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: 1404790
Sex: F
Age: 30
State: FL

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

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

Lab Data:

Allergies: Pineapples

Symptom List:

Symptoms: Fast heart rate at random when sitting troubled breathing increased tiredness and headaches

Other Meds: None

Current Illness: None

ID: 1404791
Sex: M
Age: 50
State: NC

Vax Date: 04/10/2021
Onset Date: 04/16/2021
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:

Symptoms: Arm Where injection site occurred has lingering pain that will not abate. No reason for pain no movement. But nerve just keeps acting up and going crazy. May not be related but it is at the injection site

Other Meds: None

Current Illness: None

ID: 1404792
Sex: F
Age: 51
State: IL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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:

Symptoms: I got my period after not having it for over 2 years. It was very heavy and lasted almost two weeks.

Other Meds: None

Current Illness: None

ID: 1404793
Sex: F
Age: 12
State: ND

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: none listed

Symptom List:

Symptoms: Patient was nervous about getting the vaccine. Patient felt dizzy as she stood up and started to faint. Her mother and I caught her to lower her to the ground and she came back out of it before we even got her to the ground. She became pale and sweaty.

Other Meds: n/a

Current Illness: n/a

ID: 1404794
Sex: M
Age: 16
State: NJ

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

Symptom List:

Symptoms: Fever 18 hours after second dose injection. Stiff neck, tightness in chest approx. 30 hours after second dose injection.

Other Meds: None

Current Illness: None

ID: 1404795
Sex: M
Age: 19
State: DE

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Severe headache, starting in the day of injection and continuing each day after injection; fever and vomiting on day 5 after injection; an episode of shortness of breath on Day 5.

Other Meds: Vitamin C

Current Illness: None

ID: 1404797
Sex: F
Age: 30
State:

Vax Date: 05/01/2021
Onset Date: 05/20/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Body odor seems very strong and bad smelling. This has continued to occur for a month now and I am not pregnant nor more stressed. My diet has not changed. I'm not sure it's the vaccine but I have no other explanation.

Other Meds:

Current Illness:

ID: 1404798
Sex: M
Age: 12
State: MA

Vax Date: 06/13/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: Patient received the Pfizer vaccine on Sunday (06/13/21) and had mild upset stomach, headache and felt achey for approximately 24 hours post vaccine that then fully resolved. At approximately 4am on 06/16/21 he developed sharp substernal chest pain that was located centrally and a bit to the left with pain worse on inspiration and with movement. No other symptoms at that time. Went to the Emergency Department where he was transferred to Hospital as his troponin was elevated at 4.02 ng/ml. His chest pain resolved with 1 dose of Ibuprofen 400 mg.

Other Meds: None

Current Illness: None

ID: 1404799
Sex: M
Age: 15
State:

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Syncopal post vaccination, loss of consciousness, no other issues, awoke in seconds, monitored and left AMA with mom

Other Meds:

Current Illness: None

ID: 1404800
Sex: F
Age: 17
State: WA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: inappropriate age for vaccine. patient is only 17 years old.

Other Meds:

Current Illness:

ID: 1404801
Sex: F
Age: 41
State: NC

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Soreness, gummy and sticky feeling, redness at injection site.

Other Meds: Boric acid vaginal suppository taken 06/14/2021

Current Illness: None

ID: 1404802
Sex: M
Age: 63
State: CA

Vax Date: 04/04/2021
Onset Date: 04/05/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: High levels of pain and stiffness in joints, tendon anchorages and muscles. Initially concentrated in hips; migrating to shoulders joints, deltoids, trapezoid, front of pelvis, buttocks.

Other Meds: None

Current Illness: None

ID: 1404803
Sex: M
Age: 47
State: MO

Vax Date: 04/28/2021
Onset Date: 05/17/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: None immediately after the shot. But I noticed the ringing on my left ear started gradually and it's been several weeks and even with steroids it won't go away.

Other Meds: Astorvastatin (for Cholesterol and Triglycerides) - once a day 10mg Bupropion (for ADHD) - daily 25mg twice a day

Current Illness: None

ID: 1404804
Sex: M
Age: 23
State: WA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: No known allergies.

Symptom List:

Symptoms: At 6:46 pm on 06/16/2021, 23 year old male patient was vaccinated for his first COVID vaccine by Pfizer. Within 30 seconds, while getting up, he felt dizzy and sat back down. Cool towel was provided, and head was supported. He turned extremely pale. Store PIC arrived. We helped patient lay on the floor of the clinic room. He had a pulse, 911 was called and paramedics arrived. They checked vitals and performed EKG, determined he was alright. Patient waited in waiting area for 45 minutes, was provided a Gatorade drink and glucose tablet after he was fully conscious. Then he drove home (called at 8:45pm) to check on patient, he was fine.

Other Meds: None

Current Illness: None

ID: 1404805
Sex: M
Age: 19
State: ID

Vax Date: 05/28/2021
Onset Date: 06/02/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Pericarditis

Other Meds: None

Current Illness: None

ID: 1404807
Sex: F
Age: 14
State: OR

Vax Date: 06/09/2021
Onset Date: 06/14/2021
Rec V Date: 06/17/2021
Hospital: Y

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

Lab Data:

Allergies: no known allergies

Symptom List:

Symptoms: See above. Received COVID 2 June 09 at pharmacy. Developed acute onset lower chest pain and abd. pain. Eval at emergency room showed negative troponin, CBC, EKG, CXR. Pt with elevated lipase to mid 500's and slightly bumped AST and ALT. Patient responded well to IVF with lipase decrease to 50. AST and ALT improved, but still slightly above normal. had normal AST and ALT on routine check 05/2021 (On Accutane)

Other Meds: Patient on Accutane and Prozac and birth control pills

Current Illness: Patient had chest pain and upper abdominal pain approximately 7 days after first COVID vaccine on May 19, 2021 Patient had chest pain and upper abdominal pain approximately 5 days after second COVID vaccine on June 09,2021. Seen in emergency room. Patient with elevated lipase to mid 500's, and slightly bumped transaminases. (had been normal on 05/2021 check since on Accutane).

ID: 1404808
Sex: F
Age: 32
State: OK

Vax Date: 03/29/2021
Onset Date: 06/02/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: 2 weeks after the shot I had a scary night where I had severe chest pain. I sat up for a few hours hoping I wasn't having a heart attack and taking water and tums. I have never had chest pain before or since. I was very concerned and wondered if it was the vaccine. I didn't have anything unusual to eat or drink. I was happy when it finally resolved that same night. I also experienced Bell's Palsy 2 months after the vaccine. (~June 1st) I have never experienced Bell's Palsy. I am not sure if either of these events were related to the vaccine, but I have no intention of getting a yearly covid or flu vaccine now that I have Bell's Palsy. It is terrible, and I'm not taking ANY chance of getting this again even if that means I get the flu and covid yearly. I placed my trust in science, and not I am not sure I made the right choice. Although I hope my facial movement and ability to use my lips and face come back, I realize that some never recover.

Other Meds: Levothyroxine

Current Illness: None

ID: 1404809
Sex: F
Age: 54
State: AR

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Cephalosporins - allergy

Symptom List:

Symptoms: Initial 48 hours of fever, chills, fatigue 1-2 weeks post injection, Bell's palsy on left side of face 4+ months (enduring), fatigue, joints ache (hips, wrists, elbows, shoulders)

Other Meds: Amitryptaline 25 mg hs Prozac 20 mg.

Current Illness:

ID: 1404810
Sex: F
Age: 26
State: CA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: Patient received 2nd dose Moderna 3 weeks after 1st dose.

Other Meds: unknown

Current Illness: none

ID: 1404811
Sex: F
Age: 27
State: CA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: Patient received 2nd dose Moderna 3 weeks after 1st dose.

Other Meds: unknown

Current Illness: none

ID: 1404812
Sex: M
Age: 5
State: TX

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Patient has a knot at injection sight, with large area of swelling, redness and warmth. (Red area width is as large as a new roll of toilet paper.)

Other Meds: Daily Flinstone vitamin, Singular

Current Illness: May 22, 2021: Allergies with 24 hour fever of 101.8, congestion (Took zyrtec, singular and Florent inhaler)

ID: 1404813
Sex: M
Age: 14
State: CA

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Nuts, tree, grass

Symptom List:

Symptoms: 24 hour after the shot patient lost consciousness and collapsed on the floor and bruised his face

Other Meds: Zyrtec-D12 hours

Current Illness:

ID: 1404814
Sex: F
Age: 50
State: CA

Vax Date: 05/14/2021
Onset Date: 05/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Tinnitus- since vaccine I?ve have a constant ringing in my ears , hard to fall asleep and then have nighttime awakenings. Shortness of breath, chest pain, tingling of my left side of the face , fatigue.

Other Meds: None

Current Illness:

ID: 1404816
Sex: F
Age: 47
State: CA

Vax Date: 05/08/2021
Onset Date: 05/21/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Had nausea, fatigue, fever, sore arm, itchy throat under left ear etc. Later buzzing sound noticed constantly, in the left ear, after May 21st. Tinnitus

Other Meds: None

Current Illness: None

ID: 1404817
Sex: M
Age: 41
State: NM

Vax Date: 06/14/2021
Onset Date: 06/15/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Shellfish

Symptom List:

Symptoms: Swelling and slight pain at injection site

Other Meds: Allopurinol Losartan potassium

Current Illness: None

ID: 1404818
Sex: F
Age: 67
State: KY

Vax Date: 06/13/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Severe tinnitis 06/16/2021 Inflammation and rash left upper arm next day and still continues

Other Meds: Carvedilol 12.5 mg twice daily Omeprazole 40 mg daily Magnesium oxide 250 mg three times daily Calcium 600 mg daily Atorvastatin 40 mg daily Vitamin D3 50000 u weekly

Current Illness: Hypertension Obesity Electrolyte imbalance

ID: 1404819
Sex: F
Age: 15
State: NC

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
Hospital: Y

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

Lab Data:

Allergies: mangos

Symptom List:

Symptoms: acute pancreatitis ; Pt awoke at 4 AM day after her COVID vaccine with abdominal pain. Pain abided some and she was able to fall back asleep. When she woke up in the morning she had crampy pain in the epigastric abdominal area. Pain is constant, worsened some with laying down and improved with sitting up. She feels like she has some mild difficulty breathing when she is lying flat. She has not been able to eat much because eating makes her feel like her stomach is going to explode. She is barely keeping down much water due to pain. She denies any nausea or vomiting.

Other Meds: Vitamin D Hyocyamine

Current Illness: none

ID: 1404820
Sex: M
Age: 37
State: MO

Vax Date: 06/10/2021
Onset Date: 06/15/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None known

Symptom List:

Symptoms: Severe violently shaking/chills and fever

Other Meds: Blood pressure medication

Current Illness: None

ID: 1404821
Sex: F
Age: 67
State: PA

Vax Date: 02/19/2021
Onset Date: 02/20/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Excruciating headache and mild fever for nearly 24 hours

Other Meds: None

Current Illness: None

ID: 1404822
Sex: F
Age: 36
State: CA

Vax Date: 04/08/2021
Onset Date: 05/08/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: penicillian Peanuts Cashews

Symptom List:

Symptoms: 30 days after the vaccine was administered started to get swelling of ankles and edema. Painful not able to walk on. Diet or exercise did not change. Heart flutters and dizziness may times.

Other Meds: Zyrtec Vitamin d 1000mg Vitamin c 1000mg Fish oil 1000mg

Current Illness: None

ID: 1404823
Sex: F
Age: 35
State: WA

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: I am allergic to Malarone, Gabapentin, Amatriptyline, also allergic to gluten and dairy. I have Mast Cell Activation Syndrom and am a fairly allergic person in general do to this condition.

Symptom List:

Symptoms: Lips went totally white and chapped, burning all around my lips began (day after shot) Burning got worse the next day around my mouth, lips got even more chapped (two days after) Ate something I've never reacted to before for dinner after dinner my entire face broke out in rash, my lips swelled up, my throat swelled, blood pressure dropped, heart raced, and I was about to faint (so lay down). Stopped reaction with two benedryl. (three days later) - note this sort of thing has happened before after certain drugs when taken in aggregate over days (Malarone, Gabapentin) For next 4 weeks I had a host of symptoms that were unliveable including (note: some have lasted longer) - Fainting spells, low blood pressure - Full body nerve pain and facial nerve pains that were very intense - Dry mouth - Tachycardia at night (RAPID heart beat) - Lip angioedema usually in the morning only to be controlled with antihsitimines (still the case months later) - Massive diarrhea usually in the morning with lip angiodema - Trouble breathing and chest pain and wheezing, one massive asthma attack Treatment: Antihistimines at first, but made POTS too bad so went off (helped swelling though) Steroid inhaler to help me breath Steroids (prednisone) burst in late April/early May - moderately helpful when on the course, but made digestive issues worse and acid reflux worse, lip burning and swelling came back after i went off this Post-Steroid burst: - Still having lip burning - Still having horrible dry mouth - Still trouble breathing and wheezing and shortness of breath - horrible digestive issues (acid reflux) - nerve pain Treatment post steroids - treated my MCAS - Quercetin, Vitamin C, and NAC, eventually found compounded allegra to work without the dysautonomia side effects and now on 180mg / day has helped a lot of these symptoms - Using Cromolyn Sodium nebulized for the breathing issues and chest pain - helping a lot for this! With the MCAS drugs I'm improved, but I still have the following (June 16) - horrible acid reflux all day every day (doesn't matter what I eat) - Dry mouth - I also have lip burning that is pretty constant (although swelling is down) - Moderate wheezing (but its better than before) - Moderate facial pain (but better than before) - Headaches (pretty sure it's a side effect of my meds)

Other Meds: I took an allegra 20 mg about an hour prior to vaccination

Current Illness: None. My chronic condition was very much under control at time of vaccination.

ID: 1404825
Sex: F
Age: 36
State: AZ

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, clarithromycin

Symptom List:

Symptoms: Nausea roughly an hour after vaccine, then fever 100.6 one day after vaccine, extreme fatigue resulting in having difficulty caring for my children, sore arm, headache, back and neck pain that required ibuprofen to be able to move without pain. Those effects only lasted about 24 hours. Then, the next day, I awoke with a swollen lymph node in my left armpit which has been causing pain all day, if my arm is at my side, requiring ibuprofen and cold compresses to treat.

Other Meds: Multivitamin

Current Illness:

ID: 1404826
Sex: F
Age: 47
State: HI

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Sucrose Iron

Symptom List:

Symptoms: Suspected anaphylactic reaction managed with epinephrine, solumedrol, Benadryl

Other Meds: EpiPen

Current Illness:

ID: 1404827
Sex: M
Age: 12
State: CA

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List:

Symptoms: 5 minutes from getting the vaccine, patient felt dizzy and looked very pale, there was remarkable pallor on the patient's face. skin looked pale.. initial blood pressure reading was 140/72. blood pressure upon discharge was recorded @ 128/82. Temp was 97.8 'C. Patient was given glucose tablets and few seconds after, patient felt better, skin suddenly turned pinkish.. patient recovered. Patient was monitored for 30 minutes, and stable upon discharge.

Other Meds: NONE

Current Illness:

ID: 1404828
Sex: F
Age: 58
State: MN

Vax Date: 06/06/2021
Onset Date: 06/10/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Hydrocodone

Symptom List:

Symptoms: Plural Effusion left lung, and Cough diagnosed by Dr. on 06/16/2021. Both symptoms started approximately 4 days after 2nd COVID 19 vaccination on 06/07/2021.

Other Meds: Cymbalta, Viibryd, Lipitor, Trazodone, Buspar, Proton Pump Inhibitor

Current Illness: None

ID: 1404829
Sex: F
Age: 31
State: CA

Vax Date: 05/27/2021
Onset Date: 05/30/2021
Rec V Date: 06/17/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
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Lab Data:

Allergies: Amoxicillin

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Symptoms: Swelling, tension, and pain in both knees. Sudden onset. Sharp decrease of flexibility and mobility.

Other Meds: None

Current Illness: None

ID: 1404830
Sex: M
Age: 61
State: AL

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 06/17/2021
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Allergies: None

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Symptoms: Fever, headache, nausea and brain fog. Suppressed energy, mood and stamina. Depression. I am a cyclist and before this vaccine I was extremely healthy. After my second shot the above listed symptoms were magnified 10 fold plus muscular burning and aching. I missed 6 days of work and to this day I am suffering a huge drop in energy, mood and stamina. I feel foolish for taking this vaccine. Shame on you all.

Other Meds: Multi vitamin

Current Illness: None.

ID: 1404831
Sex: F
Age: 43
State: CA

Vax Date: 01/11/2021
Onset Date: 03/10/2021
Rec V Date: 06/17/2021
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Symptoms: In March I developed the worst heart palpitations I have ever had in my life. I was having a flutter every other beat with an atrial premature contraction. I have since had to be put on isopropyl medication, magnesium beta blockers. I have never had this problem with my heart

Other Meds: None

Current Illness: None

ID: 1404833
Sex: F
Age: 28
State:

Vax Date: 05/20/2021
Onset Date: 05/24/2021
Rec V Date: 06/17/2021
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Allergies: None

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Symptoms: Full body inflammation (mostly joints) and headache during sleep, mostly when waking. Went away completely after 3 days. Movement or ice against the back of neck eased burning.

Other Meds: None

Current Illness: None

ID: 1404835
Sex: F
Age: 28
State:

Vax Date: 06/10/2021
Onset Date: 06/17/2021
Rec V Date: 06/17/2021
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Allergies: None

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Symptoms: General menstruation symptoms (pain, bloating, cramps) 3x worse and heavier

Other Meds: none

Current Illness: none

ID: 1405055
Sex: M
Age:
State: PR

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 06/17/2021
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Symptoms: "Cold sore" shingles outbreak in the lip, relatively large several hours after receiving vaccine second dose; "Cold sore" shingles outbreak in the lip, relatively large several hours after receiving vaccine second dose; This is a spontaneous report from a contactable consumer (patient). A 48-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Lot Number: EW0170, Expiration date: unknown), via unspecified route, administered in left arm on 23Apr2021 09:00 AM (at the age of 48-year-old) as 2ND DOSE, SINGLE DOSE for COVID-19 immunization. Patient previously received the first dose of BNT162B2 on 31Mar2021at 09:00 am (batch/Lot no: ER8734) at left arm for covid 19 immunization. The patient medical history and concomitant medications were not reported. On 23Apr2021 at 18:00, after the vaccination, the patient experienced Cold sore- shingles outbreak in the lip, relatively large several hours after receiving vaccine second dose. Prior and since vaccination patient has not been tested or diagnosed for covid-19. No other vaccines received within 4 weeks to covid vaccine. No treatment received. The outcome of the events was recovering. No follow-up attempts possible. No further information expected.

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ID: 1405056
Sex: F
Age:
State: PR

Vax Date: 04/07/2021
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Rec V Date: 06/17/2021
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Symptoms: mental fatigue; Pain began in the shoulder and over the days it moved to the scapula, neck and head; unusual physical fatigue; This is a spontaneous report from a contactable consumer or other non hcp (patient). A 44-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), via an unspecified route of administration, administered in left arm on 07Apr2021 09:00 as 1st dose, single dose (at the age of 44-years-old) for covid-19 immunization. Medical history include allergy to Aspirin (e.c.) and raw fish. The patient's concomitant medications were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient did not receive any other medications the patient received within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has been tested for COVID-19. On an unspecified date in 2021, the patient had pain began in the shoulder and over the days it moved to the scapula, neck, and head, only on the left side (arm in which it was injected). Unusual physical and mental fatigue that appeared after five days and lasted a week and a half. The patient was treated with anti-inflammatory medicine. On an unspecified date in 2021, the patient was recovered from the events. Follow-up attempts are needed; information about lot/batch number has been requested.

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ID: 1405132
Sex: M
Age: 4
State: IL

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/17/2021
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Symptoms: I put the vaccines in our EMR (billing system). I noted the vaccine (MMR) was expired; no further AEs reported; expired dose of MMR II; This spontaneous report has been received from a nurse referring to a 4-year-old male patient. The patient's pertinent medical history, drug reactions or allergies were not reported. The patient's concomitant vaccines included: second dose of varicella virus vaccine live (Oka/Merck) (VARIVAX) and the fifth dose of diphtheria vaccine toxoid, pertussis vaccine acellular 3-component, polio vaccine inact 3v (vero), tetanus vaccine toxoid (KINRIX). On 13-MAY-2021, the patient was vaccinated during routine school vaccination with the second dose of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live recombinant human albumin (rha) (M-M-R II) 1 subcutaneous injection for prophylaxis (formulation, concentration, anatomical site of vaccination were not reported; lot number S007813 and expiration date 14-MAR-2021, which were verified as valid). It was noted after the administration of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II) that the vaccine had expired (expired product administered), (wrong technique in product usage process). The patient's response was normal, drug treatment was not required, and there were no additional adverse events to report.

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ID: 1405133
Sex: U
Age: 0
State: IN

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 06/17/2021
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Symptoms: No additional adverse events reported; Expired vaccine used; This spontaneous report was received from a medical assistant referring to an 8-week-old patient of unknown gender. The patient's concomitant medication, pertinent medical history and drug reactions/allergies were not reported. On 17-MAY-2021, the patient was vaccinated with an expiration dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) (strength was not reported; dose: 2 milliliter, lot # 1661000, expiration date was 13-MAY-2021) orally for prophylaxis. This dose was found supported by memo with no previous temperature excursions. No additional information given. No additional adverse events were reported.

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ID: 1405134
Sex: U
Age: 0
State: NY

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 06/17/2021
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Symptoms: No additional AE reported. No PQC; the vaccine was administered while out of recommended range.; This spontaneous report was received from a registered nurse referring to a 5-month-old patient of unknown gender. The patient's concomitant medication, pertinent medical history and drug reactions/allergies were not reported. On 15-MAY-2021, the patient was vaccinated with rotavirus vaccine, live, oral, pentavalent (ROTATEQ) (strength was not reported; dose: 2 milliliter, lot # 1694410, expiration date was 19-DEC-2021) orally for prophylaxis. The vaccine was out of recommended temperature range (product storage error). The vaccines were stored in a temperature 89 Fahrenheit (F) with a time frame 24 hours. There was no previous temperature excursion. Data logger was involved. No additional adverse event (AE) or product quality complaint (PQC) was reported.

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ID: 1405135
Sex: F
Age: 1
State: MI

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/17/2021
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Symptoms: No additional AE reported; patient received a dose of VARlVAX and M-M-R II that has experienced an ongoing temperature excursion; This spontaneous report was received from a medical assistant and nurse who refers to a 12-month-old (also reported as 13-month-old) female patient. The patient had no known allergies. Information regarding pertinent medical history was not provided. The patient had 2 siblings. The patient birth weight was reported as 7 lbs and 4.2 oz. On 14-MAY-2021, the patient received following vaccines (reported as concomitant): hepatitis a vaccine (reported as HEP A), pneumococcal vaccine conj 13v (crm197)(PREVNAR 13) and diphtheria vaccine toxoid (+) hib vaccine conj (tet tox) (+) pertussis vaccine acellular 5-component (+) polio vaccine inact 3v (mrc 5) (+) tetanus vaccine toxoid (PENTACEL). On the same date, the patient was vaccinated with improperly stored: measles (+) mumps (+) rubella (wistar ra 27-3) virus vaccine, live (rHA) (M-M-R II) lot # S039319, expiry date 04-DEC-2021, second dose, subcutaneously in the left vastus lateralis, for prophylaxis; and with varicella virus vaccine live (oka/merck) (VARIVAX) lot # T029535, expiry date 01-SEP-2022, second dose, subcutaneously in the right vastus lateralis, for prophylaxis (formulation, concentration, dose, frequency for both vaccines were not reported). Digital data logger was involved. The suspect vaccines underwent the temperature excursion, the highest temperature reported was 114.8 degrees of Fahrenheit (F), and the temperature during the time of administration was unknown. The temperature excursion started on 13-MAY-2021 at 09:15 and vaccines were not back in the proper range (time frame of excursion was reported as ongoing). There was no previous temperature excursion. Patient's parents were notified at vaccines excursion and they did not report any adverse events the patient experienced (no adverse event). The patient would be re-vaccinated within appropriate timeframe. No product quality complaint (PQC) was involved.

Other Meds:

Current Illness: Prophylaxis

ID: 1405136
Sex: F
Age:
State: NY

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Rec V Date: 06/17/2021
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Symptoms: She has had reactions to other vaccines, such as the Pneumococcal vaccine.; This spontaneous report was received from a 74 year old female patient with bronchiectasis and atypical mycobacterial infection. On an unknown date, the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent)(manufacturer unknown) (strength, route, dose, frequency, anatomical location, lot # and expiration date were unknown) for prophylaxis. On an unknown date, the patient experienced vaccine reaction (vaccination complication). At the time of the report, the outcome of vaccination complication was unknown. The patient did not mention the causality assessment between the event and pneumococcal vaccine, polyvalent (23-valent)(manufacturer unknown)vacciantion.; Sender's Comments: US-009507513-2106USA003286:

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Current Illness: Atypical mycobacteriosis; Bronchiectasis

ID: 1405137
Sex: U
Age:
State: MI

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 06/17/2021
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Symptoms: No additional adverse effect reported.; ROTATEQ, M-M-R II and VAQTA that underwent a temperature excursion were administered.; This spontaneous report was received from a nurse prescriber and refers to a patient of unknown age and gender. The patient's pertinent medical history, drug reactions, allergies and concomitant therapies were not provided. On 25-MAY-2021, the patient was vaccinated with improperly stored doses of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (rHa) (M-M-R II) (lot # T007232, expiration date reported as 26-FEB-2022, but upon internal validation established as 27-FEB-2022) (exact dose, route of administration and anatomical location were not provided) and hepatitis A vaccine, inactivated (VAQTA) (lot # T035720, expiration date reported as 14-APR-2022, but upon internal validation established as 15-APR-2022) (exact dose, route of administration, anatomical location were not provided) for prophylaxis. The administered doses were stored in temperature above 46 Fahrenheit degrees (F) (46.8 F) for 30 minutes. No previous temperature excursion occurred. Digital data logger was involved. No additional adverse effect reported. This is one of several reports received from the same reporter. combinationproductreport: Yes; brandname: VAQTA SYRINGE (DEVICE); commondevicename: Hepatitis A Vaccine, Inactivated; productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: T035720; expirationdate: 15-APR-2022; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet criteria for reportability; Sender's Comments: US-009507513-2106USA003900: US-009507513-2106USA003899: US-009507513-2106USA003901:

Other Meds: VAQTA SYRINGE

Current Illness:

ID: 1405138
Sex: F
Age:
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Rec V Date: 06/17/2021
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Symptoms: she was really sick; she thinks the nurse put the bolus really close to the bone in her deltoid, she had a black bruise; high fever; Indication: to help with chronic sinus infections; This spontaneous report was received from a currently 55-year-old female patient reporting on herself. No information was provided regarding the patient's relevant medical history, concurrent conditions, concomitant medications and previous drug reactions or allergies. In 1999 reported as " a long time ago when the patient was 33-years-old", she was vaccinated with pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX23) in her deltoid unspecified side to help with chronic sinus infections (product use in unapproved indication) (dose, frequency, route of administration, vaccination scheme, lot number and expiration date were not reported). Subsequently, the patient had high fever (pyrexia), she was really sick (illness). She further stated, she thought the nurse put the bolus really close to the bone in her deltoid. So, she had a black bruise (vaccination site bruising). The outcome of the aforementioned events was unknown. Causality assessment was not provided by the reporter.

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Current Illness: Chronic sinusitis

ID: 1405139
Sex: M
Age: 0
State: SC

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 06/17/2021
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Symptoms: no adverse event; Drug use in unapproved age group; This spontaneous report was received from a nurse, concerning a 3-month-old male patient. No information was provided regarding the patient's pertinent medical history, concomitant medications and previous drug reactions or allergies. On 27-MAY-2021, the patient was vaccinated with 1 dose of the following vaccines: hepatitis a vaccine, inactivated (VAQTA) 25U/0.5ml pre-filled syringe (lot number T035720, which was verified to be a valid lot number, expiration date reported and upon internal validation established as 15-APR-2022), varicella virus vaccine live (Oka/Merck) (VARIVAX) (lot number T032930, which was verified to be a valid lot number, expiration date reported as 28-SEP-2022 but upon internal validation established as 08-SEP-2022) and Measles, Mumps, and Rubella (Wistar RA 27-3) Virus Vaccine, Live (recombinant Human albumin) (M-M-R II) (lot number T006165, which was verified to be a valid lot number, expiration date reported and upon internal validation established as 19-FEB-2022) (frequencies, routes of administration, anatomical locations and vaccination schemes were not reported). All the vaccines were administered as prophylaxis. The vaccines were reconstituted with sterile diluent (lot number T022570, which was verified to be a valid lot number, expiration date reported and upon internal validation established as 08-FEB-2023) (product use issue). No additional adverse events were reported. combinationproductreport: Yes; brandname: VAQTA SYRINGE (DEVICE); commondevicename: Hepatitis A Vaccine, Inactivated; productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: T035720; expirationdate: 15-APR-2022; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet criteria for reportability

Other Meds: STERILE DILUENT; VAQTA SYRINGE

Current Illness:

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm