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: 1350804
Sex: M
Age: 60
State: OR

Vax Date: 04/24/2021
Onset Date: 05/26/2021
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: LA

Lab Data:

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Chest pain Pericarditis, AFIB

Other Meds: Many

Current Illness: none

ID: 1350805
Sex: F
Age: 51
State: TX

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: Fatigue, Nausea, sweats. No improvement with acetaminophen.

Other Meds:

Current Illness: N/A

ID: 1350806
Sex: M
Age: 28
State: IN

Vax Date: 05/24/2021
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: No

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

Symptoms: My average heart rate was between 60-70BPM, but two days after the second does of Pfizer, it elevated to 90-110 BPM accompanied with tiredness. No other symptoms as of now.

Other Meds: No

Current Illness: No

ID: 1350807
Sex: F
Age: 61
State: FL

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: nka

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: pt says about 30 hours after getting the 1st covid vax she had muscular pain all over her body but extremely bad in the lower back and was unable to walk. She had trouble getting around due to the intense pain and has not been able to sleep more than 4 hours per night yet feels very tired. She has a head ache along with restless muscles. She had a flare up of her skin disease. These symptoms were still present but was getting better when she got the 2nd dose of the covid vax on 5/20/21 (right arm Lot# 039B21A). About 24 hours after getting 2nd dose she developed all of the same symptoms she had after getting the 1st dose but more aggressive. She spoke to Dr. and he told her he could up her prednisone meds which she decided not do. Pt says she feels like her symptoms are slowly improving at this time.

Other Meds: levothyroxine 88mcg qd, prednisone 8mg varies, famotidine 20 mg bds, , Cymbalta 60 mg bds, soma 350mg 4 x daily prn, Xanax 0.5mg prn, methotrexate 0.8 ml once weekly, folic acid 1mg taken every day expect the day of the methotrexate, baria

Current Illness:

ID: 1350808
Sex: F
Age: 55
State: NY

Vax Date: 05/04/2021
Onset Date: 05/05/2021
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: Sulfa, iodine, contrast dye

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

Symptoms: Persistant digestive problems (diarrhea for first two mornings, followed by gas, bloating, pain, indigestion) peaking after about 5 days and gradually subsiding after about 18 days, accompanying fatigue, occasional brief & mild dizziness,. Also occasional mild tingling/numbness of left fingertips for first few days.

Other Meds: Irbesartin, Amlodapine, Synthroid, Vitamin D, Fish Oil

Current Illness: None

ID: 1350809
Sex: F
Age: 26
State: GA

Vax Date: 01/28/2021
Onset Date: 01/29/2021
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: It was just swelling, redness, and heat at the site of the vaccination. After sending the picture to my Doctor he thought it was cellulitis and he prescribed me amoxicillin.

Other Meds: Lexaprol.

Current Illness: None

ID: 1350810
Sex: M
Age: 50
State: CA

Vax Date: 05/23/2021
Onset Date: 05/23/2021
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: Low-grade fever starting at hour 12 and lasting over 24 hours. Soreness at the injection site lasting over 48 hours. Exacerbation of chronic myofascial pain syndrome starting at hour seven and lasting over 24 hours.

Other Meds: Vitamin D, vitamin C, vitamin E, famotidine, citalopram, loratadine

Current Illness: None

ID: 1350811
Sex: F
Age: 33
State: VA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
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: Phenol allergy in mantoux

Symptom List: Pharyngeal swelling

Symptoms: I had facial numbness (upper lip , nose and che) that started ~2 hrs after the injection and continued for several hours.

Other Meds: None

Current Illness: None

ID: 1350812
Sex: F
Age: 17
State: MA

Vax Date: 05/26/2021
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 was feeling dizzy after getting her second Pfizer Covid shot. EMS believed patient was having anxiety attack. Patient felt better after about 30 min and she went home with her mother.

Other Meds:

Current Illness:

ID: 1350813
Sex: F
Age: 38
State: DE

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin. (anaphylactic shock) Vancomycin Clindamycin Percocet Naproxen Nitrates MSG Artificial flavorings Decongestants

Symptom List: Diarrhoea, Nasal congestion

Symptoms: My side effects were extreme & hit fast around 1:30am. I was Dizzy & confused & Disoriented & was in like a semi coma when it first hit. When I could finally wake up around 2am I was very hot & shaking & my heart was racing. I had severe chills 102.7 fever & could feel my body was in shock. My face was red for days and fever & headache & Very dehydrated quickly extremely weak & could not drive. Went to urgent care on Saturday 5/22 & they check me over & did EKG. did not improve until late Monday 5/24 & even today 5/26 I still feeling a little dizzy randomly.

Other Meds: Seasonique

Current Illness:

ID: 1350814
Sex: M
Age: 20
State: FL

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Panic attack with elevated pulse 110. 12:52pm Patient leave HR 83.

Other Meds:

Current Illness:

ID: 1350815
Sex: F
Age: 52
State:

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Pt w/ hx of DM currently on Glipizide 10mg BID and Insulin Glargine 12units QHS. Pt vomited 50mL of digested food. Pt c/o flushing/sweating, nausea, and tingling at upper lip. Pt given PO fluid 1120mL inc. orange juice. Pt likely had a vasovagal episode given flushed and nauseous. No hives, stridor, wheezing, c/f anaphylaxis. Given lip tingling (as swelling or problem swallowing), given 50mg PO benadryl. BP 178/115, HR 95, RR 18 -- > 148/100 -- > 145/96, 90, 16 -- > 138/93 -- > 146/97, 86, 16. Pt feels much improved and requests to leave 30mins after initial adverse reaction began. Pt stable and released from the vaccination site. ER precautions discussed.

Other Meds: Glipizide 10mg BID and Insulin Glargine 12units QHS

Current Illness:

ID: 1350816
Sex: F
Age: 71
State: VA

Vax Date: 02/09/2021
Onset Date: 02/11/2021
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: Doxycline, tetracyclines in general, sulfa

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

Symptoms: Within days of my first vaccination, two large rashes appeared on my right thigh and right abdomen. Rashes were itchy and warm to the touch. The largest rash is 9 1/2" x 5". A biopsy confirmed my dermatologist's diagnosis of granuloma annulare. She has treated it topically (Halog, Clobetasol propionate) and with injections to the site, but the granuloma has in no way diminished. In the past few days I have acquired 3 new sites of what appears to be granuloma (left groin, thigh, and ankle). I am concerned that the granuloma is generalized and is a side effect of the Pfizer Covid-19 vaccine.

Other Meds: CURRENT MEDS: Losartan potassium 50 mg. ? 2/day Hydrochlorothiazide montelukast potassium 10 mg. Budesonide- inhaled 2X/day Astelin 1-2/day for allergy/to prevent sinus infections. Zyrtec,1/day Losartan Trazadone (50 Mg 3/day) as n

Current Illness: None

ID: 1350817
Sex: F
Age: 20
State: NC

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: My period came a few days early and has been much heavier/more cramps and pain overall.

Other Meds: Aleve

Current Illness: None

ID: 1350818
Sex: F
Age: 39
State: NY

Vax Date: 05/21/2021
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: NA

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

Symptoms: Patient had acute onset of highly uncomfortable peripheral neuropathy symptoms - specifically paresthesias with mild akesthesia (she is able to control it)

Other Meds: Tri Femora Nifedipine

Current Illness: eczema

ID: 1350819
Sex: M
Age: 79
State: PA

Vax Date: 03/04/2021
Onset Date: 05/26/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: extended moderate diarrhea and lower back ache (not pain) from soon after second shot to current time

Other Meds: generic Crestor, generic avodart, COQ10

Current Illness: none

ID: 1350820
Sex: F
Age: 64
State: ME

Vax Date: 04/07/2021
Onset Date: 05/19/2021
Rec V Date: 05/26/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Sulphur

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

Symptoms: Shingles outbreak

Other Meds: None

Current Illness: None

ID: 1350821
Sex: F
Age: 40
State: WA

Vax Date: 03/29/2021
Onset Date: 03/30/2021
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: Tylenol 3

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I wasn't feeling well, I started having a really bad headache, fever, sore and achy like I had the flu. I started having problems heaviness and shortness of breath. I started getting a rash that turned into hives all over my entire body. I was having feelings of anxiety and overall not well. I'm still getting hives from it. The other clinic I saw was the clinic 5096342913. I still am using an inhaler from the shortness of breath.

Other Meds:

Current Illness:

ID: 1350822
Sex: F
Age: 64
State: WA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
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 became ill on 5/15 and tested positive for covid-19 on 5/21/21.

Other Meds: Prednisone 7.5 mg daily

Current Illness:

ID: 1350823
Sex: F
Age: 32
State: ID

Vax Date: 01/17/2021
Onset Date: 01/23/2021
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: Mild General inflammation

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

Symptoms: 1 week after my first dose, I was bed ridden from fatigue, body ache, head and neck pain, nausea, weakness and pain that I felt in my veins and bones, and slight dizziness and occasional warmth/fever. All symptoms relieved naturally 1 week later.

Other Meds: None

Current Illness: Mild General inflammation

ID: 1350824
Sex: F
Age: 46
State: VA

Vax Date: 12/22/2020
Onset Date: 12/24/2020
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: vancomycin

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

Symptoms: 2 days after receiving the vaccine I developed shingles at the sight of my vaccination on my left upper arm. 3 days later I developed lock jaw which lasted for 4 months.

Other Meds: protonics wellbutrin

Current Illness: none

ID: 1350825
Sex: F
Age: 20
State: NC

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: IM
Vax Site: LA

Lab Data:

Allergies: Sulfa allergy.

Symptom List: Unevaluable event

Symptoms: I feel inclined to file this report in hopes that someone could study how receiving this vaccine affected my endometriosis. Please understand that I?m a proponent of vaccination and building herd immunity; however, women?s health is important and we have a right to be AWARE of ALL side effects. I?ve done my best to research this topic and was able to find very few sources on how COVID-19 vaccines impact menstruation. Aside from the lack of statistics, I found forums on social media platforms with women explaining how their menstrual cycles became irregular some way or another. I did experience the common side effects of fever, nausea, vomiting, diarrhea, soreness, and fatigue. In addition, I experienced severe cramps, back pain, thigh pain, groin pain, and nerve pain associated with the sciatic and obturator. I?m happy to be vaccinated because my immune system is far from the best, but if I were to have known that I would be unable to walk from the pain radiating from my back, pelvis, and thigh I would?ve opted for Moderna or Pfizer. At this point in time, I would NOT recommend the Janssen vaccine to someone with endometriosis. At that, this vaccine should be nowhere near as political as it is! My healthcare providers should be more willing to validate my symptoms, rather than saving face with the validity of the vaccine. I was told since my menstrual cycle is irregular I must coincidentally be getting my period, BUT I have not experienced any bleeding nor even spotting. I have no idea what the vaccine did to my body, I have no clue why it would induce such severe pain. I?m glad that the ?normal? symptoms have subsided by the second day, but the nerve pain complicates walking long distance or carrying heavy objects. I think I?ll eventually make a full recovery in the upcoming days, but this experience was so frightening. I laid on the floor for hours crying after I vomited up everything I had eaten. I couldn?t sleep because I couldn?t bear to lay down for long durations of time- and by that I mean more than ten minutes. It genuinely felt like I was getting my period, but whatever it was led to no external bleeding. Again, I?m grateful for the scientists who dedicate their lives to such integral work. I just wish I would?ve known about what was internally happening to my body beforehand, I would?ve chosen a different vaccine.

Other Meds: I have Bipolar II Disorder which I take Lamictal, Seroquel, Remeron, and Prazosin for.

Current Illness:

ID: 1350826
Sex: F
Age: 54
State:

Vax Date: 05/25/2021
Onset Date: 05/25/2021
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: 1st Pfizer Vaccine, Lot#E0172. They put her on a cot for 30 minutes due to dizziness, anxiety and slight shortness of breath. Elevated legs and she started to feel better.

Other Meds:

Current Illness:

ID: 1350827
Sex: M
Age: 32
State: FL

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/26/2021
Hospital: Y

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: Myocarditis with troponinemia to 4, no volume overload/heart failure. Presented with chest pain the day after vaccination, did not abate, associated with palpitations, went to the ED and found to have troponinemia. Treated conservatively. Left heart cath showed non obstructive CAD, preserved LVEF 55%, discharged home on colchicine.

Other Meds: None

Current Illness:

ID: 1350828
Sex: M
Age: 4
State: OK

Vax Date: 11/26/2018
Onset Date: 11/26/2018
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient received expired vaccine. Per documentation vaccine expired 11/10/2018. Patient received vaccine 11262018.

Other Meds:

Current Illness:

ID: 1350829
Sex: F
Age: 15
State: MO

Vax Date: 05/14/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: 2 days after administration of vaccine, the patient experienced 5 days of depressive symptoms including low mood, fatigue, tearfulness, and social isolation/school avoidance. After 5 days, the patient returned to her previous baseline. No other clear stressors/triggers could be identified.

Other Meds: Fluoxetine 40 mg PO daily Adderall XR 5 mg PO BID (morning and noon) Drospirenone-Ethynil Estradiol 3-0.02 mg, 1 tablet PO daily Melatonin 3 mg PO qhs

Current Illness: None.

ID: 1350830
Sex: F
Age: 22
State: GA

Vax Date: 04/16/2021
Onset Date: 04/19/2021
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: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: For the first two days, I had sever body pain, fever, and migranes. On the third day, I had severe chest pain and breathing difficulty that lasted for two additional days. The chest pain went away on the sixth day but the breathing difficulty lasted for a few more days. I never recieved treatement for any of the side effects.

Other Meds: N/A

Current Illness: N/A

ID: 1350831
Sex: F
Age: 53
State: IN

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Allergic to penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fever, chills, headache and body aches

Other Meds:

Current Illness: None

ID: 1350832
Sex: F
Age: 26
State: FL

Vax Date: 05/24/2021
Onset Date: 05/25/2021
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: No

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

Symptoms: Only had arm pain and then was tired up to 27 hrs after shot. After that though, I got extreme pain in my head like an severe migraine and I felt like my head was going to explode, dizziness, shaking of my hands and legs (not like cold sweat shaking or something), nausea, and concussion symptoms like the light was too bright and noises were too loud and I was in pain trying to think to say one word and I could not formulate a sentence. The symptoms were not like sick/flu ones like a fever or running nose, I was not sick but in pain like my organs felt like they were shutting shut. Very odd, could not function so I had to go to sleep. Woke up better but not sure if it will occur again. Unknown what was affected from those symptoms. I was at dinner ordering food when this all occurred. I had to then ask right after ordering it to have it to go because I could not stay there with all the noises and light. I felt I was in extreme pain.

Other Meds: Birth control and b12 vitamin.

Current Illness: No

ID: 1350833
Sex: F
Age: 40
State: VA

Vax Date: 05/19/2021
Onset Date: 05/20/2021
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: sulfa, erythromycin, amoxicillin, codeine

Symptom List: Nausea

Symptoms: nausea and vomiting the next day with chills through the night; extreme fatigue and hot and cold spells lasting a week (at least)

Other Meds: Fluoxetine

Current Illness:

ID: 1350834
Sex: M
Age: 39
State: AZ

Vax Date: 03/17/2021
Onset Date: 03/20/2021
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: penicillin

Symptom List: Injection site pain

Symptoms: Headaches started within 1 day of vaccination and persisted for 3 weeks before ending; Lightheadedness started 3 days after vaccination and has not subsided; periodic tingling and short bursts of pain in feet and hands started ~4 weeks after vaccination and have been decreasing in intensity but are not gone; small yellowish bruises have unexplainedly shown up ~4 weeks after vaccination (top of right foot), ~5 weeks after vaccination (left forearm), ~8 weeks after vaccination (right side upper back), ~9 weeks after vaccination (lower left abdomen); occasional instances of chest discomfort started 6 weeks after vaccination and still occur infrequently No specific diagnosis; treatment has included increased daily walking, increasing water intake, occasional wearing of compression socks (knee high)

Other Meds: Equate Men's daily multivitamin, Vitamin C (500mg), Omega-3 fish oil (500 mg), Metronidazole gel 1%, Soolantra ivermectin cream 1%

Current Illness: lymph node infection in left arm pit treated with antibiotics one month prior

ID: 1350835
Sex: M
Age: 85
State: CA

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: patient originally schedule to receive 1st dose of pfizer vaccine however they ended up receiving moderna and their scheduled appt for the 2nd dose was not changed so they got the 2nd dose at 3 weeks instead of 4 weeks.

Other Meds:

Current Illness:

ID: 1350836
Sex: F
Age: 23
State: NY

Vax Date: 05/26/2021
Onset Date: 05/26/2021
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: Mangos, and pollen.

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

Symptoms: ADMINISTRATION ERROR: vaccinator inserted syringe with needle into patient's Right Deltoid, needle became dislodged from syringe, plunger was pushed causing vaccine to spill out of syringe onto patient's arm, very little of the vaccine entered the needle itself. Vaccinator consulted writer (clinical lead at vaccine POD), writer escalated situation to clinical director/administrator for site. Vaccinator was instructed to document wasted dose and to vaccinate the patient on their opposing arm (left deltoid in this case). Writer completing VAERS report to document administration error and wasted Moderna vaccine dose. Patient observed for required duration of time (30 minutes), no adverse events were observed. Lot#: 035C21A Exp: 10/30/2021

Other Meds: Kyleena Intrauterine Device (IUD).

Current Illness: Denies.

ID: 1350837
Sex: M
Age: 67
State: SC

Vax Date: 02/24/2021
Onset Date: 02/26/2021
Rec V Date: 05/26/2021
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: No known allergies

Symptom List: Tremor

Symptoms: Grand mal seizure 2 days following vaccine. Patient was hospitalized.

Other Meds: Amlodipine, Clonidine, Hydralazine, Labetalol, Lisinopril, Omeprazole, Potassium

Current Illness:

ID: 1350838
Sex: M
Age: 89
State: NE

Vax Date: 03/11/2021
Onset Date: 05/10/2021
Rec V Date: 05/26/2021
Hospital: Y

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

Lab Data:

Allergies: nka

Symptom List: Erythema, Pruritus

Symptoms: Moderna COVID19 Vaccine EUA Hospitalization after 1 week history of hyspnea on exertion. Found to have acute saddle pulmonary embolus along with multiple bilateral pulmonary emboli throughout both lungs

Other Meds: acetaminophen, Fish oil, multivitamin

Current Illness:

ID: 1350839
Sex: F
Age: 30
State: CA

Vax Date: 04/08/2021
Onset Date: 04/15/2021
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: I am not allergy to any medications, foods, or other products.

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

Symptoms: I broke out in rashes and my right leg became really, really sore.

Other Meds: I take a lot of supplements on a daily basis.

Current Illness: I have been battling a GI infection for over a year now.

ID: 1350840
Sex: F
Age: 57
State: CA

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:

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

Symptoms: Patient got Pfizer covid 19 vaccine as fisrt dose on March 6, 2021 from other place. But she got Moderna vaccine as second dose from my pharmacy on May 25,2021.

Other Meds:

Current Illness:

ID: 1350841
Sex: F
Age: 52
State: PA

Vax Date: 01/16/2021
Onset Date: 05/17/2021
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: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fatigue Sore throat Congestion or running nose Care Coordination Progress Note COVID 19 Navigator Initial Patient Assessment Ordering Prescriber has completed required FDA EUA elements. COVID-19 Positive Result Date (and on chart/file): 05/20/2021 Start of Symptoms Date: 05/17/2021 Meets Criteria: ANY AGE: ? Body mass index (BMI) ?35 ? Chronic kidney disease ? Diabetes ? Immunosuppressive disease AGE SPECIFIC: ? ? 65 years of age ? ?55 years of age AND had Cardiovascular Disease OR Hypertension OR COPD/other chronic respiratory disease

Other Meds: buPROPion XL (WELLBUTRIN XL) 150 mg 24 hr tablet loratadine (CLARITIN) 10 mg tablet meloxicam (MOBIC) 7.5 mg tablet montelukast (SINGULAIR) 10 mg tablet MULTIVITAMIN (DAILY VITAMIN ORAL)

Current Illness:

ID: 1350842
Sex: F
Age: 55
State: OH

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Morphine, Celexa, bees. Peanuts and Brazil nuts.

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

Symptoms: She got her vaccine, she only had her arm hurting. The next morning it itched where she got her shot and then she started breaking out with a rash that continued to get worse. She went to the doctor today as it was down both arms, on her hands, blotchy with bumps and this morning she started getting spots on her eyelids and the side of her face that started to swell. She saw a NP today who gave her a steroid shot as her right eye was starting to swell shut. Told her to continue taking Benadryl and to take Allegra in-between for the itching and to report this to VAERS. She has been taking Benadryl and the itching, which has helped some but not a lot, but was wearing long sleeves so she wouldn't itch it. She still has a large red circle at the injection site and that's where she initially scratched her arm.

Other Meds: Baclofen, Gabapentin, zinc, Vitamin D3, L-lysine, Simvastatin, Topiramate, Trazadone.

Current Illness: None.

ID: 1350843
Sex: F
Age: 81
State: CA

Vax Date: 05/25/2021
Onset Date: 05/25/2021
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:

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

Symptoms: patient originally schedule to receive 1st dose of pfizer vaccine however they ended up receiving moderna and their scheduled appt for the 2nd dose was not changed so they got the 2nd dose at 3 weeks instead of 4 weeks.

Other Meds:

Current Illness:

ID: 1350844
Sex: F
Age: 37
State: NY

Vax Date: 04/20/2021
Onset Date: 04/22/2021
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: Tetracycline

Symptom List: Pain in extremity

Symptoms: Developed sub acute thyroiditis. Have been followed by Endocrinologist post partum. Doctor suspects may have been experiencing post partum thyroiditis with minimal symptoms however suspect that following vaccine with strong immune response, triggered sub acute thyroiditis.

Other Meds: Prenatal Vitamin Probiotic DHA

Current Illness: 2 months post partum

ID: 1350846
Sex: F
Age: 11
State: MN

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/26/2021
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: Patient was under age of recommended vaccination. Age reported was '12' but was 2 months shy of birthdate.

Other Meds:

Current Illness:

ID: 1350847
Sex: M
Age: 52
State: MN

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/26/2021
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: Ace inhibitors

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

Symptoms: Fever, bilateral arm numbness and shoulder pain

Other Meds:

Current Illness:

ID: 1350848
Sex: M
Age: 14
State: MO

Vax Date: 05/17/2021
Onset Date: 05/19/2021
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: Canine Protein Containing Products (2+ reaction on allergy testing) Cat Hair Std Allergenic Ext (Itching) Tree Nut (Swelling)

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

Symptoms: 1-2 days after administration of vaccine, the patient had a week-long episode of moodiness and irritability. This culminated in a suicide attempt by hanging in his bedroom that was interrupted by his father. There is no prior history of suicide attempts and no other clear, identifiable triggers to this incident. After 7 days, the patient returned to his previous baseline of mood.

Other Meds: Sertraline 100 mg PO qhs Intuniv 2 mg PO qhs Methylphenidate 5 mg PO daily.

Current Illness: None

ID: 1350849
Sex: F
Age: 56
State: TX

Vax Date: 03/07/2021
Onset Date: 03/29/2021
Rec V Date: 05/26/2021
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: I am allergic to sulfa.

Symptom List: Vomiting

Symptoms: Two weeks after receiving the vaccine my legs started swelling. I went to my PCP and he measured my legs and sent me to hospital because he said that it looked like I had blood clots. While in the ER, they started performing tests, and they found a DVT in the left leg and to PE's, one on each lung. I was under observation because I was given Lovonex to thin my blood. While in the hospital the swelling started to go down and that is when I was discharged. I am now seeing a vein specialist and a pulmonary doctor. I was given Eloquis 5mg 2x per day. I am still having pain and swelling in both legs, but the leg with the DVT is worse. It is very hard to walk around because my left leg will swell a lot.

Other Meds: I was taking Levothyroxine 200 mcg, Pantoprazole 40mg 2x per day, Dicyclomine 10mg 3x per day, Zofran 8mg, Hydrocodone 10.325 mg 3x per day, Hydroxy-chlroquine 200mg, Folic Acid 1mg 2 tablets 2x per day, Vitamin B2 1.25 mg, Prednisone table

Current Illness: I have lupus, rheumatoid arthritis and thyroid disease.

ID: 1350850
Sex: F
Age: 42
State: MI

Vax Date: 05/18/2021
Onset Date: 05/20/2021
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: vicodan and doxycycline

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: arm became hot to touch and red rash size of nickel at injection site

Other Meds: arm became red and hot to touch at site of injection

Current Illness: none

ID: 1350851
Sex: F
Age: 61
State: TX

Vax Date: 03/21/2021
Onset Date: 04/29/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: 5=20-2021 CC: fever, vomiting, nausea, diarrhea/ Pt c/o nausea, vomitting, diarrhea, and Fatigue for 3+weeks. 5-20-2021 HPI: pt with c/o fever, chills, + nausea, + vomiting; pt has completed her Pfizer COVID vaccine series on 3/21/2021; sx started about 3 weeks ago. Daughter and husband, both unvaccinated, were diagnosed with COVID. As of 5-26-2021, pt is doing better. All symptoms, except for diarrhea and nausea have resolved by now.

Other Meds: gabapentin 300 mg capsule 3 cap(s) orally 2 times a day baclofen 10 mg tablet 1 tab(s) orally 3 times a day prn venlafaxine 75 mg tablet 1 tab(s) orally 2 times a day, Notes: in addition to the 150mg Maxalt-MLT 10 mg tablet, disint

Current Illness:

ID: 1350852
Sex: F
Age: 15
State: MO

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Amoxicillin: Reported by Guardian, "hives head to toe."

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Spoke with clients guardian about adverse event. Guardian reported nurse calling her after she went back to school after vaccine due to a rash on chest, lower abdomen, and from inside of arms from elbows to wrist on client. Mother took client to ER to be checked out. Per report of Guardian, ER doctor said, "this rash shouldn't stop client from receiving second vaccine." Guardian also reported ER doctor prescribing Prednisone for 5 days and Benadryl as needed. Guardian did not say what ER doctor ended up diagnosing the rash cause. Guardian reported client reporting rash was itchy, but Guardian reported she did not see client actively itching. Guardian also reported client very nervous about vaccine and was being told mixed messages about vaccine from peers from school. Per CDC guidelines instructed Guardian to have client evaluated by allergist before receiving second Covid-19 Vaccine. Guardian reported client is doing well now.

Other Meds: Concerta Oxcarbazepine Trazadone Lithium Risperidone As Needed: Hydroxyz

Current Illness:

ID: 1350853
Sex: F
Age: 86
State: NY

Vax Date: 05/18/2021
Onset Date: 05/19/2021
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: RA

Lab Data:

Allergies: Wellbutrin

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

Symptoms: Patient was observed going down the stairs with an unsteady gait. Patient observed leaning on one side, and then falling back into a sitting position onto stairs. RSA's assisted resident to dining room. Patient later observed not being able to ambulate, and needing to be pushed in wheelchair.

Other Meds: Synthroid 50 mc daily, Remeron 30 mg bedtime, Folic Acid 1 mg daily, Vitamin D 50,000 units daily.

Current Illness: Unknown.

ID: 1350854
Sex: M
Age: 64
State: MN

Vax Date: 05/01/2021
Onset Date: 05/06/2021
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 hospitalized within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm