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: 1364838
Sex: F
Age: 50
State: PA

Vax Date: 01/22/2021
Onset Date: 05/09/2021
Rec V Date: 06/01/2021
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: Codeine EletriptanIndigestion / GI upset

Symptom List: Dysphagia, Epiglottitis

Symptoms: Cough Fatigue Muscle or body aches Headache Sore throat Congestion or running nose Nausea or vomiting Suspected COVID-19 virus infection Acute upper respiratory infection Acute nonintractable headache, unspecified headache type Seasonal allergic rhinitis due to pollen

Other Meds: acetaminophen (TylenoL) 325 mg tablet ALPRAZolam (XANAX) 0.5 mg tablet amLODIPine (NORVASC) 5 mg tablet ascorbic acid, vitamin C, (VITAMIN C) 500 mg tablet atorvastatin (LIPITOR) 10 mg tablet citalopram (CeleXA) 40 mg tablet ibuprofen (MOTR

Current Illness:

ID: 1364839
Sex: M
Age: 27
State: MA

Vax Date: 05/04/2021
Onset Date: 05/24/2021
Rec V Date: 06/01/2021
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

Symptom List: Anxiety, Dyspnoea

Symptoms: Arm soreness at the injection site, but it didn?t start until about 3 weeks after the shot

Other Meds: Oxcarbezopene 900mg daily Finasteride 1 mg daily

Current Illness:

ID: 1364840
Sex: F
Age: 61
State: FL

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 06/01/2021
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: Latex Penicillin

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

Symptoms: When I got home, I had a headache. I felt tired. I took a nap. When I woke up, I was sick. I was nauseated, my stomach and body hurt all over. The headache was three days long. I felt achy and sore the next day as well. I felt like I had a flu. There were huge blood clot looking blisters, and red dots on both my arms. My left arm was worse than my right arm. I called the doctor and she asked me to come in, but I had to take pictures first of my arms before coming in. Then when I was able to go to the office, I took blood tests and the MRI. Everything came back okay.

Other Meds: High blood pressure medication High cholesterol medication Multi vitamins: vitamin B3, Zinc, and E Lysine

Current Illness:

ID: 1364841
Sex: F
Age: 35
State: CA

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: Cipro Cephalosporin Z-pack Possible allergies: (hives all over) Augmentin Bactrim

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: It?s like one of my autoimmune is flaring up badly. I take hydroxychloroquine to manage the pain I used to feel in my shoulder, back, legs. But ever since the vaccine which the following day started with body aches and fever for 24 hours and another 24 hours of horrible bodily aches. On the third day I felt much better but my right leg had a slight ache. The ache here and grew until now which now if affecting my lower back. I thought to let you know because I haven?t had this much pain in years and it?s definitely the worse flare I have had since my diagnosis in 2017. I know you need more info about the effects on people who have autoimmune disease(s). And this was not a normal reaction. Its been nearly three weeks and the pain is only getting worse thus far.

Other Meds: 125 mcg levothyroxine 400 mg hydroroxychloroquine

Current Illness: Undifferentiated connective tissue disorder Hashimoto thyroiditis with hypothyroidism Lyme

ID: 1364842
Sex: F
Age: 71
State: TX

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

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

Lab Data:

Allergies: The antibotic called Vantin and Ethylchoride.

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

Symptoms: I begin feeling lightheaded, my face started feeling flushed, my body was tingling, EMT took my blood pressure and it was high with a high heart rate, headache. Kept having chronic daily headache since the vaccination. Now I'm on medication for the headaches. Having imbalance like I can't walk or feel like I'm going to fall over.

Other Meds: I take Synthriod, Celabrax, Claratin, multivitamin, calcium, vitamin D-3, super joint support supplement, fiber.

Current Illness: No.

ID: 1364843
Sex: F
Age: 27
State: TN

Vax Date: 05/18/2021
Onset Date: 05/25/2021
Rec V Date: 06/01/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Exactly one week after the second vaccine I developed a severe headache. It was a pulsing in my entire forehead and into my eyes. It started the morning of May 25 and I have woken up with the same headache since then. Advil sometimes works but it does not completely reduce the symptoms.

Other Meds: 72 mg of Concerta, 100mg Spironoloactone, Allegra 24 hour, 200mg Fluvoxamine, and Sprintec

Current Illness: None

ID: 1364844
Sex: M
Age: 37
State: VA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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 recorded

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fainted, excessive sweating

Other Meds: No record

Current Illness: Hypertension

ID: 1364845
Sex: F
Age: 78
State: CA

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Pharyngeal swelling

Symptoms: I had the vaccine and three hours I was on a walk and I had to turn around half a mile and come back home and I had extreme fatigued for a whole month and my husband would have to wake me up three times a day to feed me, I have severe head aches, my kidney level functioning drop to above 50, then the second month I would sleep 3 3 hour nap for the day, I could not get my stamina back. I went about 2 days later to the doctor. She did some blood tests, I have had 4 of them, and all of them have been fine. Now is month 4 and I am slowly recovering, my heart doctor gave me Colchicine and I have been on that for 5 days. I have to get up 7 times in the night to go to the bathroom for diarrhea. In the 29th of June I will have an ECHO cardiogram.

Other Meds: Valsartan, Martazatine 30 mg

Current Illness: Yes, extreme fatigued, head aches, and kidney level drop from above 60 to 47

ID: 1364846
Sex: F
Age: 22
State: PA

Vax Date: 01/26/2021
Onset Date: 05/07/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Sore throat Congestion or running nose

Other Meds:

Current Illness:

ID: 1364847
Sex: F
Age: 20
State: NE

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: fainted. light headedness. vomiting. dizziness

Other Meds: Fluoxetine 10mg Omeprazole 20mg

Current Illness: None

ID: 1364848
Sex: F
Age: 23
State: IL

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: PCN Sulfa

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

Symptoms: Itchy throat that advanced to swelling, rash both upper arms

Other Meds: None

Current Illness: None

ID: 1364849
Sex: F
Age: 28
State: NC

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: none noted

Symptom List: Rash, Urticaria

Symptoms: Pt given Vax at 11:11am, about 11:23am pt started feeling dizzy and nauseous. Pt laid on the floor and put feet on the chair. Ice pack provided to forehead at 11:28am, BP 11:31am 97/61 P53. Pt is talking, awake. said she moved her arm and was an influx of pain and that's what made her dizzy. 11:40am- BP 107/67 P55. pt more awake and feeling better, 11:43am BP 102/74 P68. Pt sat up on her own, ate a few pieces of chocolate. feeling much better 11:52am BP 109/73 P 66 pt was able to stand up and feeling ok

Other Meds: none noted

Current Illness: none noted

ID: 1364850
Sex: F
Age: 57
State: MN

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 06/01/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Dreams every night

Other Meds: hydrochlorothiazide lisinopril fenofibrate micronized advil as needed tylenol as needed aspirin as needed

Current Illness: none

ID: 1364851
Sex: F
Age: 57
State:

Vax Date: 02/11/2021
Onset Date: 02/28/2021
Rec V Date: 06/01/2021
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: I am allergic to latex, penicillin.

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

Symptoms: I had swelling in my feet and i have red blotches all over my feet and leg.

Other Meds: I take alot of medications.

Current Illness: None

ID: 1364852
Sex: M
Age: 75
State: NY

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 06/01/2021
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: n/a

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

Symptoms: Patient was intending to receive the Shingrix vaccination and was given Janssen Covid-19 vaccination. No known ADR's followed the error. Patient had already completed his series of Covid-19 vaccinations in the previous months.

Other Meds: n/a

Current Illness: n/a

ID: 1364853
Sex: M
Age: 59
State: NM

Vax Date: 05/24/2021
Onset Date: 05/26/2021
Rec V Date: 06/01/2021
Hospital: Y

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

Lab Data:

Allergies: amoxicillin - rash, clindamycin

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

Symptoms: patient seen in clinic 5/26 for severe head ache, chest pain, diaphoresis, subjective fever and chills, SOB. Transferred to ER elevated troponin, transferred to other Hospital where he underwent cardiac cath and diagnosed with NSTEMI.

Other Meds: Lantus, victoza, metformin, carvedilol, losartan, atorvastatin, ASA, diclofenac, tramadol, Ibuprofen (OTC), omeprazole

Current Illness: ER visit 4/6 for LUQ pain - chronic, reported night sweats prior to vaccine for several months.

ID: 1364854
Sex: F
Age: 32
State: PA

Vax Date: 01/23/2021
Onset Date: 05/10/2021
Rec V Date: 06/01/2021
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: NKA

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

Symptoms: Family Medicine Acute upper respiratory infection Dx URI ? Generalized Body Aches ? Fatigue

Other Meds: hydrocortisone acetate 2.5 % cream with perineal applicator ibuprofen (MOTRIN) 200 mg tablet

Current Illness:

Date Died: 05/25/2021

ID: 1364855
Sex: M
Age: 46
State: FL

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Dizziness, blurred vision, headache, nausea

Other Meds: None

Current Illness: High blood pressure

ID: 1364856
Sex: F
Age: 38
State: WA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 06/01/2021
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: Some of the vaccine leaked out at the hub during administration - more than half of the dose was given so a repeat dose was not given.

Other Meds:

Current Illness:

ID: 1364857
Sex: F
Age: 56
State:

Vax Date: 05/15/2021
Onset Date: 05/21/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: Penicillins

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

Symptoms: colitis(5/8) and esophageal dilation (5/18) who presents with fever, chills, esophageal/epigastric pain and dysphagia as well as incidental finding of cecal bascule

Other Meds: albuterol (PROVENTIL HFA, VENTOLIN HFA) 90 mcg/actuation cyclobenzaprine (FLEXERIL) 10 MG tablet fluticasone propion-salmeteroL (ADVAIR) 250-50 mcg/dose DISKUS HYDROcodone-acetaminophen (NORCO) 10-325 mg per tablet montel

Current Illness:

ID: 1364858
Sex: F
Age: 64
State: PA

Vax Date: 01/25/2021
Onset Date: 05/10/2021
Rec V Date: 06/01/2021
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: Codeine Nsaids (Non-steroidal Anti-inflammatory Drug)Nausea And Vomiting

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

Symptoms: Cough Fatigue Headache Sore throat Office Visit 5/20/2021 PA-C Family Medicine Other form of dyspnea +1 more Dx Cough Reason for Visit Progress Notes PA-C (Physician Assistant) ? ? Family Medicine ? ? Encounter Date: 5/20/2021 ? ? Signed Cosigned by: MD at 5/31/2021 7:50 PM Expand AllCollapse All MDM 1. Other form of dyspnea 2. Chest pressure History and physical exam consistent with chest pressure with dyspnea. EKG shows nonspecific T wave changes. Although I see no acute ischemic changes, she does have risk factors for heart disease and is complaining about worsening dyspnea on exertion and I therefore encouraged her to go to the emergency department for blood work to verify that this is not cardiogenic. Symptoms could likely be due to her respiratory illness but given her history of hypertension and family history of heart disease, feel a set of troponins is indicated. Patient is agreeable and states she will go to emergency department. She does have her sister with her who is driving. Patient does not appear to be toxic or dehydrated and vital signs are stable. See HPI and physical exam to review pertinent information regarding visit. Images available were reviewed by me and reviewed with pt/family. Prescription medication recommendations were reviewed in light of the patient's age, past medical history and comorbidities. Plan of care reviewed; patient/family member agrees with plan. See patient discharge instructions for more details. Follow up with PCP if symptoms do not improve or go to ER if symptoms worsen. Discussed antibiotic stewardship as appropriate Careline information discussed and included in AVS. Patient was seen today for cough. Diagnoses and all orders for this visit: Other form of dyspnea - X-ray chest 2 views; Future - ECG 12-lead: URGENT CARE (Here and Now) Chest pressure History Chief Complaint Patient presents with ? Cough productive cough with white sputum, diarrhea x 7 days, today is day 10 since COVID positive dx and not getting better ED Discharged 5/20/2021 (1 hours) Hospital ER MD Last attending ? Treatment team Pneumonia due to COVID-19 virus Clinical impression Shortness of Breath Chief complaint ED Provider Notes MD (Physician) ? ? Emergency Medicine Expand AllCollapse All HPI Chief Complaint Patient presents with ? Shortness of Breath HPI 64 y.o. F p/t ED for cough SOB diarrhea and CP. Has history of hypertension. No smoke history. No lung disease history. She has had 10 days of symptoms. Tested positive for COVID-19. She was vaccinated. She works as a respiratory therapist as an outpatient performing PFTs daily. Symptoms have not gotten any better and she started feeling short of breath over the last 2 days. She had mild cough, productive. No leg pain or swelling. No history of DVT or PE. Seen at urgent care and found to have EKG with nonspecific T wave changes so sent to the ED for further evaluation the light of her chest pressure. Chest pressure and shortness of breath are worse with ambulation and activity. No fevers. Has had some chills. Loss of taste and smell. Chest x-ray obtained an outpatient was demonstrated to some patchy infiltrate in the right lower lobe.

Other Meds: amLODIPine (NORVASC) 5 mg tablet amoxicillin (AMOXIL) 500 mg capsule atorvastatin (LIPITOR) 20 mg tablet buPROPion XL (WELLBUTRIN XL) 150 mg 24 hr tablet busPIRone (BUSPAR) 15 mg tablet DULoxetine (CYMBALTA) 60 mg capsule ergocalciferol (VI

Current Illness:

ID: 1364859
Sex: M
Age: 49
State: TN

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: None 2 hours post vaccine

Other Meds:

Current Illness:

ID: 1364860
Sex: F
Age: 42
State:

Vax Date: 05/28/2021
Onset Date: 05/30/2021
Rec V Date: 06/01/2021
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: Certain types of yeast, an antibiotic that resulted in hives, but patient doesn't remember which one

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

Symptoms: Had reaction both times (broke out in hives) but did not realize they were the result of vaccines until the second dose. Started on inner thigh, looked like ringworms. Then it started turning into welts. Also had white bumps. The rashes started moving to the elbows on 5/31/21. Eyes started getting very itchy this morning (6/1/21) and looks like she has bug bites on eyelids. Hydrocortisone did not work well, tried using antihistamine but did not work well either. Has been using ice packs and minimize physical activity.

Other Meds:

Current Illness:

ID: 1364861
Sex: F
Age: 0
State: OH

Vax Date: 10/03/1962
Onset Date: 04/15/2021
Rec V Date: 06/01/2021
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

Symptom List: Injection site pain, Pain

Symptoms: Right arm pain into shoulder, neck and ehind righ ear

Other Meds: Levothyroxine Rosuvastatin Amitryptiline Singulair

Current Illness: Vestibular neuritis Chronic sinus issues

ID: 1364862
Sex: F
Age: 22
State: DC

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: latex, peanuts, tree nuts, ativan, zosyn, betadine, clonazepam, ketamine, klonopin, ondansetron, tegaderm, cortisporin, vancomycin

Symptom List: Injection site pain, Menorrhagia

Symptoms: developed headache and slight dizziness within minutes of vaccine administration.

Other Meds: medroxyprogesterone, darbepotein alfa, PRN benadryl, PRN epi, PRN hydrocoritsone

Current Illness: none

ID: 1364863
Sex: F
Age: 50
State: KS

Vax Date: 04/01/2021
Onset Date: 05/29/2021
Rec V Date: 06/01/2021
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: codeine

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

Symptoms: Per patient, reported on 06/01/2021, she has been having increased episodes of menopausal sx (i.e. hot flashes "every 5-10 minutes" and night sweats) since receiving 2nd Covid vaccination on 04/01/2021. Prior to vaccination, patient states symptoms "were under control."

Other Meds:

Current Illness: None noted in patient chart.

Date Died:

ID: 1364864
Sex: M
Age: 77
State:

Vax Date: 03/02/2021
Onset Date: 05/08/2021
Rec V Date: 06/01/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: First dose given 2/9/2021 see further information below. Date of death 5/16/2021. Hospital 5/8/2021 to 5/16/2021

Other Meds:

Current Illness:

ID: 1364865
Sex: F
Age: 68
State: TN

Vax Date: 04/22/2021
Onset Date: 05/03/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: NO

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Dark rash appeared on the left side of my face near my lips. Rash spread to my upper lips, my lips and some spots on my forehead. I treated it as if it was a simple rash with vitamin E and Aleo Vera Gel. The rash was itchy, flaky and irritating. The rash is still very visible even though I have been using the above items.

Other Meds: Lisinopril 40 mg., Hydrochlorothiazide 25 mg., Janumet

Current Illness: NONE

ID: 1364866
Sex: F
Age: 65
State: AZ

Vax Date: 02/18/2021
Onset Date: 02/20/2021
Rec V Date: 06/01/2021
Hospital: Y

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: Penicillin, Latex, Adhesives, Codeine (Intolerance)

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

Symptoms: Couldn?t breath, Ambulance to ER, Blood Test and Chest CT showed multiple pulmonary embolisms in both lungs, hospital stay for 3 days, multiple IV doses of Heparin, Echocardiogram showed enlarged right side of heart, released with script for Eliquis

Other Meds: Synthroid 112 mcg, Amlodipine 5 mg, Diovan 160 mg, Bupropion 300 mg, Trazodone 75 mg, Potassium Citrate, Hydroxyzine 25 mg (1/4 pill as needed), Vitamins C and D and multi, Calcium, Allegra, Glucosamine/Chondroitin

Current Illness: N/A

ID: 1364867
Sex: F
Age: 40
State: RI

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: Nickel Seasonal Allergies Allergy Induced Asthma

Symptom List: Nausea

Symptoms: I sat down after vaccination and I felt sore right away up arm and up shoulder, went home, as driving, migraine began, vomiting, couldn't smell. Had to go to Dr and get shot for headache and nausea, vomited for 2 days, loss of appetite, bad body aches. After that I was able to eat and drink bland and it subsided.

Other Meds: Zoloft

Current Illness: None

ID: 1364868
Sex: F
Age: 13
State: WI

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: Unspecified period reactions to food

Symptom List: Injection site pain

Symptoms: Patient developed swelling in her throat and tongue within the 15 minute waiting time.. Nurses at the clinic administered an Epi-pen treatment and told us to go immediately to the emergency room. Patient was examined, monitored, and treated with three different drugs. We were at the ER for approximately two and a half hours. About four hours later she complained about similar symptoms and we returned to the ER. she was again examined, monitored, and treated again with one drug. The second visit was for approximately and hour and a half.

Other Meds:

Current Illness: None

ID: 1364869
Sex: F
Age: 26
State: MN

Vax Date: 10/15/2019
Onset Date: 10/18/2019
Rec V Date: 06/01/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: diffuse hives for 4 months.

Other Meds: none

Current Illness: none

ID: 1364870
Sex: F
Age: 74
State: CO

Vax Date: 01/26/2021
Onset Date: 02/03/2021
Rec V Date: 06/01/2021
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: I am allergic to Gluten, Lactose intolerant (Lorazepam, sotalol, lisinopril , tetracycline, naproxen, cortisone, Aleve.)

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

Symptoms: The main thing that I remember is that I experienced an irregular heartbeat. It was racing faster than usual. It could have been into A-Fib, but it was so different from A-Fib and that's why I was concerned. It lasted for 8-10 hours. I called my Cardiologist and he saw me on 02/06/2021. By the time I had my appointment, everything was back to normal. Well, as normal as can be with A-Fib.

Other Meds: I was taking Flecainide 125 mg (also takes 125 mg in evening), metoprolol 75 mg (also takes 100 mg in evening), Xarelto 15 mg, Calcium 600 mg, vitamin D, Vitamin C 500, Tylenol (unsure of dosage at time of vaccination).

Current Illness: I did not have any other illnesses.

ID: 1364871
Sex: M
Age: 66
State: MI

Vax Date: 04/05/2021
Onset Date: 04/26/2021
Rec V Date: 06/01/2021
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: Oak, maple, birch, trees, grass, tomatoes, milk, opioids.

Symptom List: Tremor

Symptoms: He got his vaccine, he had no symptoms at all. About 3 weeks later he woke up in the morning, his arm was swollen from the elbow down to his fingers, so swollen that he was not able to make a fist which took a week to 10 days to go back down to normal He went to the doctor and they sent him for x-rays of the elbow, which showed arthritis and nothing else. they took his BP on both sides to see if there was a difference, there was a 15 point difference in that. His doctor decided to do an US to see why there was a difference in that pressure. The US was a week later showed that he had a blockage underneath his right collarbone, narrowing with no plaque. He has had surgery on his carotid artery 6 years ago, so they sent a report to his vascular doctor. Talking with him they blockage is 50% to 99% and he asked his staff that he has had CAT scans prior to that due to the carotid surgery and they felt that they had prior CAT scans that showed no blockage. The vascular surgeon is going to watch it for now as it shows no plaque in the artery and is not sure if it is due to the vaccine or not. They told him to call us and file the report. He is having light headedness daily, which he did not have prior to the vaccine.

Other Meds: Plavix, four 325 mg daily, multivitamin, Sudafed, albuterol inhaler, nasal spray.

Current Illness: None.

ID: 1364872
Sex: F
Age: 33
State: NC

Vax Date: 05/27/2021
Onset Date: 05/28/2021
Rec V Date: 06/01/2021
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: gluten, nickle, band-aid adhesive, amoxicillin, and oxycodone

Symptom List: Erythema, Pruritus

Symptoms: Knot in arm 2 inches below injection site: 5/28/2021-5/29/2021 pain at injection site: 5/28/2021-5/29/2021 diarrhea: 5/28/2021 throughout the day nausea: 5/28/2021-5/30/2021 intermittently throughout the day extreme fatigue: 5/28/2021-5/31/2021 all day everyday extreme dizziness: 5/28/2021-5/31/2021 intermittently throughout the day; not as much on 5/29/2021, but the worst on 5/30/2021 menthol metallic taste in mouth and throat: 5/28/2021-5/31/2021 intermittently throughout the day slight tingle and swelling of tongue: 5/28/2021 intermittently throughout the day red face: 5/28/2021-5/29/2021 throughout the days whenever walking hot and sweaty then followed by fully body chills: 5/28/2021 intermittently throughout the day chills: 5/28/2021-5/30/2021 intermittently throughout the day

Other Meds: Loryna (birth control)

Current Illness: None

ID: 1364873
Sex: F
Age: 20
State: PA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: approximately two minutes after administration of vaccination patient had sat down in waiting area and became lethargic/dizzy/blurred vision. She had passed out with face pale and lips turning blue, minimally responsive. Called 911 and while awaiting for ambulance patient had recovered from all symptoms with the exception of "spotted visions." Observed patient for over an hour while a family member came and upon the time of departure there was resolution of all adverse events.

Other Meds: None

Current Illness: None

ID: 1364874
Sex: F
Age: 24
State: CA

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 06/01/2021
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: Patent was accidentally administered the wrong covid-19 vaccine. Patient received Moderna vaccine on 05/07/2021 and returned for second dose on 05/28/2021, in which pfizer vaccine was given.

Other Meds:

Current Illness:

ID: 1364875
Sex: F
Age: 23
State: CO

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 06/01/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient indicated they have not received a dose of the Pfizer vaccine and was provided a vaccine on 5/28/21. Upon review of records, patient has received a dose of vaccine on 5/19/21.

Other Meds:

Current Illness:

ID: 1364876
Sex: F
Age: 31
State: OK

Vax Date: 04/22/2021
Onset Date: 05/27/2021
Rec V Date: 06/01/2021
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: None

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

Symptoms: DVT right leg, er visit, medication, still get my treatment Seizure

Other Meds: None

Current Illness: None

ID: 1364877
Sex: F
Age: 56
State:

Vax Date: 04/24/2021
Onset Date: 05/07/2021
Rec V Date: 06/01/2021
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: Penicillins

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

Symptoms: new eosinophilic esophagitis 13 d after dose one of pfizer vaccine Pain in her esophagus, dysphagia, felt like throat was swollen. Heartburn.

Other Meds: albuterol (PROVENTIL HFA, VENTOLIN HFA) 90 mcg/actuation cyclobenzaprine (FLEXERIL) 10 MG tablet fluticasone propion-salmeteroL (ADVAIR) 250-50 mcg/dose DISKUS HYDROcodone-acetaminophen (NORCO) 10-325 mg per tablet montel

Current Illness:

ID: 1364878
Sex: M
Age: 68
State: CT

Vax Date: 03/13/2021
Onset Date: 04/30/2021
Rec V Date: 06/01/2021
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: Pericarditis

Other Meds: Vitamin D, Preservision

Current Illness: none

ID: 1364879
Sex: F
Age: 59
State: TN

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: Celebrex

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

Symptoms: Left arm muscle severe pain. Symptoms and muscle soreness getting worse.

Other Meds: Multi-vitamin High blood pressure medicine Cymbalta

Current Illness: None

ID: 1364880
Sex: F
Age: 18
State: KY

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: Second dose was unknowingly given 2 weeks apart, not 4. Patient has tolerated well, waited 15 minutes in clinic with no issues

Other Meds:

Current Illness:

ID: 1364881
Sex: F
Age: 44
State: CA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 06/01/2021
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: sulfa, oxycodone

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

Symptoms: This is my third report. Since my first vaccine shot on 3/25, I have experienced debilitating headaches every day. After my second shot on 4/26, my headaches increased to a 9 out of 10 on the pain scale. Since my second shot, I've continued to have headaches, muscle spasms, and body jerks every single day. Because of the intensity of pain, I've visited the ER, Urgent Care, primary care, and seen a neurologist, rheumatologist, and acupuncturist . So far, I've had a CT scan, MRI with and without contrast, and I am due to have MRA in the coming weeks. No medication that has been prescribed by any of my doctors has made my headaches go away. I've taken: NSAIDS, Acetaminophen, Ibuprofen, Aspirin, Excedrin, Naproxen, Tramadol, Gabapentin, and Norco. I've also supplemented with Magnesium. Nothing has worked. I did not have a history of headaches prior to taking the vaccine.

Other Meds: Daily vitamin

Current Illness: none

ID: 1364882
Sex: F
Age: 22
State: OH

Vax Date: 05/23/2021
Onset Date: 05/30/2021
Rec V Date: 06/01/2021
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: Keflex

Symptom List: Vomiting

Symptoms: Itchy red rash started Sunday morning (5/30/2021) at 11am on left upper arm. By 3pm it was on my right upper arm. At around 9pm it spread to both lower arms within the hour. Tuesday morning (6/1/2021) about 2am rash on arms was almost gone but started on both legs.

Other Meds:

Current Illness:

ID: 1364883
Sex: F
Age: 36
State: VA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: patient felt dizzy after getting the pfizer covid shot , she mentioned she didn't eat before she comes in, and kept watching her , making sure she is hydrating , patient said she feels much better, and good to go

Other Meds:

Current Illness:

ID: 1364884
Sex: F
Age: 41
State: PA

Vax Date: 01/26/2021
Onset Date: 05/03/2021
Rec V Date: 06/01/2021
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: PenicillinsDermatitis

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

Symptoms: Cough Fatigue Sore throat Muscle or body aches Headache Congestion or running nose

Other Meds: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler cetirizine (ZyrTEC) 10 mg tablet LORazepam (ATIVAN) 0.5 mg tablet(Expired) montelukast (SINGULAIR) 10 mg tablet selenium sulfide 2.5 % lotion sertraline (ZOLOFT) 50 mg tablet

Current Illness:

ID: 1364885
Sex: F
Age: 12
State: IA

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 06/01/2021
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: penecillian

Symptom List: Injection site swelling, Limb discomfort

Symptoms: light headed, headache, dizzy, vomiting ,sore throat, ,hard to swallow, weak, felt like someone sitting on her chest lost sense of smell and taste. Taken by medics to local hospital, , Placed on IV , GI cocktail, chest x rays 2 views, EKG,

Other Meds: none

Current Illness:

Date Died: 05/08/2021

ID: 1364886
Sex: F
Age: 73
State: NV

Vax Date: 04/14/2021
Onset Date: 05/04/2021
Rec V Date: 06/01/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Death after fall and hospitalization.

Other Meds: Omeprozole

Current Illness: Urinary Tract Infection

ID: 1364887
Sex: F
Age: 39
State: CO

Vax Date: 05/25/2021
Onset Date: 05/28/2021
Rec V Date: 06/01/2021
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: none

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

Symptoms: As of today I am being referred to a breast cancer specialist, and pending a diagnosis. Both breast areolas became hypersensitive to touch on friday, March 28th. On Saturday the pain level reached a 9 despite using the maximum levels of ibuprofen, Tylenol, and Advil. I contacted the nurse line at the veterans' administration and they referred me to the emergency room, which made the referal to the breast cancer specialist. The second adverse effect is dizziness with nausia consistant since may 5th.

Other Meds: buropion hcl 300 Mg 24hr sa tab

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm