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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1347180
Sex: F
Age: 41
State: MN

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

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Site: Bruising at Injection Site-Medium, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)

Other Meds:

Current Illness:

ID: 1347181
Sex: F
Age: 71
State: CA

Vax Date: 04/08/2021
Onset Date: 05/02/2021
Rec V Date: 05/25/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Positive COVID-19 test with symptoms after being fully vaccinated

Other Meds: On chemotherapy

Current Illness:

ID: 1347182
Sex: F
Age: 51
State:

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 05/25/2021
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:

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

Symptoms: Patient presented to the ED on 4/9/21 and diagnosed with diverticulitis. Patient presented to the ED and was subsequently hospitalized on 4/20/21 with pancreatitis. These visits were within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1347183
Sex: F
Age: 21
State: MA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 05/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Night of vaccine for 3 days, extreme chills and cold sweats, fever, cold symptoms. No medication administered. Numbness in left leg 1 week later.

Other Meds: Birth control pill,

Current Illness: N/A

ID: 1347184
Sex: F
Age: 46
State: MI

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: Bactrim, shrimp, peanuts, sesame, fish

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

Symptoms: Onset of dyspnea, wheezing, chest pressure, nausea immediately following immunization. Patient was treated on-site with IM epinephrine before transport to hospital, with resolution of her difficulty breathing but continued nausea. In Emergency Department treated with oral Benadryl, prednisone, famotidine, Zofran.

Other Meds: Albuterol, Symbicort, Vesteril, Omeprazole, Tylenol

Current Illness: "Stomach pain"

ID: 1347185
Sex: F
Age: 26
State: PA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/25/2021
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: NONENONE

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

Symptoms: PATIENT RECEIVED VACCINE AT 4:15PM ON 5-20-21. EXPERICENCED FEVER, SWEATING, FATIGUE, AND INJECTION SITE PAIN WITHIN HOURS OF VACCINE. NEXT MORNING PATIENT EXPERIENCED ARM, SHOULDER, FINGER OF LEFT ARM MUSCLE SPASMS. LEFT HAND STIFFENED AND LOCKED IN POSTION FOR COUPLE MINUTES DURING DAY. PATIENT DID NOT SEEK MEDICAL ATTENTION BECAUSE SHE SAID SHE WAS TO WEAK TO CALL FOR HELP AND JUST SLEPT. SHE THOUGHT IT WOULD BE BETTER ONCE SHE AWOKE. PATINET DID FEEL SOMEWHAT BETTER NEXT DAY, BUT STILL EXPERIENCING MUSCLE SPASMS AND WEAKNESS AND HAVING DELAYED RESPONSE FOR MUSCLE CONTRACTION. SPOKE TO MD BECAUSE SHE COULD NOT GET APPOINTMENT 2 DAYS AFTER SHOT AND WAS TOLD TO TAKE TYLENOL, BENADRYL FOR SYMPTOMS. PATIENT DID NOT SEEK MEDICAL HELP AT ER DUE TO NO INSURANCE COVERAGE.

Other Meds: NONE

Current Illness: NONE

ID: 1347186
Sex: F
Age: 57
State: NC

Vax Date: 03/27/2021
Onset Date: 04/30/2021
Rec V Date: 05/25/2021
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: NA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient experienced soreness in arms and legs and eventually suffered a stroke

Other Meds: NA

Current Illness: NA

ID: 1347187
Sex: M
Age: 75
State: TX

Vax Date: 01/25/2021
Onset Date: 04/26/2021
Rec V Date: 05/25/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: Moderna COVID-19 Vaccine EUA: Patient received Moderna COVID-19 vaccines from physician office on 12/28/2020 and 1/25/2021. Patient presented to Emergency Department on 5/3/2021 complaining of watery, green diarrhea that started on 4/25/2021. Stool studies were done as an outpatient that were reported as negative. He was prescribed Flagyl and Bactrim which initially improved symptoms, but then symptoms returned. EGD and colonoscopy were performed. EGD revealed some inflammatory changes in the duodenum where biopsy was taken. Per the pathologist, H pylori organisms were not observed. Within the colon small polyps were noted as was mild inflammation of the entire colon.These studies were followed by CT enterography which revealed a known 3cm duodenal diverticulum and fluid filled colon compatible with diarrheal state as well as some inflammatory changes of the colon as was seen on lower endoscopy.

Other Meds: Atorvastatin 40 mg QD, Amlodipine 10 mg QD, Losartan 100 mg QD, Finasteride 5 mg QD, Tamsulosin 0.4 mg QD, Saw Palmetto 450 mg QD, Pristiq 50 mg QD, Famotidine prn, Preservision BID, Vitamin D 5000 units QD, Caltrate BID, Ipratropium 0.03%

Current Illness:

ID: 1347188
Sex: M
Age: 18
State: IL

Vax Date: 05/13/2021
Onset Date: 05/22/2021
Rec V Date: 05/25/2021
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: half of face is drooping., bell palsy

Other Meds: None

Current Illness: None

ID: 1347189
Sex: M
Age: 25
State: WA

Vax Date: 05/11/2021
Onset Date: 05/18/2021
Rec V Date: 05/25/2021
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: Amoxicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Possible pericarditis. Substernal chest pain worse with inspiration and laying down starting 1 week after 2nd COVID vaccine. Normal EKG. Physical exam is normal/negative.

Other Meds: Ascorbic Acid, multivitamin, vitamin D

Current Illness: None

ID: 1347190
Sex: M
Age: 12
State: MT

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/25/2021
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 received the vaccination at 1148. A few minutes after receiving the vaccine the patient became faint. The patient was placed in Trendelenburg, drank juice and remained laying for 20 minutes. VSS at 1103 when patient sat up. Patient did experience dizziness or blurred vision upon sitting upright. After sitting for several minutes his blood pressure was 100/59.

Other Meds:

Current Illness:

ID: 1347191
Sex: M
Age: 58
State: PA

Vax Date: 01/24/2021
Onset Date: 05/03/2021
Rec V Date: 05/25/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: Itchiness at injection site,

Other Meds: treatment for DM

Current Illness: none

ID: 1347192
Sex: M
Age: 58
State: MD

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/25/2021
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: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1347193
Sex: F
Age: 59
State: AZ

Vax Date: 03/12/2021
Onset Date: 04/01/2021
Rec V Date: 05/25/2021
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: Around 4pm, I had severe chest pains. I thought I had a heart attack. I called the ambulance and spent time in the ER. I was then told I had a perforated ulcer. Then I had surgery. In 2014, I did have gastric bypass surgery done and was later told the perforated ulcer is sometimes a result of the gastric bypass surgery.

Other Meds: Levothyroxine Ezetimibe Citalopram

Current Illness:

ID: 1347194
Sex: M
Age: 19
State: FL

Vax Date: 05/23/2021
Onset Date: 05/24/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: chills, possible fever, pain in chest on either side and cough; trouble breathing

Other Meds: none

Current Illness:

ID: 1347195
Sex: F
Age: 28
State: ME

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/25/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Near syncope.

Other Meds:

Current Illness:

ID: 1347196
Sex: F
Age: 54
State: TX

Vax Date: 01/22/2021
Onset Date: 01/26/2021
Rec V Date: 05/25/2021
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: NKDA, Mushrooms

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

Symptoms: Initially thought I was having a stroke. Went to ER. Not having stroke. A few weeks lates started having: Loss of balance including falling, speech difficulty, memory impaired, cognitive functions diminished, vision irregularities. Went to see Dr. who prescribed Steroid IV infusion for 5 days. Trazadone for sleep, and has ordered IVIG infusions ( awaiting on someone to administer.

Other Meds: Gabapintin, Hydracodone, Alprasalama, Synthroid, Wellbutrin, Escitalopram, Metroprolol

Current Illness: Covid. Just over one month prior

ID: 1347197
Sex: M
Age: 35
State: ME

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/25/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Syncope. allowed to rest in supine position and monitored

Other Meds:

Current Illness:

ID: 1347198
Sex: F
Age: 51
State: MA

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 05/25/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Gluten Fluticasone Quinoa

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I was deeply fatigue, achy like I had the flu and diarrhea and I believe it triggered my illness because I did have to get on bigger dose of my medicine.

Other Meds: Levothyroxine Losartan Potassium Norathindrone Vitamin D Vitamin B-12 Glucosamine General B Supplement Omega 3 inositol Magnesium Potassium Multivitamin Vitamin C APA

Current Illness: None

ID: 1347199
Sex: M
Age: 61
State: VA

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: vaccination was expired by 40 minutes

Other Meds: n/a

Current Illness: n/a

ID: 1347200
Sex: F
Age: 49
State: TX

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Additional Details: after waiting 15 minutes after second moderna vaccine patient felt dizzy upon standing. Had patient wait another 15 minutes and took blood pressure twice while she was in the store. Both times the BP was greater than 150/100. Offered patient benadryl for the dizziness but she refused. after the additional 15 minutes passed she was able to get up and walk.

Other Meds:

Current Illness:

ID: 1347201
Sex: F
Age: 45
State: CA

Vax Date: 05/14/2021
Onset Date: 05/16/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: Face got swollen and I continue to experience sudden swelling of face, discharge/clotting when not on menstrual cycle, dizzy spells, fatigue, headaches/migraines ongoing, shortness of breathe.

Other Meds: N/A

Current Illness: None

ID: 1347202
Sex: M
Age: 44
State: TX

Vax Date: 04/22/2021
Onset Date: 05/14/2021
Rec V Date: 05/25/2021
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: No

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

Symptoms: I believe it's shingles. I believe it started between the second and first dose.

Other Meds: None

Current Illness: None

ID: 1347203
Sex: F
Age: 66
State: NY

Vax Date: 12/22/2020
Onset Date: 01/25/2021
Rec V Date: 05/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: Unusual "high pitched roaring" in ears, which is not the typical ear ringing, very loud, sounds like water running through pipes inside a wall, the sound interferes with normal hearing

Other Meds: cod liver oil capsule, MVI

Current Illness: none

ID: 1347204
Sex: F
Age: 56
State: VA

Vax Date: 01/19/2021
Onset Date: 01/21/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: NSAIDS Shellfish Augmentin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Tinnitus started within 12 hours. Has been constant 24/7 since 1/21/21. It feels like it is mostly on the left side of my head.

Other Meds: Synthroid 50mg

Current Illness: None

ID: 1347205
Sex: F
Age: 33
State: MA

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 05/25/2021
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: Mushrooms

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

Symptoms: Participant experienced redness, swelling and itching which started the day after her first and second dose and disappeared within 24 hrs. Then she noticed a pain that started at the injection site and ran down to 2 fingers on her left hand. It occurred after the 1st dose and disappeared 2 days before the 2nd dose and continued after the second dose but was more severe. The pain is still there and has not fully gone away. Participant wrote a message to her doctor after the 2nd dose she was advised to wait for the symptoms to disappear her doctor prescribed Motrin and Tylenol that did not help so she was then prescribed Lidocaine patches that she used for 3 weeks and then stopped because they did not help much.

Other Meds: none

Current Illness: none

ID: 1347206
Sex: F
Age: 61
State: TN

Vax Date: 05/05/2021
Onset Date: 05/19/2021
Rec V Date: 05/25/2021
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: Phenergan,, Neosporin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Rash began on posterior L neck 5/19/21. Gradually progressed to L arm then Left breast Left stomach left thigh. Then began on right after 5-6 days. Raised papular and macular erythematous areas. Pruritic. Started Prednisone taper and triamcinolone cream today .

Other Meds: Ferrous sulfate, Trulicity, HCTZ, Metformin, Celexa, trazodone, Losartan, Pravastatin, calcium, Vitamin D3, Omeprazole, Baclofen

Current Illness:

ID: 1347207
Sex: M
Age: 55
State: NY

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Within (12) hours of injection: Fatigue set in which is still occurring (9) days later. Within (5) days of injection: Left arm is showing a lot of discoloration & numerous black & blue within 6? of vaccination site.

Other Meds: Diphenhydramine

Current Illness:

ID: 1347208
Sex: M
Age: 62
State: MO

Vax Date: 04/30/2021
Onset Date: 05/22/2021
Rec V Date: 05/25/2021
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: NONE

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

Symptoms: PT REPORTING BRUISING ON BOTH LOWER ARMS AND KNEES. WAS WORKING ON HIS CAR, AND DID NOT BELIEVE HE HAD BRUISED THESE EXTREMITIES, BUT STARTED SEEING BRUISING ABOUT 48 HOURS AFTER THIS ACTIVITY. FELT HE SHOULD ASK PHARMACIST AT VACCINATION SITE IF THIS MAY BE A CONCERN

Other Meds: NONE

Current Illness: NONE

ID: 1347209
Sex: F
Age: 61
State: IN

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/25/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)

Other Meds:

Current Illness:

ID: 1347210
Sex: F
Age: 53
State: VA

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient checked in to Immunization for Pfizer Covid Vaccine Dose #1 (LOT EW0183 EXP 08/21) at 1254 then sent to observation area. shortly after receiving the dose of Pfizer covid vaccine, patient complaint of itchiness. Observer went to notify Nurse. Nurse noted patient was also having trouble talking and difficulty swallowing and breathing. EPIpen was immediately administered to Right Thigh (0FM500 exp May 22) at 1325. Patient states she has history of Anaphylaxis with Influenza vaccine and a "list" of medications. Patient stated immediately after receiving the COVID vaccine, when itchiness began she self medicated with 25mg of Benadryl PO when she alerted the Observer of the itchiness. Code was called at 1331 and transported to ED for further treatment and evaluation. Nurse from Immunizations went with Code team member to transport patient to ED when 2nd Epipen (0FM407 EXP FEB22) was administered with direction of MD in elevator after patient began having tightness in chest and grabbing throat.

Other Meds:

Current Illness:

Date Died: 04/27/2021

ID: 1347211
Sex: F
Age: 94
State: PR

Vax Date: 03/26/2021
Onset Date: 04/18/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: Unknown.

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

Symptoms: Dies at the Hospital do to a respiratory arrest.

Other Meds: Xalatan, Neurontin, Vitamin D, Acetaminophen, Mirapex, Levodopa, carbidopa, Lexapro, Cetaphil cream, Dialogistic.

Current Illness: Unknown.

ID: 1347212
Sex: F
Age: 48
State: GA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 05/25/2021
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: penicillin, amoxicillin, erythromycin , latex, gelatin, alphagal 9 allergy to all mammals) trees, grass, mold, roaches, dust, cats, dogs

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

Symptoms: I felt great all day, so I was excited and then I felt like I got hit by bus, I had massive fatigue, fever 102.5, body aches, chills, and I had a horrible headache. the fever and headache lasted till Saturday morning. My fatigue lingered and out of breathe and I went to see my doctor. My doctor said my immune system over reacted. He gave me a steroid shot, he gave me a prednisone med dose pack, I was better 36-48 hours after I saw the doctors.

Other Meds: verapamil 120mg, Zyrtec, Cingular, dymista , vit d, b12 shot

Current Illness: IGG deficiency

ID: 1347213
Sex: F
Age: 62
State: MN

Vax Date: 04/28/2021
Onset Date: 05/07/2021
Rec V Date: 05/25/2021
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:

Symptom List: Tremor

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

Other Meds:

Current Illness:

ID: 1347214
Sex: F
Age: 64
State: MO

Vax Date: 05/13/2021
Onset Date: 05/16/2021
Rec V Date: 05/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known

Symptom List: Erythema, Pruritus

Symptoms: Rash on chest 3-4 days after vaccine on 5/13. Patient complains of itching. Rash has persisted 12 days, ongoing, but healing.

Other Meds: None

Current Illness: None

ID: 1347215
Sex: M
Age: 32
State: CA

Vax Date: 03/09/2021
Onset Date: 05/14/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Developed COVID-19 symptoms on 5/14/2021 confirmed by PCR on 5/19/2021

Other Meds:

Current Illness:

ID: 1347216
Sex: F
Age: 47
State: MA

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Received 2nd COVID-19 vaccine 4/27. On the evening of 4/28, noticed chest pain especially with deep breaths. Felt like couldn't get air in, some improvement with position changes. Took 3 advil with some improvement. Off and on for days following. SOB position changed to improve breathing. Following day, audibly out of breath at a meeting meeting. Felt similar to last march- suspected COVID- periodic SOB. Advised to go to ED Had a rub murmur. Off and on SOB. Bedside ECHO did not show pericarditis but never had an official ECHO.

Other Meds: apri, zyrtec

Current Illness: none

ID: 1347217
Sex: F
Age: 29
State: CO

Vax Date: 02/26/2021
Onset Date: 04/20/2021
Rec V Date: 05/25/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: platelet count and other red blood cell results dropped significantly over a 2 month period. Unable to determine cause outside of vaccine.

Other Meds: Imodium 2mg Effexor 74mg Vitamin D 2,000 unit B12 1,000 sublingual Remicade (IV every 8 weeks) Mutlivitamin

Current Illness: Crohn's Disease Immunocompromised Status Depression

ID: 1347218
Sex: F
Age: 45
State: CO

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient fainted after receiving 2nd dose of covid vaccine while being under 15 minute post vaccine observation. Patient fainted in arms of clinical observer. She did not fall or hit her head. She was aroused after her episode (about 30 seconds in duration). She then drank some juice. She continued to be diaphoretic, pale and felt as though she were going to faint again. Since her symptoms did not seem to be resolving we called an ambulance. EMS arrived within 5 minutes and took patient to the hospital.

Other Meds:

Current Illness:

ID: 1347219
Sex: M
Age: 46
State: TX

Vax Date: 05/17/2021
Onset Date: 05/21/2021
Rec V Date: 05/25/2021
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: AUGMENTIN

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

Symptoms: PT GOT THE VACCINE ELSEWHERE: PT ALSO STATES, THIS IS HIS 2ND DOSE OF pziefer HE STATES HE HAD PAIN ON BOTH LEGS AFTER A COUPLE OF HOURS OF THE VACCINE TODAY HE COMES IN WITH BOTH FEET SWOLLEN AND PAIN

Other Meds: N/A

Current Illness: N/A

ID: 1347220
Sex: F
Age: 34
State: MN

Vax Date: 01/22/2021
Onset Date: 05/24/2021
Rec V Date: 05/25/2021
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: Pain in extremity

Symptoms: I found out I was pregnant 2 days after the 2nd dose was administered. I would have been 3 weeks and 3 days pregnant at the time. My husband and I are both perfectly healthy and had been trying for 2 years to get pregnant. At our 20 week anatomy scan 5/24 it was discovered our baby has bilateral cleft lip/palate. I was not taking any medications around the time, nor smoking or drinking alcohol. I do not have diabetes. No one in our family has history of cleft lip/palate. I was taking a prenatal vitamin daily, even for years before discovering we were pregnant.

Other Meds: prenatal vitamin, melotonin 1 mg prn

Current Illness: No

ID: 1347221
Sex: F
Age: 78
State: OH

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: The patient called in around 1:00 pm on 5/25/21 to report symptoms after vaccine. She said that she had pain in the right side of neck and in the back of the head and felt dizzy after the 15 minute wait when she stood up to leave after receiving her vaccine. She said that she felt tired later and slept well all nigh. At 6 am she said that she had cramps in calves, legs, and arms. At 9:30 am she woke up and felt tired and had a strange sensation in the back of the neck and numbness in the mouth and jaw. She said she is feeling a little better now.

Other Meds:

Current Illness:

ID: 1347222
Sex: F
Age: 60
State: MI

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/25/2021
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: NKDA

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

Symptoms: Patient bent down to pick something up and lost vision in her left eye, described it as a field of black with shooting colors like fireworks in her eye. She presented to her optometrist Dr. She also presented to the ER for further evaluation. She underwent lab work and a CT of the head without contrast. She was diagnosed with a retinal occlusion of the left eye.

Other Meds: hydrocodone, Xanax, albuterol HFA, niacin, vitamin D3, zinc, metformin, ibuprofen, zestoretic, Flonase, pravastatin, albuterol nebulizer medication, magnesium, Metamucil, Tylenol

Current Illness: no acute illnesses

ID: 1347223
Sex: M
Age: 26
State: MI

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/25/2021
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: Unknown

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

Symptoms: The patient fainted shortly after receiving his vaccination. He claimed to have a history of fainting after blood draws. He was fully recovered shortly after.

Other Meds: Unknown

Current Illness: None mentioned

ID: 1347224
Sex: M
Age: 46
State: FL

Vax Date: 04/23/2021
Onset Date: 05/06/2021
Rec V Date: 05/25/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: N/A

Symptom List: Vomiting

Symptoms: Shortness of breath, heavy weight on my chest, feeling weak, needed to sit or lay down.

Other Meds: Valacyclovior 500mg, 1000mg L-Lysine, Vit D supplement, Omega 6 tablet

Current Illness: N/A

ID: 1347225
Sex: M
Age: 79
State: CT

Vax Date: 02/19/2021
Onset Date: 03/01/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: NONE KNOWN

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: AFIB

Other Meds: CARVEDILOL, NORVASC, 81 MG ASPRIN, FOLIC ACID, LOSARTAN,METHOTREXATE, OMPEPRAZOLE, PREDISONE, SIMVASTIN,FLOMAX MAXZIDE, NOW ON ELOQUIS BECAUSE OF AFIB

Current Illness: STARTED ON CARVEDILOL IN EARLY DECEMBER AND WITHDREW FROM METOPROLOL

ID: 1347226
Sex: F
Age: 19
State: CO

Vax Date: 05/22/2021
Onset Date: 05/23/2021
Rec V Date: 05/25/2021
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: Bleeding from nose and large blood clots from nose, fever, chills

Other Meds:

Current Illness:

ID: 1347227
Sex: F
Age: 29
State: CA

Vax Date: 04/14/2021
Onset Date: 04/20/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I started experiencing thousands of PVC a day (premature ventricular contractions) after the first shot, and symptoms worsened with the second shot. Holter Monitor reported 2,000 PVCs in 24h. I can feel every single one of those PVCs. Even at day May 25th, symptoms are not gone and I still experience hundreds of PVCs a day. I am not sure if this could be due to the potential heart inflammation cases. I don't have stress in my life currently and I have never experience heart palpitations in my life. blood tests to check for electrolytes and other potential trigers of PVCs have come all within reasonable levels.

Other Meds: None

Current Illness: None

ID: 1347228
Sex: F
Age: 75
State: NJ

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/25/2021
Hospital:

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

Lab Data:

Allergies: Tetanus, Epinephrine, Steroids, Penicillin, aspirin, multiple antibiotics not listed.

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

Symptoms: She got her vaccine, had pain at the injection site, rash around the injection site that formed a blister. She had the worst case of flu that she had ever had and hit her all of a sudden. Had the tiredness, headache, chills, fever, nausea, fatigue. She also had mouth burning and distorted taste, which is still not quite back, and ringing in the ears. She had fallen asleep and woken up as if something had hit her in the chest, and her heart was beating fast, and took her BP it was 210/170. It stayed up over 200 for 4 days. Friday she let it go and waited until Monday to call her cardiologist office and it was still over 212. He increased her medications and increased them again. She still does not feel 100%, but better than before. He told her not to get the 2nd vaccine due to her reaction. Her blood pressure is considerably better, but is not back to where it was before the vaccine. She is still having the fatigue and tiredness, but is better than it was. Still feels a little nauseous, still has the distorted taste in her mouth, things don't taste right to her. She is still having a little bit of ringing in the ears.

Other Meds: Coumadin, Nadolol, Losartan, Levsin.

Current Illness: None.

Date Died: 05/17/2021

ID: 1347229
Sex: M
Age: 90
State: MN

Vax Date: 02/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/25/2021
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: Lisinopril

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

Symptoms: Admitted to hospice care on 05/11/2021 with an admitting diagnoses of Mantle Cell Carcinoma. Date of death 05/17/2021

Other Meds: furosemide, metoprolol, ibrutinib, omeprazole, multi vitamin, psyllium powder, tamsulosin

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm