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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1336632
Sex: F
Age: 14
State: MA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1336633
Sex: F
Age: 38
State: KS

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: Salmon

Symptom List: Anxiety, Dyspnoea

Symptoms: Headache, nausea, chills, fever, frequent urination

Other Meds: None

Current Illness: None

ID: 1336634
Sex: M
Age: 41
State: MO

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Hypertension-Mild, Additional Details: blueish right calf

Other Meds:

Current Illness:

ID: 1336635
Sex: F
Age: 13
State: MA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/21/2021
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: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1336636
Sex: F
Age: 20
State: VA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild, Systemic: Visual Changes/Disturbances-Mild, Additional Details: Patient noticed blurred vision prior to fainting. Was clammy and unresponsive. Patient came to quickly, but had another episode a few minutes later. No prior history with fainting after vaccinations.

Other Meds:

Current Illness:

ID: 1336638
Sex: F
Age: 54
State: OH

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

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: pfizer covid vaccine administered 5:15pm 5/20, at 5:30pm pt. experiencing deep breathing and chest pains; called 911 dispatcher told me to give 4-81mg ablets; life squad arrived immediately; evaluated pt.; it was evaluated as an anxiety event.

Other Meds:

Current Illness: hi bp depression

ID: 1336639
Sex: M
Age: 14
State: OH

Vax Date: 05/13/2021
Onset Date: 05/15/2021
Rec V Date: 05/21/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Sore throat, headache, body aches, fatigue, cough, dizziness, Fever and nausea. Still ongoing. Went to clinic to get COVID tested it was negative. Seen by a nurse practitioner, gave him meds for cough and nausea. Still hasn't resolved 7 days later.

Other Meds: none

Current Illness: none

ID: 1336640
Sex: M
Age: 40
State: VA

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: The day after having my first dose my right arm had soreness and discomfort. Then following my second dose my right arm has now been experiencing numbness & tingling for the past three days consistently.

Other Meds: None

Current Illness: None

ID: 1336641
Sex: F
Age: 16
State: MA

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1336642
Sex: F
Age: 34
State: IN

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Fever on 5/19, migraine and nausea on 5/21

Other Meds: Fiber, Zyrtec, lexapro

Current Illness:

ID: 1336643
Sex: M
Age: 14
State: MA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/21/2021
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: Error: Wrong Dose of Vaccine - Too High.

Other Meds:

Current Illness:

ID: 1336645
Sex: F
Age: 18
State:

Vax Date: 02/02/2021
Onset Date: 02/05/2021
Rec V Date: 05/21/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient had several ED visits within 6 weeks of receiving COVID vaccination. DOS include 2/5/21, 2/7/21, 2/22/21, 3/1/21, 3/4/21, 3/5/21 and 4/10/21. She presented to the ED and was subsequently hospitalized on 3/10/21, 3/22/21, 4/18/21, 5/8/21. All of these visits were related to mental health except on 3/1/21 when she had gastroenteritis.

Other Meds:

Current Illness:

ID: 1336646
Sex: M
Age: 40
State: IN

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: Flu symptoms, achiness, nausea, headache for about 24 hours. Went away with the rest and Tylenol

Other Meds:

Current Illness:

ID: 1336647
Sex: F
Age: 14
State: MA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/21/2021
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: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1336648
Sex: M
Age: 24
State: VT

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/21/2021
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: Vaso Vagal response, vomiting

Other Meds:

Current Illness:

ID: 1336649
Sex: M
Age: 17
State: IN

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: Nuts, Peanuts, Seafood, Eggs, Coconut, and Strawberries.

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

Symptoms: Chills, Muscle Soreness, fever and Severe Headache from about 5:30 p.m. 05-19-2021 - 1:30 p.m. 05-20-2021. Less severe chills, fever, and severe headache from 1:30 p.m. 05-20-2021 - 6:30 a.m. 05-21-2021. Less severe headache continues after shower finished 6:30 a.m. 05-21-2021 until present 05-21-2021.

Other Meds: Zyrtec

Current Illness: None

ID: 1336650
Sex: F
Age: 15
State: SC

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: No known

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

Symptoms: Patient had no reaction or side effects for 15 minutes after the shot. After 15 minutes, patient started experiencing uncontrollable movement of her upper arm and shoulder. The uncontrollable movement was mainly in the upper arm. Patient did have some uncontrollable movement in her fingers. Patient also had uncontrollable laugh as well which was not so significant. Patient's caregiver (mom) also indicated that she had trouble forming a sentence, but as per patient it was due to her being nervous. Patient stayed in the pharmacy for over an hour. Over the time, her symptoms had subside. The uncontrollable laughter was almost gone. Uncontrollable movement of her upper arm had also reduce significantly and patient was very calm after sometime. Patient was alert and able to understand and conscious. Patient was advised to see PCP or pediatrician for further evaluation.

Other Meds: No known

Current Illness: No known

ID: 1336651
Sex: F
Age: 15
State: MA

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1336653
Sex: M
Age: 35
State: NY

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Approximately 2-5 minutes after receiving vaccine patient fainted. Patient was pale, sweaty and unresponsive. Patient regained consciousness shortly after but was still pale and sweaty for some time. Patient was given water, ice pack and closely monitored for 30 minutes. Patient and family with him stated that he does not do well with shots and this is a common occurrence. After approximately 15 minutes color came back to patient and he stated he was fine although monitoring continued until 30 minutes.

Other Meds:

Current Illness:

ID: 1336654
Sex: F
Age: 37
State: OH

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

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Additional Details: Patient felt tongue swell and face felt itchy and numb. Patient was conscious, talking and able to swallow water. Gave her 25 mg of benadryl. Called 911, medics transported to hospital. Patient called and said hospital gave her more benadryl and steroids.

Other Meds:

Current Illness:

ID: 1336655
Sex: M
Age: 13
State: MA

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1336656
Sex: M
Age: 64
State: MA

Vax Date: 02/12/2021
Onset Date: 03/01/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies: Bacrtim, Losartin, Oregano

Symptom List: Unevaluable event

Symptoms: Tinnitus. Continuous. No treatment that I know of

Other Meds: Zinc, Vit B, Magnesium, Co Q10

Current Illness:

ID: 1336657
Sex: F
Age: 28
State: NC

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Additional Details: patient states her tongue and throat feel tingly similar to when she has reactions to peanuts, she states no difficulty breathing at this time.

Other Meds:

Current Illness:

ID: 1336658
Sex: F
Age: 63
State: OH

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: The patient states she woke up the morning after the vaccination and was in A-Fib. She states she has a pacemaker and has been in A-Fib before, but has not had an episode in "quite a while" She wondered if the episode could be related to the vaccine.

Other Meds:

Current Illness:

ID: 1336659
Sex: F
Age: 14
State: MA

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1336660
Sex: F
Age: 44
State: IN

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: Zoloft. Aleve, arothrymiacin, zithromiacin, sulfa drugs

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

Symptoms: Headache, fatigue, sore throat

Other Meds: Wellbutrin

Current Illness:

ID: 1336662
Sex: M
Age: 16
State: MA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/21/2021
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: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1336663
Sex: F
Age: 50
State: NC

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

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

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 4/22/21- Fever, Chills, night sweats, body aches 4/23/21- Fever, Chills, Body aches 4/24/21- Body aches, numbness and weakness on right side of body 4/29/21- Went to healthcare facility complaining of numbness and weakness on the right side of the body. Was seen by a doctor and did a neuro assessment. She then decided that she was having a ?stroke? or a ?brain bleed?. While at ER the PA did another neuro assessment and said could be having a stroke and was admitted into the hospital on 4/29/21

Other Meds: Multi-Vitamin Vitamin D, C Magnesium Zinc

Current Illness: none

ID: 1336664
Sex: F
Age:
State: TN

Vax Date:
Onset Date:
Rec V Date: 05/21/2021
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: Fever, headache, body ache, fatigue, loss of appetite, nausea, loss of sense of taste, sneezing, congestion, runny nose, coughing

Other Meds: None

Current Illness: None

ID: 1336665
Sex: F
Age: 40
State: HI

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1336666
Sex: F
Age: 26
State: ND

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA. Woke up around 2 am day after vaccine was administered with a fever and nausea. Nausea went away, but developed headache and body aches. Fever continued throughout the day. Woke up next day feeling fine.

Other Meds: N/A

Current Illness: N/A

ID: 1336667
Sex: M
Age: 26
State: NV

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Site: Pain at Injection Site-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Headache-Mild, Systemic: Hypotension-Mild, Systemic: Nausea-Mild, Systemic: Seizure-Mild, Systemic: Shakiness-Mild, Systemic: Visual Changes/Disturbances-Mild, Systemic: Weakness-Mild, Additional Details: Patient passed out within 5 minutes of receiving the shot. He had some convulsions and 911 was called. BP was 106/70. Pt stated he felt weird, his arm hurt, everything went white, and he felt numb before passing out and had a headache. Pt has history of passing out when giving blood and did not disclose that information. Pt was taken care of by paramedics that sent him home.

Other Meds:

Current Illness:

ID: 1336668
Sex: F
Age: 63
State: MD

Vax Date: 03/19/2021
Onset Date: 05/07/2021
Rec V Date: 05/21/2021
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: No known allergies Sensitive to morphine and some antibiotics

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

Symptoms: On or around May 7th I started to experience a significant decrease in blood glucose levels. Insulin requirements drastically were reduced over the following 7 days. Long acting insulin was reduced by 35% and short acting insulin by 75% within a 7 day period. I reported this phenomenon to my endocrinologist, on May 11. I also reported this to where I am a research participant in their study. Neithe researchers or my endocrinologist were able to provide an explanation. Therefore, I requested a C-Peptide test which came back negative. I wanted to report this as a possible correlation between the building of Covid antibodies/immune cells and depletion of glucose in type 1 diabetes. Thank you.

Other Meds: Humalog Insulin Basaglar Insulin Plaquenil 200mg Pravastatin 20mg Metanx Vitamin B Complex Levothyroxine 120mcg Valtrex 500mg Ubiquinol Pilocarpine 5mg

Current Illness: No illness at time of vaccination

ID: 1336669
Sex: F
Age: 62
State: MD

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/21/2021
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: Individual received her second moderna vaccine at 9:30 on 4/29/21- 12 hours later she went to bed and had right hip, groin and lower back pain that was described as extreme and she was unable to sleep. She did not take any medication at this time because she was afraid to due to the vaccine. On 5/1/21 she went to healthcare facility because she was having severe pain in her abdominal right lower quadrant, and stated she was worried she had appendicitis. 5/1/21 CT, blood work and urinalysis- client indicated the CT was clear, blood work was good, urinalysis showed some bacteria and she was started on antibiotics. 5/9/21 Went to healthcare facility due to not being able to walk, pins and needles sensation with stabbing hot pain in her groin and back. Her urine screen was clear, xrays were taken but looked okay considering her age. Stated She was started on prednisone, muscle relaxers and anti inflammatory medications. Stated she had never taken the meds they prescribed but they did not help. She went back to her PCP on 5/13 - was referred for Physical therapy. Individual stated she has gone to two therapy appointments and pain is lessening but is elicited with standing. pain continues to be localized in groin and upper leg.

Other Meds: Zetia, Vitamin D

Current Illness:

ID: 1336671
Sex: F
Age: 34
State: SC

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 05/21/2021
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: After 1st vaccine: within 1hr of vaccine Hives on face that lasted until the next morning. And recurrent pop up hives prior for 3 weeks After 2nd vaccine: Around 2am woke up with hives , Large raised wheals all over my body that did not go away until the next morning. Recurrent small hives for a week

Other Meds: None

Current Illness: None

ID: 1336672
Sex: F
Age: 34
State: IN

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: N/A

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

Symptoms: Headache, extreme fatigue, body and joint aches.

Other Meds: OTC vitamins, and fiber

Current Illness: N/A

ID: 1336673
Sex: F
Age: 86
State: NJ

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: The day after the first shot, my mother had bad knee pain in her left knee. It went on for days/week. After the second dose, days out she started feel very tired and bad pain in her feet that went to her hands and she couldn't get out of bed or urinate properly. Her facility doctor gave her Gabepentin for the pain but it did not help. She declined over a week or so and then She was admitted into the hospital for dehydration (March 19, 2021). The put a catheter in her to get urine out and bring her kidney function back to her normal (she does have kidney disease). Gave her more Gabepentin (which does not help pain in feet an hands) and released her to rehab. and she is now on oxygen. Rehab was bad so I got her out and released to her facility so she could receive rehab there. She declined again with the same reaction: extreme fatigue, can't walk and now urinates and defecates in an adult diaper and now breathing is very labored. She was admitted to the hospital and they can't find out why she is in this way. They did blood work, tests, scan and X-rays without any answers. They switched up meds on her and then released her to rehab since she hasn't walked in weeks/month at this point. She is regaining strength but now on oxygen even when sitting. She is 86 and walked with a walker all around her facility and when going to doctor appointments. Now she is in a wheelchair for doctor appointments since she has no strength and needs oxygen to walk. Her facility saw her decline after the second shot and my mom is very vocal and each day told them how she felt awful and it is because of the shot. She still has neuropathy in her feet and hands but it is not as painful as it originally was and it peaked and now just painful about a 5-6 on a scale of 0-10.

Other Meds: 2 high blood pressure meds, furosemide, vitamin C, montelukast, pepcid, hydroxurea, Zoloft, busbar, another anxiety med, levothyroxine

Current Illness: none

ID: 1336674
Sex: M
Age: 16
State: ME

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Weakness-Medium, Additional Details: Patient started to get lightheaded while sitting in a chair during his post vaccine observation time. He was hypotensive and had lost the color in his face. His mother and I were able to get him over to a bench to lay down, where he also drank a bottle of water. After roughtly 45 minutes he felt strong enough again to walk around and leave.

Other Meds:

Current Illness:

ID: 1336675
Sex: F
Age: 18
State: PA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Systemic: Fainting / Unresponsive-Medium, Systemic: Headache-Mild, Additional Details: got emotionally excited after shot fainted for 25 seconds, patient was tired bur responsive

Other Meds:

Current Illness:

ID: 1336676
Sex: M
Age: 34
State: MA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Stroke-Severe, Additional Details: pt says he experienced a stroke ~5 hours after receiving the second pfizer shot. pt did not mention experiencing a stroke after the first shot

Other Meds:

Current Illness:

ID: 1336677
Sex: M
Age: 58
State: IL

Vax Date: 03/13/2021
Onset Date: 03/15/2021
Rec V Date: 05/21/2021
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: Pain in extremity

Symptoms: Swollen ankles

Other Meds: Hydrochlorothiazide 25mg, Metoprolol 50mg, Vit B12, Vit D3, MultiVitamin

Current Illness: High Blood Pressure, rash, eye infections

ID: 1336678
Sex: F
Age: 51
State: IL

Vax Date: 01/21/2021
Onset Date: 01/29/2021
Rec V Date: 05/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: None

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

Symptoms: Ringing in left ear

Other Meds: None

Current Illness: None

ID: 1336679
Sex: M
Age: 41
State: GA

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: REPORTED FAINTING BY WITNESSES, NURSE VISUALIZED DIAPHORESIS, DRY HEAVING, PT REPORTED WEAKNESS.

Other Meds: None

Current Illness: None

ID: 1336681
Sex: F
Age: 65
State: NC

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/21/2021
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: Site: Pain at Injection Site-Mild, Systemic: right arm has been sore since first shot see below for more details-Mild, Additional Details: Her right arm has been sore, she can still feel where the needle went into her arm from the first Covid vaccination. This arm waxes and wanes with different severities of pain and the pain,sensations, and uncomfortableness has lasted 21 days. I told patient if the pain continues for another week or if the pain gets worse, seek medical attention for it.

Other Meds:

Current Illness:

ID: 1336682
Sex: F
Age: 22
State: IN

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Menthol

Symptom List: Vomiting

Symptoms: Dizziness, lump at injection site, muscle soreness

Other Meds: Birth control, Zoloft, Ibuprofen

Current Illness: Stomach virus

ID: 1336683
Sex: F
Age: 18
State: IN

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: n/a

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: weakness, nausea, headache, faintness all lasting all day the day after

Other Meds: Buspar and Prozac

Current Illness: n/a

ID: 1336684
Sex: F
Age: 19
State: NJ

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Site: Swelling at Injection Site-Medium, Systemic: Allergic: Difficulty Breathing-Medium

Other Meds:

Current Illness:

ID: 1336685
Sex: M
Age: 54
State: WI

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: No adverse outcome. Patient received 2nd dose of Pfizer at 14 days rather than 17 days. Instructed by provider to give 2nd dose early due to patient being transferred.

Other Meds:

Current Illness:

ID: 1336686
Sex: F
Age: 70
State: TX

Vax Date: 02/06/2021
Onset Date: 02/09/2021
Rec V Date: 05/21/2021
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: Three days after getting my first vaccine I started having swelling and soreness under both arms. It has been 3 1/2 months and these symptoms still exist. I did wait 2 weeks after last shot (3-1-2021) and had a DTP vaccine also.

Other Meds: Crestor, Trilipix, Benicar, D3, Probiotic, Miralax, Nystatin Ointment, Nifedipine/Lidocaine, Nutrafol, Omega 3 with CoQ10, Tylenol, Metronidazole

Current Illness: Anal Fissure

ID: 1336687
Sex: M
Age: 36
State: MD

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Penicillin

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

Symptoms: I would not describe as adverse, merely a side effect, and doing due diligence to report. I began tasting and smelling small amounts of smoke periodically. Confirmed with my spouse that she didn't smell anything. Started at ~18:00 and continued on until I'd gone to bed, ~23:00. No noted lasting effects the morning after.

Other Meds: Zyrtec

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm