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
92,076
AK1,880
AL6,345
AR4,151
AS46
AZ14,991
CA66,887
CO12,550
CT8,943
DC1,795
DE2,009
FL42,724
FM4
GA17,031
GU124
HI2,580
IA4,919
ID2,892
IL22,128
IN24,197
KS5,047
KY9,111
LA5,500
MA15,718
MD13,434
ME3,351
MH8
MI20,971
MN13,585
MO10,747
MP30
MS3,198
MT2,477
NC18,051
ND1,501
NE3,109
NH3,218
NJ20,216
NM4,218
NV4,728
NY37,667
OH20,793
OK6,692
OR9,244
PA25,607
PR2,588
QM2
RI2,163
SC7,261
SD1,282
TN10,445
TX39,890
UT4,618
VA15,980
VI67
VT1,830
WA16,071
WI12,042
WV2,571
WY926
XB5
XL1
XV2

ID: 1402759
Sex: F
Age:
State: FL

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: nausea, need to urinate, blood in urine, headache, backache, neckache, heart rate greater than 100

Other Meds: none

Current Illness: none

ID: 1402760
Sex: M
Age: 49
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402761
Sex: M
Age: 65
State: IA

Vax Date: 03/18/2021
Onset Date: 04/15/2021
Rec V Date: 06/16/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: 1st Moderna vaccine 3/18/21, no symptoms/adverse events. 2nd moderna vaccine 4/14/21, no adverse events until 5/28/21 had lost ability to move left side, was found on floor in home 4 days later on 5/26. Taken to hospital and was diagnosed with stroke. I asked the physician to report this to VAERS and he wouldn't because he didn't believe the vaccine was the cause. CDC states healthcare providers are required by law to report any unplanned hospitalization, disability (no date limit) after covid-19 vaccination, but physician kept refusing to report this to VAERS. My husband was from home independently and is now disabled, unable to move his left side and is going to a facility for long term care.

Other Meds: Lisinopril

Current Illness:

ID: 1402762
Sex: F
Age: 21
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pfizer Vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted, and recommended dose repeated.

Other Meds:

Current Illness:

ID: 1402763
Sex: F
Age: 55
State: CA

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

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

Lab Data:

Allergies: None

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

Symptoms: I felt like I was going to faint so I went up to the team and I said I felt woozy and light headed. They had me sit where they could watch me. Someone took my vitals and my heart rate was irregular. They sent me to the ER. By the time I got to the ER they said my EKG was normal. When I got home I had a really bad head ache and I am subject to migraines. I took a migraine pill. I also threw up, but that happens when I get a migraine. When I took my second shot I took migraine pill and I was ok.

Other Meds: Omeprazole 40 mg daily, Lisinopril, Multi vitamin, Fiber capsule, Vitamin D 1000 IU, Move free glucosamine immune supplement 1 tablet twice a day, Cetirizine once a day.

Current Illness: None

ID: 1402764
Sex: M
Age: 26
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PFizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402765
Sex: F
Age: 35
State: OK

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402766
Sex: M
Age: 24
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Pfizer Vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted, and recommended dose repeated.

Other Meds:

Current Illness:

ID: 1402767
Sex: F
Age: 7
State: MA

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

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

Lab Data:

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 10AM Pt had Pfizer vaccine in clinic had observation after vaccine 15 minutes, pt went home . but in 10:20am, mom carry Pt, rush back to clinic , and report to me Pt c/o black out/ weak/ dizzy. , VS T 97.6T HR 84/55 Pain scale 0, Oxygen sat 99, PT A/O x3 but pale , and state she don't feel well.no SOB, place Pt in Bed with f oot elevated,. and Pt was monitor x1:30 hour. give vital sign check, fluid to drink, Pt was discharge At 12:15 AM, with no sx of illness, vital sign WNL, instructed call if sx recurrent or ER, f/u 3 week ,with PMD,

Other Meds: Vitamin D 1000u tab 1 tab daily

Current Illness: none

ID: 1402768
Sex: M
Age: 32
State: AR

Vax Date: 03/16/2021
Onset Date: 05/20/2021
Rec V Date: 06/16/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pneumonia and enlarged heart fluid in my lungs hard time breathing only 10% heart function now, also have a blood clot in my heart

Other Meds: Klonopin 1 mg 3 times a day, metropol 100 mg 1 a day, lorsartin 25 mg 1 day, warfarin 5 mg 1 day.

Current Illness: Repaired mitrocondrial valve. Panic attacks, no spleen high blood pressure, old leg break, muscle cramps,

ID: 1402769
Sex: F
Age: 75
State: AZ

Vax Date: 01/28/2021
Onset Date: 02/01/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: antibiotics , Augmentin iodine, codeine

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

Symptoms: high blood pressure, I was having continual headaches , loss of smell and taste and hair loss, I did not lose my sense of smell and taste when I had COVID-19 in November 15th, 2020. I never had high blood pressure prior to the vaccination. I am on high blood pressure medication after the vaccine. I was on BP medication when I took the second dose and my BP still went real high. I still have loss of taste and smell , and I still have high blood pressure, and I'm still continuing with the headaches.

Other Meds: metoprolol er succinate 50mg clonidine .1 mg when BP goes over 150/90 latanoprost eye drop for glaucoma vitamin d-3 1000 125 mcg biotin because my hair started falling out after the 2nd dose b-12 supplement ocuvite ventolin inhaler as nee

Current Illness: Covid 19 tested positive on November 15, 2020 , mild symptoms, low grade fever,

ID: 1402770
Sex: M
Age: 30
State: OK

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402771
Sex: M
Age: 24
State: WA

Vax Date: 02/05/2021
Onset Date: 05/21/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient seen in ER on 5/21/21 due to chest pain that was diagnosed as pericarditis, patient with continued chest pain on in clinic visit on 5/26/21 in PCP office. Patient was sent back to ER for new nature of chest pain, and given ibuprofen.

Other Meds:

Current Illness:

ID: 1402772
Sex: F
Age: 55
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402773
Sex: F
Age: 31
State:

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient administered under-diluted diluted dose of vaccine. Patient did not experience adverse reaction from receiving higher dose.

Other Meds:

Current Illness:

ID: 1402774
Sex: M
Age: 40
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402776
Sex: M
Age: 14
State: NC

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Administered Janssen 0.5ml to 14 yo client in Right Deltoid. Client ambulated out of clinic reporting no adverse reactions.

Other Meds:

Current Illness:

ID: 1402777
Sex: M
Age: 42
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402778
Sex: F
Age: 54
State: MN

Vax Date: 04/07/2021
Onset Date: 04/11/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Left ear pain. Developed into plugged ear... Saw primary care/urgent care 4 times. Treated with ear drops and amoxicillin. Just saw ENT. Symptoms not resolved.

Other Meds:

Current Illness:

ID: 1402779
Sex: F
Age: 49
State: WA

Vax Date: 04/03/2021
Onset Date: 04/04/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: I am allergic to pets and I have outside allergies.

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

Symptoms: I had a headache instantly after receiving the vaccine. At 03:00AM, on 04/04, I woke up and started vomiting for the next 3 hours. I was able to stop enough to get my children up and then I started to vomit again. I took some anti-nausea medication (promethazine and Ondansetron) it helped a little, but I kept throwing it back up. My children called 911 and they sent an ambulance for me. They gave me another ondansetron, but I had used a suppository. They took me to a ER. While at the ER they performed a lot of tests. There was an abdominal CT, transvaginal ultrasound because of the stomach pain, I had an EKG and a lot of blood work. They gave me medication for my migraine and I was given an IV. I also received something for the pain in my stomach, but I don't recall what it was. I was given enough medication to where I could finally get a little rest. The results that they came back with was that there was free fluid in my belly, there were spots on the scans around my ovaries and uterus and there was a lot of swelling in my intestines and stomach. I was referred to a couple other different doctors. Six months prior to receiving the vaccine, I went into septic shock and my heart briefly stopped. There was a lot of damage to different systems of my body after that happened. The doctors were not sure what kind of reaction I had. They weren't sure if it was a coincidence with what I already had going on, or if it was the vaccine. I also had a false positive pregnancy test and if I test, it still shows positive. They drew blood to verify that I was not pregnant. I went to an OBGYN and now I need to go to an gastroenterologist. I also followed up with my PCP.

Other Meds: I was taking Maxalt, Zofran, Advair, multivitamin, trazadone, magnesium, Folic Acid, prescription vitamin D, Plaquenil, Xeljanz, morphine, hydrocodone, baby aspirin, Lipitor and restasis.

Current Illness: I did not have any other illnesses at the time.

ID: 1402780
Sex: F
Age: 42
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402781
Sex: F
Age: 15
State: OK

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: PFizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402782
Sex: F
Age: 58
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402783
Sex: F
Age: 35
State: NY

Vax Date: 06/14/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: Aspirin, ibuprofen, zofran, Pepcid, kiwi, paprika

Symptom List: Injection site pain, Pain

Symptoms: Pain in chest, wheezing, uncontrollable coughing which lead to my throat feeling like it?s closing, all while sweating and feeling itchy all over body. Arm hurt super bad too. Doctors gave me epipen, Benadryl & steroids in the ER. Doing better a day later.

Other Meds: Zyrtec

Current Illness: None

ID: 1402784
Sex: F
Age: 11
State: CA

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Dose given 2.5 months prior to 12th birthday

Other Meds: None

Current Illness: None

Date Died: 05/19/2021

ID: 1402785
Sex: F
Age: 89
State: OH

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/16/2021
Hospital: Y

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

Lab Data:

Allergies: SULFA

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

Symptoms: Patient experienced malaise and shortness of breath within 2-3 hours of getting the shot. Progressed over the next 48 hours and then presented to ER where she was diagnosed with acute hypoxic respiratory failure due to a myocardial infarction. Transferred to care center on 05/15/2021. Patient nor her family desired any heroic measures due to her age and comfort measures were instituted. She expired on 05/19/2021. Prior to the vaccination, patient had been active, going to the YMCA to exercise 4 times weekly. She had no previous history of previous cardiac or respiratory problems.

Other Meds: AMITRIPTYLINE, AMLODIPINE, BISOPROLOL/HYDROCHLOROTHIAZIDE, BUSPIRONE, DONEPEZIL, PAXIL, NP THYROID, ZOLPIDEM

Current Illness: NONE

ID: 1402786
Sex: M
Age: 32
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: PFizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402787
Sex: F
Age: 22
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402788
Sex: F
Age: 75
State: OK

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1402789
Sex: F
Age: 53
State: WI

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin/Bactrim Latex Bee Sting

Symptom List: Nausea

Symptoms: Swollen lymph nodes Fever Nausea Diarrhea Chills Sweats Pain at injection site

Other Meds: Metformin 2000 mg daily Trulicity 1.5 mg weekly Tresiba 30 units daily Flonase daily Lisinopril 40 mg daily Aspirin 81 mg daily

Current Illness: None

ID: 1402790
Sex: M
Age: 12
State: NC

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: Low grade fever, pain at the injection site, severe chills, severe muscle and body aches, severe fatigue and tiredness, severe nasal congestion, severe runny nose, unable to perform normal daily activities for 3 days, continued with residual symptoms and mild to moderate activity impairment for 9 days.

Other Meds: Zyrtec

Current Illness: None

ID: 1402791
Sex: F
Age: 74
State: TN

Vax Date: 06/04/2021
Onset Date: 06/14/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

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

Symptoms: The patient presented to the pharmacy with a red swollen rash that extended from her shoulder to elbow on the outer arm. She said it was warm and itchy.

Other Meds: unknown

Current Illness: unknown

ID: 1402792
Sex: M
Age: 46
State: MN

Vax Date: 04/24/2021
Onset Date: 05/04/2021
Rec V Date: 06/16/2021
Hospital: Y

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1402793
Sex: M
Age: 73
State: NC

Vax Date: 02/27/2021
Onset Date: 03/12/2021
Rec V Date: 06/16/2021
Hospital: Y

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

Lab Data:

Allergies: Morphine.

Symptom List: Tremor

Symptoms: 01/22/2021 EKG WHICH WAS NORMAL. EYE PROBLEMS 03/12/2021 EKG DONE HEART WAS IRREGULAR. 03/29/21 HEART MONITOR, NOT NORMAL 28% OF THE TIME, HAD MONITOR FOR TEN DAYS. 04/7-8/2021 ER VISITS HEART RATE 29 BEATS PER MINUTE HEART ABRASION SURGERY 06/18/21

Other Meds: I was taking Protonic.

Current Illness: No.

ID: 1402794
Sex: F
Age: 16
State: NY

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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Allergies: No

Symptom List: Erythema, Pruritus

Symptoms: Hives but diphenhydramine cleared up

Other Meds: Mono-Linyah

Current Illness: No

ID: 1402795
Sex: F
Age: 15
State: CA

Vax Date: 05/22/2021
Onset Date: 05/23/2021
Rec V Date: 06/16/2021
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Allergies: NKA

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

Symptoms: Patient received the 1st COVID vaccine Pfizer Lot#EW0185 on 05/22/21 at 11:18AM. The patient presents to the vaccination site today for her 2nd COVID Pfizer vaccine with her mother. She alerted RN that she developed dizziness 24 hours following her 1st vaccine. RN alerted RN lead who responded. The patient told RN the dizziness lasted about one hour. She did eat prior to receiving the vaccine on 05/22/21. The patient did eat today prior to presenting to the vaccination site. The patient did not report SOB after the 1st dose of COVID vaccine Pfizer. The patient did not consume any medications for the reactions to the 1st dose. They did not follow up with any medical care providers after developing dizziness. The patient denies any chronic conditions, or current medications. The patient has no known allergies. RN consulted with the Medical Consult Team regarding the patient and her reactions to the first dose of COVID vaccine Pfizer. Approval was received from PHN via text message. RN provided education regarding s/s of anaphylaxis, to report any symptoms during observation to EMT, to follow up with PCP if the patient develops any symptoms post vaccination, to consume water prior to vaccination and after, and V-safe. The patient was also instructed to wait 30 minutes in the observation period. The patient and her mother voiced understanding of this. The patient stated she had already drank water while waiting in line pending vaccination. Patient received the 2nd COVID vaccine Pfizer Lot#EW0187 on 06/12/21 at 12:44PM. The patient waited in the observation area for 30 minutes with her mother. She did not alert the EMTs of any symptoms during her observation period.

Other Meds: None

Current Illness:

ID: 1402796
Sex: F
Age: 48
State: MS

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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Allergies: none listed

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

Symptoms: Immediately after the shot (10:29 am) , the patient's arm developed a round, swollen area around the injection site that turned into a hard knot. Within 5 minutes, the patient described feeling hot, dizzy, experiencing an elevated heart rate, and her arm was hurting (10:34 am). Over the next 10-20 minutes her symptoms did not improve, but she began to feel light-headed and stated multiple times that she may pass out; She also described having a dry mouth and tingling sensations in her arm (10:45 am). We monitored blood pressure every 5 minutes, asked the patient to lay on the floor, and fanned her. She refused an ambulance initially, but did ask for one ~30 minutes after vaccine administration. Patient refused an epi-pen.

Other Meds: Losartan/Hctz 50/12.5 mg

Current Illness: Patient said that she has had a cold for the last few weeks

ID: 1402797
Sex: F
Age: 32
State: CA

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/16/2021
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Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: prone to passing out with vaccines so patient was placed in zero gravity chair to administer vaccine. Patient passed out while laying in chair but regained consciousness soon after. Water given and additional observation recommended

Other Meds: none

Current Illness: none

ID: 1402798
Sex: F
Age: 21
State: MT

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/16/2021
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Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Headache, Chills, Nausea

Other Meds:

Current Illness:

ID: 1402799
Sex: M
Age: 37
State: TX

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/16/2021
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Allergies: None known

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

Symptoms: Severe tinnitus, variable throughout the night, louder than the train horn 4 blocks away. Severity slowly lessened the next day, by evening June 2 it was at the steady state level it is still at now, 2 weeks later. It's extremely distracting and reduces my ability to focus or think clearly. I have a purely thinking job and this is an extremely disruptive and productivity reducing level of sound. Related but not what is being reported: Fever of 103F from about 7pm (6 hours after injection) to early morning. Down to 101F by 8am. 400mg ibuprofen taken at 9pm. I've never had any negative reaction to any other vaccine before.

Other Meds: None

Current Illness: None

ID: 1402800
Sex: F
Age: 15
State: IN

Vax Date: 06/14/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
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Allergies: None

Symptom List: Pain in extremity

Symptoms: Severe headache about 7 hours after vaccination, also severe body aches and chills responded to ibuprofen

Other Meds: None

Current Illness: None

ID: 1402801
Sex: F
Age: 51
State: WI

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 06/16/2021
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Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: Approximately 10 hours after receiving the second shot of the Pfizer COVID 19 vaccine, I started to experience 'ringing' or a 'buzzing noise in my ears. The noise has been CONSTANT / never ending since that time, which has been over 4 months.

Other Meds: daily multi-vitamin

Current Illness: none

ID: 1402802
Sex: F
Age: 33
State: MD

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/16/2021
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Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient had insomnia for 24 hours could not sleep, she admits to having a bad headache and vertigo that have not resolved.

Other Meds:

Current Illness:

ID: 1402803
Sex: M
Age: 28
State: NJ

Vax Date: 06/02/2021
Onset Date: 06/03/2021
Rec V Date: 06/16/2021
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Allergies: nkda

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

Symptoms: Developed left lower leg pain the follow day after receiving his second COVID vaccine. Still persistent to date.

Other Meds: none

Current Illness: none

ID: 1402804
Sex: F
Age: 60
State: LA

Vax Date: 06/11/2021
Onset Date: 06/12/2021
Rec V Date: 06/16/2021
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Allergies: penicillin

Symptom List: Vomiting

Symptoms: had 2nd shot at 9 am woke up 2 am throwing up with chills and fever and stomach discomfort. took advil; when i woke back up at 6 am underneath my tongue was so swollen I could not talk and difficultly in swallowing. Took an allegra and swelling went down about 2 hours. Now I have ulcers/sores under my tongue, slight sore throat and ears. As of today, June 16th, condition still persists.

Other Meds: probiotic, advil

Current Illness: none

ID: 1402805
Sex: F
Age: 69
State: TX

Vax Date: 01/25/2021
Onset Date: 01/27/2021
Rec V Date: 06/16/2021
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Allergies: Respiratory Allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I started getting welts and hives on different parts of the body, my neck, stomach, back, legs, arms, everywhere. I took some Benadryl and it didn't go away. I reached out to the doctor on 02/01/2021 and he gave me a dose pack and a cortisone shot. The hives went away for a few weeks and came back. I went to the dermatologist on 03/17/2021, had a biopsy and prescribed a cream. On 5/7/2021, I went back to the doctor because my upper lip was swollen and I had hives again. I was given another cortisone shot and they went away for a few weeks and came back. On 5/26/2021, I had a televisit with my Allergist and was told to up the dosage of my Allegra and was prescribe Pepcid. On 6/01/2021, it happened again with bright red hives with funny shapes all over my legs. I went back to the doctor and was given another cortisone shot and was referred to a new dermatologist.

Other Meds: Started taking Sulfamethoxazole on 01/23/2021, Singulair, Allegra, Symbicort

Current Illness: No

ID: 1402806
Sex: F
Age: 70
State: FL

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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Allergies: Denies

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

Symptoms: 70 y/o with past medical history of C4/C5 compression who presents with shortness of breath post vaccination. Patient states that this is the second vaccination in the two-dose Pfizer series. Patient denies reaction to previous vaccinations. Patient received the vaccination to the right arm. Patient denies sore throat, difficulty swallowing, chest pain or rash. NP and Paramedics at patient side. Patient with noted elevated BP (184/91) and remaining vitals normal (99% O2, 82 HR). EKG normal. Patient placed on 2L O2 by NC. Patient provided with water bottle. Patient monitored for 25 mins with resolution of symptoms. BP normalized to 145/72 and patient weaned off O2 with no further complaints of shortness of breath. Remaining vitals within normal limits. Patient aware that if symptoms persist or worsen to seek further medical care. Patient discharged in stable condition

Other Meds: Denies

Current Illness: Denies

ID: 1402807
Sex: M
Age: 38
State: MN

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/16/2021
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Allergies: None reported

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient came into our vaccination clinic we were having for youth. He asked about getting the vaccine for himself as well. Since he was an adult Moderna vaccine was offered to him. He stated he had not received the vaccine previously and would like to get vaccinated. He completed the vaccine form and indicated he had not received a COVID vaccine. Moderna vaccine was given to the patient thinking he was receiving his 1st dose by RN. When entering data into the system, it was discovered that patient had received a Moderna COVID vaccine 5 days prior. This was not immediately brought to my attention. I was just notified today. I have attempted to call patient to notify him but there was no answer.

Other Meds: Unknown

Current Illness: None reported

ID: 1402808
Sex: M
Age: 19
State: CA

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 06/16/2021
Hospital:

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Allergies: n/a

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

Symptoms: pt verbalized he felt sleep and confused 12 hours after the vaccine

Other Meds: n/a

Current Illness:

Date Died: 06/07/2021

ID: 1402809
Sex: M
Age: 57
State: WA

Vax Date: 05/28/2021
Onset Date: 06/07/2021
Rec V Date: 06/16/2021
Hospital:

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Lab Data:

Allergies: UNK

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

Symptoms: Deceased 6/7/21 (Unsure if related)

Other Meds: UNK

Current Illness: UNK

Total 2021 VAERS Injuries: 704,237

Page last modified: 26 October 2021 2:21am