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: 1337418
Sex: F
Age: 34
State: PA

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Period came 7 days early.

Other Meds: Prenatal vitamins

Current Illness:

ID: 1337419
Sex: F
Age: 35
State: CO

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NONE

Symptom List: Anxiety, Dyspnoea

Symptoms: Within 8 hours of receiving the vaccine, it felt like my arms, legs, and back were being beaten. I have pain in my neck. I have bright red splotches on my inner thighs.

Other Meds: Daily mulivitamin

Current Illness: NONE

ID: 1337420
Sex: F
Age: 44
State: PR

Vax Date: 01/21/2021
Onset Date: 01/23/2021
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: None reported

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

Symptoms: I got vaccinated at my work on 001-21-2021. I started to develop fever, chills, body aches, fatigue and also experienced shortness of breath two days after my first dose Pfizer vaccine. I went to ER where I got tested for Covid. My results came back and I was positive for Covid. Due to Covid I was out of work for one month. I can say today that my breathing is not the same as before, a bit shallow and I get fatigued easily. For my second dose, I developed headaches and fever which only lasted two days and then my symptoms went away.

Other Meds: High blood pressure medication

Current Illness: None reported

ID: 1337421
Sex: F
Age: 37
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: NSAIDs

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Rash (2? diameter) and firmness at injection site, painful to touch. Headache, chills, low grade fever, slight sore throat, fatigue

Other Meds: Birth Control (Sempese)

Current Illness: N/A

ID: 1337422
Sex: F
Age: 57
State: VA

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: CODEINE

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

Symptoms: PT CAME TO PHARMACY TO RECEIVE A SHINGLES VACCINE AND ACCIDENTALLY RECEIVED A COVID VACCINE. THE PT HAD ALREADY BEEN FULLY VACCINATED FOR COVID WITH 2 DOSES OF MODERNA, 2ND DOSE WAS APRIL 2021. TODAY RECEIVED A PFIZER COVID VACCINE

Other Meds: ADDERALL, PRISTIQ, EFFEXOR

Current Illness: NKA

ID: 1337423
Sex: M
Age: 11
State: OH

Vax Date: 05/20/2021
Onset Date: 05/21/2021
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: none

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

Symptoms: father reported that patient's DOB was 5/17/09 and was 12 years old on VAR questionnaire. When processing rx after administration, a duplicate patient record came up with a different DOB of 5/27/09 which would make pt 11. Upon calling parents, we verified that pt's DOB was 5/27/09 and he wouldn't be twelve for another 7 days after first dose administration.

Other Meds: none

Current Illness: none

ID: 1337424
Sex: M
Age: 63
State: WI

Vax Date: 04/22/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Unknown

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient tested PCR positive for COVID on 5/20/2021. He is asymptomatic and was fully vaccinated for 8 days prior to test. Test was conducted pre-procedure.

Other Meds: Unknown

Current Illness: None

ID: 1337425
Sex: F
Age: 34
State: PA

Vax Date: 04/15/2021
Onset Date: 04/15/2021
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: Doxycycline, minocycline, tetracycline

Symptom List: Pharyngeal swelling

Symptoms: Numbness beginning in the nose and spreading to the jaw and rest of face, arms and hands. Numbness and weakness in the hands and lower arms lasted for 3 days before gradually resolving

Other Meds: Labatalol 100 2x daily

Current Illness:

ID: 1337426
Sex: M
Age: 64
State: MI

Vax Date: 03/25/2021
Onset Date: 05/17/2021
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: Contrast Dye Methadone Morphine Oxcodone Zoloft

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: shortness of breath which is been ongoing for the last several days. His symptoms have progressively worsened over that time. He was seen here in the ED 5 days ago and had a neb treatment for COPD, he had a positive D-dimer and negative CT angiogram of the chest for PE. He was discharged home on Azithromycin and prednisone for AECOPD. His symptoms unfortunately continued to worsen with increased cough and shortness of breath no fever, chills, sore throat, nausea, vomiting or diarrhea. He came back to the ED today for evaluation since he was feeling worse. Patient has a history of lung cancer on the right status post pneumonectomy in 2013. On initial eval in the ED he was noted to have bilateral rhonchi on the left greater than right and received neb treatments and Solu-Medrol 125 IV push. His symptoms did improve somewhat. ED staff checked a COVID 19, despite confirming his second Pfizer vaccine was received on 3/21/2021, and it came back positive. Procalcitonin was negative. He clearly has an exacerbation of his COPD but with the COVID 19 positivity, the ED staff was concerned with his comorbidities that his prognosis is poor in the face of progression of symptoms. I was contacted and agreed to admit him for Remdesivir therapy, supplemental O2, dexamethasone and supportive care.

Other Meds: Albuterol klonopin

Current Illness: None known

ID: 1337427
Sex: F
Age: 61
State: NJ

Vax Date: 04/29/2021
Onset Date: 04/30/2021
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: Sulfa medication

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Severe headache lasting 3 full days Nausea lasting 3 full days Dizziness lasting 3 full days No appetite lasting 3 full days Stayed in bed 3 full days Did not seek medical attention

Other Meds: Pregabalin 200 mg three times a day Simvastatin 40 mg at bedtime Trazadone 100 mg at bedtime

Current Illness: None

ID: 1337428
Sex: F
Age: 45
State: PA

Vax Date: 04/24/2021
Onset Date: 05/01/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: My menstrual cycle was unusually three weeks late. Otherwise, I feel fine.

Other Meds: generic allergy medication

Current Illness: none

ID: 1337429
Sex: M
Age: 17
State: MN

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: NKDA

Symptom List: Rash, Urticaria

Symptoms: Patient is under 18 years old (Moderna not approved for this age); received first dose from this location; administered second dose per Moderna dosing schedule

Other Meds: TRETINOIN CREAM, CLINDAMYCIN GEL, MAGNESIUM, MELATONIN, LATUDA, ZIPRASIDONE, LEVOTHYROXINE, BUSPIRONE, DIVALPROEX, DESMOPRESSIN , GUANFACINE

Current Illness:

ID: 1337430
Sex: M
Age: 14
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: NKDA

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

Symptoms: Within 30 secs to 1 minute following vaccination patient started to seize. He came out of the seizure quickly (approx 20-30 sec). EMS was called and on site in minutes. Patient was breathing on his own but breathing was rapid. He lost color in his face/lips. When EMS arrived they noted that he was hypotensive and bradycardic. He began to regain color while EMS was on site. They opted to take him in for further evaluation. No history of seizures.

Other Meds: NA

Current Illness: NA

ID: 1337431
Sex: F
Age: 36
State: PA

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: Pins and needles immediately after injection in arm, days later still have pins and needles in left arm/hand/fingers

Other Meds:

Current Illness:

ID: 1337432
Sex: F
Age: 47
State: CA

Vax Date: 04/01/2021
Onset Date: 04/30/2021
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: Could not move arm the next day. I called to report the adverse event. Noticed later swelling and bumps around injection site. 3 weeks later the redness and bumps are still there. Terrible allergic reaction. Was told by pharmacist to buy over the counter medicine for adverse reactions.

Other Meds:

Current Illness:

ID: 1337433
Sex: F
Age: 30
State: KS

Vax Date: 02/05/2021
Onset Date: 05/18/2021
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 Known Allergies

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

Symptoms: Patient fully vaccinated for COVID 19- Moderna Dose #1 January 5th, 2021 Dose #2 February 5th, 2021 Became symptomatic on 18 May 2021 and Tested Positive for COVID 19 on 20 May 2021

Other Meds: Unknown

Current Illness: Unknown

ID: 1337434
Sex: F
Age: 29
State: IN

Vax Date: 05/19/2021
Onset Date: 05/20/2021
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: None

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

Symptoms: At time of shot, I was 23 weeks pregnant. This is my third pregnancy, no issues thus far in pregnancy or any previous. At roughly 9:30am the day after the shot was administered (roughly 18 hours after) I begin to get full body aches, strong headaches, joint pain, and a low grade fever. This persisted until around 7am the next morning.

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1337435
Sex: F
Age: 29
State: NH

Vax Date: 05/08/2021
Onset Date: 05/16/2021
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: Potential gluten sensitivity (not celiac)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 5/8/21 - Received first moderna covid vaccine. No adverse reaction except mild pain/sorenss at injection site. 5/16/21 - Skin sensitivity on left upper arm and left upper chest and back. Felt like sunburn without the heat. 5/17/21 - Skin sensitivity spread to most of torso including left arm and right forearm. Left armpit slightly inflamed. 5/18/21 - Skin sensitivity spread to torso and inner/upper back of thighs. Lower right back discomfort (tightness radiating from side of right butt cheek and bottom side of right hip). Intermittent leg tingling and weakness. Heat pad on lower back and Aleve help. 5/19/21 - Skin sensitivity inner/upper back of thighs and stomach. Arm skin sensitivity gone. Lower right back discomfort increasing Intermittent leg tingling and weakness increasing. Heat pad on lower back and Aleve help. 5/20/21 - Skin sensitivity inner thighs and lower stomach. All other skin sensitivity gone. Lower right back discomfort slightly less. Intermittent leg tingling and weakness gone most of the day with a few intense episodes. Heat pad on lower back helps. 5/21/21 - Most symptoms lessened or gone. Very slight skin sensitivity on lower stomach and slight discomfort in calves.

Other Meds: Vitamin D

Current Illness: None

ID: 1337436
Sex: F
Age: 65
State: MN

Vax Date: 03/18/2021
Onset Date: 04/07/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Other Meds:

Current Illness:

ID: 1337437
Sex: F
Age: 42
State: IN

Vax Date: 05/19/2021
Onset Date: 05/19/2021
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: Zithromycin and erythromycin

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

Symptoms: Nausea immediately for over 48 hours Diarrhea for over 48 hours Feeling that I'm not getting air even with deep breaths Feet burning on bottom

Other Meds: None

Current Illness: Spinal surgery on April 19th 2021 disectomy and lumbendectomy

ID: 1337438
Sex: M
Age: 28
State: TX

Vax Date: 05/20/2021
Onset Date:
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: N/A

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

Symptoms: Patient received a COVID-19 vaccine at the COVID vaccination clinic. The vaccines were shipped addressed to 2 Soldiers who were hosting the vaccination clinic. The vaccination were alarming in transport and both Pfizer and USAMMA both told the Soldiers that the vaccines were no longer viable and should not be given to the patients. Due to a lack of and miscommunication, 5 patients received the vaccines.

Other Meds: N/A

Current Illness: N/A

Date Died: 05/20/2021

ID: 1337439
Sex: M
Age: 39
State: TN

Vax Date: 04/28/2021
Onset Date: 05/11/2021
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: NONE

Symptom List: Unevaluable event

Symptoms: ACCORDING TO DAD, HE GOT THE VACCINE ON 4/28/21. ON MAY 11 HE WAS COMPLAINING OF N/V, LATER HEADACHE AND ALTERED VISION, ENCEPHALOPATHY, CARDIAC ARREST AND DEATH.... AFTER MULTIPLE LOCAL ER VISITS. HE NEVER HAD FEVER. I WAS CALLED ON HIS CASE DUE TO CONCERN FOR CNS INFECTION. HE WAS ADMITTED ON 5/18 AND DIED ON 5/20 THIS MAY OR MAY NOT BE RELATED TO THE COVID VACCINE, BUT IT IS IMPORTANT IT IS REPORTED JUST INCASE IT IS AND MAY HELP SOMEONE.

Other Meds: NONE

Current Illness: NONE PER DAD

ID: 1337440
Sex: M
Age: 17
State: VA

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: Patient fainted approximately 5 minutes after receiving his second Pfizer vaccine. He was observed to have tonic-clonic jerking but this was not seizure nor does the patient have a history of seizures. His mother reported fainting previously during stressful situations. Ice pack was given and BP was taken at 11:20 and was 100/65 and pulse was 101. When EMS arrived, patient's BP was 134/80 and pulse was 83. Patient reported stomach pains post-fainting. EMS cleared patient to leave and he signed off that he did not want to go to the hospital.

Other Meds: none

Current Illness: none

ID: 1337441
Sex: F
Age: 17
State: CA

Vax Date: 03/29/2021
Onset Date: 04/27/2021
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: Developed nausea, vomitting, abdominal pain and early heavy menstral bleeding. Previously on oral contraceptive with normal periods. Got period a week earlier (while still taking oral contraceptives) and had a much heavier period. Had nausea and vomiting that awakened her from sleep the morning preceding the bleeding started.

Other Meds: Oral contraceptives

Current Illness: None

ID: 1337442
Sex: F
Age: 26
State: VA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
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: Reglan, Augmentin, Flagyll, Bactrim, Cypro

Symptom List: Injection site pain, Menorrhagia

Symptoms: Severe migraine 24 hours after, worsening migraines since. Moderate-severe fatigue since 24-36 hours after that has not changed after 6 weeks. Shortness of breath 24 hours after for 5 hours (same time as migraine), SPO2 93 when checked with personal pulse oximeter.

Other Meds: Birth control

Current Illness: None

ID: 1337443
Sex: F
Age: 51
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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: Second dose in series was given one week prior to when it was due. Patient informed of incident and advised to call the Health Department with any adverse reactions.

Other Meds: none

Current Illness: none

ID: 1337444
Sex: M
Age: 15
State: CA

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: n/a

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After injection, patient stood up and we noticed he was falling. We caught him, laid him on the floor and called 911. His blood pressure was 75/33 and heart rate was 57. Emergency crew took him to the hospital. I called his mom in he evening and she said he was fine, he got nervous during vaccination

Other Meds: n/a

Current Illness: n/a

ID: 1337445
Sex: F
Age: 30
State: WA

Vax Date: 05/17/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Insect allergy (yellow jackets and red ants), tree pollen allergy

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 12:00 am 5/18: Chills, shivering, 2 hr duration 8:00 am 5/18: tiredness 6 hr duration - took Tylenol 1 pill at 9:00 am. 3:00 pm 5/18: 99.5?F returned after Tylenol wore off 08:00 am 5/19: difficulty standing due to multiple dizzy spells ongoing through present (8:50 am 5/21).

Other Meds: Equate One Daily Women?s multivitamin/multimineral supplement, Kirkland AllerClear 10mg Loratadine tab, Nature Made Fish oil

Current Illness: No illnesses. Breastfeeding.

ID: 1337446
Sex: F
Age: 70
State: PR

Vax Date: 04/13/2021
Onset Date: 04/14/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Dr. informs that after the administration of the vaccine against Covid-19 on the date 4-13-2021 and the next day on 4-14-2021 she began to present with severe tinnitus

Other Meds:

Current Illness:

ID: 1337447
Sex: F
Age: 18
State: GA

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: patient came in on 5/20 to receive second dose of COVID (pfizer) vaccine and her mother called on 5/21 in the morning to inform us that her daughter was having swelling in her face from the eyes down but not involving her mouth, tongue or throat. She had given her daughter ibuprofen and benadryl. I recommended she take her to the ER for further evaluation. She said she would and would contact me later to let me know how she was doing.

Other Meds:

Current Illness:

ID: 1337448
Sex: M
Age: 64
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Arm pain, bone pain, chills and temperature.

Other Meds:

Current Illness:

ID: 1337449
Sex: F
Age: 43
State: WA

Vax Date: 04/02/2021
Onset Date: 04/04/2021
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: Intermittent shortness of breath for several weeks and fatigue for several days.

Other Meds:

Current Illness:

ID: 1337450
Sex: F
Age: 16
State: IL

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

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

Lab Data:

Allergies:

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

Symptoms: swollen lymph nodes under arm pit; severe migraines

Other Meds:

Current Illness:

ID: 1337451
Sex: F
Age: 30
State: MD

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: None

Symptom List: Tremor

Symptoms: Sharp pain reported in right ear with mild hearing impairment. Reported to feel similar to pain caused by pressure changes during taking off in an airplane.

Other Meds: None

Current Illness: None

ID: 1337452
Sex: F
Age: 45
State: OR

Vax Date: 05/01/2021
Onset Date: 05/04/2021
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: Excessive menstrual bleeding. Cycle started on 5/4. Today is the 21st and I'm still bleeding. This is abnormal. I usually consistently bleed for 5 days or less.

Other Meds: None

Current Illness: None

ID: 1337453
Sex: F
Age: 41
State: PR

Vax Date: 04/29/2021
Onset Date: 05/07/2021
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: Aspirin

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

Symptoms: I have already made an adverse effect report with temporary case number 494850. This effect that I'm reporting was after making the previous report. 7 days after the vaccine both my eyes hurt, at about 3pm more or less my eyes started to hurt a lot, then I go to bed that night and Saturday both my eyes were swollen to the point that I could hardly see because I could not open them, last Sunday my eyelids and the lower part of the eye began to swell further, I felt a lot of pain and itchiness. Monday I went to the doctor he told me my eyelids were infected, I was prescribed antibiotics in drops and creams. Today around the 21st day one of my eyes is better, the other one remains swollen in the eyelid (left eye).

Other Meds: N/A

Current Illness: No

ID: 1337454
Sex: M
Age: 16
State: NM

Vax Date: 04/27/2021
Onset Date: 04/27/2021
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: None

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

Symptoms: Received moderna, <18yo

Other Meds: None

Current Illness: None

ID: 1337455
Sex: M
Age: 55
State: NY

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

Lab Data:

Allergies: No known drug allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: We inadvertently immunized this patient with a Pfizer vaccination for their second dose instead of the intended vaccine, Moderna. Pt received their Moderna Dose 1 vaccine on 4/22/21 and mistakenly received Pfizer as a Dose 2 on 5/20/21.

Other Meds: Unknown

Current Illness: Unknown

ID: 1337456
Sex: F
Age: 34
State: TX

Vax Date: 03/18/2021
Onset Date: 03/24/2021
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: none

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

Symptoms: One week after the first shot I started having abnormal vaginal spotting. I have not had a period since before getting the first dose. I noticed extreme thirst hours after getting both doses that lasted about 24 hours.

Other Meds: Fluoxetine

Current Illness: none

ID: 1337457
Sex: F
Age: 19
State: IN

Vax Date: 09/23/2020
Onset Date: 09/23/2020
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: Allergic potentially to pollen. No other known allergies to food or other products.

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

Symptoms: An hour after receiving the vaccination, I developed a massive lump in my arm, with soreness and redness. Growing concerned I did online research to potentially see what was going on, and following the suggestions from websites- even CDC, I was led to believe that swelling is a normal experience for the vaccination. So a month goes by from the vaccination date, October 23 and the soreness and lump still has not gone down. Still following the advice online, it was suggested that "swelling" can take even up to 3 months to go down. Waiting for the 3 months, it is now January 2021 and I still have the lump in my arm and the arm is still sore, and noticeably more tired and quick to become tired and weak than my right arm, where I have not received the vaccination. At this, I scheduled an appointment at my local clinic to see what is going with my arm. The doctor ordered a Sonagram for my arm. Even though it was ordered in February, their only available appointment was in April. Once receiving my sonagram, it was found to have: hypoechoic area in the subcutaneous plane with heterogenous echotexture suggesting complexity. This may be related to a complex seroma versus hematoma. This mass developed after receiving the vaccination- as I did not have this mass nor diagnosis prior to receiving the vaccination.

Other Meds: No prescriptions, no over-the-counter medications, no dietary supplements or any other supplements, nor herbal remedies taken at time of vaccination.

Current Illness: No other illnesses at time of vaccination.

ID: 1337458
Sex: F
Age: 36
State: FL

Vax Date: 05/15/2021
Onset Date: 05/15/2021
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: NKDA

Symptom List: Pain in extremity

Symptoms: *painful lymph nodes all on left side esp in neck *pain in spleen *pain in hips, knees, and ankles b/l *pain behind shoulder blade area left side *numbness and tingling in hands and feet which has transitioned to just tingling in b/l finger tips *abnormal vaginal bleeding

Other Meds: adderall

Current Illness: none

ID: 1337459
Sex: F
Age: 17
State: NM

Vax Date: 04/27/2021
Onset Date: 04/27/2021
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: Penicillin

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

Symptoms: Received Moderna, <18yo

Other Meds: None

Current Illness: None

ID: 1337460
Sex: F
Age: 39
State: TN

Vax Date: 02/05/2021
Onset Date: 02/06/2021
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: Participant woke up with fever of 104 F, muscle aches, headache and fatigue. She took Tylenol and Motrin to alleviate symptoms. She had to stay in bed for a few days and continue to take Tylenol and Motrin throughout those few days. Symptoms improve after 4 days. Participant sought care from a colleague (doctor). No tests or medications prescribed.

Other Meds: Prozac; Gabapentin; Tizanidine; Magnesium; Zinc; Vitamin C; Mega B; Adderall.

Current Illness: None except issues related to getting Covid in September

ID: 1337461
Sex: M
Age: 74
State: NC

Vax Date: 05/04/2021
Onset Date: 05/04/2021
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: Adhesive tape

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

Symptoms: Pt developed petechiae on BLEs the same day he was given the vaccine (5/4/2021) and the petechiae started to improve 3-4 days later. No other adverse symptoms reported.

Other Meds: APAP 650mg PO Q4-6H PRN, Imbruvica 420mg PO QD, losartan 100mg PO QD, melatonin 10mg PO QHS, tamsulosin 0.4mg PO QPM,

Current Illness: UTI

ID: 1337462
Sex: M
Age: 39
State: IL

Vax Date: 04/28/2021
Onset Date: 05/19/2021
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: penicillin

Symptom List: Vomiting

Symptoms: Tinnitus right ear but not the left

Other Meds: none

Current Illness: none

ID: 1337463
Sex: F
Age: 38
State: IN

Vax Date: 05/19/2021
Onset Date: 06/09/2021
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: Amoxicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: First night- body ache, fever 2nd day- lymph node swollen on my left armpit and it?s painful, tiredness and weak.

Other Meds: Tyenols

Current Illness:

ID: 1337464
Sex: M
Age: 28
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: RA

Lab Data:

Allergies: Seasonal Allergies; others N/A

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

Symptoms: After shot. I was sitting down for the advised 15 minutes. I got up to pass the time and look at an aisle in the store. All of a sudden everything went white and my head got light headed and I had to go down on my knees, I was then weak and advised to stay seated. Eventually it passed but I am shaken up.

Other Meds: N/A

Current Illness: N/A

ID: 1337465
Sex: M
Age: 19
State: MD

Vax Date: 05/07/2021
Onset Date: 05/07/2021
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: None reported

Symptom List: Injection site swelling, Limb discomfort

Symptoms: ADVERSE OUTCOME: patient experienced tonic clonic seizure not sustained minute after injection He told our staff this happens every time he has blood drawn or an injection? Dr. in office aware at time of vaccination and present and documented below. Came in for COVID-19 vaccine. 10 minutes after shot (L) deltoid. He was sitting and said to me he was feeling dizzy and immediately he had convulsion and became pale. We called 911. It lasted 1-2 minutes. Dr. came to see him, he had irregular heartbeat, feeling very tired and weak BP (L) arm 100/60 at 4:15pm. 2nd reading after 10 minutes (L) arm 112/78 p-64. He mentioned he has same reaction after injections, or blood draw. He did not want to be taken to hospital. Pt left at 5:00 with his aunt. He is visiting. When I entered the the patient was having convulsion, clonic phase, stiffening arms and legs. The consciousness came back in 1-2 minutus; he could communicate with me. He said he could breath fine. His heart rhythm was still irregular. Blood pressure was checked. He could not walk because he was too tired. 911 called. 911 cleared patient, BP and heart rate regular and stable per staff. Discharged with family member ambulating on his own, alert and oriented. Plan: must see PCP neurologist. NOT to receive second vaccine unless has complete diagnostic work up and clearance. Should have second injection vaccine in a monitored hospital setting with paramedics.

Other Meds: Unknown

Current Illness: Unknown

ID: 1337466
Sex: M
Age: 29
State: NY

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: No known drug allergy

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

Symptoms: We inadvertently immunized this patient with a Pfizer vaccination for their second dose instead of the intended vaccine, Moderna. Pt received their Moderna Dose 1 vaccine on 4/22/21 and mistakenly received Pfizer as a Dose 2 on 5/20/21.

Other Meds: Unknown

Current Illness: Unknown

ID: 1337467
Sex: F
Age: 55
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Pt returned and was turned away for their second dose of COVID on 5/19. Pt indicated that they had hives after the first dose of COVID on 4/21.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm