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: 1355170
Sex: F
Age: 43
State: MI

Vax Date: 05/22/2021
Onset Date: 05/24/2021
Rec V Date: 05/27/2021
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: NONE

Symptom List: Dysphagia, Epiglottitis

Symptoms: Became very fatigued, nauseous beginning around the 48 hours. Nausea would come and go and has lasted over the course of the 60 hours proceeding the vaccine. I feel shaky and weak--which also comes and goes during the same time frame. Head feels "foggy".

Other Meds: multi vitamins, whey protein isolate, hydrochlorothiazide, Zoloft

Current Illness: NONE

ID: 1355171
Sex: F
Age: 22
State: OR

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Second COVID vaccine dose administered 21 days after first dose vs. 28 days.

Other Meds:

Current Illness:

ID: 1355172
Sex: F
Age: 4
State: NV

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/27/2021
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:

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

Symptoms: Local skin reaction, redness, no swelling, no itching, minimal pain

Other Meds:

Current Illness:

ID: 1355173
Sex: M
Age: 62
State: FL

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/27/2021
Hospital: Y

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

Lab Data:

Allergies: Mango

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The day after the second dose of the Pfizer vaccine, my father started to experience lethargy, headaches, nausea and vomiting. These are all advertised as common symptoms of the second dose so he did not seek medical treatment until 5/11/21, five days after. He went to the emergency room, his systolic blood pressure was over 200. A CT scan showed bleeding going from his basal ganglia to the right ventricle of his brain. His blood pressure had gotten so high that he had a hemorrhagic stroke. He has since been in the ICU. He had to undergo a ventriculostomy, was put onto a ventilator, and has now had a tracheostomy. He still has not regained full motor function and will have a long road to recovery after the stroke.

Other Meds: Ibuprofen

Current Illness:

Date Died: 05/20/2021

ID: 1355174
Sex: M
Age: 51
State: CA

Vax Date: 05/07/2021
Onset Date: 05/20/2021
Rec V Date: 05/27/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: On 5/20/21 the patient was at home with his mother when he had acute nausea, light-headedness, and abdominal pain. He presented to the ED by ambulance. Excerpt from ED notes od MD follows: "Initial ED interventions: iv fluids, low dose iv ativan, iv toradol, iv zofran. ED course: patient arrives very anxious, writhing on bed, difficult to redirect. With chronic tonicity, not seizing. Mother arrives, and he recognizes her, seems to be consoled somewhat by her presence, but she is unable to direct him, and describes his behavior as irregular, and events acute this evening at her home. Patient rests, and then HR decrease to 50s on monitior and patient found to be pulseless - I immediately start chest compressions, and achieve ROSC after PEA arrest with administration of EPI/compressions. Patient intubated per procedure note without complication. L femoral central attained per procedure note without complication. CPR performed over ED course intermittently (always PEA arrest) with ROSC achieved with administration of EPI, EPI drip started in addition to sedation meds, and iv fluids. No obvious STEMI on ECG to administer lytics, with suspicion of dissection and AAA prominent. I am able to stabilze and accompany patient to CT suite, where I recognize B/L massive PE immediately. I discuss with Dr. of Cardiology, who agrees with admininstration of alteplase. I disucss risks with mother who consents verbally. Patient without response to alteplase, and with continued pattern of PEA arrest following bradycardia. I discuss etiology of presentation with mother,and that patient is with very poor prognosis of survival, and likely poorer prognosis of neurological status, and patient is made comfort care, and fentanyl drip increased, patient is taken off of ventilation and drips. Pronounced deceased at 22:00. MDM: Initial concern for but not limited to appendicitis, AAA, diverticulitis, renal stones, pyelonephritis, musculoskeletal pain, pancreatitis, toxic ingestion, ACS, obstruction, perforation, sepsis (2/2 PNA, UTI, meningitis, intra-abdominal infection), AAA, dissection, PE - as ED course progresses, differential narrows and consider more likely PEA arrest secondary to ACS, PE, dissection, AAA, necrotic pancreatitis, tension PNX (less likely). Considered but do not suspect seizures, stroke. Imaging studies reviewed - CXR with ETT in place, no acute pathology. CTA chest/A/P remarkable for massive proximal B/L PE. Labs reviewed. ECGs without STEMI, with sinus tach initially, LBBB after initial ROSC, and then AFib in RVR on subsequent ECG. Per above, patient suffered massive B/L PE, with subsequent cardiac arrest, despite heoric efforts including thrombolysis. Death called art 22:00. Diagnosis: massive B/L PEs, PEA arrest. Disposition: deceased."

Other Meds:

Current Illness:

ID: 1355175
Sex: F
Age: 32
State: MI

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 05/27/2021
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: Almonds, seafood, penicillin, vicodin, latex, zofran

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

Symptoms: I started having a swollen throat after the vaccine later in the night I noticed it was more difficult to breathe I felt like I wasn't able to catch as much air. I wasn't able to do much. The next day, Sunday , it was even harder I couldn't walk It wasn't that my throat was closing up I just felt like something heavy was on my chest. On Monday I went to work and I could not walk even three ft. I went to the hospital I then followed up with my primary care. I was given an inhaler which I used for 2 days after which things began to return to normal. It was about a week total from the vaccine that I began to feel better.

Other Meds: Zyrtec, citalopram

Current Illness: Swollen throat from 1st dose of vaccine

ID: 1355176
Sex: M
Age: 42
State: NY

Vax Date: 04/06/2021
Onset Date: 04/08/2021
Rec V Date: 05/27/2021
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: No

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: A lot of pain in the arm where I received the vaccine.

Other Meds: None

Current Illness: No

ID: 1355177
Sex: M
Age: 20
State: FL

Vax Date: 05/23/2021
Onset Date: 05/26/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: Cephalosporin antibiotics Penicillin

Symptom List: Pharyngeal swelling

Symptoms: At approximately 12:30 PM on May 26, 2021, Pt. began vomiting while he was at school. Prior to vomiting, school staff reported that he seemed unwell (pt. is severely disabled and has very limited speech). The first episode of vomiting was followed by multiple (4-5) episodes of vomiting blood. School staff including the school nurse report observing clots in the blood, bright red blood, and brown coffee ground type blood in the vomit. The school staff called 911 and pt. was transported to Hospital. In the ambulance pt. vomited again and the paramedic reported observing blood in the vomit. Pt. was observed in the ER and given Zofran and liquids. Blood tests and a CT scan with and without contrast were performed. Neither tests explained the bloody vomiting. Pt has since stopped vomiting and is resting quietly at home and eating normally. The hospital referred Noah to a Gastroenterologist for follow up.

Other Meds: Oxcarbazepine, Prozac

Current Illness: None

ID: 1355178
Sex: M
Age: 34
State: NJ

Vax Date: 05/23/2021
Onset Date: 05/23/2021
Rec V Date: 05/27/2021
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: Systemic: Confusion-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Nausea-Medium, Additional Details: pt fell from chair and landed on floor. scraped his face on the way on the floor. i ran to the patient and asked him if he is okay and checked to see if he was breathing, 911 was called, and after about 3 seconds, the patient regains conciousness and explains he has no idea how he ended up on the floor but remembers getting the vaccine and sitting. this occured about 5 minutes into the 15 minute post vaccination observation. pt states he gets sqeamish and nauseus at the thought of needles

Other Meds:

Current Illness:

ID: 1355179
Sex: F
Age: 50
State: FL

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/27/2021
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: NKDA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: PATIENT SAYS THAT AFTER VACCINE SHE HAS HAD PAIN IN HER LEFT ARM. SHE DESCRIBES IT AS MOVING TO DIFFERENT PARTS OF HER ARM. SOMETIMES ITS AT THE TOP OF HER ARM NEAR THE JOINT AND SOMETIMES IT GOES DOWN TOWARDS HER FOREARM

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1355180
Sex: M
Age: 1
State: MO

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Knot in left thigh, hovering the leg, and off balance when walking.

Other Meds: none

Current Illness: none

ID: 1355182
Sex: F
Age: 69
State: SC

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/27/2021
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: Penicillin Aspirin Lisinopril

Symptom List: Rash, Urticaria

Symptoms: Entire body ache Chills, (could not get warm) Pain at injection site Pain at touching of site Lg harden area at injection site , the size and shape of half a small orange Presently, the size of a walnut, still hard and painful at touch.

Other Meds: Tresiba Amlodipine Metoprolol Synjardy Hydrochlorothiazide Lasix Spironolactone Montelukast Cyclobenzaprine Tylenol Arthritis 650mg Tramadol Allergy Relief Women's Multivitamin Temazepam Stool softeners

Current Illness:

ID: 1355183
Sex: M
Age: 56
State: PA

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)

Other Meds:

Current Illness:

ID: 1355184
Sex: F
Age: 62
State: CA

Vax Date: 05/16/2021
Onset Date: 05/19/2021
Rec V Date: 05/27/2021
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: Started hives on day 3 that turned into painful blister on vaccine arm. Has continued to spread to other parts of my body. Still having new hives and blisters on Day 12. Itchy, red.

Other Meds: None

Current Illness: None

Date Died: 05/26/2021

ID: 1355185
Sex: F
Age: 83
State: IA

Vax Date: 04/22/2021
Onset Date: 05/26/2021
Rec V Date: 05/27/2021
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: Bacitracin, Bismuth, Buspirone, Cephalexin, Fluoxetine, Hydrocortisone, lidocaine, Penicillin's, Propoxyphene,

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

Symptoms: Patient found dead

Other Meds: Calcium, Cod liver oil, Vitamin D2, Fexofenadine, furosemide, Iron, Levothyroxine, Lisinopril, Loratadine, Melatonin, metoprol, Warfarin

Current Illness: none

ID: 1355186
Sex: F
Age: 27
State: CO

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 05/27/2021
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 reported

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA: soon after vaccination patient noted swelling of left external auditory canal that subsequently drained yellow pus. Later in the day the patient noticed facial swelling. Presents to urgent care with fever, headache, nasal congestion, and sore throat. Diagnosed with cellulitis, prescribed topical and oral antimicrobials, advised to manage pain with NSAIDs.

Other Meds: bupropion, clonazepam, Adderal, lamotrigine, ibuprofen

Current Illness: none reported

ID: 1355187
Sex: M
Age: 38
State: IN

Vax Date: 05/24/2021
Onset Date: 05/25/2021
Rec V Date: 05/27/2021
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: none

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

Symptoms: Headache, Body Ache, Low Grade Fever, Sore Throat, Coughing

Other Meds: none

Current Illness: none

ID: 1355188
Sex: F
Age: 17
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient under age 18 was vaccinated with Moderna, which is a vaccine error, on 4/02/2021 027b21a. Second vaccine provided 4/30/2021 - Moderna 008C21A. Troubleshooting: Scribe and vaccinator did not validate age; screeners at the beginning of the process did not ask or turn away on a Moderna-only day. Second vaccine would have been given per standing orders. Unreported as error, found in data mining. Age restriction/confirmation rules were put into effect after the date of the first vaccine to prevent underage vaccines.

Other Meds:

Current Illness:

ID: 1355189
Sex: M
Age: 17
State: HI

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Headache, stuffy nose, body aches , swollen glands under his throat, pain when swallowing, hard to swallow. No difficulty breathing, no wheezing, no cough, no rashes. Mother gave Benadryl. Mother reports symptoms started the day the vaccine was given. Resolved within 3 days.

Other Meds: None

Current Illness: None

ID: 1355190
Sex: F
Age: 40
State: WA

Vax Date: 03/18/2021
Onset Date: 04/19/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Before the vaccine, I had complete normal monthly periods. 28 days clockwork. I have not had a period since the vaccine. My FSH level have gone from normal, to 46.2mIU/ml. My prolactin is also elevated to 46.670 ng/ml CRP is elevated as well. I have hot flashes and night sweats and racing heartbeats. My doctor is going to re-run labs but has also ordered an MRI pituitary study

Other Meds: daily multivitamin 50 mic gram synthroid daily

Current Illness: I had the first vaccin on 3/18/2021 and started having COVID symptoms a few hours later, and in fact, had COVID at the time I receive the first vaccine, but I did not know that I had COVID at the time. I received the second dose (Pfizer) a few weeks later and after the overt COVID symptoms (fever, chills, lack of taste and smell) resolved.

ID: 1355191
Sex: M
Age: 54
State: TX

Vax Date: 05/04/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
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: n/a

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

Symptoms: Welts on skins from arm to neck, patient was sent to the emergency room.

Other Meds: n/a

Current Illness: n/a

ID: 1355192
Sex: F
Age: 18
State: KS

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/27/2021
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: Systemic: Fainting / Unresponsive-Mild, Systemic: Weakness-Mild

Other Meds:

Current Illness:

ID: 1355193
Sex: M
Age: 52
State: NY

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
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: Bactrim

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

Symptoms: Pt arrived to vaccination site for scheduled first dose appointment. Computer pop up window indicated a first dose of Moderna given. Pt screened & questioned if he received first dose of Moderna & replied in negative. Error discovered after Pfizer dose administered & upon attempting to reconcile medical record. Pt approached in observation area & again queried if first dose of Moderna was given, replied negative & then changed to "yes" . Moderna vaccine lot # & provider verified via phone with pt's case worker . Unable to obtain further vaccine info (dose,VIS date, route, site). No adverse effects noted while in observation for extended amount of time.

Other Meds:

Current Illness:

ID: 1355194
Sex: M
Age: 13
State: MI

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/27/2021
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: Redness and lump at the injection sight

Other Meds: None

Current Illness: None

ID: 1355195
Sex: F
Age: 17
State: TX

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 05/27/2021
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 IS 17 YEARS OLD . MODERNA VACCINE HAS NOT BEEN APPROVED FOR INDIVIDUALS UNDER THE AGE OF18. PATIENT INADVERDENTLY RECEIVED HER FIRST DOSE OF MODERNA VACCINE. NO KNOWN REPORTS OF COMPLICATIONS FOLLOWING DOSE ADMINISTRATION

Other Meds:

Current Illness:

ID: 1355196
Sex: F
Age: 74
State: IL

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 05/27/2021
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: Allergic to Ibuprofen and Penicillin

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

Symptoms: After getting the vaccine I came home and I fell asleep for a couple hours and I woke up very sick to my stomach and vertigo really bad. I was coughing a lot and I could not breathe and it was terrible. I was also tired and my muscles were sore. I made a doctor's appointment and I was waiting on the car and I tried eating some chips and I could not taste them. Then they let me in the hospital and I had a Covid test done and it was positive. That happened in 04/09/2021. They gave me a medicine for vertigo and an inhaler, Ibuterol and a medicine to control wheezing in my lungs

Other Meds: Blood pressure pills and medicine for cholesterol and vitamin D

Current Illness: None

ID: 1355197
Sex: M
Age: 23
State: MD

Vax Date: 03/26/2021
Onset Date: 03/29/2021
Rec V Date: 05/27/2021
Hospital: Y

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

Lab Data:

Allergies: no

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Developed sharp,constant left sided CP which was relieved with sitting forward 3 days after his second dose of Moderna Covid-19 vaccine. No palpitations, edema or SOB. Dx: Probable Myocarditis

Other Meds: no

Current Illness: no

ID: 1355198
Sex: F
Age: 1
State: CA

Vax Date: 05/13/2021
Onset Date: 05/15/2021
Rec V Date: 05/27/2021
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 Known Drug Allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt started with low grade temps up to 99.2, rash on trunk on and off last week but in the last day the rash has spread to the rest of the body from head to toe with little itching. Parents were using calamine lotion to help with itching. Parent advised by Dr. to use hydrocortisone 1% cream as needed for itchy areas.

Other Meds: None

Current Illness: None

ID: 1355199
Sex: F
Age:
State: CA

Vax Date:
Onset Date: 01/26/2021
Rec V Date: 05/27/2021
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: latex, lactose intolerant

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

Symptoms: After the vaccine I had really sore left arm the next day. On the following weekend I had a severe vomiting that caused me to go to the urgent care to get prescription for the nausea and vomiting that was an ongoing episode for about 6-7 hours throughout the whole night. I had a headache, fatigue and it resolved within 48 hours.

Other Meds: wellbutrin 150mg, Gianvi birth control

Current Illness: N/a

ID: 1355200
Sex: F
Age: 35
State: TX

Vax Date: 05/08/2021
Onset Date: 05/09/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Nausea

Symptoms: I took second dose of Pfizer vaccine on May 8th. I felt arm pain and tired for three days since May 8th. After 7-days when I took the 2nd Pfizer shot, I started getting heavy vertigo feeling. I've also had two brief episodes of room spinning dizziness, as well. At the same time, my tinnitus has increased in a variety of different sounds. I am so anxious. These symptoms last two weeks and I cannot relief.

Other Meds: I didn't take any medications

Current Illness: no

ID: 1355201
Sex: F
Age: 21
State: MN

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

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

Lab Data:

Allergies: none, I am a vegetarian

Symptom List: Injection site pain

Symptoms: I have a nexplanon arm implant for birth control which has stopped my period for the last 3-4 years. I started spotting and sort of having a period about three weeks after getting the second moderna covid shot. This is really strange for me and abnormal, and want it to be a side effect that is included in patients knowledge.

Other Meds: I took ibuprofen the morning after because I was having body aches and the chills

Current Illness: None

ID: 1355202
Sex: F
Age: 62
State: ME

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/27/2021
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 came in for vaccine and caretaker on 5/26 said it was their second dose and signed off on the forms when it was in fact their 3rd dose. First dose was given on 2/10/2021. Care taker did not disclose until after vaccine given that patient had received monoclonal anitbodies in January for Covid so vaccine should have been delayed 90 days. Second dose was given after 90 day period from antibodies on 4/28/2021. Caretaker insisted they wanted her to get another shot. We declined until we saw guidance issued from US CDC or another organization. Caretake instead came in as a walk-in and did not disclose the previous 2 doses, only 1. Counseled on watching for additional adverse reactions.

Other Meds:

Current Illness:

ID: 1355203
Sex: F
Age: 59
State: TX

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/27/2021
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: NOT REPORTED

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

Symptoms: COMPLAINT OF YAWNING AND N/V. BP: 86/47

Other Meds: NOT REPORTED

Current Illness: NOT REPORTED

ID: 1355204
Sex: F
Age: 74
State: TN

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 05/27/2021
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: Seasonal allergies

Symptom List: Tremor

Symptoms: BOTH HAND ASLEEP WHEN I WOKE UP AND WHEN I OPENED MY HANDS THEY BURNED AS IF THEY WERE ON FIRE AND STILL DO THE SAME THING TODAY

Other Meds: metoprol paroxctine omeprozol 81mg asprin meloxicam

Current Illness: Arithrisis Hypertension

ID: 1355205
Sex: F
Age: 55
State: MA

Vax Date: 04/07/2021
Onset Date: 04/19/2021
Rec V Date: 05/27/2021
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: Penicillin

Symptom List: Erythema, Pruritus

Symptoms: Develop shingles on the head with extreme headache mild rash, did not progress towards eye. Had the shingrix vaccine 4 years ago.

Other Meds: Tymlos, Topamax, Levo

Current Illness: none

ID: 1355206
Sex: M
Age: 35
State: CA

Vax Date: 04/08/2021
Onset Date: 04/24/2021
Rec V Date: 05/27/2021
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: None

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

Symptoms: So I started to notice a dry cough, after the vaccine. I started feeling feverish and hurting. An then started to have a running nose and a discomfort and it would start in the evening and it's not going anywhere. He said that the doctor prescribe me some Doxycycline to take twice a day.

Other Meds: I am taking Omega 3, vitamins c, vitamins D3 and Ashwagandha.

Current Illness: I took three vaccination and they were, MMR, TDAP and Flu shot.

ID: 1355207
Sex: F
Age: 33
State: OH

Vax Date: 05/18/2021
Onset Date: 05/22/2021
Rec V Date: 05/27/2021
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: Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Hypertension-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Unable to Sleep-Medium, Additional Details: pt state went to ER twice will follow up with her dr

Other Meds:

Current Illness:

ID: 1355208
Sex: F
Age: 67
State: NJ

Vax Date: 05/26/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
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: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Hypoxia, Hospitalized on Bipap

Other Meds: Amlodipine, Aspirin, Clonidine, Colace, Cyclobenzaprine, Hydrochlorothiazide, Losartan, Methadone, Mirtazapine, Nico- Derm C-Q , Multivitamin, Tylenol extra strength

Current Illness:

ID: 1355209
Sex: M
Age: 66
State: MI

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
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: No known allergies

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

Symptoms: 1.5ml given instead of .5 ml

Other Meds: Amoldine 5mg atorvastine40mg carvedilol 12.5 lisinopril 40mg omeprazole 20mg tadalafil

Current Illness: None

ID: 1355210
Sex: F
Age: 28
State: PA

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/27/2021
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: Pharmacist reported on behalf of patient after receiving second dose of Moderna 5/20/2021, 24 hours later on 5/21/2021, two red blotches on vaccinated arm near where shot was given. Patient reported tired, no fever but red blotches were warm to the touch, not raised but painful. Patient reported taking Tylenol for 1 day only. Patient reported less red from initially and still visible,lighter in color and still warm to the touch.Pharmacist referred patient to her GP for evaluation.

Other Meds:

Current Illness:

ID: 1355211
Sex: F
Age: 58
State: NV

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: Sulfas

Symptom List: Pain in extremity

Symptoms: pt stated arm was feeling numb. pt refused medical attention. was given Benadryl once 25mg tab. pt wait and monitored for 30 minutes and was ok upon leaving. pt was not in respiratory distress.

Other Meds: Pt given benadryl

Current Illness: None

ID: 1355212
Sex: M
Age: 26
State: CO

Vax Date: 05/26/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
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: Extreme headache and moderate fatigue.

Other Meds:

Current Illness:

ID: 1355213
Sex: M
Age: 21
State: PA

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
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:

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

Symptoms: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Medium, Systemic: Shakiness-Medium

Other Meds:

Current Illness:

ID: 1355214
Sex: M
Age: 51
State: NY

Vax Date: 05/10/2021
Onset Date: 05/17/2021
Rec V Date: 05/27/2021
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: Patient had his Covid vaccine 5/10/21 upper left arm, then a week later he presented with puffy left arm. Staff attempted x 2 to assess his left arm. Patient refused both times. Staff observed that patient did have full range of motion with no complaints of pain or discomfort. Appt was set up to assess his left arm edema. Both times patient refused. Dr was made aware that patient still has some edema and that staff was unable to measure related to uncooperative nature of patient. Dr. feels it is an adverse reaction to his Covid-19 (Adenovirus) Vaccine. This is now listed on his Allergy list. Dr feels this edema will resolve itself.

Other Meds: Loxapine, quetiapine, vitamin D, Thera-M, albuterol, propranolol, docusate, vitamin b, alendronate, loratadine

Current Illness:

ID: 1355215
Sex: M
Age: 76
State: NC

Vax Date: 01/23/2021
Onset Date: 05/13/2021
Rec V Date: 05/27/2021
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: atorvastatin, pravastatin

Symptom List: Vomiting

Symptoms: Patient was diagnosed with covid infection on 5/16. He required inpatient admission, but recovered quickly. Pulmonary function worsened after discharge, and he began hospice.

Other Meds: anoro ellipta, daliresp, eliquis, metoprolol, symbicort, ventolin, B12, xolair, xopenex, zithromax, aspirin, ergocalciferol, ferrous sulfate, fluticasone, furosemide, gabapentin, ipratropium, lisinopril, montelukast, prednisone

Current Illness: n/a

ID: 1355217
Sex: F
Age: 26
State: IN

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/27/2021
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: Adhesive tape

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Nauseous,fever, fatigue, muscle aches, tiredness, headache, soreness in arm

Other Meds: Took before lamotrogine, folic acid, sertraline

Current Illness: Had illness week before wasn?t covid it was stomach flu

ID: 1355218
Sex: F
Age: 46
State: WY

Vax Date: 05/12/2021
Onset Date: 05/22/2021
Rec V Date: 05/27/2021
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: codeine

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

Symptoms: patient reports tremor in right arm-went to ER and they thought it was related to the vaccine, they ruled out stroke

Other Meds: dicyclomine 10 mg 1q6-8hprn promethazine 25 mg 1q8hprn

Current Illness: asthma abdominal pain

ID: 1355219
Sex: F
Age: 63
State: CA

Vax Date: 04/28/2021
Onset Date: 05/23/2021
Rec V Date: 05/27/2021
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: Morphine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Was diagnosed with Shingles. I had the shingles vaccine about 5 years ago. The nurses at the hospital said this vaccine likely causes the shingles.

Other Meds: Zoloft Excedrin Vitamin d

Current Illness: No

ID: 1355220
Sex: F
Age: 57
State: NC

Vax Date: 04/12/2021
Onset Date: 04/23/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: On April 23rd, I noticed a sore on my left ear that evening. It was very tender. It finally occurred to me on the 27th. That's when I went to the dr's office because I thought I might have shingles. The dr started me on valtrex for a week. I was told because I work in a cancer center that I could not be at work with shingles. They thought that I might be contagious and I had to work from home for four days before they cleared me to come back to work.

Other Meds: caltrate - calcium with vitamin D/ 1 tablet 2xday (generic) / 315mg calcium/6.25micrograms vitamin D pepcid - 20mg/2xday flonase - 1spray each nostril 2xday/50micrograms per spray allegra- 180mg/1xday venlafaxine - generic/37.5mg/1xday

Current Illness:

ID: 1355221
Sex: F
Age: 33
State: WA

Vax Date: 01/27/2021
Onset Date: 01/29/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient reports being seen at Medical Center following COVID vaccination. Reports now several months of fatigue, cough, ?chest and abdominal pain, unable to resume normal activites. Stated she coughed up blood and felt very sick in first few days after vaccine, was seen by PCP who said it was expected vaccine effect. Later continued to be sick and went to medical facility. She stated labs were drawn that showed her liver and maybe kidneys were inflamed. I think they may have also tested her for COVID which was negative. I am not her provider. She called health facility to ask for help. I said I would put in VAERS report

Other Meds:

Current Illness: None known

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm