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: 1359273
Sex: F
Age: 64
State: MO

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt given Janssen vaccine per ususal protcol and asked to wait in designated chairs for 15min. After about 7 mins pt came to counter saying she had a pain in her neck and her chest was tight. Pt instructed to sit down, was alert, talking and breathing on her own. 911 was then called so pt could be looked at. EMS arrived on scene and transported pt

Other Meds: humiara for RA all info given to by pt

Current Illness: no

ID: 1359274
Sex: F
Age: 63
State: WA

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

Lab Data:

Allergies: Amoxicillin, sulfa drugs

Symptom List: Anxiety, Dyspnoea

Symptoms: Chills, body and joint aches, fever up to 101.1 appeared 12 hours after injection, lasted about 32-36 hours. Soreness and aches at injection site for about 72 hours after injection. Large red patch and severe itching around injection site, appeared about day 4 after injection, lasted less than 24 hours.

Other Meds: Multivitamin, B complex, Vitamin C, Vitamin D, gingko biloba, glucosamine/chondroitin, cranberry,

Current Illness: None

ID: 1359275
Sex: M
Age: 28
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: After administration, the patient sat in a chair for observation. 2-3 minutes after administration patient had a loss of consciousness, falling out of his chair onto the carpeted floor. Patient observed having seizure-like contractions of his upper extremities and slight arching of his back while having this loss of consciousness. LOC lasted less than 10 seconds. Patient was placed on his side, and when he regained consciousness could answer all questions appropriately and without delay. Patient was placed in a wheel chair and taken to a private observation area where vital signs could be attained. Patient again had a LOC while being wheeled in the wheel chair to the private observation area. Patient was placed on a gurney, supine. Vital signs taken and patient was found to have a heart rate in the 40s and a blood pressure of 90/66. Patient was ashen and diaphoretic. Patient was observed for 30 minutes in the private observation area where his condition improved to normal before leaving the facility.

Other Meds: None

Current Illness: None

ID: 1359277
Sex: M
Age: 12
State: TX

Vax Date: 05/23/2021
Onset Date: 05/26/2021
Rec V Date: 05/28/2021
Hospital: Y

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

Lab Data:

Allergies: None known

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient developed acute onset of chest pain on the 3rd day after receiving Pfizer vaccine. Patient describes pain as squeezing in his chest. Pain resolved after about 20 minutes, but patient's mother brought him to emergency room where he had an abnormal ECG and was admitted for further evaluation.

Other Meds: None

Current Illness: None reported

ID: 1359278
Sex: F
Age: 74
State: WA

Vax Date: 03/30/2021
Onset Date: 04/04/2021
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: LA

Lab Data:

Allergies: pennicillin codiene

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

Symptoms: Terrible pain affecting all joints; arms, back, shoulders, neck; collar bones, etc Out of breath; fatigue easily; difficulty getting out of chair; walking, doing yard work, interrupted sleep due to pain. this is arthritis , psoritic type with severe aching/pain. Have been referred to rheumatologist. Initial psoriasis flare=up 5 days after injection.

Other Meds: prilesec magnesium fiber

Current Illness:

ID: 1359280
Sex: M
Age: 44
State: NJ

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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:

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

Symptoms: Severe vertigo lasting 6hours, headache, neck pains, chills.

Other Meds: Gabapentin

Current Illness: No

ID: 1359281
Sex: F
Age: 12
State: AZ

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient experienced vertigo and nausea about 5 to 10 minutes after being vaccinated. She was given water and observed for another 30 minutes, after which she was feeling better.

Other Meds: None

Current Illness: None

ID: 1359282
Sex: F
Age: 43
State: TX

Vax Date: 05/20/2021
Onset Date: 05/20/2021
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:

Symptom List: Pharyngeal swelling

Symptoms: Patient is not having any adverse reaction. but first dose given 04/29/21, so the second dose was given a week early on 05/20/21

Other Meds:

Current Illness:

ID: 1359283
Sex: M
Age: 60
State: OK

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: NKDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: About 5 min after getting immunization the patient started to stand to tell an associate that he was having a reaction. He got light headed and started to pass out. A pharmacy technician was able to get to him in time and guide him to the ground. He was unresponsive for 10-30 seconds. Before we could take further action he regain consciousness. After a couple minutes he wanted to go back to chair. Within a minute he lost color and passed back out. This time he came back sooner and stayed on the ground till EMSA arrived. Only BP we got was several minutes into the event 124/82 HR 54. Paramedics did not transport the pt.

Other Meds: Omeprazole, Flomax, Olmesartan

Current Illness: None

ID: 1359284
Sex: F
Age: 59
State: AL

Vax Date: 04/08/2021
Onset Date: 04/22/2021
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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 4-08-2021 Frequent urination 4x during night vivid dreams 4-22-2021 Muscle weakness, loss of muscle tone , falling, red eyes, swollen wrist 5-1-2021 Went to Urgent care for adverse reactions was prescribed muscle relaxant 5-5-2021 Feel and broke wrist from muscle weakness

Other Meds: none

Current Illness: autoimmune disease

ID: 1359285
Sex: M
Age: 26
State: NH

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: SYR
Vax Site: LA

Lab Data:

Allergies: no known

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

Symptoms: Patient reported a headache and feeling like he was going to pass out. Patient went assessed seemed to be having a stress response to the vaccine according to EMTs.

Other Meds: none

Current Illness: no known

ID: 1359287
Sex: F
Age: 45
State: OR

Vax Date: 05/01/2021
Onset Date: 05/02/2021
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: Penicillin Codeine

Symptom List: Rash, Urticaria

Symptoms: Double vision

Other Meds: Lamactil 200mg Wellbutrin 300mg Levothyroxin 113mcg

Current Illness: Na

ID: 1359288
Sex: M
Age: 13
State: IL

Vax Date: 05/28/2021
Onset Date:
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: no adverse event- issue was that vaccine had past 6 hours after being reconstituted. vaccine was prepared 7 hours 20 minutes before giving

Other Meds:

Current Illness:

ID: 1359289
Sex: M
Age: 36
State:

Vax Date: 04/16/2021
Onset Date: 04/18/2021
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: none

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

Symptoms: 4-18-21 woke up with N/V/neck pain and stiffness which subsided over the next couple of days. Patient treated the symptoms with Acetaminophen 1g twice daily as needed. with some relief. 5-3-2021 am Patient was unable to move his neck and was in pain. He went to immediate care center He was given a dose of Solumedrol and a Medrol pack. He was informed that he had swollen lymph nodes in his neck and follow up with his primary

Other Meds: none

Current Illness: none

ID: 1359290
Sex: F
Age: 51
State: SC

Vax Date: 05/27/2021
Onset Date: 05/28/2021
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: No

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

Symptoms: Muscle tightness and pain, joint pain, headache, nausea, severe back pain, abdominal pain, scratchy sore throat, emotional, depressed, shortness of breath, severe fatigue, confusion, foggy head, lack of focus, lack of concentration, eye sensitivity, skin sensitivity

Other Meds: Multivitamin, Woman's Probiotic, Cognitive Health with Citicoline, Uricalm with D-Mannose, Allegra-D 24hr

Current Illness: Severe Depression Disorder with Anxiety, Abnormal pre-cancerous cells on cervix, seasonal allergy symptoms

ID: 1359292
Sex: M
Age: 14
State: IN

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Unknown

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

Symptoms: When reconstituting the Pfizer COVID19, an error was made but not discovered until 3 doses (0.3ml ea) had been given. There were only 3 + doses in the vial. Upon review it appears that only 1 ml of NaCl had been used to dilute.

Other Meds: Unknown

Current Illness: Unknown

ID: 1359293
Sex: M
Age: 41
State: AZ

Vax Date: 05/28/2021
Onset Date: 05/28/2021
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:

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

Symptoms: He got his first dose of Pfizer. I believe he was suffering from anxiety attack. He told me that is how he often feels seeing needles. His blood pressure and heart rate were all normal. EMS services were called and the patient was checked out and ok.

Other Meds:

Current Illness:

ID: 1359294
Sex: F
Age: 48
State:

Vax Date: 05/28/2021
Onset Date: 05/28/2021
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: Itchiness and redness of the vaccine site. Cold pack applied. Vital signs within normal limits. After 26 minutes they removed the cold pack. Five minutes later the site was no longer red or itchy.

Other Meds:

Current Illness:

ID: 1359295
Sex: F
Age: 54
State:

Vax Date: 05/20/2021
Onset Date: 05/21/2021
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: Severe nausea, vomiting and new migraine onset

Other Meds:

Current Illness:

ID: 1359296
Sex: F
Age: 23
State: AZ

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

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

Lab Data:

Allergies: denies

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

Symptoms: Pt presented to ED at apx 1pm on 5/28/21 with signs of anaphylaxis. Swollen upper and lower lips, sensation of swollen throat, and facial swelling, with urticarial lesions to upper chest wall and arms. No GI symptoms. No hypotension. Received 0.3mg IM epinephrine, 50mg IV benadryl, 125mg IV solumedrol, and 20mg IV pepcid. Symptoms slowly resolved over 3-4 hours. Pt could not recall any other now inciting event or product other than vaccine she had yesterday around 4pm. No reaction to first pfizer vaccine noted.

Other Meds: Peppermint pills long acting insulin

Current Illness:

ID: 1359297
Sex: M
Age: 30
State: CA

Vax Date: 05/21/2021
Onset Date: 05/22/2021
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: N/a

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

Symptoms: What appears to be a heat rash on my right arm near elbow pit, also on my left forearm, my neck, legs.

Other Meds: N/a

Current Illness: N/a

ID: 1359298
Sex: M
Age: 25
State: CO

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: After 2 minutes of vaccination, patient passed out and had an absent seizure. However, it lasted about 1 to 2 minutes, he was able to wake up by himself.

Other Meds: NA

Current Illness: NA

ID: 1359299
Sex: F
Age: 51
State: TX

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

Lab Data:

Allergies: Benadryl, sulfer,

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

Symptoms: Around 6pm or so I started feeling nauseous, itching at site of injection, red, swollen with fever. Tightness of chest, wheezing, throat irritation, dizziness, headache, weakness, anxiety, change in eyesight where it comes and goes, muscles and joint pain. Just really hurting all over. Upset stomach, feeling tired and unwell. My eyes also have mucus in them and vision comes and goes. I have felt okay during the day until around 6pm the symptoms occur and last the rest of the night. My arm also is painful at injection site and swollen , kind of like a knot. This is the next day after injection. When I had the first shot I had same reactions and it lasted 4 days.

Other Meds: Geodon, cymbalta, clonazepam, buspirone, hydroxyzine, tylenol

Current Illness: None

ID: 1359300
Sex: F
Age: 50
State: OH

Vax Date: 03/21/2021
Onset Date: 04/02/2021
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: Sulfa, Tramadol

Symptom List: Injection site pain, Pain

Symptoms: Rash all over body similar to shingles. Swollen lymph nodes. Was in ER two different times due to the rash, and face swelling. Lip was swollen on right side similar to a very large cold sore that has lasted for 8 weeks. Very painful. Doctors also have tested me for an autoimmune disease, that has come back positive. ANA Titer 1:1280. Possibly this has brought to surface an underlying autoimmune disease due to the fact that I had Covid-19 so bad. Was hospitalized with it, and had neurological issues along with GI problems. No respiratory problems.

Other Meds: Lyrica, Topamax, Synthroid, Paxil, Cymbalta, Tylenol

Current Illness: No

ID: 1359301
Sex: F
Age: 13
State: CA

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: SYR
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: Chest pain

Other Meds: Vit D supplementation

Current Illness: none

ID: 1359302
Sex: F
Age: 65
State: MI

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

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

Lab Data:

Allergies: Doxycycline100mg and Keflex500mg. Both cause nausea, vomiting, extreme diarrhea. Isasorbide ( Indur ) 30mg - extreme headache. Morphine - vomiting. Lillies - Throat tightens and swells. Onions- stomach pain with diarrhea.Levofloxacin 250mg - hives, sleepy. Bactrim and sulfa- Rash hives from head to toe. Proparacaine with Fluosescien for eye pressure dialation. Nexium- weakness

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

Symptoms: Had Heart Attack next morning.

Other Meds: 500 mg of vitamin B12, 1000mg of fishoil, baby aspirin 81mg. All taken daily

Current Illness: None

ID: 1359303
Sex: F
Age: 39
State: WA

Vax Date: 05/28/2021
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: LA

Lab Data:

Allergies: bees, trees

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt. arrived for first Pfizer vaccine, pt. alerted staff to anaphylaxis risk to bees and trees but stated she has never had an adverse reaction to vaccinations. Pt. has not used her epi pen in 10 years. Approx 10 minutes into observation pt. complains of lip tingling, swollen lips and states "half of face is swollen". EMS contacted and vital signs stable except for elevated blood pressure. Pt. given 25mg Benadryl and water. Second dose of Benadryl 25mg given at 1733. Pt. educated to seek medical attention if reaction increases. Cleared by EMS, pt. exited facility in stable condition with partner.

Other Meds: labetalol prn

Current Illness:

ID: 1359304
Sex: M
Age: 32
State: IN

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: When reconstituting the Pfizer COVID19, an error was made but not discovered until 3 doses (0.3ml ea) had been given. There were only 3+ doses in the vial. Upon review it appears only 1 ml of NaCl had been used to dilute

Other Meds: Unknown

Current Illness: Unknown

ID: 1359305
Sex: M
Age: 17
State: GA

Vax Date: 05/15/2021
Onset Date: 05/15/2021
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:

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

Symptoms: NO ADVERSE EVENT REPORTED - PATIENT WAS NOT CORRECT AGE AT TIME OF VACCINATION

Other Meds:

Current Illness:

ID: 1359306
Sex: F
Age: 53
State: IL

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

Lab Data:

Allergies: NOT KNOWN

Symptom List: Nausea

Symptoms: PATIENT CALLED THE PHARMACY TODAY (5-28-21) AND SPOKE TO STAFF PHARMACIST. PATIENT STATED THAT SHE WAS INSTRUCTED TO STAY IN STORE FOR 15 MINUTES AFTER THE VACCINE WAS ADMINISTERED, WHICH SHE SAID THAT SHE DID. WHILE SHE WAS DRIVING HOME SHE GOT DIZZY AND CRASHED HER CAR INTO A DITCH. SHE STATED SHE WANTED TO CALL AND TELL US WHAT HAPPENED AND THAT WE SHOULD BE TELLING PATIENTS TO HAVE "SOMEONE DRIVE THEM HOME"

Other Meds: NOT KNOWN

Current Illness: NOT KNOWN

ID: 1359307
Sex: F
Age: 50
State: CA

Vax Date: 05/23/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: penicillin, cantaloupe

Symptom List: Injection site pain

Symptoms: "Pfizer-BioNTech Covid 19 vaccine EUA": About 24 hours after my second shot, I felt strong nausea, losing control of the environment, feeling very unwell, weak, blood pressure must have dropped, my vision had darkened, I was about to collapse on the floor had I not reached my bed quickly. Couple of minutes later I had the urge to vomit but nothing came out, and then I had a normal bowl movement. After all that, I felt like the pressure had been released, took 1 tylenol, and went back to bed to rest. It's been 4 days now since the fainting symptoms, and I've been fine so far. The scary part was really the fainting symptoms, I wasn't expecting that.

Other Meds: Synthroid 75 mcg

Current Illness: none

ID: 1359309
Sex: F
Age: 47
State: CO

Vax Date: 05/08/2021
Onset Date: 05/12/2021
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: Penicillin

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

Symptoms: left eye stroke (blood clot), Central Retinal Vein Occlusion, no treatment, vision foggy

Other Meds: Claritin-D, Trazodone, Risperidone, Zoloft, Nasacort

Current Illness: No

ID: 1359310
Sex: F
Age: 14
State: AZ

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: PATIENT UNDER AGE 18 WAS GIVEN JANSSEN COVID-19 VACCINE.

Other Meds:

Current Illness:

ID: 1359311
Sex: F
Age: 37
State: IL

Vax Date: 04/09/2021
Onset Date: 05/07/2021
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: Tremor

Symptoms: I have been having heart palpations and some slight chest pains for a couple weeks. I was not sure if caused by stress, but it has gone on for some time and really started a few weeks after my second dose.

Other Meds: None

Current Illness: None

ID: 1359312
Sex: M
Age: 19
State: WA

Vax Date: 04/23/2021
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: Erythema, Pruritus

Symptoms: left sided chest pain x1 week. Pericarditis on EKG. Troponin negative

Other Meds: None

Current Illness: None

Date Died: 02/06/2021

ID: 1359313
Sex: M
Age: 66
State: NJ

Vax Date: 01/14/2021
Onset Date: 01/25/2021
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: none

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

Symptoms: My husband had a stroke on 01/25/2021, with one large blood clot and many small blood clots. He was put on a ventilator until 02/06/2021 when I asked to have it removed. I died within 5 minutes after it being removed.

Other Meds: Tacrolimus, Myfortic, Prednisone, Bactrim, Omeprazole, Metoprolol, Tamsulosin, Vytorin, Amlodlpine, Calcitriol, Jadiance, Humalog, Lantas, Trulicity, Fish Oil, Aspirin, Multivitamin

Current Illness: none

ID: 1359314
Sex: M
Age: 15
State: IN

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: Unknown

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

Symptoms: When reconstituting the Pfizer COVID19 vaccine, an erro was made but not discovered until 3 doses (0.3ml ea) had been give. There were only 3+ doses in the vial. Upon review it appears that only 1ml NaCl solution had been used to dilute.

Other Meds: Unknown

Current Illness: Unknown

ID: 1359508
Sex: F
Age: 36
State: IN

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Morphine Flu Vaccine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Nausea, chills, body ache, low temp, goosebumps, migraine

Other Meds: Hydorchlorothiazide vit D 3 Folic acid Protonix Sprintec birth control Hydroxyzine L-Lysine

Current Illness: Granulomatosis, hypertension, cerebral gliosis, GERD,

ID: 1359509
Sex: F
Age: 45
State: NC

Vax Date: 03/17/2021
Onset Date: 04/19/2021
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:

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

Symptoms: Soreness of arm

Other Meds: Metroprolol, Zyrtec, Hydrochlorothiazide, Slow Release Iron, Magnesium, Fluticasone

Current Illness:

ID: 1359510
Sex: M
Age: 17
State: TN

Vax Date: 05/07/2021
Onset Date: 05/08/2021
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:

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

Symptoms: Pt reported he was "aware of his heart" and that it "felt like when adrenaline is running through his body" that began approximately 24 hours after vaccination, and resolved 48 hours after starting. He reported this information at his second dose appointment 21 days after vaccination. He says his symptoms were hard to describe, but he overall felt poorly and says he could feel his heart beating more than normal. He denied chest pain, racing heart, excessing sweating, headache, agitation. Patient has no history of cardiac issues. After 48 hours his symptoms resolved with no intervention.

Other Meds:

Current Illness:

ID: 1359511
Sex: F
Age: 18
State: MN

Vax Date: 05/24/2021
Onset Date: 05/25/2021
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: Medication: - Hydrocodone > rash, fever, nausea, vomiting and diarrhea. Food Allergies: (Main). - Strawberry > Cough, itchy throat, eczema/dermatitis, mild swelling. - Chicken > Abd. pain, diarrhea, eczema/dermatitis, flushing and irritable. - Cherry > Rashes, itchy mouth and throat, hives (rare, now.), constipation. - Cocoa > Abd. pain, eczema, diarrhea.

Symptom List: Pain in extremity

Symptoms: 1) Major rash on face, chest and stomach. Very painful, swollen, itchy and uncomfortable. Started day of vaccine. Still present, 4 days later. 2) Lots of vomiting. Started day after vaccine. Lasted 1 day. 3) Abdominal pain. Started day after vaccine. Lasted 2 days. 4) Lots of diarrhea. Started day after vaccine. Lasted 2 days.

Other Meds: - Clonidine. 0.5mg tablet. PO. Nightly. - Depakote. 250mg tablet. PO. Daily. - Depakote. 500mg. X2 250mg tablets. PO. Nightly. - Lexapro/Escitaloproam. 20mg tablet. PO. Daily. - Naltrexone/Naloxone/Revia. 50mg tablet. PO. Daily. - Benadryl/

Current Illness:

ID: 1359512
Sex: F
Age: 65
State: WA

Vax Date: 04/06/2021
Onset Date: 04/08/2021
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: Gluten, humira

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

Symptoms: I had my sedrate checked a few weeks prior to my vaccination. It was 19 and I was doing great. I was vaccinated April 6 and began to feel really ill 2 days afterwards. I felt like I had the flu and all joints were red and painful. I had a hard time walking and the fatique was and still is extreme. After 6 days, April 12, I went to see my GP, I had labs and my sedrate had gone up to 79. I was re-tested on May 4 and it was 84. I will be retested in a week but I can tell it is still really high. I am not functional. I am in pain, I am so fatigued I am unable to do anything and I am unable to think clearly. Just making a grocery list or writing this feels like too much.

Other Meds: Prednisone, Xejanz

Current Illness: no

ID: 1359513
Sex: F
Age: 51
State: MI

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Patient stated that shortly after getting the Pfizer vaccine she started having unexpected menstrual bleeding which continued for 7 days. She also had abdominal cramping that was 100X worse than her previous menstrual cramps. The cramps went on for 3 days. She discharged clots while bleeding and she also states that she had really bad "medical smelling" gas for about 2 weeks. She did have diarrhea and lasted for about 2 weeks as well.

Other Meds: Unknown

Current Illness: Unknown

ID: 1359514
Sex: F
Age: 46
State: PA

Vax Date: 01/24/2021
Onset Date: 02/26/2021
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: None

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

Symptoms: Preventricular contractions. Many of them. Every day. Started feb 26,2021 Stopped around April 17 2021

Other Meds: Women's daily vitamin

Current Illness: None

ID: 1359515
Sex: M
Age: 33
State: CA

Vax Date: 05/17/2021
Onset Date: 05/28/2021
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

Symptom List: Vomiting

Symptoms: (+) DVT 2 weeks after the vaccine

Other Meds: None

Current Illness: None

ID: 1359517
Sex: M
Age: 54
State: PA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
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: Pollen, shellfish

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Severe chills, went to bed and slept well. Felt better in morning. Sluggish later in afternoon; took very long nap and felt substantially better. Also, off and on for several days was soreness and skin sensitivity especially on right nipple area.

Other Meds: Statin

Current Illness: NA

ID: 1359518
Sex: F
Age: 29
State:

Vax Date: 05/20/2021
Onset Date: 05/24/2021
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: NKDA

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

Symptoms: petechial rash on left inner thigh, 5 cm x 8 cm

Other Meds: none

Current Illness:

ID: 1359519
Sex: M
Age: 35
State: IL

Vax Date: 01/08/2021
Onset Date: 04/09/2021
Rec V Date: 05/28/2021
Hospital: Y

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: Widespread petechiae beginning on 4/9/21, ultimately diagnosed with aplastic anemia, required a bone marrow transplant

Other Meds: Losartan

Current Illness: Hypertension

ID: 1359520
Sex: M
Age: 35
State: IN

Vax Date: 05/24/2021
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: RA

Lab Data:

Allergies: None

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

Symptoms: Soreness in arm beginning the afternoon vaccine was administered and lasting approx 56 hours, fatigue beginning in the late afternoon and lasting approx 36 hours, urticaria developed bilaterally on the medial elbows beginning overnight Tuesday into Wednesday morning. The urticaria is now drying out and beginning to heal but is still present. No intervention was sought from a medical provider. It is mild and no treatment was needed.

Other Meds: None

Current Illness: None

ID: 1359522
Sex: F
Age: 41
State: CA

Vax Date: 05/14/2021
Onset Date: 05/15/2021
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: No

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

Symptoms: May 14 application of the vaccine, May 15 severe headache, May 16 tingling and itching in the extremities of my body and head, face, tongue, loss of strength in my fingers on my left hand. Today is May 28 and the symptoms continue with less improvement. I feel burning in my hands and feet.

Other Meds: Probiotics

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm