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
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: 1350593
Sex: F
Age: 29
State: SC

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
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: The patient was given 0.3 ml of undiluted Pfizer Covid vaccine, resulting in 6 times the authorized dose. The error was discovered 1 hour after the vaccine was given and the patient was notified via phone 3 hours after administration. Patient was advised by the pharmacist to take 2 extra strength Tylenol before bed and again in the morning to help with possible side effects. The patient was followed-up by the pharmacy the following morning and only reports a stuffy nose. No other adverse events have been reported to date.

Other Meds:

Current Illness:

ID: 1350594
Sex: F
Age: 13
State: TX

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/26/2021
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: No allergies of medications

Symptom List: Anxiety, Dyspnoea

Symptoms: After the vaccine she started having some pain around her heart.

Other Meds: Over the counter vitamin

Current Illness: NA

ID: 1350595
Sex: F
Age: 42
State: AL

Vax Date: 02/02/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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: unk

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

Symptoms: Completed Pfizer COVID vaccine series with dose #1 1/12/21 and dose #2 2/2/21. Tested positive for COVID via rapid antigen and PCR 5/26/21 as part of required routine testing for working at a care facility. No signs/symptoms.

Other Meds: unk

Current Illness: unk

ID: 1350596
Sex: F
Age: 28
State: MD

Vax Date: 05/21/2021
Onset Date: 05/22/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Changes with monthly Menstrual . Dose 1 (04/30/2021) after pzifer vaccine, heavy period came the same day after I was injected and it came 1 week early. And now dose 2 (05/21/2021) of Pzifer vaccine heavy cramping period came immediately after vaccine as well 1 week early. menstrual is always on time never early nor painful. seeing immediate changes after these 2 doses.

Other Meds: None

Current Illness: None

ID: 1350598
Sex: F
Age: 61
State: MD

Vax Date: 03/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/26/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient presents to the ED with shortness of breath, chest pains and palpitations. Has noticed rapid heart rates for last 2 months, started immunotherapy. Started on diltiazem and symptoms resolved. Diagnosed with Afib and COPD exacerbation. Recently diagnosed with left lung squamous cell carcinoma. patient will start on eliquis, digoxin and diltiazem. Discharged with symptoms resolved.

Other Meds:

Current Illness:

ID: 1350599
Sex: F
Age: 30
State: IN

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/26/2021
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: None

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

Symptoms: Extreme pressure in my head which made it nearly impossible to keep my eyes open. Severe sensitivity to light. Profuse sweating followed by chills (this happened for hours). Nausea. Dizziness.

Other Meds: Zyrtec

Current Illness: None

ID: 1350600
Sex: M
Age: 22
State: OH

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Very serious aches and pains in my joints. Fever, sore throat, pain in arm. Swollen glands and stiff joints. All started around 9 Pm

Other Meds: Wellbutrin

Current Illness: None

ID: 1350601
Sex: F
Age: 30
State: MI

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

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

Lab Data:

Allergies: na

Symptom List: Pharyngeal swelling

Symptoms: no adverse event. The vaccine was given on the expiration date. Clinic staff initially was told the vaccine could be used but found out later in the day that it should not have been used.

Other Meds: na

Current Illness: na

ID: 1350602
Sex: F
Age: 17
State: GA

Vax Date: 04/12/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received dose 1 of Moderna covid vaccine under the age of 18

Other Meds:

Current Illness:

ID: 1350603
Sex: F
Age: 39
State: PR

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient presents a week after the administration of the vaccine a left side facial paralysis and 2 days before the paralysis had a pressure on the left side posterior.

Other Meds: NO

Current Illness: NO

ID: 1350604
Sex: F
Age: 53
State: CA

Vax Date: 05/24/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: Severe body aches, chest pain, sweating, chills, slept all day, very uncomfortable, haven't felt this sick in over a decade, unlike any ?flu?, nauseated. Weak, no energy, no appetite. Husband had same shot as me, had same reactions, terrible feeling

Other Meds: Ibuprophen, naproxen

Current Illness: No

ID: 1350605
Sex: F
Age: 48
State: AR

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/26/2021
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: Oxycodone, yeast

Symptom List: Rash, Urticaria

Symptoms: Pain at site, surrounding and upper shoulder. Sore throat and a bit swollen , coughing, congestion, coughing up thick discharge, bad headache, extremely tired. This is in just less than 48 hrs. Have not seen a dr at this point, will treat sx and see if it gets worse, if its not better over next couple days will go to urgent care.

Other Meds: Gabapentin, hydrocodone, Topomax, clonidine, metformin, metoprolol, levothyroxine, quetiapine

Current Illness: NA

ID: 1350606
Sex: F
Age: 58
State: WI

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: ALLERGIC TO NITRO AND IVP DYE.

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

Symptoms: APPROXIMATELY 22 MIN. AFTER RECEIVING VACCINE, CLIENT BECAME LIGHT HEADED, DIZZY, SHORT OF BREATH, THROAT SWELLING, EYES WATERING, BLOOD PRESSURE DROPPED, TIGHTNESS IN CHEST. 911 CALLED. PARAMEDICS GAVE IV EPI. AND TRANSPORTED CLIENT TO HOSPITAL ER. MD DIAGNOSED ANAPHYLAXIS DUE TO COVID VACCINE. IN ER, CLIENT WAS GIVEN PREDNISOLONE AND ALBUTEROL TREATMENT. CLIENT RESTED IN ER WHILE BEING MONITORED. CLIENT THEN RELEASED TO GO HOME.

Other Meds: VIT. D 3 50,000 IU Q WK. MESALAMINE 800 MG Q DAY.

Current Illness:

ID: 1350607
Sex: F
Age: 55
State: IN

Vax Date: 04/05/2021
Onset Date: 04/28/2021
Rec V Date: 05/26/2021
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: Minocycline triple antibiotic lotion

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

Symptoms: Genital lesions, consistent with herpes virus appeared. Treated with Metronidazole 500 mg and Valacyclovir HCL 1g. Outbreak went away.

Other Meds: Iron 18 mg 2x p/day Black Cohosh 800 mg 2x p/day multi-vitamin 1x p/day probiotic 1x p/day

Current Illness: none

ID: 1350609
Sex: F
Age: 50
State: CA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 05/26/2021
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: Penicillin

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

Symptoms: Fever, chills, headache, fatigue, malaise, body ache felt like beaten up and could not get out of bead or walk, brain fog, unable to eat. This lasted for about 2.5 - 3days.

Other Meds:

Current Illness:

ID: 1350610
Sex: F
Age: 58
State: KS

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/26/2021
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: sulfa - breaks out in welts

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

Symptoms: 2nd dose received. AFter a few minutes, patietn reporting "fuzzy lip" sensation. No swelling, angioedema, chest pain, shortness of breath, tongue swelling, airway obstruction or difficulty speaking or diaphoresis. No issues with 1st dose. Monitored for 30 minutes. Symptoms improved/resolved and patient was discharged from clinic.

Other Meds: unknown

Current Illness: unknown

ID: 1350611
Sex: M
Age: 64
State: ND

Vax Date: 04/06/2021
Onset Date: 05/15/2021
Rec V Date: 05/26/2021
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: No known allergies.

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

Symptoms: Patient admitted to hospital 5/15/2021 with acute toxic encephalopathy due to disseminated varicella zoster virus and acute hypercapneic respiratory failure. Patient remains hospitalized as of date of this report. Encephalopathy is resolving and patient has been extubated but remains on 4 liters of oxygen via nasal canula.

Other Meds: amlodipine, carvedilol, Mucinex, losartan, metformin, Crestor

Current Illness: None reported.

ID: 1350612
Sex: M
Age: 19
State: CA

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received Moderna at different location in Feb 2021. Patient was only able to get Pfizer due to military limitations.

Other Meds: None

Current Illness: None

ID: 1350613
Sex: F
Age: 56
State: PA

Vax Date: 05/19/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient called and described a itchy rash on leg(s).

Other Meds:

Current Illness:

ID: 1350614
Sex: M
Age: 28
State: PA

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
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: patient called reporting trouble sleeping due to fever and chills along with body aches

Other Meds: n/a

Current Illness: n/a

ID: 1350615
Sex: F
Age: 43
State: VA

Vax Date: 03/10/2021
Onset Date: 03/01/2021
Rec V Date: 05/26/2021
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: Sulfa

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

Symptoms: joints ache, muscle, skin tender

Other Meds: Celebrex Wellbutrin XL Cymbalta Singulair

Current Illness: none

ID: 1350616
Sex: M
Age: 33
State: NJ

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 05/26/2021
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: Unevaluable event

Symptoms: Night of and next morning of vaccine: fever of 103.8 F recorded, and associated shivering From 2nd day after shot: claims of: pounding headache, no appetite, nausea and eating caused more nausea Claimed that marijuana usage alleviated some of the nausea and appetite issues

Other Meds:

Current Illness:

ID: 1350617
Sex: F
Age: 43
State: CT

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Extremely painful injection followed by shoulder pain, weakness, lack of mobility. Been taking Advil or Tylenol everyday. Have tried ice and heat. Still in a lot of pain. I?m so frustrated I don?t know what kind of doc to go to. Please get back to me

Other Meds:

Current Illness:

ID: 1350618
Sex: M
Age: 15
State: CO

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/26/2021
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: Rash on arm starting from injection site, progressing over the following days.

Other Meds: None reported

Current Illness: None

ID: 1350619
Sex: F
Age: 51
State: OH

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: started with chills and shaking with no fever soon followed by body aches from head to toe. several hours later the nausea and vomiting began. A month later I am more fatigued than I ever was before the vaccine. My energy level plummeted after the second vaccine and has not yet recovered.

Other Meds: metoprolol

Current Illness: none

ID: 1350620
Sex: M
Age: 17
State: CO

Vax Date: 05/15/2021
Onset Date:
Rec V Date: 05/26/2021
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: none

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

Symptoms: none, vaccine administration in unauthorized age

Other Meds: none

Current Illness: none

ID: 1350621
Sex: M
Age: 60
State: IL

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient complained that he tatste the medicine and also dizziness after he received the first dose of pfizer vaccine. Assessment done and patient sent home in stable condition. Patient stated that he feels a lot better.

Other Meds:

Current Illness:

ID: 1350622
Sex: M
Age: 12
State: KS

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

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

Lab Data:

Allergies: no

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Seizure for 20 seconds and then post ictal for 10-15 minutes, by time got to the ED back at baseline

Other Meds: no

Current Illness: no

ID: 1350623
Sex: F
Age: 63
State: TN

Vax Date: 05/15/2021
Onset Date: 05/20/2021
Rec V Date: 05/26/2021
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: NKDA

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

Symptoms: 5 days after injection developed right sided face and lip numbness, tingling, burning, swelling. Diagnosis: Bells Palsy

Other Meds: Vitamin b12, Levothyroxine, Lisinopril, Atorvastatin

Current Illness: NONE

ID: 1350624
Sex: F
Age: 42
State: OH

Vax Date: 03/23/2021
Onset Date: 04/25/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Codeine, adhesive tape, erythromycin

Symptom List: Nausea

Symptoms: I had a break through period 15 days into my cycle which is not normal, I saw my obgyn because I was concerned. My cycle was abnormally heavy and long.

Other Meds: Tylenol

Current Illness:

ID: 1350625
Sex: F
Age: 50
State:

Vax Date: 04/09/2021
Onset Date: 04/19/2021
Rec V Date: 05/26/2021
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: Excessive menstruation. Moderate to heavy for 38 days.

Other Meds:

Current Illness:

ID: 1350626
Sex: F
Age: 15
State: NY

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/26/2021
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 per vaccine administration record

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

Symptoms: Patient claimed she saw spots and was then unresponsive to the mother. Blood pressure was taken prior to EMT arrival with blood pressure of 105/68 and pulse of 70. Patient barely ate that day prior to coming in for the vaccine. Mother later disclosed that the patient had a event similar to this prior (date unknown) with the patient after getting an IV injection.

Other Meds: Unknown

Current Illness: None per vaccine administration record

ID: 1350627
Sex: M
Age: 29
State: SC

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
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:

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

Symptoms: The patient was given 0.3 ml of undiluted Pfizer Covid vaccine, resulting in 6 times the authorized dose. The error was discovered by myself about 1 hour after vaccine administration and the patient was contacted via phone about 3 hours after administration. I advised the patient to take 2 extra strength Tylenol before bed and upon awakening the next morning to help with possible adverse effects from the vaccine. The patient was called the following morning and reports no adverse effects.

Other Meds:

Current Illness:

ID: 1350628
Sex: F
Age: 28
State: IN

Vax Date: 04/10/2021
Onset Date: 05/23/2021
Rec V Date: 05/26/2021
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: Antihistamine Amoxicillin Acetaminophen

Symptom List: Tremor

Symptoms: Random nose bleeds for 3 days straight starting 5/23/21

Other Meds: None

Current Illness: None

ID: 1350629
Sex: F
Age: 48
State: TX

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/26/2021
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: Sulfa drugs

Symptom List: Erythema, Pruritus

Symptoms: Severe dizziness

Other Meds: None

Current Illness: None

ID: 1350630
Sex: F
Age: 35
State: CA

Vax Date: 04/29/2021
Onset Date: 05/06/2021
Rec V Date: 05/26/2021
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: Patient said on injection the arm started the hurt. Pain did not resolve. Pain worsened. Patient went to ER around 3 weeks later due to increasing pain

Other Meds:

Current Illness:

Date Died: 05/19/2021

ID: 1350631
Sex: M
Age: 82
State: CT

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/26/2021
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 reported

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

Symptoms: Per daughter, patient, after uneventful vaccine administration and 15 minute observation period, returned home, and father had lunch with wife and daughter. At 1:30, father remained home while daughter and wife went grocery shopping. Upon return from grocery store, approximately 1 hr. 45 minutes later, daughter found father unresponsive in bathtub with small amount of water, faucet off, and father partially clothed. Per daughter, the shower chair had been removed from the tub by her father. Per daughter, an autopsy was planned. Results are pending.

Other Meds: Bayer baby aspirin

Current Illness: none reported

ID: 1350632
Sex: M
Age: 17
State: MI

Vax Date: 05/04/2021
Onset Date: 05/16/2021
Rec V Date: 05/26/2021
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: Cashews, pistachios

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient was seen on 5/19/21 complaining of numbness and tingling in both of his hands, face, and mouth, and stated that it started three days prior. He was not having any fevers and there was no known injuries. Dr. ordered a CBC w/ diff, CMP, ferritin, Hemoglobin A1C, iron and TIBC, and TSH, all of which came back normal. Patients' mom called hospital on 5/22/21 stating that he had an incident during a game on 5/21/21 where he became disoriented and felt like he became less alert. He went to the Emergency Department on 5/23/21 with numbness and tingling that was present for one week and a headache for one day. After evaluation it was decided that neurology would see him outpatient. Neurology saw him on 5/25/21 and he said he has had difficulty concentrating and maintaining attention. He has also had memory issues. They ordered an MRI and EEG which have not occurred yet.

Other Meds: Allegra D

Current Illness:

ID: 1350633
Sex: F
Age: 46
State: OR

Vax Date: 05/21/2021
Onset Date: 05/22/2021
Rec V Date: 05/26/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: She developed shortness of breath the day after receiving the vaccine. Three days later she presented to ED and was found to have extensive right DVT and bilateral PEs. She has no prior history of DVT/PE. She had taken a flight 6 days before getting the vaccine. She has responed to treatment and was discharged the next day.

Other Meds: Acetaminophen, atorvastatin, fenofibrate, gemfibrozil, topiramate

Current Illness: none

ID: 1350634
Sex: F
Age: 16
State: MI

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/26/2021
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: none

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

Symptoms: Patient sat about 2 minutes after getting vaccine and started to walk away to sit in our designated area. She immediately turned around to sit down again. She then proceeded to start falling to her right and passed out. I was able to catch her and then she started shaking as if having a seizure. This lasted about 5 seconds . She stopped and then it happened again for about 5 seconds. When she came to, she tried to walk away again and had to return to sitting. Then she vomited twice. Upon checking her blood pressure after about 30 minutes, it was 97/66. She sat for a total of about an hour before feeling good enough to leave. She was nauseous for the remainder of the day and the next day as well.

Other Meds: escitlopram, iron

Current Illness: Covid March 10

ID: 1350636
Sex: M
Age: 74
State:

Vax Date: 03/25/2021
Onset Date: 04/23/2021
Rec V Date: 05/26/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.

Other Meds:

Current Illness:

ID: 1350637
Sex: M
Age: 16
State: VA

Vax Date: 05/23/2021
Onset Date: 05/24/2021
Rec V Date: 05/26/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Previously healthy 16 year old male presenting to hospital as a transfer for chest pain and elevated Troponin levels concerning for myocarditis. Patient has otherwise been healthy. Two days ago he received his second dose of COVID vaccination. He initially felt fine, but later that day had some body aches. The next day he felt feverish off and on and had dull left upper sternal border chest pain intermittently. Today, he reports sharp 7/10 mid sternal chest pain, lightheadedness, sweating, chills, and intermittent non-productive cough. He presented to original hospital for evaluation. The patient admits to tactile warmth since Sunday with no documented temperatures. He recently received his second dose of Pfizer just before onset of these symptoms. He reports difficulty sleeping since Sunday, but no shortness of breath, rashes, syncope, nausea, or vomiting. He has not had any other recent illness, fevers, or known COVID-19 exposures. He denies any history of prior cardiac disease and there is no known family history of cardiac disease, arrhythmias, or sudden death in the child or adolescent period. He denies illicit or recreational drug use. In the ED, he was well appearing with pain now 1 out of 10. POC troponin was 16.8 ng/mL. He had labs pertinent for ESR 10, CRP 3.0, BNP 24. RP2 PCR was negative. UDS was negative except for opiates (s/p morphine). IV was placed and patient was started on IV fluids. EKG was obtained and showed questionable left atrial enlargement per ED read. Cardiology was consulted and performed Echocardiogram in the ED at bedside and was within normal limits. Cardiology resident team contacted for admission. Past Medical History: No major medical diagnoses Past Surgical History: Orchiopexy, T&A Family History: No cardiac family history Social History: Lives at home with mother. Has two healthy siblings not living at home Immunizations: Up to date Medications: None Allergies: NKDA Etiology of likely myocarditis remains unclear at this time. In his age group, this would most likely represent a viral myocarditis. He would likely benefit from cardiac MRI during this admission for further evaluation of myocarditis. His EKG findings with his age group are unlikely to be secondary to myocardial infarct. No arrhythmias or heart block noted on EKG at time of admission or telemetry in ED. There is no family history of autoimmune disease or cardiac disease to suggest an autoimmune component or genetic etiology.

Other Meds: None

Current Illness: None

ID: 1350638
Sex: F
Age: 47
State: MI

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 05/26/2021
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: N/A

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

Symptoms: Red/swelling at injection site for nearly 1 month, intense full body pain

Other Meds: Multivitamin, Potassium Supplement, Vitamin D Supplement, Vitamin B12, Lacix, Cymbalta, Celabrax, Norco, Ometrazole, Valium, Zosran, Adderal, Vasotec, Topamax, Inhaler (Serevent), Symbicort, Immatrex, Troventil, Lidocane (Cream), Diclosenac

Current Illness: N/A

ID: 1350639
Sex: F
Age: 20
State: PR

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/26/2021
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: None

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

Symptoms: Within five minutes of administering the vaccine, involuntary movements in the mouth began and then involuntary movements began throughout the body, such as seizures. Involuntary movements throughout the body were every 30 to 40 seconds. She was taken to the emergency room. They tested and administered medications for allergies and keeping the airways open. She was transferred to the emergency room of another hospital for neurological tests. In the hospital they performed EKG, CBS, CT and neurological physical examination. All the results came out fine, except for the low phosphorous. Involuntary movements continued throughout. They release her from the hospital. Involuntary movements continue, return in 24 hours to the emergency room. They performed an EKG because it indicated that he was having chest pain. Turning out well. They discharge her but she continues with the involuntary movements. Four days later she managed to get a doctor to see her, who is her neurologist. The doctor advises that it could be non-epileptic seizures or some conversion. Zoloft and klonopin recipe. Continue with the involuntary movements. All day sharpening at bedtime. Seven days later in conversation with the doctor he refers to an epileptologist and sleep specialist for tests. Nine days later, an EGG of 24 was performed to coordinate a hospitalization. Although the movements today are more sporadic, they continue without explaination.

Other Meds: None

Current Illness: Allergy, Allergic Asthma, Migraine, Hypoglycemia

ID: 1350640
Sex: M
Age: 48
State:

Vax Date: 04/24/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Patient was given first Pfizer dose on 4/24/21 and asked at the time if he had received any other Covid vaccine doses reported that he had not. When he returned for his second Pfizer dose on 5/25/21, documentation was found in his chart that he had received Janssen from a pharmacy on 3/10/21. On 4/24/21, the Janssen dose was still not in his chart. The second Pfizer dose was held and not given on 5/25/21.

Other Meds:

Current Illness:

ID: 1350641
Sex: F
Age: 50
State: VA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient stated headache and stomach pains were present soon after getting the shot. Patient had had stomach pains for >1 year but are now worse. No reports of trouble breathing. Advised to follow up with PCP.

Other Meds:

Current Illness:

ID: 1350642
Sex: M
Age: 53
State: OH

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 05/26/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Fatigue, brain fog, ache, chills

Other Meds: None

Current Illness: None

ID: 1350643
Sex: M
Age: 30
State: FL

Vax Date: 05/24/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Muscle spasm, muscle cramps, hallucinations, cold sweats. Happen at night between midnight and 5am.

Other Meds: Losartan/HCTZ 50/12.5mg Baclofen 10mg Terbinafine 250mg

Current Illness:

ID: 1350644
Sex: F
Age: 34
State: TX

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: A day after the second shot of the vaccine, I felt fatigued and had a headache for 3 days. Starting day 4, itchiness started and would not go away. Still itchy, when I am not on medication.

Other Meds: Fiber, prenatal vitamins, and collagen

Current Illness: None

ID: 1350645
Sex: M
Age: 74
State:

Vax Date: 03/28/2021
Onset Date: 04/27/2021
Rec V Date: 05/26/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm