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: 1336748
Sex: F
Age: 50
State: NY

Vax Date: 04/25/2021
Onset Date: 05/05/2021
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: Allergy to mold and dust mites; Occasional allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: 1) In the late afternoon on vaccination day has a very small fever and felt extremely tired. This continued for 3 days and resolved naturally. Did not take any medications. 2) On May 5 early in the morning noticed a redness at the injection site, slightly larger than the size of a quarter coin. No itch. Later in the day started to feel very tired again, although not as bad as on the days following the injection. On May 6 the redness on the arm doubled in size, redder around the edges and whiter in the middle. On May 7 in the late evening noticed that my left supraclavicular lymph node became swollen. The area felt tender and painful to touch. This continued for 84 hours and then resolved. No medication taken.

Other Meds: I have been taking a multivitamin pack for diabetics, pretty much on the daily bases for many years now. That has never caused an adverse reaction.

Current Illness:

ID: 1336749
Sex: M
Age: 65
State: MN

Vax Date: 03/26/2021
Onset Date: 04/18/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Other Meds:

Current Illness:

ID: 1336750
Sex: F
Age: 46
State: WY

Vax Date: 05/13/2021
Onset Date: 05/15/2021
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: NKA

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

Symptoms: Beginning 5/15/2021 at 2pm, she experienced a fever that was not relieved by OTC medications, genital itching, burning, and pain. She noticed blood when wiping after urinating at 8pm. She also noticed "sores, blisters" on the vulva. She went to the ER for evaluation at 6am 5/16/2021 and was treated with antiviral medication (Acyclovir PO). In the afternoon of 5/16/2021 highest fever recorded was 102.6. High fever associated with uncontrollable shivering. Took Tylenol and Advil rotating every 3hrs and fever finally dropped to 99.0. On 5/17/2021 she was put on an infusion of Acyclovir every 8hrs (outpatient). Sores on vulva became progressively larger and the vulva was swollen and hard. On 5/18/2021, no improvements were noted and fevers continued every afternoon. On 5/19/2021 She saw Dr. for further evaluation. She was diagnosed with a secondary infection and it was decided by the doctor that she was being treated with the wrong medication. The doctor decided her sores resembled Lipschutz ulcers. Her infusions of Acyclovir were discontinued and she was placed on Vancomycin and steroid infusions every 12hrs. She was also prescribed lidocaine ointment for pain relief. The fevers resolved after the first infusion of Vancomycin and steroids. On 5/20/2021, the sores stopped growing. On 5/21/2021 the swelling has decreased, vulva is softening and the pain is 5/10. She saw Dr. again today and was taken off the Vancomycin and put on PO Bactrim for 7 days. She has two more steroid infusions. She will then switch to oral steroids and gradually wean off of them. She will f/u with Dr. on 5/27/2021.

Other Meds: Allegra, Singulair, Advil

Current Illness: None

ID: 1336751
Sex: M
Age: 24
State: DE

Vax Date: 04/21/2021
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: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Breakthrough COVID symptoms- nausea, fever, vomiting, diarrhea, loss of smell and test one month after second vaccine

Other Meds: Adderal XR Valcyclovir

Current Illness:

ID: 1336752
Sex: F
Age: 82
State: MO

Vax Date: 02/25/2021
Onset Date: 04/14/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Symptom onset 4/12/21 (cough, diarrhea, feverish, nausea, chills, fatigue and abdominal pain). 4/14/21 PCR positive for COVID-19 virus. Admitted inpatient 4/14/2021.

Other Meds:

Current Illness:

ID: 1336753
Sex: F
Age: 43
State: TX

Vax Date: 12/18/2020
Onset Date: 12/19/2020
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: Statin drugs (hives and swelling), triamterene/HCTZ (hives)

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

Symptoms: The day after the vaccine, participant felt very tired and slept most of the day. Participant complained of headaches and took Tylenol 500mg -1000mg three times a day and would add Ibuprofen 400mg if needed. Headaches can range from mild to severe and cause her to wake up in the middle of the night. Participant continued to have daily headaches and hesitant to get the 2nd dose. However, she went ahead and got the 2nd dose of the vaccine. The headaches intensity and severity remained the same. After about 1 week after the 2nd dose, participant had an online consult with the doctor. Doctor did not prescribe anything and participant continued to take Tylenol and ibuprofen.

Other Meds: Vivelle; Claritin

Current Illness: None

ID: 1336754
Sex: F
Age: 70
State:

Vax Date: 03/05/2021
Onset Date: 04/30/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient presents to the ED complaining of chest tightness over last 2 days. Also noted racing heart rate and extremity tremors while walking up her stairs. Episode lasted for 2 minutes, continued to have these short episodes. Pain went away when lying down. Also felt back pain and nausea. No SOB or dizziness. Patient suspected of having unstable angina, with known CAD status. Patient was asymptomatic upon discharge.

Other Meds:

Current Illness:

ID: 1336755
Sex: F
Age: 27
State: WA

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, ceclor, erythromycin

Symptom List: Pharyngeal swelling

Symptoms: over the course of ~24 hours starting the morning after the second dose: 100 degree fever, chills, joint and muscle pain and aches, extreme weakness and dizziness preventing most movement. couldn't stay sitting or standing due to dizziness and was bedridden for most of the day. could still eat and drink normally and didn't have any issues keeping fluids down, but general movement was extremely difficult and painful. the worst cause of the dizziness seemed to be through sight and was manageable as long as my eyes were kept closed. symptoms were treated with ibuprofen and acetaminophen and mostly cleared up by the next morning with the exception of mild aches and dizziness.

Other Meds: paroxetine (paxil) 40 mg once daily, lamotrigine (lamictol) 100 mg once daily, venlafaxine (effexor) 150 mg once daily, adderall 5 mg twice daily, quetiapine (seroquel) 100 mg once daily

Current Illness: none

ID: 1336756
Sex: F
Age: 11
State: MI

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: Patient was seen for a covid-19 vaccine. Patient's parent filled out the consent form and the demographic form and entered the DOB on both forms. the nurse verified the DOB with the patient/parent and changed the DOB on the consent sheet because that is what she was advised when asking the patient. (Front Staff) then called the Mom, to clarify the date of birth of patient. Mom stated they lied about her daughter?s date of birth and made a parental decision to have her daughter get the vaccine early and changed her birthday, her actual DOB . (Practice Manager) called person from County and was advised not to give the patient the second dose. The second dose can only be given after the patient turns twelve. We were also advised to enter the vaccine into MCIR and fill out a VAERS form. The VAERS form was submitted on 5/21/2021. (Practice Manager) reached out to the Mom, to advise her that patients second Covid-19 appointment will be canceled. She was also advised if the insurance comes back and denies payment of the vaccine; she will be held responsible for the amount that is due. mom asked when patient can get the second dose and I advised her she had to wait until patient turns 12 years old. She asked if the patient would have to restart the vaccine. I advised her I cannot answer that because she does not fall into the guidelines and would have to reach out to the county and I provided her with the number to reach County Covid-19. At this time there are no adverse reactions to report.

Other Meds:

Current Illness:

ID: 1336757
Sex: M
Age: 23
State: MO

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: nkda

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received vaccine and proceeded to the post vaccination waiting area, patient experienced a syncope episode within 5 minutes of vaccination. Patient was back to being completely alert within 5 minutes and did not want to seek emergency treatment. Patient left on his own power.

Other Meds: Ibuprofen

Current Illness: none

ID: 1336758
Sex: F
Age: 35
State:

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: Patient was given second dose pfizer after receiving first dose moderna.

Other Meds:

Current Illness:

ID: 1336759
Sex: F
Age: 39
State: FL

Vax Date: 05/21/2021
Onset Date:
Rec V Date: 05/21/2021
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: Shellfish and Corn

Symptom List: Rash, Urticaria

Symptoms: Patient experienced dizziness, and tingling in both arms and legs

Other Meds: Benadryl, Astelin, Magnessium, Epi-Pen, ALbuterol

Current Illness: Migraine 2 weeks ago

ID: 1336760
Sex: F
Age: 58
State: KY

Vax Date: 02/02/2021
Onset Date: 05/21/2021
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: Patient tested positive for COVID-19 on 05/21/2021

Other Meds:

Current Illness:

ID: 1336761
Sex: F
Age: 31
State: OH

Vax Date: 03/16/2021
Onset Date: 05/14/2021
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: no known allergies other than to metals such as Nickle

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

Symptoms: It has been exactly one month since my second dose of the Covid-19 vaccine and I have been experiencing fairly extreme lightheadedness and dizziness for the last week. Symptoms began on Friday, May 14th in the evening and have yet to go away. I do not have ringing in the ears but I do feel as though I have the spins - constantly. the feeling of spinning is not visual in any way, only in my head. I have not experienced stomach nausea. It feels like Vertigo, I have no history of any vertigo or dizziness.

Other Meds: Only medication i am taking is Gianvi - Birth Control

Current Illness: none

ID: 1336762
Sex: F
Age: 52
State: TX

Vax Date: 12/31/2020
Onset Date: 12/31/2020
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: 1. Left side facial numbness 2. Anxiety 3. Smile is symetrical 4. Protruding tongue centered 5. Elevated BP 172/112 approx. 10:30am 6. 2nd BP reading 153/93 10:58am 7. 3rd BP reading 146/89 11:15am 8. O2 Sats 98% on RA 9. HR 72, RR 18

Other Meds:

Current Illness:

ID: 1336763
Sex: F
Age: 51
State: OH

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: penicillin contrast dye

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

Symptoms: pt felt light headed and sweaty a few minutes after vaccine. we gave her ice packs and she felt much better and went to leave for work. She then started to feel thirsty and woozy. We laid her on her back and and kept a close eye on her breathing. She said her breathing was fine. When she started to say her throat was dry and her tongue looked swollen we gave her an epi-pen and the ambulance took her to the hospital.

Other Meds: rosuvastatin metformin singulair albuterol vitamin D motrin

Current Illness:

ID: 1336764
Sex: F
Age: 43
State: NC

Vax Date: 04/01/2021
Onset Date: 04/09/2021
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: I am allergic to corn and anything related to Demerol and diary

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

Symptoms: I was having strange heart palpitation. i had really bad gas that caused heart racing, vomiting all the way until the 4/20/21. I starting feeling better 21st and I was at 100 percent on the 6th of May

Other Meds: Not at the time

Current Illness: None

ID: 1336765
Sex: F
Age: 21
State: NE

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: no

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Hives and itching resolved with 2 doses of benadryl

Other Meds: no

Current Illness: no

ID: 1336766
Sex: M
Age: 27
State: MD

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Within 1 minute of receiving the vaccine, patient was walking down an aisle in the store and lost consciousness. He bumped the back of his head on a shelf and fell to the floor. He quickly regained consciousness and remained still. His blood pressure was taken and was within normal range. EMS was called and arrived 10 minutes later and patient was taken under their care.

Other Meds: n/a

Current Illness: none

Date Died:

ID: 1336767
Sex: F
Age: 19
State: IL

Vax Date: 04/03/2021
Onset Date: 04/30/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Patient presented 5/16/2021 with 1 week dizziness, fever and sore throat, found to have acute myopericarditis c/b cardiogenic shock and bradycardic arrest.

Other Meds: Cetirizine

Current Illness: None

ID: 1336768
Sex: F
Age: 14
State: PA

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Nuts-hives

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

Symptoms: Patient stated she was not feeling well after her first dose of pfizer covid vaccine. Patient had seizure like activity and was unconscious for a about 15-30 seconds. an ambulance was called vitals were taken. patient and patent family declined transport to medical facility.

Other Meds:

Current Illness:

ID: 1336769
Sex: F
Age: 67
State: NY

Vax Date: 12/29/2020
Onset Date: 12/29/2020
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: Unevaluable event

Symptoms: Tingling on left side of face

Other Meds:

Current Illness:

ID: 1336770
Sex: F
Age: 41
State: NY

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: none

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: 41 yo female with PMHx morbid obesity (s/p gastric bypass) and HTN, p/w LH, after COVID vaccine. No h/o LH, palp, arrthythmia. Has h/o HTN, on losartan and metoprolol. Took meds today, no recent dose changes, though has had doses decreased in past year after gastric bypass. Has not had BP checked recently due to doctor visits being mostly virtual now. Has had h/o dumping syndrome, but none recently. Felt better after sitting down, HR initially high 40s, BP 108/80, shortly after HR up to 55 with resolution of sxs. After 20 min, orthostatics checked, which were negative. Pt ambulated without symptoms. Pt released after 30 min observation period.

Other Meds: metoprolol, losartan

Current Illness: none

ID: 1336771
Sex: F
Age: 56
State: NY

Vax Date: 02/02/2021
Onset Date: 04/30/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Shingles on cervical left side, rash, burning and tingling

Other Meds: Norvasc Mometasone topical

Current Illness: None

ID: 1336772
Sex: U
Age: 20
State:

Vax Date: 04/26/2021
Onset Date: 04/26/2021
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: Chest tightness, mild diff breathing. EMS administered albuterol. Pt felt relief. Pt alert and conversing properly.

Other Meds:

Current Illness:

ID: 1336773
Sex: F
Age: 45
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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Trembling, involuntary movement of arms, back, face.

Other Meds: None

Current Illness: None

Date Died: 05/20/2021

ID: 1336774
Sex: F
Age: 59
State: NC

Vax Date: 03/26/2021
Onset Date: 05/13/2021
Rec V Date: 05/21/2021
Hospital: Y

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: Codeine, Morphine, Percocet

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient developed fever, dyspnea and headache on 5/12/2021; tested positive for COVID-19 on 5/12/2021; patient died on 5/20/21

Other Meds: Tacrolimus, Cellcept, prednisone and cyclosporine

Current Illness: Hx of double lung transplant in 2005 (chronic rejection) and ERSD on hemodialysis

ID: 1336775
Sex: M
Age: 60
State: GA

Vax Date: 04/07/2021
Onset Date: 04/28/2021
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:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient hospitalized due to COVID-19 after testing positive and being fully vaccinated.

Other Meds:

Current Illness:

ID: 1336776
Sex: F
Age: 63
State: UT

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: Penicillin and Sulfa.

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

Symptoms: She had the vaccine, had a headache, had nausea, headache pain that still persists. She does not have any rashes to the vaccine site. She just have the headache that does not want to go away. When she put the needle in she felt like she had a very large needle and felt pain which radiates from her neck and all the way down her arm. She took ibuprofen for the symptoms, but did not call her doctor. She is also have pain in her muscles as well. She did not want to take much as she wanted to have her body fight the reactions

Other Meds: Lisinopril, Nexium.

Current Illness: None.

ID: 1336777
Sex: M
Age: 36
State: PA

Vax Date: 04/08/2021
Onset Date: 04/28/2021
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: NKA

Symptom List: Nausea

Symptoms: Exposure to COVID-19 virus

Other Meds: acetaminophen (TYLENOL) 500 mg tablet BENEFIBER SUGAR FREE, DEXTRIN, 3 gram/4 gram powder bisacodyL (DULCOLAX) 5 mg EC tablet diaper,brief,adult,disposable (PREVAIL BRIEF LARGE) misc diaper,brief,adult,disposable (Protective Underwear Large

Current Illness:

ID: 1336778
Sex: F
Age: 36
State: CT

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Fever, tiredness, feel like I got run over my a truck, nauseated, stomach upset, body pains, chills, hot and cold flashes, weak

Other Meds: Prozac, multivitamin

Current Illness:

ID: 1336779
Sex: F
Age: 71
State: CO

Vax Date: 01/16/2021
Onset Date: 01/22/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies: Toridal, codeine, internal iodine, sulfa

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

Symptoms: Sore arm for 24 hrs Appendicitis 7 days later

Other Meds: Synthroid

Current Illness: none

ID: 1336780
Sex: M
Age: 53
State: FL

Vax Date: 03/09/2021
Onset Date: 03/21/2021
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:

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

Symptoms: Swollen & red right index finger with no trauma.

Other Meds: Entresto 24-26 MG Spironolactone 25 MG Carvedilol 12.5 MG L

Current Illness:

ID: 1336781
Sex: F
Age: 49
State: CA

Vax Date: 05/21/2021
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:

Symptom List: Tremor

Symptoms: FELT DIZZY AND FELL ON THE FLOOR, HAS NOT EATEN PRIOR TO VACCINE, BP: 135/98, HR 94. PT WAS INSTRUCTED TO F/U WITH PCP. REFUSED TRANSPORT.

Other Meds:

Current Illness:

ID: 1336782
Sex: F
Age: 30
State: WI

Vax Date: 05/13/2021
Onset Date: 05/14/2021
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: Lactose intolerant

Symptom List: Erythema, Pruritus

Symptoms: Painless intermittent acrocyanosis of both hands starting day following vaccine.

Other Meds: No meds

Current Illness: None

ID: 1336783
Sex: M
Age: 40
State: NC

Vax Date: 05/15/2021
Onset Date: 05/15/2021
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: Not known

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

Symptoms: Bad kidney pain on right side vomiting drained achy fever lasted 3 days and still doesn't feel great very sluggish and still some pain.

Other Meds: Goody powders and multi vitamin and omprezole 20 mg

Current Illness:

ID: 1336784
Sex: F
Age: 25
State: VA

Vax Date: 04/27/2021
Onset Date: 05/10/2021
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: N/A

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

Symptoms: I have not gotten my period. It is 2 weeks late. I did confirm with my doctor that it is not pregnancy. My stress level is not high leaving the only other logical option being a vaccine reaction.

Other Meds: N/A

Current Illness: N/A

ID: 1336785
Sex: M
Age: 70
State: MS

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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: Aspirin; Sulfur; Cat scan dye (contrast material); Peppers (jalapeno); Dark leafy greens

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Respiratory distress.

Other Meds: Rosuvastatin, hydrochlorothiazide, losartin, bystic, vitamins E B12 D3 , and saw palmetto

Current Illness: None

ID: 1336786
Sex: F
Age: 51
State: TX

Vax Date: 01/13/2021
Onset Date: 01/13/2021
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: 1. Dry mouth 2. Tightness when swallowing

Other Meds:

Current Illness:

ID: 1336787
Sex: F
Age: 36
State: LA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: sulfa

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

Symptoms: Chest pain

Other Meds: ertility meds

Current Illness: none

ID: 1336788
Sex: M
Age: 44
State: LA

Vax Date: 05/14/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies: penicillin

Symptom List: Pain in extremity

Symptoms: This is a 44 M with NIDDM, HTN, HLD, Schizophrenia here with c/o fever and generalized body aches for about 7-8 days. Says was having body aches for about 8 days, had COVID 19 vaccine first dose on 5/14/21. Since then, had worsening body aches and also started having fever(not sure how much). Urine color changed to brown in the past week. No change in appetite or nausea or vomiting prior to admit as per him. No new medications and does not consume recreational drugs. Not an alcoholic, no recent trauma, does not work out and was not exposed to extreme heat or cold recently. In ER, patient was found to having AKI, shock liver, CK level which is too high to be calculated, had 1 episode of high-grade fever. He was therefore started on IV fluids and admitted for further management of rhabdomyolysis. Overnight had no urine output and having poor urine output since this a.m.. Had 1 episode of nausea and vomiting this morning. No more fever since on the floor. Complaining of epigastric pain that woke him up from sleep this afternoon.

Other Meds: vitamin d 50000 iu weekly, metaglip 5/500 am, novolog, lisinopril 20mg daily, trileptal 300mg BID, benztropine

Current Illness:

ID: 1336789
Sex: F
Age: 39
State: SC

Vax Date: 04/28/2021
Onset Date: 05/06/2021
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: I experienced a reaction known as Covid Arm. It started with a small itchy red spot on my arm slightly below the injection site. It progressed to a very large, red, inflamed, hot to the touch, itchy rash that took about 5 days to go away completely.

Other Meds: June Fe, Daily Multivitamin Gummy

Current Illness: None

ID: 1336790
Sex: F
Age: 63
State: OK

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

Lab Data:

Allergies:

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

Symptoms: Patient was given a expired covid shot due to storage procedure. She received her 2nd dose. She is not experiencing any adverse reaction but it was an error on our part. We have called both cdc and Pfizer and they said we can revaccinate. Patient is coming back to get revaccinated.

Other Meds:

Current Illness:

ID: 1336791
Sex: F
Age: 51
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No know drug allergies

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

Symptoms: Patient given 2nd dose of vaccine 21 days after receiving the first dose. Upon follow-up with patient she experienced no adverse events from the vaccine.

Other Meds: unknown

Current Illness: unknown

ID: 1336792
Sex: F
Age: 41
State: CO

Vax Date: 04/01/2021
Onset Date: 04/23/2021
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: codeine causes hives

Symptom List: Vomiting

Symptoms: Patient had both shots ringing in ears started prior to 2nd vaccine, unclear other cause being referred to ENT

Other Meds: nortriptylline, verapamil

Current Illness: denies

ID: 1336793
Sex: F
Age: 32
State: CA

Vax Date: 05/17/2021
Onset Date: 05/21/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I started bleeding vaginally 8 days earlier than my period usually would start. I am usually like clockwork, but I began my period 8 days early.

Other Meds:

Current Illness: None

ID: 1336794
Sex: F
Age: 37
State: MD

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: Pt. reported nausea after waiting. 30 minutes observation period. Seen by Medic . No intervention. Left on stable condition at 15:12 p.m. Recorded by RN.

Other Meds:

Current Illness:

ID: 1336795
Sex: F
Age: 35
State: WA

Vax Date: 04/14/2021
Onset Date: 04/24/2021
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: tuna fish hazelnuts

Symptom List: Injection site swelling, Limb discomfort

Symptoms: April 14 vaccination; April 15 chills, nausea, vomiting; April 24-May 1 leg paresthesias; April 29 upper body post exertional maalaaise following activities of daily living; May 1 subtle paresthesias in hands arms, start of period; May 1-8 paresthesias resolve with aid of 250mg magnesium, post exertional malaise continues, muscle weakness in abs and legs gradually worsens; May 8 can't walk back from mail box, call husband for ride, arm and neck weakness; May 10 parents arrive, take over child/house care; May 11 PCP appointment, Neurologist and MRI referral; May 14 bed ridden with muscle weakness, need help eating/brushing teeth etc.; May 15-18 mobility allows for movement around house; May 19 MRI; May 21 MRI results benign, muscle weakness persists, allowing for low levels of mobility around house but continued need for help with child care and household chores. Self-administered daily medications: Vitamin D 8,000, CoQ10, magnesium 250 mg, ibuprofen 600-800 mg

Other Meds: levothyroxine .075 mg

Current Illness:

ID: 1336796
Sex: M
Age: 74
State: TX

Vax Date: 12/31/2020
Onset Date: 12/31/2020
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: 1. Fever 101.2. (Temp at 0900 prior to vaccine administration 97.3) 2. Shortness of Breath 3. O2 Sats less than 70 4. Second temperature reading 97.4 on same day

Other Meds:

Current Illness:

ID: 1336797
Sex: F
Age: 63
State: GA

Vax Date: 03/09/2021
Onset Date: 04/29/2021
Rec V Date: 05/21/2021
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: Chills, muscle ache, new loss of taste, shortness of breath, fatigue and nausea. Abdominal pain and diarrhea Hospitalization

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm