3 times then subsided. Patients color came back. She sat for a few additional minutes. Drank some water and left clinic completely stable. She has had a history of fainting with heat and with injections.

Other Meds: none

Current Illness: none

ID: 1333376
Sex: F
Age: 45
State: CA

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/20/2021
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 started to c/o itchy face about 9 mins after covid 19 Pfizer 1st dose vaccine . Vitals taken at 1044 BP 134/86, O2 98, P 82 at 1050 Dexamethasone 4mg IM lot 7051558 Expiration 02/2022 and Diphenhydramine 50mg IM lot 080008 Expiration 08/2022 was given, vitals at 1052 BP 138/96 O2 98% P80 at 1105 patient stayed she felt better no more itching reported. Vitals at 1105 VP 124/90 O2 99, P78. Patient was examined by doctor.

Other Meds:

Current Illness:

ID: 1333377
Sex: M
Age: 71
State: MT

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received the second dose of his COVID vaccine a week early. No adverse reaction during the 15minute wait time.

Other Meds:

Current Illness:

ID: 1333378
Sex: M
Age: 45
State: TN

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 05/20/2021
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: Sesame / Simvastatin

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

Symptoms: Initial pain (dull ache) in my left shoulder that subsided after 48 hrs. unless I raise my arm 90? from my abdomen or pick up anything over 5 lbs. Reported to Moderna after 4 weeks of pain.. Seen by my GP on 05/03/2021 who prescribed Naproxen. This did not help at all. I could not take steroids due to acute diverticulitis. Reported to Moderna again on 05/20/2021.

Other Meds: Equate Complete Multivitamin Adults 50+ Rexall Diphenhydramine HCL / Loratadine MiraLAX Alprazolam / Omeprazole / Phenytoin / Bupropion/ Ezetimibe / Norco / Amoxicillan / Metronidazole (last doses of antibiotics taken on same day as second

Current Illness: Acute Diverticulitis

ID: 1333379
Sex: F
Age: 38
State:

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: At 11:45 AM the day following my Vaccination, I began having chills. Then I had 102 degree fever. This last for roughly 24 hours. I has have heat and redness at the injection site.

Other Meds: None

Current Illness: None

ID: 1333380
Sex: F
Age: 51
State: CA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/20/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: Pt received Pfizer for dose 2 instead of Moderna.

Other Meds:

Current Illness:

ID: 1333381
Sex: M
Age: 53
State:

Vax Date: 02/18/2021
Onset Date: 03/18/2021
Rec V Date: 05/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient presented to the ED and was subsequently hospitalized within 6 weeks of receiving COVID vaccination. Diagnosis was severe sepsis.

Other Meds:

Current Illness:

ID: 1333383
Sex: F
Age: 24
State: CA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: client stated feeling dizzy few seconds after injection and had vasovagal response and passed out for approx 3 seconds, v/s remained stable, client required no further treatment, observed for a total of 35 mins, client states feeling better after 5 mins. left facility in stable condition, ambulating w/o assist, accompanied by mother ( who also received injection w/o incident)

Other Meds: n/a

Current Illness: n/a

ID: 1333384
Sex: F
Age: 31
State: CO

Vax Date: 04/27/2021
Onset Date: 05/11/2021
Rec V Date: 05/20/2021
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 reported

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

Symptoms: I experienced on 05-11-2021, morning sickness, nausea and vomiting. I was about 4-5 weeks pregnant at he time of vaccination. I contacted my midwife via telehealth portal and gave me nausea medication. My EDD: 12-15-2021. ****The dose of 04-27-2021, is actually my second, first dose. my first dose was deemed invalid due to storage. ***

Other Meds: None reported

Current Illness: None reported

ID: 1333385
Sex: F
Age: 23
State: TX

Vax Date: 04/22/2021
Onset Date: 05/01/2021
Rec V Date: 05/20/2021
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: No

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

Symptoms: Redness on upper arm around the place that took the dose after take the vaccine for around 9 days. Didn?t take medicine. The redness disappear after two days. The lymph is swollen (and pain if I touch it) on the side that take the vaccine after 9 days after taking vaccine. Then, it recovered after gradually.

Other Meds: No

Current Illness: No

ID: 1333386
Sex: F
Age: 24
State: TX

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: Patient c/o feeling dizzy, SOB, chest pain , sharp pain to the heart, numbness to the face. BP 120/80 Pulse 76 taken by nurse on site. EMS was also called to the scene. Patient refused ambulance transport and signed refusal form. Patient is okay and left facility with husband. Advised to monitor conditions closely and call 911 if it gets worse.

Other Meds: None

Current Illness: None

ID: 1333387
Sex: F
Age: 17
State: CO

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 05/20/2021
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: unauthorized use of COVID Vaccine. Discussed with parent, patient had fever and body aches after both vaccines. No other complaints.

Other Meds: none

Current Illness: none

ID: 1333388
Sex: F
Age: 25
State: MO

Vax Date: 04/29/2021
Onset Date: 05/01/2021
Rec V Date: 05/20/2021
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 reported

Symptom List: Injection site pain, Pain

Symptoms: Two days following vaccination, on May 1 2021, the patient experienced fatigue, headache, and swollen lymph nodes in the armpits. This lasted until May 10 2021. The patient notified the pharmacist today at the time of her second dose of the side effects experience with her first dose.

Other Meds: none reported

Current Illness: none reported

ID: 1333389
Sex: F
Age: 55
State: GA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: First 3 days (72 hrs) I had severe flu symptoms, the following week to 10 days after the dose, fatigue and malaise. At day 9 following dose (May 9) and since, there has been redness and swelling of mouth and tongue, bleeding during toothbrushing, painful tongue (like a burn from hot liquid) and excessive dryness of the lips causing splitting and peeling, diminished feeling in the inside of the mouth (no diminished feeling on tongue), and loss of taste.

Other Meds: desmopression acetate, levothyroxine, hydrocortisone, vitamin D and calcium, vitamin C, apple cider vinegar gummies,

Current Illness: meds are related to a dx of panhypopituitism

ID: 1333391
Sex: M
Age: 16
State: NY

Vax Date: 04/22/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: NKDA

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

Symptoms: pt under age. true age 16 y/o. Originally registered D.O.B

Other Meds: n/a

Current Illness: n/a

ID: 1333392
Sex: F
Age: 41
State:

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: ADMINISTERED COVID VACCINE (MODERNA 1ST DOSE) TO PT ON 5/14. PT WORKS IN THE STORE AND WAS ON HER WAY TO THE BACK OF THE STORE WHEN SHE NOTICED A CLEAR LIQUID RUNNING DOWN HER ARM FROM THE VACCINE ADMIN SITE. PT THEN TOOK OFF THE INJECT-SAFE BANDAGE AND SAID THERE WAS A CLEAR LIQUID POOLING IN THERE AS WELL. FROM THE DESCRIPTION, IT SEEMED THAT THE MAJORITY OF THE ADMINISTERED VACCINE LEAKED BACK OUT. PER RESEARCH FROM MODERNA/CDC, IT IS ADVISED THAT PT RECEIVE THE DOSE AGAIN, IN THE OPPOSITE ARM. PT WAS INFORMED ACCORDINGLY.

Other Meds:

Current Illness:

ID: 1333393
Sex: F
Age: 84
State:

Vax Date: 02/22/2021
Onset Date: 04/12/2021
Rec V Date: 05/20/2021
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: Patient positive for COVID-19 on 04/12/21 after completing vaccination. Asymptomatic and PCR test collected the same day came back negative.

Other Meds:

Current Illness:

Date Died: 05/11/2021

ID: 1333394
Sex: F
Age: 82
State: NC

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 05/20/2021
Hospital: Y

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

Lab Data:

Allergies: Methotrexate Shellfish

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

Symptoms: Mental Decline. Went into respiratory failure when released from rehab facility. Also had digestive issues.

Other Meds:

Current Illness: Copd Asthma

ID: 1333395
Sex: M
Age: 12
State: CA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Left arm swelling, redness, warmth and tenderness. Started on Bactrim for cellulitis treatment.

Other Meds:

Current Illness:

ID: 1333396
Sex: M
Age: 40
State: VA

Vax Date: 05/12/2021
Onset Date: 05/13/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: no known drug allergies

Symptom List: Injection site pain

Symptoms: Nausea then vomiting for a full 24hrs after receiving vaccine. It started approx 24hrs after receiving vaccine.

Other Meds: Suboxone 8/2mg

Current Illness: none

ID: 1333397
Sex: M
Age: 27
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Almost immediately after patient received the second dose of vaccine he stood up and passed out to the floor. He slightly seized for a few seconds until it stopped. When patient came to he stated that his knee hurt but he didnt believe he hit his head and he felt a bit light headed. Patient laid down for a while with us until he started to feel better. His BP was 102/58, but normally runs low. He said that he has passed out before and has been under a lot of stress, also had not eaten that morning before getting vaccinated. His significant other was with him and was planning to drive home. Patient was offered a call to EMS but refused.

Other Meds:

Current Illness:

ID: 1333398
Sex: F
Age: 60
State: NC

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: Sulfa, now also Moderna

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

Symptoms: Anaphylaxis 2 minutes after administration; gagging and heaving; throat swelling until she couldn't breathe; 0.3 mg EPIPEN administered into left thigh; EPIPEN relieved acute throat swelling so that patient was able to breathe; blood pressure 182/127 and pounding headache; transported to hospital by EMS.

Other Meds: Unknown

Current Illness: Unknown

ID: 1333399
Sex: M
Age: 25
State: TX

Vax Date: 04/21/2021
Onset Date: 04/24/2021
Rec V Date: 05/20/2021
Hospital: Y

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: Tremor

Symptoms: The patient had his 2nd Moderna vaccine on 4/21/21. He had headache and malaise for 2 days that resolved. On 4/24, he developed chest pain radiating to his jaw and left upper arm. He presented to the ED, he had an elevated troponin of 2.24 increased to 12.87. EKG showed ST elevation consistent with myocarditis. He was transferred to RRH and underwent cardiac cath on 4/26 which showed no CAD. He was not febrile. He was treated with metoprolol

Other Meds: None

Current Illness: None

ID: 1333400
Sex: M
Age: 23
State: SC

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: PATIENT WAS FEELING FAINT AFTER SHOT. I TOLD HIM TO PUT HIS HEAD DOWN AND HE STARTED SWEATING. HE ALSO STATED HE WAS HAVING PROBLEMS BREATHING. I GOT A COLD COMPRESS WHICH HELPED SOME. I MOVED HIM TO LAYING DOWN AND TOOK HIS BLOOD PRESSURE. PRESSURE WAS GOOD. PULSE WAS 49. MONITORED PATIENT FOR A LITTLE. HE STARTED FEELING BETTER AND GOT HIM BACK TO SITTING AND WAITED ANOTHER 20-30 MINUTES. PATIENT LEFT WITH HIS FIANCE.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1333401
Sex: F
Age: 88
State:

Vax Date: 03/28/2021
Onset Date: 04/01/2021
Rec V Date: 05/20/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient presented to the ED and was subsequently hospitalized with anemia within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1333402
Sex: F
Age: 16
State: VA

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: none known

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

Symptoms: Shortly after vaccination became warm, diaphoretic and pale BP 78/96

Other Meds: none known

Current Illness: none known

ID: 1333403
Sex: M
Age: 35
State: IN

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Needle became partially unscrewed resulting in a partial dose administered. Unable to determine how much vaccine was administered compared to how much was lost on the patient's arm. Following CDC guidelines, we administered a full dose in the opposite arm immediately. The patient was notified.

Other Meds: NA

Current Illness: NA

ID: 1333404
Sex: M
Age: 62
State: CO

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: N/A

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

Symptoms: The patient, was administered Moderna for his second dose, while he received Pfizer for his first vaccination. The tech checking the patient in, double verified with the patient that he was getting his Moderna vaccination. Pt states, ?yes, I am receiving Moderna for my second vaccination.? The car window states moderna 2nd dose from registration. The RN administering vaccines, confirmed with pt, ?are you receiving your second dose of moderna?? Pt again states, ?yes, I am receiving Moderna for my second vaccination.? After being vaccinated, the scribe, noticed the vaccination card has Pfizer for first vaccination. Clinical Lead, went to our Tech Master to verify in the system what the pt received for his first dose. System shows that pt received Pfizer for the first dose. Pt was observed for 15 mins and displayed no adverse reactions. Pt is alert and oriented x4, walking and talking independently. Medical Director, was called and notified.

Other Meds: N/A

Current Illness: N/A

ID: 1333405
Sex: M
Age: 21
State: CO

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/20/2021
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: Not that i am aware of

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

Symptoms: I started to feel my leg starting to shake on and off but when the weekend came around , it started to shake more and more and the pain started to spread

Other Meds: Zyrtec and Flonase for seasonal allergies and gabapentin

Current Illness: no other illnesses at the time of vaccination or up to a month prior

ID: 1333406
Sex: F
Age: 73
State: NY

Vax Date: 03/04/2021
Onset Date: 03/12/2021
Rec V Date: 05/20/2021
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: First got Hives, was prescribed Steroides after subsided started again with small red lumps like bug bites, and still happening. Constant itching, went to Dermatologist twice, no cure, prescribed itch cream. I have never had Hives or any kind of itching like this all my life until I received the vaccine.

Other Meds: yes

Current Illness: None

ID: 1333407
Sex: M
Age: 56
State: MI

Vax Date: 04/09/2019
Onset Date: 05/01/2021
Rec V Date: 05/20/2021
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: This case was reported by a consumer via call center representative and described the occurrence of vaccination failure in a 58-year-old male patient who received Herpes zoster (Shingrix) for prophylaxis. Co-suspect products included Herpes zoster (Shingrix) for prophylaxis, COVID-19 MRNA-1273 VACCINE (COVID-19 VACCINE MODERNA) (batch number 040B21A, expiry date unknown) for prophylaxis and COVID-19 VACCINE MODERNA (batch number 002B21A, expiry date unknown) for prophylaxis. Concurrent medical conditions included ulcerative colitis. Concomitant products included azathioprine. On 11th June 2019, the patient received the 2nd dose of Shingrix. On 9th April 2019, the patient received the 1st dose of Shingrix. On 9th April 2021, the patient received the 2nd dose of COVID-19 VACCINE MODERNA. On 11th March 2021, the patient received the 1st dose of COVID-19 VACCINE MODERNA. In May 2021, between 1 and 2 years after receiving Shingrix and more than 2 years after receiving Shingrix, the patient experienced shingles, feeling abnormal, back pain (with radiation), leg pain, generalized raised red spots limbs, red spotty rash, touch sensitivity increased, stinging, pain in thigh, buttock pain, burning sensation and bruising of leg. On an unknown date, the patient experienced vaccination failure (serious criteria GSK medically significant), feeling unwell and decreased immune responsiveness. The patient was treated with valaciclovir hydrochloride (Valtrex). On an unknown date, the outcome of the vaccination failure, feeling unwell, feeling abnormal, back pain (with radiation), leg pain, touch sensitivity increased, decreased immune responsiveness, stinging, pain in thigh, buttock pain, burning sensation and bruising of leg were unknown and the outcome of the shingles was not recovered/not resolved and the outcome of the generalized raised red spots limbs and red spotty rash were recovering/resolving. It was unknown if the reporter considered the vaccination failure, shingles, feeling unwell, feeling abnormal, back pain (with radiation), leg pain, generalized raised red spots limbs, red spotty rash, touch sensitivity increased, decreased immune responsiveness, stinging, pain in thigh, buttock pain, burning sensation and bruising of leg to be related to Shingrix and Shingrix. Additional details were provided as follows: The patient self reported the case. On an unknown date, less than 3 months after the 1st dose and less than 2 months after the 2nd dose the patient experienced shingles, feeling unwell, feeling abnormal, back pain (with radiation), leg pain, generalized raised red spots limbs, red spotty rash, touch sensitivity increased, decreased immune responsiveness, stinging, pain in thigh, buttock pain, burning sensation and bruising of leg. The patient had not felt good for a few weeks and then in the last week before the reporting date he started to get symptoms. The patient felt crappy and had shooting pain in his back on the left side and the pain shot down his leg and then he had a rash on his left leg later. His torso, back, butt, and upper thighs were stingy, burning, and he was sensitive to the touch on his skin before the rash appeared. He described it as aches and pains and a stingy, needle feeling. The patient had a history of ulcerative colitis and he took Azathioprine during the past few years so he was unsure if his rash was related to his weak immune system or the COVID vaccine. The patient had sent pictures of his left leg rash to his physician and they recommended him to see a dermatologist who diagnosed him with shingles after a biopsy and tests. They immediately put him on Valtrex and he claimed that things started to calm down and the rash was started to dry up. The patient described the rash as starting off as red spots that were raised up that looked like a target with a red circle around it that would get bigger. The raised spot looked like there was fluid inside. The dot in the middle looked dark in color and the red part that had spread looked like a bruise that was resolving with the color of yellow and brown. The patient had a few clusters of the rash on the inside and outside of his left leg and back on his calf. It was unknown if the reporter considered the shingles, feeling unwell, feeling abnormal, back pain (with radiation), leg pain, generalized raised red spots limbs, red spotty rash, touch sensitivity increased, decreased immune responsiveness, stinging, pain in thigh, buttock pain, burning sensation and bruising of leg to be related to COVID-19 VACCINE MODERNA and COVID-19 VACCINE MODERNA. The reporter consented to follow up.

Other Meds: Azathioprine

Current Illness: Ulcerative colitis

ID: 1333408
Sex: F
Age: 15
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: NKDA

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

Symptoms: Patient started feeling dizzy immediately after vaccine administration. Patient ate only a toast this morning. Patient given crackers and juice, water. Patient felt better Vital signs were stable Discharged to home

Other Meds:

Current Illness:

ID: 1333409
Sex: F
Age: 57
State: AL

Vax Date: 03/15/2021
Onset Date: 04/16/2021
Rec V Date: 05/20/2021
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: Metformin, Invokana, and Lortab

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

Symptoms: Four weeks after my vaccination I tested positive for COVID-19.

Other Meds: Yes

Current Illness: No

ID: 1333410
Sex: F
Age: 38
State: AK

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

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Difficulty breathing and tightness in chest after 2nd dose Moderna. Resolved after 15 minutes.

Other Meds:

Current Illness:

ID: 1333411
Sex: F
Age: 48
State: CT

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 05/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Acute onset tachycardia with palpitations 21 hours after the second dose of Moderna for Covid 19. I had a pulse oximeter reading heart rate 170 and O2 saturation of 94%. I took aspirin 81mg po once. After 15 minutes, I had left sided parasternal chest pain. I called my husband to take me to the Emergency Department. In the ED, EKG confirmed sinus tachycardia; cardiac enzymes were normal. I was given aspirin 162mg and nitroglycerin sublingual with relief within 30 minutes. Bedside echocardiogram did not reveal pericardial effusion or pericarditis. CT Angiogram of Chest did not identify pulmonary embolism. Chest xray was normal, no pneumonia or pneumonitis. D-dimer was slightly elevated. I asked asked to stay for 23 hour observation admission.

Other Meds: vitamin D 2,000 iu qd drospirenone and ethyl estradiol 3mg/0.02mg one tab qd

Current Illness: none

ID: 1333412
Sex: M
Age: 30
State: CA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/20/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Pt received Pfizer for dose 2 instead of Moderna.

Other Meds:

Current Illness:

ID: 1333413
Sex: F
Age: 29
State: KY

Vax Date: 03/08/2021
Onset Date: 03/10/2021
Rec V Date: 05/20/2021
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: Pain in soles of both feet, knee pain, joint pain, pain in knuckles

Other Meds: None

Current Illness: None

ID: 1333414
Sex: M
Age: 54
State: SC

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

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

Lab Data:

Allergies: Mustard seed, Mustard

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

Symptoms: Extremely Sore Left arm for 22 days. No treatments. Constipation for 6 days. Enema given. Light Fever on days 3,4, and 6. No treatments. Severe coughing with lung pain from day 7- Present. Treatment is cough drops/Dextromethorphan HBr on Day 26. No male penis erections from Day 10-30. No treatments. Extreme Nausea from Day 14-Present. Feelings of vomiting but never did. 4-6 hours each day.

Other Meds: None

Current Illness: None

ID: 1333415
Sex: M
Age: 72
State:

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 05/20/2021
Hospital: Y

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 had syncopal episode at home on 3/12/21, same day as second dose of vaccine, and fell. Was on floor for 8 days until admitted to hospital upon being found by family. Admitted with altered mental status and AKI.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm