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: 1357849
Sex: F
Age: 56
State: NY

Vax Date: 01/01/2021
Onset Date: 02/01/2021
Rec V Date: 05/28/2021
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: pcn asa sulfa bacitracin keflex

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient had a Myasthenia Gravis exacerbation 3 weeks after getting the COVID vaccine.

Other Meds: Taking acetazolamide 250 mg tablet 1 tab(s) orally BID Taking ibuprofen 600 mg tablet 1 tab(s) orally tid prn Taking Calcium po QD Taking Glucosamine Chondroitin as directed Taking multivitamin Multiple Vitamins tablet 1 tab(s)

Current Illness:

ID: 1357850
Sex: M
Age: 26
State: NY

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/28/2021
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: not known

Symptom List: Anxiety, Dyspnoea

Symptoms: I got fever, severe pain in the body from the tip of the head to the toes, without exception. All this for 4 days. In this same period snot and gag, throat felt a bit clogged and I did force myself to breathe the first day. Headache, tiredness, a little diarrhea only for 2 days.

Other Meds: none

Current Illness: anxiety

ID: 1357851
Sex: F
Age: 71
State: GA

Vax Date: 01/12/2021
Onset Date: 01/21/2021
Rec V Date: 05/28/2021
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: Penicillin, Tetracycline, Erythromycin, Gentamicin ,Acyclovir, Dilantin , Sulpha drugs, Benadryl, Claritin, IVP Dye, Thimerosal, All fish, all seafood, all shellfish Bandage adhesive Betadine

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

Symptoms: Participant noticed a red area near injection site that was rashy about 4 inches long then developed another smaller rash. This happened 9 days following the vaccine. She had a sore arm and called in to her doctors office. She was advised to treat with warm compress and an anti inflammatory. This lasted for about 5 days

Other Meds: Buspirone- 1xdaily Citalopran- 1xdaily Hydrochlorothiazide - 1xdaily Irbesartan Hydrochlorothiazide- 1xdaily Pantoprazole- 1xdaily Rosuvastapin- 1xdaily Febuxostat-1xdaily

Current Illness: none

ID: 1357852
Sex: F
Age: 53
State: MN

Vax Date: 01/14/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt currently has Covid 19

Other Meds:

Current Illness:

ID: 1357853
Sex: M
Age: 63
State: GA

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Patient was administered an expired vaccine

Other Meds: unknown

Current Illness: none

ID: 1357854
Sex: F
Age: 33
State: IN

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/28/2021
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: Tuberculin

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

Symptoms: Swelling and numbness/tingling in lips, tongue, face, throat. Dizziness/disorientation

Other Meds:

Current Illness:

ID: 1357855
Sex: F
Age: 24
State: TX

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
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: Scented soap Lactose intolerance SSSRIs Hormonal birth control Rimeron

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Headache-- 11:00 PM ongoing Dizziness-- 1:00 AM ongoing Body aches-- 1:30 AM ongoing Muscle and joint pain: 1:30 AM ongoing Chest pain: 2:30 AM ongoing Nausea: 3:00 AM receded after taking zofran Vomiting: 4:00 am, 6:00 am currently receded

Other Meds: Vyvanse

Current Illness: Just had a pregnancy loss

ID: 1357856
Sex: F
Age: 29
State:

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

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

Lab Data:

Allergies: No

Symptom List: Pharyngeal swelling

Symptoms: Menstrual bleeding two weeks prior to expected period.

Other Meds: Vitamin C, Vitamin D, Calcium, Magnesium, Zinc, Acidophilus

Current Illness: None

ID: 1357857
Sex: M
Age: 16
State: NY

Vax Date: 05/12/2021
Onset Date: 05/26/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: Penicillins, Pollen, Raspberry, Cats

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient was seen by me via telehealth for follow up after ED visit to Hospital on 5/26/21. On 5/26/21 patient was riding his bike, felt like his legs were heavy and lost consciousness. He said that prior to losing consciousness his vision was blurry and sounds sounded distant. Mother witnessed event and stated he had shaking of his upper extremities for a few seconds woke up and then had repeat shaking and loss of consciousness with eyes rolling up. He was taken by EMS to Hospital where evaluation per report was normal (labs, CT head, EKG)

Other Meds: Levothyroxine 125mcg once a day PRN medications: Albuterol MDi, Cetirizine, Azelastine eye drops, Flonase nasal spray,

Current Illness: Chronic illnesses: Hashimoto's Thyroid thyroiditis, mild intermittent asthma Seasonal allergies

ID: 1357858
Sex: M
Age: 27
State: WI

Vax Date: 03/30/2021
Onset Date: 05/23/2021
Rec V Date: 05/28/2021
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: Unknown

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient tested positive for COIVD-19 on 5/23/21.

Other Meds: Unknown

Current Illness: Unknown

ID: 1357859
Sex: M
Age: 23
State: PA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: I have not allergies.

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

Symptoms: It started off with a burning sensation in my throat that work it way down to my Adams apple. I started having chest pains and felt like I was being stabbed with a knife. On a scale to 1-10 the pain was a sharp 5.

Other Meds: I was taken atenolol.

Current Illness: I had no other illnesses.

ID: 1357860
Sex: F
Age: 44
State: WI

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 05/28/2021
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: Lactose, kiwi, adhesive, lemon verbena, lemon grass, banana, ragweed, tree pollen, cats

Symptom List: Rash, Urticaria

Symptoms: shortly after receiving the vaccine, she developed lightheadedness, frontal headache and a feeling of "fuzziness." "I knew it was going to start." She describes a globus sensation. She developed nausea without vomiting. Took 40 mg of prednisone and 25 mg of diphenhydramine. EMS was contacted. She tells me that she lost vision and couldn't see the paramedics when they arrived. Discharged from ED, then returned on 3/17/21, when she began experiencing face itchiness and flushing, numbness of her mouth and lips, throat inflammation, and vision loss. Patient took Prednisone this morning with little symptom relief. Compared to yesterday, the only new symptom is throat inflammation. 4/30/21 Primary care visit: presents to the clinic for evaluation of globus sensation. Patient reports that this has been an issue ever since she got her first dose of Pfizer COVID-19 vaccine. She feels as though there is something in her throat and feels pain or discomfort, most often in the mornings and evenings for several weeks. She feels the need to "clear" her throat often. She denies any trouble eating or swallowing. She feels as though her neck and face still appear swollen compared to her baseline, since getting the vaccine. She reports occasional post nasal drip but denies significant nasal congestion and does not feel this is the typical time for her to struggle with her allergies. She has noticed frequent nose bleeds in the past 2 weeks, now daily. She states that she will sometimes bleed up to 15-20 minutes. She has been feeling more tired and "foggy" or more forgetful in the past few weeks as well and fears this is starting to affect her work performance.

Other Meds: None

Current Illness: None

ID: 1357861
Sex: F
Age: 45
State:

Vax Date: 05/26/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
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: Chills, fever, headache, fatigue, general feeling of being sick Treated with Naproxen Most symptoms gone within 36 hours, but fatigue has persisted

Other Meds:

Current Illness:

ID: 1357862
Sex: F
Age: 43
State: MD

Vax Date: 04/12/2021
Onset Date: 05/05/2021
Rec V Date: 05/28/2021
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: Amoxicillin

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

Symptoms: Pain in left leg, pit in left leg, swollen left calf. Received care at Patient First. Platelets and white blood cell counts were normal. Received ultrasound of left leg from Progressive Radiology. Results were normal, no sign of clots.

Other Meds: Restasis

Current Illness: Had been under the care of a neurologist for headaches three weeks prior to vaccination. Has a MRI and MRA on 4/5/21. Both results were normal.

ID: 1357863
Sex: M
Age: 54
State: CO

Vax Date: 05/20/2021
Onset Date: 05/26/2021
Rec V Date: 05/28/2021
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: NKA

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

Symptoms: Patient is here with left upper abdominal pain and left chest pain that started last night. Patient had his second MODERNA vaccine on May 20, 7 days ago, has not felt well since then. Initially had muscle aches back pain fever or chills. Reportedly stayed in the hot tub too long and he may have gotten dehydrated. Patient had onset of left upper abdominal pain and left-sided chest pain last night. He took some over-the-counter medications without any relief. He has had a history of some stomach problems and IBS in the past but they usually resolve on their own.

Other Meds: Omeprazole 20mg Daily, Lyrica 150mg TID, Risperidone 2mg HS, Ibuprofen 800mg PRN Pain

Current Illness:

ID: 1357864
Sex: F
Age: 24
State: MI

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/28/2021
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: Tachycardia, elevated temperature without fever, dizziness, generalized weakness, malaise

Other Meds: multivitamin

Current Illness: none

ID: 1357865
Sex: M
Age: 66
State: KY

Vax Date: 04/15/2021
Onset Date: 05/12/2021
Rec V Date: 05/28/2021
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: KNDA

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

Symptoms: intermittent right throbbing headache, lasting one hour associated with nausea no vomiting. Headache recurs every 2 hours. He has a headache 5-6 days. During the headache he is warm, However, on 5-26-2021 when he woke up, he had same headache but at this time he also had pain in the right lower jaw on the right side of his neck. This is nondescript and persisted at this time

Other Meds: Glipizide,Losartan, Carvedilol, Jardiance, Amlodipine, Aspirin, Vitamin C, Centrum Silver, Calcium, Flonase nasal spray, Humalogkwik pen, Albuterol Sulfate, Famotidine

Current Illness: NA

ID: 1357866
Sex: M
Age: 66
State: MA

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 05/28/2021
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: Racing heart beat of 110 bpm vs normal 70 bpm. High fever of 103 F. Fever easily reduced by acetaminophen and ibuprofen. Racing heart beat lasted 16 hours.

Other Meds: 2x100mg Gabapentin, 81mg aspirin, Zyrtec

Current Illness:

ID: 1357867
Sex: F
Age: 18
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/28/2021
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 received 1st dose of Pfizer on 4/17/21 and then received a 2nd dose of Moderna 20 days later on 5/7/21.

Other Meds:

Current Illness:

ID: 1357868
Sex: M
Age: 32
State: TX

Vax Date: 03/25/2021
Onset Date: 05/15/2021
Rec V Date: 05/28/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: 5/15/21-7am: Loss of balance and dizziness 5/17/21-8am: complete loss of control of right leg. 9am: admitted to ER as signs of stroke. 5/18/21-started IV steroids for inflammation.

Other Meds:

Current Illness:

ID: 1357869
Sex: M
Age: 59
State: MN

Vax Date: 05/26/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
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: None known.

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

Symptoms: Head ache, chills, body aches - subsided on 5/28/2021.

Other Meds: Aspirin (325mg), Men's One-a-day vitamin for men over 50, Magnesium Citrate (250mg).

Current Illness: None.

ID: 1357870
Sex: M
Age: 31
State: FL

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

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Patient fainted almost immediately after needle was withdrawn and bandage was applied. Patient reports always fainting with any shot he gets. Was out for about 3-5 seconds, then came to, and no other issues afterwards.

Other Meds: None

Current Illness: None

ID: 1357871
Sex: F
Age: 38
State: IN

Vax Date: 05/26/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
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: None

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

Symptoms: Started bleeding as if my period is trying to start. I?ve been on birth control to help ovarian cysts since 13 and I have never had an early period or spotting. Heard this was something others experienced and wanted to add my data as well to help the Covid research.

Other Meds: Imodium Birth Control (since 13 and periods always on time, never early and never spotting)

Current Illness: None

ID: 1357872
Sex: M
Age: 29
State: PA

Vax Date: 05/05/2021
Onset Date: 05/16/2021
Rec V Date: 05/28/2021
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: NKDA

Symptom List: Injection site pain, Pain

Symptoms: The patient presented to his PCP's office with a 2 day history of chest pain associated with deep inhalation NOT relieved by heat or Tylenol. He was vaccinated with the Moderna COVID vaccine on May 5th which caused fevers and sore throat that resolved. His pleuritic left sided chest pain began 11 days from vaccination. Given the symptoms, the PCP ordered a CXR and d-dimer. Because of the elevated d-dimer and tachycardia while in the office, she ordered a CT chest for PE protocol. This showed bilateral pulmonary emboli so the patient was directed to the ER. He was admitted and started on anticoagulation therapy. Given the CT chest findings of adenopathy, Hemotalogy-Oncology service was consulted and ordered labs.

Other Meds: no

Current Illness:

ID: 1357873
Sex: F
Age: 56
State: PA

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: sulpha, amoxicillin, aspirin, red dye, wheat, barley, rye, corn

Symptom List: Injection site pain, Menorrhagia

Symptoms: Diarrhea since the day after vaccination and continuous

Other Meds: Topiramate 25 mg bid, Vitamin D3 25 mg, Vitamin B12

Current Illness: hyperparathyoid, renal stones

ID: 1357874
Sex: F
Age: 56
State:

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 05/28/2021
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:

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

Symptoms: This patient received a 3rd dose of Moderna. 1st dose on 1/13/21, 2nd dose on 2/10/21, and 3rd dose on 4/16/21.

Other Meds:

Current Illness:

ID: 1357875
Sex: M
Age: 50
State: IN

Vax Date: 05/26/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Tired, nauseous and slight body aches. These went away about after a few hours maybe three of taking over the counter pain reliever acetaminophen.

Other Meds: None

Current Illness: Upset stomach

ID: 1357876
Sex: F
Age: 18
State: OH

Vax Date: 05/16/2021
Onset Date: 05/22/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient's mother called us on 5/28 to inform us that her daughter received the Pfizer vaccine on 5/16 and started having symptoms on 5/22: Swelling of lymph nodes, breasts, and what felt like her throat, a fever of 102F and felt like her heart was pounding. Patient's mother states that her heart is no longer pounding but is still having swelling and fever.

Other Meds: unknown

Current Illness: unknown

ID: 1357877
Sex: F
Age: 47
State: IN

Vax Date: 05/25/2021
Onset Date: 05/26/2021
Rec V Date: 05/28/2021
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: Sulfa, bee stings

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

Symptoms: Diarrhea, fever, chills, body aches, headache, lethargy, increased heart rate period lasted for 18 hours

Other Meds: Zyrtec, balance of nature, florastor

Current Illness: None

ID: 1357878
Sex: F
Age: 68
State: NJ

Vax Date: 05/10/2021
Onset Date: 05/11/2021
Rec V Date: 05/28/2021
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: Nausea

Symptoms: She got her vaccine, first she had a little sore arm on the left. Then she started getting headaches. On Tuesday afternoon she started getting a light fever, chills, sweating, no appetite, diarrhea, and also her heart was racing high. Body aches all over. She called her doctor and she suggested for her to take Tylenol and to drink plenty of fluids and to eat dry toast as she was not able to hold anything down. She did not like the rapid heart beat. She told her if her heart beat to go to the ER. She had COVID in December and was in the hospital for 3 weeks and had pneumonia and other symptoms and recovered from that, and then put in rehab center for 2 more months from 1/1/21 to 3/3/21. She is still recovering, does get out of breath easily and is home bound and has to use oxygen when she moves around. She was not on oxygen before having COVID. She checks her heart rate and oxygen level every day since having the COVID and is recovered from the vaccine. She does FU with her doctor weekly due to the COVID virus.

Other Meds: Metoprolol, Metformin, Tylenol.

Current Illness: None.

ID: 1357879
Sex: M
Age: 15
State: WA

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 05/28/2021
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 KNOWN

Symptom List: Injection site pain

Symptoms: NO ADVERSE REACTION AT TIME OF VACCINE. EVENT IS THAT THE PATIENT IS UNDER THE RECOMMENDED AGE FOR ADMINISTRATION OF MODERNA.

Other Meds: NONE KNOWN

Current Illness: NONE KNOWN

ID: 1357880
Sex: M
Age: 17
State: TX

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/28/2021
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 under age 18 was vaccinated with Moderna, which is a vaccine error, on 5/7/2021 by contractor. Note indicated he received his first vaccine on 3/27/2021(he was 16 at initial vaccine) Troubleshooting: Original vaccinator did not validate age; second vaccinator did not report immediately but left notes in the data system. Unreported as error, found in data mining. He is eligible for the second vaccine per standing orders.

Other Meds:

Current Illness:

ID: 1357881
Sex: F
Age: 70
State: IL

Vax Date: 01/14/2021
Onset Date: 01/22/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: penicillin, red contrast dye used for CT scan and Peg which is included in the Mederma vaccine

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

Symptoms: On the 8 day my arm started to itch I thought what am I starching for the size of the rash was raised. Measured 4 inches wide 6 inches long oval shaped. Hot to the touch and very painful. Virtual visit: Hydrocortisone cream

Other Meds: Irbespram, Crestor, Reclast IV solution 1time per year at the point of vaccine 3 doses, Tylenol arthritis, vitamin D 3, align,

Current Illness: none

ID: 1357882
Sex: M
Age: 45
State: MI

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/28/2021
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: Tremor

Symptoms: dizziness starting the day after 2nd dose and continuing every day. There have been times that I had to sit down and other times I had someone else drive.

Other Meds:

Current Illness:

ID: 1357883
Sex: F
Age: 58
State:

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient received a 3rd dose of Moderna. 1st dose on 2/2/21, 2nd dose on 4/5/21, 3rd dose on 5/5/21.

Other Meds:

Current Illness:

ID: 1357884
Sex: F
Age: 16
State:

Vax Date: 04/15/2021
Onset Date: 04/17/2021
Rec V Date: 05/28/2021
Hospital: Y

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: Myocarditis. Chest pain started 2 days after the 2nd shot. Elevated troponin and went upto 20. Near syncope and tiredness.

Other Meds:

Current Illness: None

ID: 1357885
Sex: F
Age: 56
State: KY

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/28/2021
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: NKA

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

Symptoms: Pt came to clinic for second covid vaccine. Completed paperwork/screening questions. Did not advise that had had previous injection at another site. Nurse administered Moderna vaccine. When she provided card, pt handed her a card that indicated that she had had a dose of pfizer on 4/21/21. CDC recommendations reviewed. Pt advised of error and CDC recommendation. Understanding verbalized. No issue during observation period.

Other Meds: Lisinopril, omprazole, HCTZ, Atorvastatin

Current Illness: N/A

ID: 1357886
Sex: F
Age: 69
State: IA

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Moderns Covid-19 Vaccine EUA adverse reaction included: the following symptoms started within 16-18 hours after injection: severe body aches, severe headache, extreme exhaustion that kept me bedridden for at least 2 days but lingered 2 more days after that; no appetite (slight nausea), unknown if I had fever, This reaction to the vaccine was worse than when I actually had Covid previously. 3 days after the shot I had moderate bouts of diarrhea in the morning and lingering lack of appetite and fatigue. Did not feel back to my normal self until 5 days later. I will NOT be getting the second dose because of this reaction

Other Meds: losartan, levothyroxine

Current Illness: none

ID: 1357887
Sex: M
Age: 65
State: WI

Vax Date: 02/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/28/2021
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: Unknown

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

Symptoms: Patient tested positive for COVID-19 on 5/11/21.

Other Meds: Unknown

Current Illness: Unknown

ID: 1357888
Sex: M
Age: 44
State: CA

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/28/2021
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: Extreme increase in tinnitus in left ear and also new tinnitus in right ear. Uncertain if additional hearing loss has occurred.

Other Meds: Olly men's multi PreserVision AREDS 2

Current Illness: None

ID: 1357889
Sex: M
Age: 46
State: AZ

Vax Date: 05/22/2021
Onset Date: 05/26/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pain in extremity

Symptoms: Rash in both armpits

Other Meds: alopurinol, losartan, hctz

Current Illness: none

ID: 1357890
Sex: F
Age: 41
State: FL

Vax Date: 04/25/2021
Onset Date: 05/02/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: A week after vaccine, I experienced my right arm hurting and having tingles. This has not gone away and I currently feel my right arm still not the same way it was before the vaccine.

Other Meds: Armour Thyroid, Methyl Folate

Current Illness: Hypothyroidism/Hashimotos

ID: 1357891
Sex: F
Age: 84
State:

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 05/28/2021
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: Patient received a a completed series of Pfizer and then received a 3rd dose of Moderna. 1st dose of Pfizer on 1/30/21, 2nd dose of Pfizer 2/22/21, 3rd dose of Moderna on 4/23/21.

Other Meds:

Current Illness:

ID: 1357892
Sex: F
Age: 33
State: TX

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/28/2021
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: Tylenol

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

Symptoms: Patient experienced itchiness with hives, tingling around face and ears, post-Moderna #2. Physical exam notes redness behind ears, bilateral lungs clear. Redness to the nose, mild airway involvement. Pt scratching scalp, neck, nose and lower back. States that she cannot stop itching. EMS assessment at 1100: initial BP 146/104, HR 92, BP 143/73, HR 90. Given Benadryl 25 mg tab @ 10:10 am, Benadryl 25 mg IM @ 10:25 am. Ice pack applied. Fire department was called. Pt states that after Benadryl IM, itchiness stopped and she felt better. Physical exam shows redness to lower back and nose is decreasing. EMS obtained AMA. Husband came to pick up wife.

Other Meds:

Current Illness:

ID: 1357893
Sex: M
Age: 15
State: WA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/28/2021
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: NONE KNOWN

Symptom List: Vomiting

Symptoms: AT THE TIME OF VACCINE, NO ADVERSE EVENT REPORTED DUE TO PATIENT AGE

Other Meds: NONE KNOWN

Current Illness: NONE KNOWN

ID: 1357894
Sex: F
Age: 66
State: NJ

Vax Date: 04/01/2021
Onset Date: 04/08/2021
Rec V Date: 05/28/2021
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: Shortness of breath Double vision

Other Meds:

Current Illness:

ID: 1357895
Sex: M
Age: 54
State: NC

Vax Date: 05/27/2021
Onset Date: 05/28/2021
Rec V Date: 05/28/2021
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: SULFUR DRUGS

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

Symptoms: SEIZURE MEMORY LOSS IN COHERENT

Other Meds: NONE

Current Illness: NONE

ID: 1357896
Sex: F
Age: 72
State: OR

Vax Date: 02/27/2021
Onset Date: 04/12/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: On April 19, 2021, I noticed complete numbness on right side of my face, above my lip and up through my nose, right eye and head. After several days, I contacted my primary care physician. She was concerned I may have suffered a stroke so on Friday, April 23, she sent me for a CT Scan at Imaging. The results of the scan were negative for a stroke. However, my PCP asked that I see my neurologist as soon as possible which was Thursday, April 29th at 10:15 am. A Neurologist sent me back to Imaging for an MRI. The MRI also proved negative for stroke and confirmed my brain tumor was staying the same size. I still have numbness in the right side of my face, eye and head.

Other Meds: Carbamazepine ER 12 HR 300 MG 5 daily, 2 in am, 3 in pm Vitamin D 3 125 MCG (5000 IU)

Current Illness: None

ID: 1357897
Sex: F
Age: 41
State: NJ

Vax Date: 02/04/2021
Onset Date: 03/04/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

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

Symptoms: Lymph nodes swollen. Stomach irritation and ulcerative colitis acted up within one month of last dosage. Continue pain under the arm.

Other Meds: Lialda

Current Illness:

ID: 1357898
Sex: M
Age: 79
State: IL

Vax Date: 04/30/2021
Onset Date: 05/04/2021
Rec V Date: 05/28/2021
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: iodine

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

Symptoms: SHINGLES facial: requiring oral acyclovir and ophthalmological abx.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm