VAERS 2021 Database www.vaers.hhs.gov

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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: 1337776
Sex: F
Age: 58
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Hydrocodone

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient is a 58-year-old, female. Alert, oriented X4, clear speech, able to answer to questions. No known medical conditions. History of allergies to Hydrocodone. Patient requested to be vaccinated in anti-gravity chair. At 9:06 am, the patient received her second dose of Pfizer (lot number EW0185, expires on 08/2021) on right deltoid. At 9:25 am, patient notified EMT that she was experiencing lightheadedness, dizziness, nausea and ringing in ears. EMT gave patient emesis bag and began taking patient's vitals. Patient remained A&Ox4 and talking to EMT. At 9:27 am: BP of 122/70, HR 71, SPO2 99%. EMT reclined patient in chair and encouraged deep breathing. At 9:35 am: BP 124/74, SPO2 99%, HR 71. Patient states she had a light breakfast, so EMT offered patient a snack. Patient consumed 1 granola bar. Patient states she experienced ringing in ears for approximately 2 weeks following her first dose. Patient did not seek medical treatment. RN provided patient with education related to adverse reactions to vaccine. RN recommended patient talk to PCP about persistent ringing in ears. At 9:48 am: BP 122/80, SPO2 99%, HR 76. At 9:52 am, patient reports slight ringing in ears. Patient denies headache. Patient still experiencing "slight" dizziness. Patient requesting to leave site at 9:55 am. Lead RN provided patient with education concerning when to call 9-1-1, including worsening of symptoms and trouble breathing. Patient was instructed to follow up with PCP. At 9:56 am, patient walked to car with steady, balanced gait.

Other Meds:

Current Illness:

ID: 1337777
Sex: F
Age: 65
State: PA

Vax Date: 04/07/2021
Onset Date: 05/20/2021
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: statins

Symptom List: Anxiety, Dyspnoea

Symptoms: Early evening of 5/20/2021 large red rash appeared bilaterally on calves, with spreading of rash overnight of 5/20 to 5/21/21 to the front of right leg. Affected areass hot to touch with minimal itching. No exposure to possible irritants. It should be noted that patient had also started on tricor 4/20/2021. The rash is a known symptom of both the covid vaccine and tricor therapy in some cases. Blood tests ordered (cbc, complete metabolic panel and liver enzymes) but results not yet available. PCP has seen similar rashes in other patients after covid vaccine so recommended filing the report to vaers out of an abundance of caution.

Other Meds: esomeprazole 40 mg day for hx of esophagitis; ester c 1000 mg daily; zinc picolonate 30 mg daily; turmeric capsule 500 mg 2x day; cinnamon capsule 500 mg 2x day; coq10 100 mg day; vitamin d3 25 mcg; gabapentin 300 mg at bedtime PRN for hip

Current Illness: none, not even a cold

ID: 1337778
Sex: M
Age: 60
State: CA

Vax Date: 03/29/2021
Onset Date: 04/02/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Three days after the first vaccination I went into AFIB, I waited 13 hrs at home until my heart reset itself. Three days after the second vaccination, I went into AFIB once again and went to emergency with heart racing at 176. Approximately 8 hrs later my heart reset with the aid of medication. I stayed in the hospital over night for observation then released @ 2 PM. I am now under the care of a cardiologist monitoring and now taking other medications for my heart

Other Meds: Fish Oil 1400 MG,, Glucosamine HCI 1500 mg with MSM 1500 mg, vitamin D 10,000 IU, one a day Men's 50+, Irbesartan 150 MG

Current Illness: None

ID: 1337779
Sex: F
Age: 64
State: MO

Vax Date: 03/29/2021
Onset Date: 04/11/2021
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: Reactivation of herpes virus....shingles on face approximately 2 weeks after second shot of moderna. Eruptions on nose, area above nose, area above inside eyebrow.

Other Meds: Sertraline

Current Illness: None

Date Died: 05/21/2021

ID: 1337780
Sex: F
Age: 72
State: KY

Vax Date: 03/08/2021
Onset Date: 05/07/2021
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: unknown

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

Symptoms: Person died on 5/7/2021 with death note stating acute respiratory failure with hypoxia, thrombocytopenia.

Other Meds: unknown

Current Illness: unknown

ID: 1337781
Sex: F
Age: 24
State: AK

Vax Date: 05/15/2021
Onset Date: 05/16/2021
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: NKDA

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

Symptoms: Myalgias, dizziness, headaches and abdominal pain.

Other Meds: Acyclovir

Current Illness: None reproted

ID: 1337782
Sex: M
Age: 28
State: IL

Vax Date: 05/05/2021
Onset Date: 05/05/2021
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 became dizzy post vaccination, recovered and released

Other Meds: Unknown

Current Illness: Unknown

ID: 1337783
Sex: F
Age: 23
State: WI

Vax Date: 03/16/2021
Onset Date: 03/17/2021
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: I am allergic to Penicillin.

Symptom List: Pharyngeal swelling

Symptoms: I woke up around 12:30 in the morning and felt achy. I fainted twice after getting out of bed. I experienced severe aches and body chills. I felt fine the day after better.

Other Meds: I was taking Zoloft and a norethindrone .35 mg.

Current Illness: I did not have any other illnesses.

ID: 1337784
Sex: F
Age: 51
State: WI

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: CLIENT VACCINATED ON TUESDAY. ON WEDNESDAY CLIENT NOTICED SOME SLIGHT NUMBNESS IN THE LEFT ARM, ARMPIT AREA, SIDE OF THE BREAST. ON THURSDAY MORNING CLIENT REPORTS "VERY NUMB", SLIGHTLY PAINFUL AND TENDER. NO CHANGE IN PHYSICAL APPEARANCE BUT DOES FEELS SWOLLEN BY THE TOUCH. LEFT HAND WAS SWOLLEN IN JOINTS, AND WAS TENDER. CLIENTS REPORTS SOME ARTHRITIS. IMPROVEMENT OF ARM THE NEXT DAY. CLIENT WILL SEEK MEDICAL ADVICE IF SYMPTOMS WORSEN OR DO NOT IMPROVE. RECOMMENDED TO SPEAK WITH ONCOLOGIST TO SEE IF OTHER CLIENTS WITH BREAST CANCER AND HX OF DOUBLE MASTECTOMY HAVE NOTICED ANY REPORTS IN OTHER PATIENTS.

Other Meds: ESTRADOL

Current Illness: NONE

ID: 1337785
Sex: F
Age: 59
State: CA

Vax Date: 04/11/2021
Onset Date: 05/11/2021
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: pt has mental health disability, pt came in April for Janssen vaccine and returned in May for another dose, pt states she recalled receiving a vaccine but did not recall what was it for, she states the home she is staying at was requesting she have the covid vaccine so that is the reason she came in in may, I asked pt if she had her Janssen vaccine card and she responded " I think so", I asked pt how she was feeling she responded fine, I informed pt I would schedule an appointments with provider, pt declined she said she was ok, per Dr. gave pt ER precautions, pt agreed. Followed up with pt 4 days later, pt stated she was fine, and she asked if she needed to return for her second vaccine, I informed pt there was no need to.

Other Meds:

Current Illness:

ID: 1337786
Sex: F
Age: 49
State: WI

Vax Date: 01/13/2021
Onset Date: 02/03/2021
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 states that two to three weeks after her second dose of the COVID-19 Pfizer series she has had daily bouts of vertigo.

Other Meds:

Current Illness:

ID: 1337787
Sex: F
Age: 27
State: CA

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: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Low-grade fever lasting for about 3 hours

Other Meds:

Current Illness:

ID: 1337788
Sex: M
Age: 4
State: TN

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: RASH

Other Meds:

Current Illness:

ID: 1337789
Sex: M
Age: 23
State: TX

Vax Date: 05/06/2021
Onset Date: 05/06/2021
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: It was identified that the patient has received 7 doses of Pfizer and 1 dose of J&J. Patient continuities to seek additional COVID vaccines doses even though his series is complete. The patient has been turned away several times at Pharmacy for attempting to get additional doses. It is possible the patient is seeking additional doses outside of Pharmacy.

Other Meds:

Current Illness:

ID: 1337790
Sex: M
Age: 39
State: OH

Vax Date: 03/24/2021
Onset Date: 04/07/2021
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: LA

Lab Data:

Allergies: no known allergies

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

Symptoms: Pt had pain in the left calf 10 days after his first vaccine. Pt then went to state on April 2. Pt came back home, the pain was gone. He had his second vaccine on 4/23 of pzifer. After 15 days of getting the second vaccine he felt very short of breath when riding his bicycle. He went to his primary care doctor and he was advised to go into the ER. He was diagnosed with a PE and left leg DVT

Other Meds: no medications currently taking

Current Illness: no

ID: 1337791
Sex: F
Age: 42
State: WA

Vax Date: 05/13/2021
Onset Date: 05/13/2021
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: Peanuts, eggs, mold, dust

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

Symptoms: Pfizer vaccine - tongue swelled impeding speech, face swollen, tingling in the face, hives on face and neck. This passed within 24 hours Tingling in hands and feet - started within five hours of shot has not improved.

Other Meds: Provigil, Midodrine, Trileptal, Neurontin, Claritin, Cromolyn Sodium, Sodium, Baclophen

Current Illness:

ID: 1337792
Sex: M
Age: 78
State:

Vax Date: 05/06/2021
Onset Date: 05/08/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient was admitted from ED due to feeling week for approximately 1 week prior. Has passed out 2-3 times a day over past week. Patient tested on admission for Covid with a positive diagnosis via POC Rapid SARS-COV-2 Antigen. Patient was treated with remdesivir, albuterol, ceftriaxone, dexamethasone. Patient discharged after 5 days with dexmethasone as new med.

Other Meds:

Current Illness:

ID: 1337793
Sex: F
Age: 46
State: PA

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: peanut allergy

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient experienced troubles breathing and throat closing 7 minutes after receiving first dose of Pfizer Covid-19. An Epipen was administered and patient started breathing better immediately after administration. Patient was monitored an extra 1/2 hour, and told we were going to call EMS for further evaluation and patient did not want us to do that because she was feeling better. Patient also has a peanut allergy. She left a message for her PCP for follow up.

Other Meds: unavailable

Current Illness: unknown

ID: 1337794
Sex: F
Age: 86
State:

Vax Date: 02/13/2021
Onset Date: 03/07/2021
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 on 3/7/21 and was subsequently hospitalized with A-fib with RVR. Patient was also hospitalized on 4/6/21 with pseudoaneurysm following procedure. These visits occurred within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1337795
Sex: F
Age: 51
State: AZ

Vax Date: 12/26/2020
Onset Date: 01/23/2021
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: Benzoin; Bacitracin; Darvon; Shellfish

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

Symptoms: First vaccine - sore arm - for two and 1/2 days. I thought I had an ear infection because I get them frequently. But my husband and daughter had tested positive for COVID. It felt like an ocean in my ears fluid. Amoxicillin that helped with symptoms. In the last 6-7 months, whenever I take antibiotics I now have to take Fluconazole. I quarantined in my room for 10 days. I was mostly okay but there was two days when I was just exhausted. I didn't have a lot of the major symptoms that others get.

Other Meds: Montelukast; Allegra; Calcium; Vit D supplement; Biotin; General Multivitamin; Lysine

Current Illness: No

ID: 1337796
Sex: M
Age: 65
State: MD

Vax Date: 03/25/2021
Onset Date: 03/26/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies: Remicade

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

Symptoms: that night got a 102.7 fever / Trouble breathing / very bad chest pains . My wife called 911 , went to hospital next morning at 6:30 am , came home that afternoon then 8:30 pm that night called 911 again , was in 3 different hospitals for next 19 days . lost 30 pounds in hospitals, been home now

Other Meds: 12 prescriptions / 3 supplements

Current Illness: none

ID: 1337797
Sex: M
Age: 34
State: CO

Vax Date: 05/04/2021
Onset Date: 05/06/2021
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: Penicillin (Hives)

Symptom List: Unevaluable event

Symptoms: Pt received Pfizer COVID-19 vaccine on 5/4/2021. Pt started experiencing sore throat on 5/6 and the nurse triage. The next day (5/7), pt went to the ED and was admitted for tx of intratonsillar abscess.

Other Meds:

Current Illness:

ID: 1337798
Sex: F
Age: 22
State: FL

Vax Date: 05/17/2021
Onset Date: 05/01/2021
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: 22 year old female pt present today due to a LARGE lump on her left armpit. Patient states has always had pea like pimple under arm pit area but 2 weeks ago noticed growth and its is getting bigger, Warm to touch from scale to 0 to 10 pt states pain is a 7, worried because her breast is also tender. Patient admits took pfizer vaccine and after first dose she develop a "bump under her axilla on left side, pt went to get second vaccine 5-17-2021 and used right arm due to the bump on left and now both axilla are hurting, swollen mildly and pain in both breast. NO fever, no pus , no erythema, mostly pain as per patient.

Other Meds: pantoprazole 40mg prn only for gerd

Current Illness: NONE

ID: 1337799
Sex: M
Age: 16
State: AZ

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Patient's mother denies patient has any known allergies.

Symptom List: Injection site pain, Pain

Symptoms: This patient was brought into the Medical Center COVID-19 vaccine clinic by his mother for vaccination. The patient is 16 years old. At the time of this incident, medical center provides only the Moderna COVID-19 vaccine at this clinic. Moderna COVID-19 vaccine is only approved under for patients over the age of 18 years old under the EUA in effect at the time of this occurrence. Prior to the event, the patient was registered into the medical center system in the presence, and with the consent of the patient's mother. The hospital registration staff failed to recognize how the patient's age of 16 years is a contraindication to Moderna COVID-19 vaccination. The patient was next brought to a COVID-19 task force medic. Task force failed to recognize the patient's age as 16 years old, despite how the patient's age was displayed on the electronic health record (EHR) screen. This information displayed in the same vaccination menu where task force documented the shot. They commenced to vaccinate the patient in his right deltoid with one Moderna COVID-19 vaccination dose; 0.5 ml in volume via intramuscular injection. Immediately after vaccinating the patient, task force was unable to complete the documentation in the EHR system. He notified me of the issue. When I looked at the screen, I noticed that the patient displayed an age of only 16 years. I asked him if he had already vaccinated the patient. He replied, "yes" he had. Upon discovering this event, I immediately contacted the patient's mother and informed her of the incident. Then, I called my chain-of-command in the COVID-19 task force and briefed the officer in charge of the incident. The COVID-19 Task Force officer instructed me to complete this VAERS report. I also informed the medical center manager on site of the incident. Medical center staff on site immediately reported the incident via their internal risk management reporting system in addition to this VAERS report.

Other Meds: Patient's mother denies patient uses any of these substances.

Current Illness: Patient's mother denies patient has any illnesses within specified time frame.

ID: 1337801
Sex: F
Age: 34
State: WI

Vax Date: 04/08/2021
Onset Date: 04/17/2021
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: Nickel, seasonal allergies, eczema in the past

Symptom List: Injection site pain, Menorrhagia

Symptoms: I experienced headaches, aches and pain whole body, feels pulsation to my hands, like carpal tunnel syndrome, My whole body feels icky, I had shortness of breath, my doctor thinks I have inflammation and I am now on prednisone medication. Pain in my back and all over and difficulty sleeping. These aches and pain come and go and move to different parts of my bodies and also resting heart rate that comes and goes. To this day I continue to have aches and pain on my body and also still on steroid prednisone medication.

Other Meds: None reported

Current Illness: None reported

ID: 1337802
Sex: F
Age: 62
State: CA

Vax Date: 05/11/2021
Onset Date: 05/11/2021
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: NA

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

Symptoms: Same night of vaccine, patient experienced fever, freezing/fire and was shaking for about 2 hours, trobing headache. Next day, patient was extremelly sore and the day after, patient delt okay.

Other Meds: Vit D, Cetirizine

Current Illness:

ID: 1337803
Sex: M
Age: 57
State: MA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
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: THE PATIENT HAD RECIEVED 2 DOSES OF PFIZER BRAND VACCINE PREVIOUSLY ON 1/21/21 AND 2/2/21. NO ADVERSE EFFECT EXPERIENCED, PT IS AT BASELINE

Other Meds:

Current Illness:

ID: 1337804
Sex: F
Age: 52
State: NJ

Vax Date: 05/07/2021
Onset Date: 05/08/2021
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: Lactose, gluten sensitivity, seasonal allergies, latex, alcohol, sensitivity to Citrus, Aleve

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Within approximately 15 minutes appreciating the vaccination I began to feel light-headed and nauseous. That sensation continued 4 the next week and finished approximately Friday, May 14th. An approximately May 11th, I started experiencing sporadic, cough, runny nose, sore throat, chills, headache, dull pain in eyes and sharp joint pain. Additionally I felt as if I had a fever but I had been taking Tylenol two to three times a day. Most of these symptoms drafted from approximately the 11th through 14th. I had a chest x-ray on the 13th with negative results. I have covid rapid test shortly before and again on the 14th both with negative results. I also noticed swelling at the base of my neck I'm around May 11th which has persisted to date. I am assuming this is due to swollen lymph nodes although such has not been confirmed by health professional. I reported my symptoms at the vaccination site. The nurse was prepared to use my EpiPen but such was not needed. I left the site after waiting about 45 minutes even though my nausea and lightheadedness remained. Presently I still have headaches throughout the day, sore throat and a hoarse voice.

Other Meds: Rosuvastatin tablets, Montelukast tablets, Omeprazole caps, fluticasone propionate nasal spray, Advair HFA, magnesium, fish oil, vitamin C, vitamin B12, vitamin D3, Centrum Silver, vitamin C, phosphatidyl serine, DMAE, honey probiotic

Current Illness: None

ID: 1337805
Sex: F
Age: 62
State: NY

Vax Date: 05/19/2021
Onset Date: 05/19/2021
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: Bee Stings and Penicillin

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

Symptoms: Patient experienced an allergic reaction approximately 10 minutes after receiving her second dose of the moderna vaccine. The individual presented with labored breathing, complaining of a feeling of "her throat closing" and had a decreased level of consciousness, she was lowered to the ground by 2 nurses then became responsive only to painful stimuli. The individuals personal epinephrine was administered in her right thigh with minimal response, vitals were obtained and an albuterol nebulizer was then administered with marked improvement in her breathing. After about five minutes a second dose .33ml epinephrine was administered in her right deltoid. After approximately one minute she began answering questions.

Other Meds: Blood Pressure Medication Type Unknown

Current Illness:

ID: 1337806
Sex: M
Age: 29
State: MO

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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Patient was in the 15 minute review time after the immunization and briefly fainted. He was slouched in his chair. I ran out to make sure he was ok. He came to immediately and I sat him on the floor. We gave him a water bottle and observed him for another 15 minutes. He said he was feeling ok and his wife/significant other drove him home. I called him on 5/19/21 to check on him. He said that he was feeling fine.

Other Meds:

Current Illness:

ID: 1337807
Sex: M
Age: 19
State: NY

Vax Date: 05/08/2021
Onset Date: 05/08/2021
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: Injection site pain

Symptoms: He started with fever and chills on the evening of the day he received the vaccine, Also severe pain in lower sternum, emesis \over the next 2-3 days developed abd pain of lower abd, cough, resp distress, waves of fatigue and hyperventilation, on 5/10 noted full body rash which was itchy, last fever was on 5/13/21, on 5/12 had blood shot eyes, 5/14 - peely skin on palms and face and felt thightness in face

Other Meds: none

Current Illness: none

ID: 1337808
Sex: F
Age: 59
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: had a reaction to first covid vaccine today - she felt lightheaded, dizzy, and her arm felt numb after the shot. called 911 to get her medical attention, but she left the store on her own (with her husband). checked back at 1:45 same day and husband said doing better

Other Meds:

Current Illness:

ID: 1337809
Sex: F
Age: 65
State: TN

Vax Date: 04/14/2021
Onset Date: 05/05/2021
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: Sulfa

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

Symptoms: Patient reports vomitting that began the day of her 2nd dose of Pfizer injection and has lasted 3 weeks at this point. The vomitting was significant the first 3 days after the injections and now still persistant nausea and vomitting multiple times per week. New onset joint pains.

Other Meds: Furosemide, Klor-con, Effexor, Vitamin b12, Calcium, Aspirin, Rosuvastatin, Wellbutrin, Vitamin D2

Current Illness: none

ID: 1337810
Sex: F
Age: 69
State: AR

Vax Date: 04/01/2021
Onset Date: 05/01/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: codeine, diazepam, meperidine, morphine, pravastatin, propxyphene, tramadol, venlafaxine

Symptom List: Tremor

Symptoms: patient with bilateral PEs with right heart strain - reported SOB since the time of the second COVID vaccination - plan for EKOS catheter tomorrow and treatment with Eliquis

Other Meds: albuterol, Fioricet, multivitamin, Celebrex, cholecalciferol, Voltaren gel, ferrous sulfate, ginkgo biloba, glucosamine, HCTZ, levothyroxine, lutein, lysine, omeprazole, turmeric

Current Illness: says SOB since receiving her second dose of vaccine, now diagnosed with bilateral PEs

ID: 1337811
Sex: F
Age: 61
State: MO

Vax Date: 05/11/2021
Onset Date: 05/13/2021
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, adhesive

Symptom List: Erythema, Pruritus

Symptoms: headache, chills, rash on chest, upper shoulders, neck and back

Other Meds: mp thyroid, Seroquel, melatonin, multivit,

Current Illness:

ID: 1337812
Sex: M
Age: 63
State: MN

Vax Date: 03/23/2021
Onset Date: 04/07/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient presented to the ED and was subsequently hospitalized with pneumonia due to COVID-19. He has been currently hospitalized since 4/7/21.

Other Meds:

Current Illness:

ID: 1337813
Sex: F
Age: 59
State: IL

Vax Date: 02/08/2021
Onset Date: 05/11/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient presented to emergency department on 5/11/21 with report of worsening of shortness of breath and chest pain for previous one week. Patient reports that she had COVID-19 3 weeks ago and at that time was diagnosed with community acquired pneumonia. CTA performed in ED noted bilateral pulmonary emboli greater on the right than on the left. There was an embolus in the right main pulmonary artery with some evidence of right heart strain with RV/LV ratio 1.1 Peripheral ground-glass opacity in right lower lobe also noted. Patient treated with heparin. No thrombectomy performed as clot burden had decreased after receiving heparin. Patient was transitioned to Eliquis and discharged to home.

Other Meds:

Current Illness:

ID: 1337814
Sex: F
Age: 75
State: OH

Vax Date: 03/05/2021
Onset Date: 05/09/2021
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: Seasonal allergies to trees, pollens, etc. Allergies to chemical smells, flowery smells, smoke, etc. Biaxin, Suprax, Lisinopril, Losartin Adhesives

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Beginning about 24 hours after shot headache, chilling, and nausea off and on for first couple of weeks. Beginning about May 9 began with severe abdominal pain, chilling, and general not feeling well., Then on May 13th noticed start of rash. Saw doctor on 14th and diagnosed with Shingles. Treated with valacyclovir for 7 days. At present still have rash, severe pain, chilling, and nausea with decreased appetite.

Other Meds: Aspirin 325 mg daily Albuterol inhaler as needed Novolin 70/30 insulin

Current Illness:

ID: 1337815
Sex: M
Age: 25
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: 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: Patient received vaccine. He has a history of fainting/becoming light headed after vaccination. He began to feel light headed and decided to lay down. Patient was given water and an ice pack. Patient was nauseous, and sweating profusely. After ~5 minutes, patient began to feel better. He waited another 15 min in the pharmacy before leaving with a driver.

Other Meds: Unknown

Current Illness: Unknown

ID: 1337816
Sex: F
Age: 48
State: NC

Vax Date: 04/23/2021
Onset Date: 04/24/2021
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: It was given in the Left arm, my arms is still stiff, it's nearly 4 weeks now. There is a band of swelling. My Left arm is not symmetrical with my Right arm. Also I had two extra migraines then I was expecting in the past 4 weeks. They did not respond to Zomig, Phenergan, or the three preventative medications I take Cyclobenzaprine, Nadolol, and Topamax. After 2 weeks, I took a series of Methylprednisone (I gave it two weeks so the vaccine could work first). The swelling reduced, but did not go away. It is still hard to raise my arm over my head. I am following up with my MD. But I thought you should know about this. I will probably switch to J&J after this, for booster shots. I'm not sure I can handle this side effect again. I would not describe it as "minor" because it's lasting so long.

Other Meds:

Current Illness: Migraine

ID: 1337817
Sex: M
Age: 60
State: NJ

Vax Date: 05/17/2021
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: NKA

Symptom List: Pain in extremity

Symptoms: Patient experienced sensation of throat closing and SOB. The next morning, he felt as if his throat was swollen. He has never experienced this sensation or reaction to vaccines in the past.

Other Meds:

Current Illness:

ID: 1337818
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: n/a

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

Symptoms: Vaccinated pt with vaccine not approved for individuals under 18 years of age

Other Meds: none

Current Illness: n/a

ID: 1337819
Sex: M
Age: 56
State: KS

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: None

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

Symptoms: Stiffness, aches, fever 99.5, lasted less than 24 hours. Symptoms mostly suppressed with aspirin.

Other Meds: None

Current Illness: None

ID: 1337820
Sex: F
Age: 15
State: TN

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Fainting / Unresponsive-Medium, Systemic: Seizure-Medium

Other Meds:

Current Illness:

ID: 1337821
Sex: M
Age: 26
State: ID

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Shellfish, tree nuts

Symptom List: Vomiting

Symptoms: Patient received first dose of Moderna COVID vaccine about 35 minutes before presentation to doctor. He started feeling scratchiness in his throat after about 10-15 minutes. He did not feel like his throat was closing off. Nor was any worse since it first started. He has had anaphylaxis with shellfish in the past and carries an EpiPen. He said it does not feel like that now. Feels like he needs some Benadryl. Patient told the pharmacy tech that he thought this might be moreso anxiety (after reading the paperwork). Did not feel like other reactions he has had in the past.

Other Meds:

Current Illness:

ID: 1337822
Sex: M
Age: 49
State: IN

Vax Date: 05/10/2021
Onset Date: 05/11/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Shaking chilling fever loss of appetite extremely sore arm and large red circle on arm

Other Meds:

Current Illness:

Date Died: 05/07/2021

ID: 1337824
Sex: M
Age: 0
State: CO

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: foaming at the mouth and had a heart attack

Other Meds:

Current Illness:

ID: 1337825
Sex: F
Age: 37
State:

Vax Date: 03/15/2021
Onset Date: 03/24/2021
Rec V Date: 05/21/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

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

Other Meds:

Current Illness:

ID: 1337827
Sex: M
Age: 17
State: CO

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: no adverse event. Unauthorized use of COVID Vaccination to 17 year old

Other Meds: none

Current Illness: none

ID: 1337828
Sex: M
Age: 29
State: TX

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: NKDA, NKA

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

Symptoms: Patient received his second shot and waited 15 minutes inside the vaccine site, he returned to his vehicle and reported feeling, "weird". He exited his vehicle and attempted to walk back into the site, but had to sit down on the curb. Traffic Enforcement noticed and called for an EMT. Pt was found to be pale, reported nausea, numbness and tingling to tongue, mouth, and bilateral upper extremities. APH Lead RN responded and found pt to be pale and broken out in cold sweat. Pt reported waves of feeling like he was going to pass out. Pt was given candy to help with blood sugar and an icepack. EMS was en route per IC. Vital Signs monitored during episode. Pt declined EMS transport and was released to his personal vehicle with his girlfriend driving him home.

Other Meds: Lamotrigine 10 mg tablet Propranolol 20 mg tablet

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm