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

Incidents per State

State Total
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 1392929
Sex: F
Age: 23
State: CA

Vax Date: 05/10/2021
Onset Date: 05/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Pt started getting bruising on lower extremities, having 7/10 pain using the Numeric Pain Intensity Scale Method. Patient also stated getting a rash (red spots) on both hands front and back, causing burning and itching. She started experiencing shortness of breath, extreme tiredness and body ache. We did order an EKG on pt and sent her to the ER, we also prescribe medication to help relief most symptoms.

Other Meds:

Current Illness:

ID: 1392930
Sex: M
Age: 12
State: OR

Vax Date: 06/07/2021
Onset Date: 06/08/2021
Rec V Date: 06/11/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: bee venom

Symptom List:

Symptoms: One day after vaccine, patient developed chest pain and headache. Three days after vaccination, presented to PCP then ED with chest pain. Found to have elevated troponin. Transferred to PICU with persistent chest pain. Chest pain dissipated after NSAIDs.

Other Meds: None

Current Illness: None

ID: 1392931
Sex: M
Age: 36
State: AL

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: I am allergic to sulfa drugs.

Symptom List:

Symptoms: After getting the second vaccine , I had the lip tingling and chin tingling for about 15 mins after. I also had jaw pains and low blood pressure which had me get me on the stretcher for about 55mins. My teeth also went numb as well. About 12 hours in I had a burning sensation in my checks and the site where I got my vaccine. First dose vaccine lot number is EN6200 I received this vaccine on February 26, 2021. With the first vaccine 20-25 after the vaccine I felt like I had a brain freeze, After one hour I had face tingling and throughout that day the face tingling got worse and my face went numb. I had right toe tingling with the first and second vaccine. The muscle spams happened three days after the vaccine and I still have muscle spams today.

Other Meds: I was taking Benadryl and Pepcid AC one hour before my vaccine, I was instructed to by my doctor.

Current Illness: None.

ID: 1392932
Sex: M
Age: 51
State: IA

Vax Date: 06/04/2021
Onset Date: 06/06/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Tegretol, bee stings, shellfish

Symptom List:

Symptoms: Day one after 2nd covid shot sore muscle at injection site and overall body ache, I had chills, extreme tiredness, headaches, lasting a few days

Other Meds: Adderall, methadone, gabapentin, fenofibrate,albuterol,descovey,tivicay,xyzal,valtrex,terbenifine, losartan

Current Illness: Lung mass

ID: 1392933
Sex: M
Age: 57
State: TX

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: patient received the second dose from a moderna vial that had been punctured 26 hours prior, but it was only good for 12 hours post-puncture

Other Meds: Tamsulosin 0.4mg Capsules

Current Illness:

ID: 1392934
Sex: M
Age: 16
State: TX

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: LATEX, KETAMINE, COMPAZINE, IV BENADRYL

Symptom List:

Symptoms: PT EXPERIENCED FAINTING, DIZZINESS, NAUSEA/VOMITTING AFTER COVID VACCINE. PARAMEDICS ARRIVED AND TOOK PT TO ER. VITALS: BP 105/68, RR: 22, HR 71, O2 99%

Other Meds: UNKNOWN

Current Illness:

ID: 1392935
Sex: M
Age: 13
State: CA

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: mild stomach upset with sulfa

Symptom List:

Symptoms: chest pain occured 4.5 hrs post second dose vaccine. next day, he felt fine, but fatigued. On the second day, chest pain occurs again upon inspiration and expiration, no shortness of breath. Only upon deep breathing, not shallow. On third day, pain is still an issue, he gets taken to urgent care. All test are normal (chest xray, EKG, lab, cbc, chem) lung sounds are normal. Chest pain continues for 3 more days. He rests and takes ibuprofen as directed. Is never is respiratory distress.

Other Meds: tyelenol Given at 8:30 pm 6/2/2021

Current Illness: none

ID: 1392936
Sex: F
Age: 13
State: MI

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: cefdinir/cephalosporins

Symptom List:

Symptoms: She was nervous before receiving the vaccine and felt lightheaded afterwards. While in the waiting room she vomited. She later drank water and after sitting down she recovered.

Other Meds: unknown

Current Illness: unknown

ID: 1392937
Sex: M
Age: 63
State:

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: hard nodule (dime size) to right deltoid w/ purplish bruise. Evaluated by EMS-Cleared

Other Meds:

Current Illness:

ID: 1392939
Sex: M
Age: 38
State: CT

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No Known Allergies

Symptom List:

Symptoms: Patient fainted approximately 7 minutes after receiving the Covid-19 vaccine by pfizer. Patient fell to the floor from the bench he was sitting at. EMS was called and patient was talked into going to the ER for observation.

Other Meds: Unknown

Current Illness: Unknown

ID: 1392940
Sex: F
Age: 70
State: MN

Vax Date: 02/16/2021
Onset Date: 03/22/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: I get allergy shots for Dust. I am allergic to cats, fish, flavin oil, all grains, trouble with some spices.

Symptom List:

Symptoms: I started getting red marks that looked like pimples on my right cheek that went into my nose, then it started itching and swelling and then it started burning. The only thing that helped me was an ice pack. I tried to get to the doctor and on the 03/25 or 03/26 they got me in. I put in cortisone on it and I did not know it should not be used on the face. When I got there he saw that I got shingles and when he looked at it it did not look like shingles, the medicine he gave me was the PIM, and I put that on and it did not cure it but it calm it down. What happened is that after that it move to my lips and I had a lot of pain on my teeth on both sides and the middle, and then it shifted to the other side. Now what I have is everything is calmed down but there are times that my teeth really hurt on those same places or I can feel some tingling like I felt before everything started itching and swelling on every part of my face. It lasted for weeks. I am going to a Neurologist to take a look at it and my health.

Other Meds: Restasis, Azelastine, PMI cream, mometasone cream, probiotic, aspirin 81, collagen, Benadryl, vitamin d, tums

Current Illness: None

ID: 1392941
Sex: F
Age: 72
State: CA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: VITAMIN D

Symptom List:

Symptoms: PATIENT RECIEVED INJECTION 1:00 PM, DIDN'T EXPIERENCE ANY SYMPTOMS WITHIN THE FIRST 15 MINS AFTER RECIEVING INJECTION. ONE HOUR AFTER INJECTION FELT CHILLS ALL THROUGHT HER BODY. ABOUT 3 PM PATIENT NOTICED AFTER STANDING UP HER LEGS FELT LIKE RUBBER AND WERE REALLY WEAK. TOOK A COUPLE STEPS FELT EXTREMELY DIZZY. PATIENT STILL HAS DIZZINESS TO THIS DAY AS WELL AS NAUSEA AND RINGING IN HER EARS.

Other Meds: MULTIVITAMINS & PRESCRIPTION

Current Illness: NONE

ID: 1392942
Sex: M
Age: 43
State: IL

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient received 1st dose Moderna on 5/14/77, patient then received a 2nd dose Pfizer vaccine on 6/11/2021. Patient was observed for 15 minutes for any side effects. After the 15 minutes he then stated he was feeling well and had no symptoms. Before patient left the facility he was informed of the administration error.

Other Meds:

Current Illness:

ID: 1392943
Sex: F
Age: 16
State:

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: After nothing occurred x 30 minutes post vaccine, Attendee suddenly became limp, stiffened body and convulsed. Was placed on cit, in recovery position, vital signs checked (stable) and EMS were called. Close monitoring and 2nd set of vital signs. Mother of Attendee was close by at all times. Attendee was awake, answered question appropriately, but slow speech - seemed post ictal. EMS arrived after 10 minutes and transported Attendee to local hospital.

Other Meds:

Current Illness:

ID: 1392944
Sex: F
Age: 51
State: TX

Vax Date: 12/22/2020
Onset Date: 01/16/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: Approximately 4 days after my 2nd vaccine shot, I began to have mild paresthesias and subtle leg weakness. I have been to a neurologist, who has done extensive testing. He has diagnosed me with small fiber neuropathy which has been slowly progressing since it's onset. I have had negative MRI's, EMG's, and huge amount of tests looking for autoimmune and labs for paraneoplastic were all negative. My fatigue an weakness is affecting my work and lifestyle now. I am 52 and very fit and active woman who golfs and exercises regularly. I have no family history nor any other medical reason to explain my symptoms except temporally appears to have started with the vaccine. There have been case reports of similar neurological things occurring. Steroids did not help.

Other Meds: Estrogen patch, Progesterone and Testosterone cream, Ca/VitD, DHEA 10mg, Nicotinamide riboside, Diindolylmethane, Wellbutrin

Current Illness: Very healthy. Mild cervical spondylosis

ID: 1392945
Sex: F
Age: 72
State: KY

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 06/11/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: penicillin, vibromycin, parafene, latex

Symptom List:

Symptoms: Immediately had migraine headaches and extreme fatigue lasted until she was admitted to hospital on May 13th 2021. 2nd week in April diagnosed with sinus infection by tele health, put steroids' and antibiotics, 2 weeks later diagnosed with pneumonia. Diagnosed with pneumonia again on May 13th also had generalized swelling, lymph node tenderness, After discharge on May 16th, swelling increased. Admitted again on June 7th swelling had became enabling, platelets are in 700,000 range fluctuating for four days from 700 to 650 and back up to 700. Hospital have ran several test, blood, liver, kidney and can not diagnose.

Other Meds: Paxil, Buspar, verapamil

Current Illness: high blood pressure

ID: 1392946
Sex: F
Age: 21
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: 10 minutes after this dose became dizzy - (Had similar reaction with 1st dose Pfizer), laid on cot - vital signs ok x2 checks - after 21 minutes left site with mom.

Other Meds:

Current Illness:

ID: 1392947
Sex: M
Age: 15
State: NY

Vax Date: 06/04/2021
Onset Date: 06/05/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: keflex

Symptom List:

Symptoms: On the day after, I had chills, migraine, and other aches and pains the entire day. Next day I felt largely better. Today is a week after my shot and my headaches are getting worse progressively, It is a distinct type of headache I've never felt before getting the vaccine.

Other Meds: Vivance

Current Illness:

ID: 1392948
Sex: M
Age: 61
State: TN

Vax Date: 05/01/2021
Onset Date: 05/04/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: Shortness of breath, injection site soreness, fever, weakness, night sweats first night following injection and progressively worsened.

Other Meds: Losarton 100 mg, morning of vaccination , Atenolol 50 mg. evening prior to vaccination, Amitriptylin 25 mg. evening prior, Meloxicam 15 mg. evening prior, Prazosin hcl 2 mg. evening prior

Current Illness:

ID: 1392949
Sex: F
Age: 48
State: PA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: unknown

Symptom List:

Symptoms: Anaphylactic reaction treated with1 dose of epipen

Other Meds: unknown

Current Illness:

ID: 1392950
Sex: F
Age: 12
State: KS

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Neck pain and spasming - sharp shooting and progressing to ear and temporal pain. Initially occurring a couple times a day and now more frequent. Also, originally started on just the left side of the neck and is now occurring on both sides.

Other Meds: None

Current Illness: None

ID: 1392951
Sex: F
Age: 68
State: WA

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Seafood, Sulfa antibiotics, Corticosteroid

Symptom List:

Symptoms: Vomiting for 30 hours, Headache, Cold sweats, Feverrish, Body aches, not enough energy. Pt has taken ibuprofen otc and rehydrated. She is going to call her doctor.

Other Meds: Amitriptylline, Tizanidine

Current Illness: None

ID: 1392952
Sex: M
Age: 60
State: AZ

Vax Date: 02/03/2021
Onset Date: 03/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: allergic to antibiotics

Symptom List:

Symptoms: none

Other Meds: none

Current Illness: none

ID: 1392953
Sex: F
Age: 33
State: WA

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None listed in medical chart

Symptom List:

Symptoms: 10-minutes post vaccination (drive-thru vaccine site), pt called for help, was swaying in car seat, became nearly unresponsive; reported headache, nausea, leg pain. No difficulty breathing. EMS was called. vital signs stable. Pt was transported to hospital.

Other Meds:

Current Illness: None

ID: 1392954
Sex: M
Age: 36
State: WA

Vax Date: 05/14/2021
Onset Date: 05/18/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Allergy to nickel.

Symptom List:

Symptoms: While laying in bed to sleep, my heart rate was 90 BPM when my normal resting heart rate is in the high 50s. While waiting to see if it would slow down, my heart rate went up up 120 BPM and remained elevated for approximately a half an hour. I went to urgent care and arrived after my heartbeat was normal. An EKG showed a premature heartbeat but they detected no other issues and sent me home. I was later given a Holter monitor for 24 hours which did not detect a premature heartbeat or any issues. On 06/08, while resting, my heart rate slowly climbed to 120 BPM for no apparent reason, then slowed down again after an hour.

Other Meds: Approximately 238 mg caffeine in diet Pepsi 12 hours prior to symptoms. 10mg Loratadine and 20mg Omeprazole about 16 hours prior to symptoms.

Current Illness: None.

ID: 1392955
Sex: M
Age: 43
State: PA

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No known allergies

Symptom List:

Symptoms: PATIENT PASSED OUT AFTER RECEIVING VACCINATION. EMS WAS CALLED AND TOOK PATIENT TO HOSPITAL VIA AMBULANCE.

Other Meds: Gabapentin 300, Montelukast 10mg, Topirimate 50mg, Sumatriptan 100mg

Current Illness:

ID: 1392957
Sex: M
Age: 50
State: CA

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: The patient was given Moderna COVID-19 vaccine by mistake instead of Pfizer COVID-19 vaccine as a second dose. The patient did not develop any adverse reactions.

Other Meds: None

Current Illness: None

ID: 1392958
Sex: M
Age: 35
State: TN

Vax Date: 04/12/2021
Onset Date: 04/16/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: Right sided headache x 5 days. No thunderclap onset. Patient complains of nausea and sensitivity to light. Headache is throbbing in nature. Patient experienced tingling in right cheek the day before presentation. Patient is treated with diphenhydramine and prochlorperazine in ER and is given a prescription for Topamax to take at home for the next 5 days.

Other Meds: Excedrin , ibuprofen as needed

Current Illness:

ID: 1392959
Sex: F
Age: 33
State: WA

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Diary, pertussis, grass

Symptom List:

Symptoms: 48 hours of adverse effects. Violent chills, extreme dizziness and vomiting. Body aches during the first 24 hours. Sore arm at injection site for 48 hours. Slept all day on day 2.

Other Meds: None

Current Illness: None

ID: 1392960
Sex: F
Age: 47
State: FL

Vax Date: 05/01/2021
Onset Date: 05/20/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: 1-3 mins after receiving shot I experienced blurry vision and dizziness. Lasted a few minutes then stopped. Afterwards a headache that lasted the rest of the day.

Other Meds: None

Current Illness: None

ID: 1392961
Sex: F
Age: 34
State: AZ

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Unknown

Symptom List:

Symptoms: Almost immediately (within 15 seconds) after administration, patient stated she did not feel well. Soon after, stated she was going to vomit, requested water, stated "I'm going to die", leaned head back once and full body forward 2 times in chair and almost(or did for a moment?) pass out seated, requested and tried to roll out of chair to floor. Pharmacist was resting arm on patient shoulder to stop potential fall, changed position to front of patient, then assisted to the floor (~2:15-2:19pm). Patient continued drinking and completed ~4oz of water while changing position from back to right side. Rolled up smocks were under her head and neck for comfort. Pharmacist and supervisor continued to ask questions which were answered correctly and she was able to grasp pharmacist's hand and squeeze with both of her hands. Patient stated this is reason she does not donate blood and '?' and ginger have helped her in the past. She stated she was feeling better and sat up against the wall. When informed that paramedics were coming to assess. She stated no need and requested water and snack, stating possible that lack of food or water and being in the warehouse for awhile may have contributed. Water and snack were denied to patient upon medical dispatch request. Patient brought herself back to lying on right side until paramedics arrived.

Other Meds: Unknown

Current Illness: Unknown

ID: 1392962
Sex: M
Age: 27
State: NY

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: 27 year old male with nka no known PMHx vaccinated with Janson vaccine on left deltoid @5:50 while on the waiting area @5:53pm patient was seating on the chair and suddenly fell dizzy patient fell on the floor hitting his face as a result of the impact patient broke his nose, with area of echimosis extending around the right orbit. 2-3 seconds after patient recovered consciousness and revised with no intervention needed... All vitals were stable.... Ambulance was offered for the patient and he refused stating this is regular for him every time he is "stick with a needle". Patient went home asymptomatic apart from tenderness and pain in the area. Next day Follow up calls were intended, but phone was never picked.

Other Meds: None

Current Illness: None

ID: 1392963
Sex: M
Age: 30
State: CA

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 06/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient received his first dose of Pfizer COVID Vaccine (Lot #EW0185, Exp 08/2021) in left deltoid on 05/21/2021 at 11:58 am. Patient states he had been taking penicillin for tonsillitis for approximately 3 days before receiving his first dose of COVID Vaccine. Patient states approximately one hour after receiving his first dose of the Pfizer COVID vaccine, he began to experience "swelling" in his throat. Patient states he was unable to speak for approximately one minute, so he took a drink of water and the swelling immediately relieved. Patient denies SOB. Patient states he lost his voice for two days following this episode. Patient called PCP to report symptom and his doctor advised patient to discontinue use of antibiotics. Patient states he has had an "uncomfortable sore throat" since discontinuing his antibiotics. Patient denies allergies or medical conditions. Patient due to receive dose 2 of Pfizer on 06/11/2021 at . On 06/11/21, patient consulted with nurse about adverse event following his first dose of Pfizer vaccine. Nurse elevated concerns to next upline nurse. Nurse elevated medical consult to doctor. Patient was given medical clearance from doctor at 3:10 pm. Patient received his second dose of the Pfizer COVID vaccine (Lot #ER8735, Exp 08/2021) at 3:11 pm. Nurse provided patient with education related to when to seek medical care, including shortness of breath, chest tightness, and sensation of throat tightness. The patient demonstrates understanding of teaching and states he will call doctor if he experiences these symptoms.

Other Meds:

Current Illness:

ID: 1392964
Sex: F
Age: 38
State: MA

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 06/11/2021
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Allergies: penicillin

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Symptoms: 12 hours after vaccination I noticed the lymph node on my right clavicle, the same side as the injection, was enlarged. The same lymph node had become enlarged after the 1st Dose of Moderna and it had returned to its normal size before the 2nd Dose. 24 to 36 hours after the 2nd Dose Moderna, the lymph node had grown almost to the size of a golf ball. Today, 06/11/2021, the lymph node has not returned to its normal size. It is now the size of a pea. Four days after the vaccination I had tachycardia. It returned to normal after a couple of days.

Other Meds: Multi vitamins Vitamin-D Zyrtec 10 mg

Current Illness: no

ID: 1392965
Sex: F
Age: 71
State: AZ

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 06/11/2021
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Allergies: I am allergy to wheat, dairy products, seasonal allergies, and I cannot take aspirin/penicilln.

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Symptoms: I am experiencing the same adverse events that carried over from the first dosage of the vaccine (hives) and currently being treated for the hives by my Doctor.

Other Meds: I was taking Zyrtec.

Current Illness: I have Asthma.

ID: 1392966
Sex: M
Age: 15
State: NY

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
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Allergies: none known

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Symptoms: Fainted, fell off chair. Regained consciousness after 30 seconds. Reported that vision became blurry and then fainted. EMS responded with EKG and BP normal, Heart Rate was 106. Left facility after 40 minutes and walked home. approx 4 blocks.

Other Meds: none

Current Illness: none

ID: 1392967
Sex: F
Age: 54
State: MI

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 06/11/2021
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Allergies: Penicillin

Symptom List:

Symptoms: Strong metallic taste but no more than 2-3days Since has gone away.

Other Meds: Motrin 800mg, Calcium, Magnesium, Selenium, Standard Process Multi Vitamin, Water pill

Current Illness: none

ID: 1392968
Sex: F
Age: 23
State: VA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/11/2021
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Allergies: none

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Symptoms: Pt received the vaccine, when she got up to leave, she started feeling faint. She walked approx 20 ft away from the pharmacy when she fainted. Her boyfriend caught her and another bystander asked for help. The pharmacist went out to help, lowered the Pt to the floor, pt lied supine until pt became conscious. Pt was asked to stay supine for 3-5 minutes before she was helped to a chair. Pt's pupil were initially dilated, pt's radial pulse was hard to find initially. After pt was seated in a chair, her pulse was 98, pupils were perl, no N/V, no abdominal discomfort. Pt stayed seated near the pharmacy for 30 minutes for further monitoring, Pt said she felt fine, pulse 78, strong and regular, pupils perl. Pt's boyfriend took her home. Pt called vaccinator a hour later and reported she felt fine .

Other Meds: none known

Current Illness: none

ID: 1392969
Sex: M
Age: 40
State: OH

Vax Date: 03/25/2021
Onset Date: 05/28/2021
Rec V Date: 06/11/2021
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Allergies: Doxycycline, Lisinopril and Bee venom

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Symptoms: Lab values came back out of normal ranges. GFR normally around 58 came back 39 on 5.28.21 and 45 on 5.29.21 and 35 on 6.10.21. Also showing elavated creatine labs. Concerned this may be vaccine related.

Other Meds: Metformin , Sodium Bicarb , Nefazadine, Vitamin D, Toprol Xl, Allopurinol

Current Illness:

ID: 1392970
Sex: F
Age: 23
State: GA

Vax Date: 05/10/2021
Onset Date: 05/12/2021
Rec V Date: 06/11/2021
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Symptoms: Tonsils became very swollen 2 days after receiving vaccine. Pain in tonsils was also involved. After pain ceased, I produced a heavy amount of mucus for 4 days. No medication helped.

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Current Illness:

ID: 1392971
Sex: F
Age: 36
State: IN

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 06/11/2021
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Allergies: Onion, coconut

Symptom List:

Symptoms: Fever of 101 Nausea (no vomit) Nasal drainage and pressure Extremely painful headache Chills

Other Meds: None

Current Illness: None

ID: 1392972
Sex: F
Age: 27
State: PA

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 06/11/2021
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Allergies: Peaches

Symptom List:

Symptoms: Redness, swelling, hardness, and warm to touch at injection site approximately 19 hrs following vaccination. Pt also had chills/body aches/headache that resolved quickly. Redness continued, and area is growing. Pt is seeking medical attention at this time. Pt has contacted PCP but is awaiting appointment.

Other Meds: Divalproex Folic

Current Illness:

ID: 1392973
Sex: M
Age: 38
State: VA

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/11/2021
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Allergies: sulfamethoxazole

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Symptoms: Patient called the pharmacy (6/5/21) to talk about his Moderna Covid vaccinations. He stated he felt drained and sluggish. He had his 1st dose on 5/5/21 and his 2nd dose on 6/2/21. In general he has had the following: Headache, dry mouth, body aches, nausea, and fatigue. I asked him how he felt the day he called on 6/5/21 (3 days post his second dose). He stated that he still had a headache and was fatigued (he only felt like lying down). Patient is an employee here and wanted to know what he should do about returning to work. I referred him to store manager. I gave her his number and she was going to call him. He had spoken to managers before 6/5/21. I explained that these side effects are possible with vaccines and that some patients respond with more side effects than others or have a stronger response. However, I am filing a VAERS because the patient mentioned that he had the following after his 2nd dose. He stated that about an hour after his vaccine on 6/2/21, he had hives and itching on his arms and neck and dry throat. He stated that he has used Benadryl and hydrocortisone to treat these symptoms. I asked him did he have any reaction after his 1st dose on 5/5/21. He stated that he had itching in his throat after the 1st one, but he thought it was just a dry throat and did not know if it was coming from the vaccine. As far as I know, 6/5/21 was the first day that the he had let anyone at the pharmacy know about any side effects. I told him to let his primary care doctor know this information that we discussed. I also recommended that he could take Tylenol if he wanted to do so. Patient used a Doctor on Demand service through employee and provider prescribed aspirin 325 mg tablet once daily.

Other Meds: Ozempic, Synjardy, Amlodipine, Losartan, Pantoprazole, Tresiba, Metformin,

Current Illness:

ID: 1392974
Sex: F
Age: 55
State: CO

Vax Date: 04/12/2021
Onset Date: 04/27/2021
Rec V Date: 06/11/2021
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Symptoms: I went to the eye doctor at the end of 04/27/2021 and when I returned on 05/12/2021 and my vision had deteriorated, and I had indications of Cataracts in both eyes. The evidence was not noted on the previous visit. I am not sure if it has anything to do with the vaccine. I developed a rash on 06/02/2021. It started on my elbow and then it moved to my thighs and it is mostly on my arms and legs. It has been there for 10 days so far. It has spread and it is red little bumps like a skin irritation and it is itchy. I have not taken any new medication recently. I am planning on seeing a doctor for the rash.

Other Meds: Lisinopril 20mg Chlortalidone Atorvastatin

Current Illness:

ID: 1392975
Sex: M
Age: 24
State: NY

Vax Date: 05/01/2021
Onset Date: 05/03/2021
Rec V Date: 06/11/2021
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Symptoms: 2 days after receiving the vaccine, I felt a severe pain in my chest/stomach area, centered just below my rib cage. It hurt when I was laying immobile, and it hurt even more when I moved. The pain lasted for approximately 4 days, by the third day I the pain had lessened considerably, and on the fourth it was only present when I was upright for extended periods of time.

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Current Illness:

ID: 1392976
Sex: F
Age: 33
State: MS

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/11/2021
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Allergies: No known allergies at this time

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Symptoms: Patient believed that her previous COVID vaccine was Moderna administrated on 04.30.21, but upon documenting today's Moderna dose, it was noted that patient's 1st COVID vaccine was actually Pfizer administered on 03.15.2021. This RN advised patient and reported this event. No distress was noted immediately following visit, but this event is being reported as a precaution in the event that additional considerations need to be made.

Other Meds: Prenatal vitamins - Denies current pregnancy

Current Illness: Denies current illness at time of Moderna dose. . Did not inquire about illness up to one month prior during interview.

ID: 1392977
Sex: F
Age: 55
State: MD

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/11/2021
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Allergies: Sulfa meds

Symptom List:

Symptoms: STRONG Metallic taste in mouth within seconds of injection lasting 48 hours initially, then off & on throughout the day for 48 additional hours. Nausea and adverse taste made it hard to eat food, affected taste buds.

Other Meds: None

Current Illness: None

ID: 1392978
Sex: F
Age: 43
State: MO

Vax Date: 03/19/2021
Onset Date: 04/12/2021
Rec V Date: 06/11/2021
Hospital: Y

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Allergies: No

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Symptoms: Started with intermittent Chest pain which I didn?t do anything about and ignored at first and then it progressed to more constant chest pain on Or around April 25th which I went to the ER twice and urgent care once in 2 days time between April 29 an April 30

Other Meds: Metoprolol XR Levothyroxine Amlodopine Irbestartan/hctz Duloxutine Oxycodone ER 12 hour Gabapentin as needed

Current Illness: No

ID: 1392979
Sex: F
Age: 50
State: TN

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 06/11/2021
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Allergies: no known allergies

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Symptoms: abdominal (sharp and cramping) pain, nausea, vomiting. Patient Is treated with morphine, ondansetron and IV fluids.

Other Meds: none documented

Current Illness: none

ID: 1392980
Sex: F
Age: 54
State: WI

Vax Date: 05/27/2021
Onset Date: 05/31/2021
Rec V Date: 06/11/2021
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Allergies: codeine

Symptom List:

Symptoms: The patient developed a deep vein thrombosis in the leg 4 days after her vaccination

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm