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: 1359523
Sex: F
Age: 36
State: NV

Vax Date: 04/30/2021
Onset Date: 05/08/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Right side of left hand has gone numb. Experiencing pins and needles in left ring finger and pinky. Small lump has formed on bottom right side of left palm.

Other Meds:

Current Illness:

ID: 1359524
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Next menstrual cycle was missed. Previous cycle 3/18/2021-3/22/2021. Next menstrual cycle 5/13/2021-5/18/2021. No April cycle.

Other Meds: Daily Rx Fluticasone (iam) Hydrochlorothiazide 12.5mg bid (ipm) Metroprolol tartrate 100mg I bid (bid) Lo loestrin FE 1/10 tab (iqd) OTC Zyrtec (Iam) Magnesium 250mg (ipm) Slow Release Iron 45mg (ipm) Advanced Women?s Formula (iam)

Current Illness:

ID: 1359525
Sex: F
Age: 48
State: MI

Vax Date: 04/23/2021
Onset Date: 04/24/2021
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:

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

Symptoms: About 12 hours after second Moderna shot, experienced 3 hours of debilitating teeth chattering, full body tension, dizziness, hot/cold, feverishness, nausea, disorientation. Then evolved into another day of dizziness. Also sore shoulder at injection site throughout. Side effects ended after third day.

Other Meds:

Current Illness:

ID: 1359526
Sex: F
Age: 17
State: IL

Vax Date: 03/13/2021
Onset Date: 03/13/2021
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: no adverse reaction. patient came to clinic for second dose and was under age at the time of immunization. it was noticed at the time of processing paperwor.

Other Meds:

Current Illness:

ID: 1359527
Sex: F
Age: 60
State: CA

Vax Date: 05/22/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine, Penicillins, Clindamycin

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

Symptoms: Patient had 2nd dose of COVID-19 shot on 05/22/2021. She developed skin problem the same day after the 2nd shot. Her skin was hot to touch and feeling itch underneath around the injection site. She took Tylenol, put ice pack and drank a lot of water. After 2 to 3 days of the 2nd dose, her left arm around the injection site had a mass that was red/purple with sharp pain and itch. No fever was reported during this time. She contacted CDC and was told to see a doctor. Her doctor prescribed Bactrim DS and diagnosed for skin infection on 05/28/2021. Pharmacist found out when doing consultation on her Bactrim DS.

Other Meds: Generic of Bactrim DS, Generic of Tylenol

Current Illness:

ID: 1359528
Sex: M
Age: 36
State: OR

Vax Date: 04/01/2021
Onset Date: 05/06/2021
Rec V Date: 05/28/2021
Hospital: Y

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: n/a

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

Symptoms: Monomorphic Ventricular tachycardia Reduced LV systolic dysfunction Myocarditis

Other Meds: n/a

Current Illness: n/a

ID: 1359529
Sex: F
Age: 20
State: WA

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: None stated

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: About 5 min after giving the vaccine, patient complained of not feeling well. Symptoms included headache, loss of sensation in arms, light headedness. Patient appeared pale, and confused. Attempted to have patient stand up and walk to counsel room opposite where she was sat. After standing, she immediately sat down, and fainted while she was seated. Pharmacist supported her head, and her boyfriend/significant other prevented her from falling off the chair. Patient was momentarily unresponsive for about 3 seconds. During this time her eyes remained open. Once patient regained consciousness, walked her to counsel room and had her lie down on her back with her legs elevated on a chair. Blood pressure was within normal limits. Patient was feeling better in about 10 minutes, and continued to monitor for another 5. Gave water to sip on, and no additional adverse effects noted.

Other Meds: Unknown

Current Illness: Denied

ID: 1359531
Sex: F
Age: 25
State: CA

Vax Date: 05/04/2021
Onset Date: 05/04/2021
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: Epinephrine

Symptom List: Pharyngeal swelling

Symptoms: Patient was very nervous after the vaccine, anxious as usual, accompanied by her MOther (Mother called 911) Patient appeared to faint for a few seconds, and back to normal at 1240PM patient stable

Other Meds: None

Current Illness: Wolf Parkinson White

ID: 1359532
Sex: F
Age: 68
State: KS

Vax Date: 03/19/2021
Onset Date: 04/01/2021
Rec V Date: 05/28/2021
Hospital:

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

Lab Data:

Allergies: Dairy, Gluten, eggs, tree nuts, peanuts,soy, strawberries

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Initially on vaccine evening 3/19/21 mild sore arm, mild brain fog, following day03/20/2021 headache, tired, second day post vaccine 03/21/2021 no noticeable symptoms . 03/17/2021 first notation of headache,, 03/18/2021 headache continued all day ,03/19,2021 notation of headache setting in early evening , 03/20/2021 notation of tiredness all day accompanied by headache and achy everywhere-joints-muscles. Days following had notation of mild headache/body aches. 04/01/2021-8:30am Extremely Dizzy upon getting out of bed, Strong Panic attack-symptoms subsided with am medications, and reappeared about 11:00am. Strong Panic attack, very dizzy, neck stiff,muscle tightness in shoulders, sysmptoms continued off and on

Other Meds: medrol, xanax,fioricet,vit-D-3 B-12 folic acid

Current Illness: anxiety/agoraphobia,Fibromyalgia, Osteoarthritis,Acid reflux,

ID: 1359533
Sex: M
Age: 77
State: AZ

Vax Date: 05/19/2021
Onset Date: 05/19/2021
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: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt received both doses of Moderna Jan and Feb 2021 at off-site location. Pt insisted on receiving Janssen in addition for extra coverage compared to Moderna. Explained to patient that there is no current recommendation on getting both vaccines as there is no study on safety/efficacy on getting both vaccines. Pt still wanted to receive the vaccine. Because there is no contraindication of getting both vaccines and there was not clear instructions in this situation at the time (5/19), Pt received Janssen. Report is now made as soon as instructions was sent out by corporate regarding similar situations. Pt was counseled to monitor on potential side effects of both vaccines.

Other Meds:

Current Illness:

ID: 1359534
Sex: F
Age: 64
State: NM

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: NA

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

Symptoms: Patient Fainted for few minutes and looked like she was seizing. Few minutes she was back up to normal and stated that she fainted every time after a shot

Other Meds: NA

Current Illness: History of Blood Clots

ID: 1359535
Sex: M
Age: 54
State: PA

Vax Date: 04/26/2021
Onset Date: 05/01/2021
Rec V Date: 05/28/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Vancomycin

Symptom List: Rash, Urticaria

Symptoms: Vertigo, nausea/vomiting, diaphoresis a few minutes up to 10 minutes every few days until the symptoms became very severe and would not subside on 5/16/2021 around 5 am. And continued frequently all day on 5/16/2021 and went to the Emergency Room on 5/17/2031 and found to have a right cerebellar stroke.

Other Meds: None

Current Illness: None

ID: 1359536
Sex: F
Age: 52
State: OK

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: LA

Lab Data:

Allergies: Statins, Hylan, Trees, animals, dust, mold

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

Symptoms: I had the vaccine about 10:00 A.M. I was fine until about 11:3 PM I woke up experiencing a lot of pain and was chilling. I took my temperature and was running about 99.5.My normal temperature is 97 degrees. I took tylonel pm. But was never able to sleep longer at night. On Thursday and today (Friday). I have continued with those symptoms with my temperature getting as high as 102. I have had a few more asthma symptoms but ok.

Other Meds: Advair, Keppra, CloBAZam, Losartan. Albuteral, B12

Current Illness: None

ID: 1359537
Sex: F
Age: 61
State: CA

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Rash around injection site which also appeared around the first injection site the day of the second vaccine which then grew into a large welt. 101.4 fever. 3 days after vaccine fever blister developed and lasted two weeks.

Other Meds: None

Current Illness: None

ID: 1359538
Sex: F
Age: 20
State: TX

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: Cinnamon

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

Symptoms: Metallic taste in mouth 8 hours after injection

Other Meds:

Current Illness:

ID: 1359540
Sex: F
Age: 54
State: NE

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

Lab Data:

Allergies: Levaquin

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

Symptoms: After waiting the required 15 minutes left the pharmacy. About 10 minutes later while driving my entire left arm including my hand became numb and my tongue and back of my throat felt like it was swelling. I was close to an ER and went there. They took my blood pressure and sent me back to the waiting room. I was not comfortable waiting as I was having difficulty breathing and was scared so I left and picked up Benadryl and took 50 mg immediately.

Other Meds: Vitamin D Vitamin C D Mannose Wellbutrin

Current Illness: None

ID: 1359541
Sex: M
Age: 16
State: TX

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: penicillin (rash)

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

Symptoms: About 10 mins after shot, fainted with eyes rolling back in head, convulsions for a few seconds. Patient helped to lay on floor. Showed confusion for a few seconds and then came to. EMTs checked vitals and blood sugar levels and said things were normal. Visited urgent care facility a few hours later where physician said episode was likely vasovagal syncope.

Other Meds: None

Current Illness: none

ID: 1359542
Sex: F
Age: 63
State: CA

Vax Date: 05/26/2021
Onset Date: 05/27/2021
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: Allergic To Some Binders/Fillers In Cheap Supplements

Symptom List: Ear pain, Hypoaesthesia

Symptoms: For approx. 24 hour period I experienced chills, fever, body aches, nasal congestion and cough

Other Meds: Metoprolol Trazodone Multi-Vitamin/Mineral Supplement

Current Illness: None

ID: 1359543
Sex: F
Age: 13
State: GA

Vax Date: 05/28/2021
Onset Date: 05/28/2021
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: No known drug or food allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient was given the Pfizer vaccine intramuscularly in her left arm. As soon as the needle was withdrawn her eyes rolled over and she slumped in her chair. We ( myself, her mother and her father) where in the process of placing her on the floor when she indicated that she wanted to get up. We placed her back into her seat and her mother proceeded to rub her back. I asked her if she needed anything but she declined. I kept her for observation for 30 minutes monitoring for any signs of shortness of breath, wheezing or swelling of the tongue or throat. No symptoms were observed. I advised her mother to notify patient's pediatrician of the incident and then released the patient.

Other Meds: Unknown

Current Illness: None known

ID: 1359544
Sex: F
Age: 65
State: AZ

Vax Date: 05/19/2021
Onset Date: 05/19/2021
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: NONE

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

Symptoms: Pt received both doses of Moderna Jan and Feb 2021 at off-site location. Pt insisted on receiving Janssen in addition for extra coverage compared to Moderna. Explained to patient that there is no current recommendation on getting both vaccines as there is no study on safety/efficacy on getting both vaccines. Pt still wanted to receive the vaccine. Because there is no contraindication of getting both vaccines and there was not clear instructions in this situation at the time (5/19), Pt received Janssen. Report is now made as soon as instructions was sent out by corporate regarding similar situations. Pt was counseled to monitor on potential side effects of both vaccines. No adverse reactions reported as of 5/28/21.

Other Meds:

Current Illness:

ID: 1359545
Sex: F
Age: 45
State: OH

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: Penacilin

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

Symptoms: 50 minutes after being vaccinated I felt very painful stabbing sensation like someone was sticking needles in my brain all over mostly the left side of my head. The needle pricking sensation lasted on and off fir 5 DAYS straight. While relaxed, calm, fully hydrated and not stressed On the 6th day my heart felt fluttery in the morning. Day 6 or 7 my heart started MASSIVELY skipping BEATS REPEATEDLY FOR 1-2 beats making my blood pressure drop suddenly over and over and over my sister who is a NURSE told me to go to the ER. The ER told my the electrical signals from my brain to my heart are not functioning properly ever since I took the vaccine. They told me it was not heart failure and suggested that I do not take the second dose of the Covid vaccine sing it appears I had a bad allergic brain reaction to the 1st shot which is not effected my HEART SKIPS A BEAT OR SEVERAL BEATS every single day since I took the vaccine my heart stops anywhere from. 5 - 12 times A DAY EVERY DAY! May 28 had a level 9 tightness / pain back left of my scull three inches from my heat towards the left back of my head lasted 20 seconds. A lot of tingling in my brain mostly the left side ever since I took the vaccine. AFYER SEEING A CARDIOLOGIST I WAS DIAGNOSED WITH THE VACCINE CAUSING ME TO NOW HAVE ?SINUS BRADYCARDIA? which means I could go into cardiac arrest. I know for a FACT the vaccine did this to me because symptoms started 50 minutes after me ig vaccinated. I had NO PRIOR HEART ISSUES BEFORE TAKIBG THE VACCINE. I?m only 46. This happened to someone else I know and I read a bunch of other people online are having the SAME ISSUE 5-7 days AFTER being VACCINATED all of a sudden having Heart ISSUES. Therefore, TAKE THIS SERIOUSLY and STOP HIDING THIS INFORMATION TO THE PUBLIC. this is not an isolated situation.

Other Meds:

Current Illness:

ID: 1359547
Sex: F
Age: 51
State: CA

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Couldn't sleep, very uncomfortable and had a repeating phrase that made me more uncomfortable. My knuckle joints on both hands ached. Had 100.4 fever the next morning. Felt extremely tired and had stomach ache that hasn't quit 34 hours later. I took Tylenol an hour after the shot and again 8 hours later. I tried eating yogurt and took a tums but nothing is making my stomach stop hurting.

Other Meds: None

Current Illness: None

ID: 1359548
Sex: F
Age: 60
State:

Vax Date: 05/26/2021
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: LA

Lab Data:

Allergies: SLIGHT REACTION TO BANDAGE ADHESIVE

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

Symptoms: FIRST SHOT: VERY SORE ARM AND HEADACHES FOR 3 DAYS SECOND SHOT: CHILLS, FEVER 101.7, SEVERE HEADACHE FOR OVER 24 HOURS, ROLLING BOUTS OF NAUSEA, VERY SORE ARM WITH DISCOMFORT IN THE LEFT PALM BELOW MY THUMB.

Other Meds: ATORVASTATIN CALCIUM 10 MG ATENOLOL 25 MG ESTRADIOL 10 MCG TAB ALENDRONATE SODIUM TABLET 70 MG VITAMIN D MULTI VITAMIN CALCIUM

Current Illness: NONE

ID: 1359549
Sex: F
Age: 39
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient had an embolic stroke

Other Meds:

Current Illness:

ID: 1359550
Sex: M
Age: 58
State: WA

Vax Date: 05/25/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Received shot at 1:10pm and was asked to wait 15 minutes before leaving. At 1:20pm I became very lightheaded and anxious. I stood up to look for a drinking fountain then woke up on the floor surrounded by people. Blood pressure was 80/40. Spent next two hours in ER on an IV. I was released once BP came back up. After getting home, I developed chest pain on the left side which I still have after three days so far.

Other Meds: Lisinopril 10mg, Tamsulosin .4mg, Ginkgo Biloba, Arginine, L-Theanine

Current Illness:

ID: 1359709
Sex: F
Age: 36
State: TN

Vax Date: 04/01/2021
Onset Date: 04/02/2021
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: No known allergies

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

Symptoms: Severe heart palpitation with racing heartbeat, dizziness, and difficulty breathing for approximately 30 seconds to 1 minute the day after vaccination. I have experienced less severe heart palpitations occasionally (approximately 1-2 per week) since the vaccination. Still waiting for an appointment with my cardiologist but have refrained from receiving the 2nd Pfizer covid vaccination dose.

Other Meds: Lansoprazole 30mg, Wellbutrin XL 150mg, probiotic supplement, multivitamin

Current Illness: None

ID: 1359710
Sex: F
Age: 13
State: AZ

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: No

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient had a vasovagal reaction within 5 minutes of receiving vaccine. She was given water to drink and an ice pack on the back of her neck. She recovered quickly to normal respiration, pulse and skin color. She left with her mother after additional time in the observation area.

Other Meds: Humira

Current Illness: Juvenile Idiopathic Arthritis

ID: 1359711
Sex: F
Age: 49
State: CA

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

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

Lab Data:

Allergies: Hydrocodone - Hives Penicillin - Hives Clindamycin - Anaphylaxis

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 49 y/o female without significant PMH other than anaphylaxis from a dental procedure, who presents to the emergency room with multiple complaints after receiving her second SARS-CoV-2 Pfizer vaccination today at about 3-3:30 PM, lot number not current available. The patient's significant other/boyfriend was driving when he noticed the patient suddenly started to complain of shortness of breath with chest pain and a maculopapular rash which later was followed by expressive aphasia and left hemiparalysis. She received Pepcid, solumedrol and Benadryl for the rash in the ER with improvement. Code neuro was called and TPA was given. Post TPA she was alert and oriented and she could currently write with her right hand and think of the words she has to say. She had associated blurry vision which has resolved after TPA was administered. She also was not able to move her left lower extremity nor her left upper extremity which is also improving to some extent after TPA administration. So far CT/CTA head and CTA neck are negative and she has been admitted for likely acute cerebral vascular accident.

Other Meds: None

Current Illness: Pre-diabetes otherwise no prior medical history

ID: 1359712
Sex: F
Age: 40
State: WA

Vax Date: 05/21/2021
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: RA

Lab Data:

Allergies: Mollusks Sulfa Drugs Tramadol Penicillin Some other antibiotics I don't do well with anything that is an opioid either.

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

Symptoms: I had the typical sore arm after the short for approximately 72 hours. The worst of it, the first 24. I did get some intense diarrhea as well for a few days but as I'm near my period, I haven't any idea if it's due to that. On the 27th of May in the evening, I noticed my lymph nodes visibly swollen out of nowhere by my clavicle and they were incredibly painful to palpate. Upon going to the ER they noted that my lymph nodes in my throat were also swollen but not painful. This being a new thing to me, I called the nurse line who advised me to go to the ER. The ER said I didn't have cancer (not helpful) and would not talk about any side effects. I got a Covid test (negative). They sent me home and told me if I have issues breathing or anything, to return. 5/28 I started developing some nausea, congestion, headache, and fatigue, and I have lacked appetite all day. Around 6 pm I developed, so far, one hive on my abdomen.

Other Meds: Vitamin D - Vegan Calm Magnesium Powder

Current Illness: None

ID: 1359713
Sex: F
Age: 42
State: IL

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

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: vertigo, nausea, fever, vomiting, chills, migraine, dizziness for 17 hours

Other Meds: none

Current Illness: none

ID: 1359714
Sex: F
Age: 21
State:

Vax Date: 05/03/2021
Onset Date: 05/03/2021
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: Injection site pain

Symptoms: Shortness of breath.

Other Meds:

Current Illness:

ID: 1359716
Sex: F
Age: 62
State: SC

Vax Date: 03/20/2021
Onset Date: 03/22/2021
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: No

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

Symptoms: I had smashed my elbow into a door jam about a month to month in a half before the injection and the pain had mostly gone away. About a week after the first injection the pain returned full force and continues to this day unless I take adoring twice a day. In the past few weeks I have noticed pain in the first joint of all my fingers.

Other Meds: Women?s One A Day and presserVision AREDS2

Current Illness: No

ID: 1359717
Sex: M
Age: 32
State: CO

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 05/28/2021
Hospital: Y

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

Lab Data:

Allergies: none reported

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA: one day after vaccination patient brought in by ambulance to emergency department (ED) for generalized tonic-clonic seizures. Patient experienced first seizure and treated, evaluated, and released from ED at another facility. Patient experienced another seizure at home and brought to this facility. Patient experienced a third seizure in the ED, antiepileptic medication was initiated, patient was admitted then discharged the next day stable on antiepileptic medication and follow-up in place. On subsequent follow-up visit with primary care patient reported no seizures but back pain. Found to have a thoracic compression fracture from seizures prior to hospital admission. On neurology follow-up continues to be seizure-free and compliant with antiepileptic medication. Diagnosed with focal epilepsy and will continue to be followed by outpatient neurology.

Other Meds: none reported

Current Illness: none reported

ID: 1359718
Sex: U
Age: 48
State:

Vax Date: 03/29/2021
Onset Date: 03/29/2021
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: Lightheadedness; Patient describes nausea and mild dizziness . Patient being sent home with mother who is driver . ER precautions given . Patient advised to follow-up with PCM for persistent symptoms.

Other Meds:

Current Illness:

ID: 1359719
Sex: M
Age: 17
State: CA

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

Lab Data:

Allergies: Allergic to dairy products, peanuts

Symptom List: Erythema, Pruritus

Symptoms: Patient felt very dizzy couple minutes after receiving the Pfizer Covid Vaccine. he felt tire, could not hear well, and was very pale. His blood pressure was 80/47, pulse was 49. 911 was called and his blood pressure went up slowly to 90s/70s.

Other Meds: N/A

Current Illness: N/A

ID: 1359720
Sex: M
Age: 25
State: GA

Vax Date: 05/24/2021
Onset Date: 05/25/2021
Rec V Date: 05/28/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: fever, arm muscle pain

Other Meds:

Current Illness:

ID: 1359721
Sex: M
Age: 51
State:

Vax Date: 03/27/2021
Onset Date: 03/27/2021
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:

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

Symptoms: Little dizzy; Lightheadedness; Waited over 20 min without resolution of nausea .Patient with hx of Gerd on PPI . Patient without cardiopulmonary symptoms . Patient encouraged to take PPI and make dietary changes x 24 hrs .Patient reported dizziness during questioning (mild) . Ambulance.

Other Meds:

Current Illness:

ID: 1359722
Sex: F
Age: 38
State: CA

Vax Date: 05/03/2021
Onset Date: 05/22/2021
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: Patient reports being 6 weeks pregnant (estimated Due 12/27/21) at time of vaccination. She has been previously been pregnant 3 times with no prior miscarriages or complications. Patient reports finding out about miscarriage on 5/22 during office visit and completed miscarriage on 5/25. Patient experienced mild fever and chills approximately 6 hours after vaccine which was controlled by acetaminophen and resolved by the following morning 5/4.

Other Meds: Prenatal +DHA

Current Illness:

ID: 1359723
Sex: F
Age: 38
State: WA

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: SYR
Vax Site: LA

Lab Data:

Allergies: nka

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

Symptoms: pt had a racing heart, felt dizzy, faint right after vaccine

Other Meds: unknown

Current Illness: unknown

ID: 1359724
Sex: F
Age: 35
State: NY

Vax Date: 04/08/2021
Onset Date: 05/17/2021
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: No

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

Symptoms: Miscarriage on 5/17/2021 10 days after second shot

Other Meds: No

Current Illness: No

ID: 1359725
Sex: F
Age: 19
State: WI

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 KNOWN

Symptom List: Pain in extremity

Symptoms: PT DEVELOPED DIFFICULTY BREATHING ABOUT 3 MINUTES AFTER THE INJECTION. EPINEPHERINE 0.3MG INJECTED INTO LEFT THIGH. PT'S CONDITION IMPROVED AFTER ABOUT 3 MINUTES. EMS CONTACTED AND MONITORED PTS CONDITION, REPORTING O2 SATS WERE WITHIN NORMAL LIMITS. PT EVENTUALLY WAS TAKEN TO HOSPITAL WHERE PT REPORTED BEING GIVEN DIPHENHYDRAMINE AND PREDNISONE PLUS A PRESCRIPTION FOR PREDNISONE TO CONTINUE AT HOME.

Other Meds: SPRINTEC

Current Illness: NONE INDICATED ON VAR

ID: 1359727
Sex: M
Age: 55
State:

Vax Date: 05/01/2021
Onset Date: 05/01/2021
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:

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

Symptoms: It is possible that the patient received 0.3ml instead of 0.5ml in the dose.

Other Meds:

Current Illness:

ID: 1359728
Sex: F
Age: 39
State: IL

Vax Date: 04/10/2021
Onset Date: 04/10/2021
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: No allergies known at this time. Sensitivity (nausea and vomiting) to numbing agents such as Lidocaine and Prilocaine

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

Symptoms: Immediately following the administration of the vaccine I felt tingling in my right hand and arm. It was fairly mild but persistent, I thought it was due to the adrenaline from the shot. However, as I drove home I continued to feel more burning and tingling pains, increasing and spreading to each of my four extremities. I went to the Emergency room on the evening of April 10th but ended up leaving after a few hours of waiting to take ibuprofen and rest at home. However, the burning and tingling continued through the night and I went to the ER again on Sunday, April 11th to be seen by a doctor. Tests were normal. I followed up with an internist on Monday August 12th and he concluded that my sensations were likely a side effect from the vaccine and recommended a TMG from a neurologist. I followed up and have been seen by a neurologist for these nerve sensations. She has diagnosed me as having peripheral neuropathy likely due to the Covid vaccine.

Other Meds: None

Current Illness: None

ID: 1359729
Sex: M
Age: 36
State: MI

Vax Date: 05/21/2021
Onset Date: 05/28/2021
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: Large red and itchy rash around site of injection, started 1 week after injection. Don't know how long it will last. When it goes away, I will amend report.

Other Meds: Depakote, Risperdal, Cogentin, Trazodone, Simvastatin, Vitamin D, Magnesium, Multi-Vitamin,

Current Illness: None

ID: 1359730
Sex: M
Age: 22
State:

Vax Date: 03/25/2021
Onset Date: 05/27/2021
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:

Symptom List: Vomiting

Symptoms: Sitting In a hot tub and started feeling faint and then climbed out and passed out

Other Meds:

Current Illness:

ID: 1359731
Sex: M
Age: 39
State: TN

Vax Date: 05/16/2021
Onset Date: 05/18/2021
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: codeine, morphine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Developed Titinuis in right ear, dizziness

Other Meds: HCTZ, aspirin, zoloft, fish oil, descovy

Current Illness: High blood pressure, epelepsy, athsma

ID: 1359732
Sex: U
Age: 49
State:

Vax Date: 05/23/2021
Onset Date: 05/23/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Lightheadedness; Collapsing or losing consciousness.

Other Meds:

Current Illness:

ID: 1359733
Sex: F
Age: 87
State: CO

Vax Date: 04/22/2021
Onset Date: 04/24/2021
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: bees, ciprofloxacin, latanoprost, penicillin, simvastatin, sulfa

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA: patient with generalized weakness since immunization. Two days after vaccination became dysarthric. Three days after vaccination became minimally responsive and brought to emergency department (ED) by ambulance. On arrival patient had right lower extremity weakness, right upper extremity mild drift, and severe dysarthria. Patient underwent thrombectomy and did not have residual neurologic deficits. Initiated on antiplatelet agent, anticoagulation, and cholesterol-lowering agent. Patient also experienced NSTEMI and newly diagnosed with heart failure and initiated medications for management. Patient discharged medically stable. Three days later patient admitted for atrial fibrillation with rapid ventricular response and worsening ischemia: initiated antiarrhythmic medications and patient improved and discharged medically stable.

Other Meds: ibuprofen, multivitamin

Current Illness: none reported

ID: 1359734
Sex: M
Age: 19
State:

Vax Date: 05/02/2021
Onset Date: 05/02/2021
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:

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

Symptoms: Nausea; Lightheadedness; Patient felt SOB after vaccine. No significant medical history, seen by EMS with no intervention needed. Released to self care.

Other Meds:

Current Illness:

ID: 1359845
Sex: F
Age: 46
State: AZ

Vax Date: 05/12/2021
Onset Date: 05/23/2021
Rec V Date: 05/28/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Two weeks after receiving my vaccine, I had a mini stroke while driving. I was able to get to my destination safely thank goodness. A friend took me immediately to the Er where I was admitted for 4 days. I experienced another stroke somewhat similar as the first but less intense 2 days after the first one.

Other Meds: Advil and woman?s multi vitamins

Current Illness: Sinus infection treat with antibiotics with minimal symptoms of runny nose after antibiotics were completed and up to the vaccine injection.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm