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: 1365094
Sex: F
Age: 34
State: NY

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

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: High fever, chills, body aches, fatigue, high resting heart rate, metallic taste in my mouth, dizziness.

Other Meds: Adderall XR 30mg, Junel Fe 24, Zyrtec, Vitamin D 1000mg, Multi-Vitamin, Vitamin C 1000mg

Current Illness:

ID: 1365095
Sex: F
Age: 36
State:

Vax Date: 05/21/2021
Onset Date: 05/25/2021
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: PCN

Symptom List: Anxiety, Dyspnoea

Symptoms: Itchy painful rash appeared on torso, buttock area and legs/arms. Appeared 4 days after second dose of vaccine.

Other Meds: Fluoxetine Buspar

Current Illness:

ID: 1365096
Sex: F
Age: 18
State: CA

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

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

Symptoms: Pt c/o chest pain and chest tightness

Other Meds: none

Current Illness: anxiety

ID: 1365097
Sex: U
Age: 64
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Lightheadedness; Vertigo. EMS at bedside.

Other Meds:

Current Illness:

ID: 1365098
Sex: M
Age: 33
State: NH

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

Lab Data:

Allergies: None

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

Symptoms: 100.3 fever, aches, chills, congestion, sore throat

Other Meds: None

Current Illness: None

ID: 1365099
Sex: M
Age: 64
State: OR

Vax Date: 05/08/2021
Onset Date: 05/09/2021
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: right sided back pain--severe. MRI done 2 weeks after onset showed signficant lumbar spondylosis and chronic disk changes. patient wished that we report this because of the temporal relationship between vaccine and pain onset.

Other Meds: rosuvastatin, aspiring

Current Illness: none

ID: 1365101
Sex: F
Age: 67
State:

Vax Date: 03/23/2021
Onset Date: 05/29/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Pt tested positive, symptomatic, after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1365102
Sex: F
Age: 70
State: IN

Vax Date: 05/06/2021
Onset Date: 05/09/2021
Rec V Date: 06/01/2021
Hospital: Y

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

Lab Data:

Allergies: NONE

Symptom List: Pharyngeal swelling

Symptoms: Patient was admitted to hospital 3 days after receiving vaccine, on 5/9/21. She initially presented with a headache and was later diagnosed with an acute PE without acute cor pulmonale, unspecified pulomonary embolism.

Other Meds: ZEGERID OTC

Current Illness: NONE

ID: 1365103
Sex: M
Age: 72
State: MI

Vax Date: 05/08/2021
Onset Date: 05/28/2021
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: LA

Lab Data:

Allergies: No Known Drug Allergy

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 5/29/2021 Breathing Problem DIB, pulse ox 68% on RA Source of Information: Patient and Available medical record History of Present Illness: This is a 72y.o. male with extensive pmh as mentioned below Hypertension D.m. Copd on home o2 chf Cad Sleep apnea ckd and multiple other presented to ed with cc of sudden onset of sob and chills which started night before the presentation and associated with body aches.paitent was requiring bi pap on arival and was hypoxic Patient receive both doses of covid vaccine. Work up in er shows elevated d- dimer aqnd cta was not done because of his elevated kidney functions. Patient was tested positive for covid and id and pulmonary were consulted. troponins were elevated and cardiology also was consulted. Recommendations form the consultants were noted

Other Meds: acetaminophen (TYLENOL) 500 MG PO Tab take 1 Tab by mouth every 6 hours. Past Week Unknown time albuterol (PROVENTIL, VENTOLIN, PROAIR) HFA 108 (90 Base) MCG/ACT INHAL Aero Soln inhale 1 Puff into the lungs every 2 hours as needed for FOR

Current Illness: Ambulates with cane ? Arthritis knees ? CHF (congestive heart failure) (CMS/HCC) ? Chronic obstructive pulmonary disease (COPD) (CMS/HCC) ? CKD (chronic kidney disease) ? Coronary artery disease ? Coronary artery disease History of coronary artery stent placement. Drug-eluting stent to the LAD 6/11/2017 3/2017 1. LV pressure was also obtained. LVDP was 22. 2. Right coronary artery is 100% occluded distally. 3. Left main coronary artery shows no significant stenosis. 4. LAD has evidence of a 90% stenosis in its mid-portion. 5. Left circumflex coronary artery shows no significant stenosis. There was evidence of a 30% to 40% stenosis in the proximal LAD with heavy calcification. ? COVID-19 01/2021 On O2 @ 3L/min with exertional dyspnea ? Deep vein thrombosis (CMS/HCC) w/ knee replacement surgery ? Diabetes mellitus, type II (CMS/HCC) ? Gout ? Hearing loss no haearing aids ? Hypertension ? Hypothyroidism ? Kidney disease, chronic, stage IV (GFR 15-29 ml/min) 10/2016 ? Leiomyosarcoma of leg, right 2021 ? Neuropathy ? Osteoarthritis ? Pulmonary embolism (CMS/HCC) w/ knee replacement surgery ? Sleep apnea not currently using

ID: 1365104
Sex: M
Age: 36
State: MI

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: NONE

Symptom List: Diarrhoea, Nasal congestion

Symptoms: INMATE INSISTED HE HAD NOT HAD THE COVID-19 VACCINE PREVIOUSLY. WAS GIVEN A SECOND DOSE OF THE JANSSEN VACCINE. INCIDENT DISCOVERED 3 HOURS LATER. INMATE WAS EXAMINED AND MONITORED. TEMP 97.4, BP 130/80, PULSE 76, RR 20. INMATE DENIES HEADACHE, CHILLS, BODY ACHES, UPSET STOMACH, AND FATIGUE. INMATES STATES THAT "HE FEELS FINE." HE HAD NO REACTION TO HIS FIRST VACCINE, JENSSEN, WHICH WAS GIVEN 3/25/21. DEPUTIES ARE MONITORING HIM FOR SYMPTOMS.

Other Meds: NONE

Current Illness: NONE

ID: 1365105
Sex: F
Age: 50
State: WI

Vax Date: 03/27/2021
Onset Date: 03/30/2021
Rec V Date: 06/01/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Patient is a 50 year old female with history significant for autism, developmental disability, hypertension, seizures, frequent falls, Tourette syndrome, s/p CVA. She presented 3/31/2021, through the Emergency Department from home with following an unwitnessed fall. She was found by her mother this evening on the floor at the bottom of a flight of stairs. She was last seen by her mother sometime in the morning. Patient not capable of providing history as verbalizations are limited at baseline to occasional single word expressions of needs. Patient was noted in the ED to have multiple bruises to her head, arms and legs in various stages of healing. Patient lives with her mother who is also her legal guardian. Mother was poor historian in the ED and was unable to help determine how long patient was on the floor. Patient's mother verbalized to ED provider that she is not able to supervise the patient at all times due to her own medical needs. ED provider noted that upon leaving the ED the patient's mother stated to staff that they should put the patient out of her misery. County Crisis Center was contacted by ED staff and a referral was made to Adult Protective Services. Patient does not answer review of systems questions when asked. Admit date: 3/30/2021 Discharge date: 4/5/2021 Primary diagnoses: Principal Problem: Severe sepsis, unknown origin, without end organ failure o Resolving, no fever o Vancomycin stopped. o Wbc improving, fever resolved o Blood cultures still negative o After 4days of IV antibiotics she was transitioned to oral augmentin whenDcing flagyl. o PCP to follow fever curve, white count... CT chest abdomen and pelvis negative at admission Blood cultures have remained negative Active Problems: Benign essential HTN Developmental disability Residual autistic disorder Fall o Most recent fall 03/30/2021, unwitnessed, possibly down unknown number of stairs o Followed by Neurology, for frequent falls, EEG on 01/18/2021 abnormal with focal epileptic seizures suspected, she has been started on Lamictal taper o Continue Lamictal as prior to admission Rhabdomyolysis o Due to Unwitnessed fall and immobile on floor for unknown number of hours on 03/30/2021 o CPK trending down. Kidney function has remained normal with ongoing IV infusion Hyponatremia Elevated troponin I level Cardiology, Dr. consulted from the ED, elevated troponin suspected to be secondary to rhabdomyolysis o Troponin 1.58 upon arrival, peaked at 1.88 and declining is subsequently o EKG demonstrates sinus tachycardia with 1st degree AV block and RBBB, rate 101, QTc 487 Echo was normal at 60% ejection fraction Closed anterior dislocation of right glenohumeral joint was reduced in the emergency department which will explain the large bruise over her right shoulder right shoulder active and passive range of motion intact Hypomagnesemia

Other Meds: fluoxetine (PROzac) 40 MG capsule Take 1 capsule by mouth daily. lamoTRIgine (LaMICtal) 25 MG tablet Take 1 tab PO qPM for 2 weeks, then take 1 tab BID for 2 weeks and then increase by 1 tab every two weeks up to 2 tabs BID lisinopril (ZEST

Current Illness:

ID: 1365106
Sex: M
Age: 0
State: IL

Vax Date: 08/07/2019
Onset Date: 08/07/2019
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: allergic to eggs, cashews and walnuts

Symptom List: Rash, Urticaria

Symptoms: About 1 hour after the vaccines, my 4 month old son suddenly lost all color, went limp, and passed out. This lasted several seconds before I was able to nudge him to become alert again. He remained very pale for a couple days afterwards.

Other Meds: Ranitidine (Zantac) liquid for reflux

Current Illness:

ID: 1365107
Sex: F
Age: 77
State: MI

Vax Date: 02/25/2021
Onset Date: 02/28/2021
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: Penicillin

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

Symptoms: She got her vaccine, her left arm hurt as it does with her regular flu shot and normally goes away after a week. The next day she read what to do, but she moved her arm slowly around to exercise it to get rid of the soreness. On the 2nd day the pain went away. By the 3rd day it was back with a vengeance, and stayed there and never got better. Her joint and everything started to hurt. It felt like she had to have rotator cuff surgery again, and it still feels that way. She went to her doctor who gave her a steroid shot which helped but then it came back again. Within a week she could move her arm, but in a certain position it hurts her extremely badly. If she raises her arm it "bites" her and the pain does not cease. Her groin area also she is having pain there as well that radiates to her knee. The front top side is burning and sore all of the time, and does not want to quit. She takes baby aspirin and was given Norco but she did not like how it made her feel and doesn't take that. The 800 of Ibuprofen did not help with the pain, neither does Tylenol or Advil. She states that the medicines make her muscles sting and burn and feel worse. She feels that the vaccine got to her vulnerable places of pain from before that have healed and feels that it has reactivated that pain and the pain won't go away. Her arm did not hurt her for years, and her leg pain had been gone for a long time, but since the vaccine she has had nothing but pain. She got her 2nd vaccine on 3/25/21, she did not have any adverse reaction, just the reaction from the 1st one did not go away and it did not go away after the 2nd one and still has the same pain. It did not bother the bladder where she had surgery, just the joints of her body where she had previous problems. Her back has been out of place and could not walk for a year and a half, but this has not bothered her back.

Other Meds: None

Current Illness: None.

ID: 1365108
Sex: M
Age: 28
State: OR

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

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

Symptoms: Patient received their first dose of Pfizer vaccine. Began to feel lighted headed and hearing was going in and out. EMS responded and their blood pressure was low, after 20 mins, vitals were normal.

Other Meds:

Current Illness:

ID: 1365109
Sex: F
Age: 30
State: MD

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Left arm numbness with mild pain. Episode of vomiting x1. Reportedly skipped breakfast and lunch; and had a great deal of anxiety about getting injection. Observed for 1 hour. Besides subjective reports, neurological exam was benign. Stayed in observation until patient could keep liquids down, and she reported she was safe to drive home.

Other Meds:

Current Illness:

ID: 1365111
Sex: F
Age: 19
State: TN

Vax Date: 05/20/2021
Onset Date: 05/21/2021
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: NKA

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

Symptoms: This patient received the Pfizer COVID-19 vaccine on 05/20/21, On 05/28/21 pt brought her child in for catch-up vaccines and reported this "adverse reaction". She stated that upon waking on the morning after she received the vaccine, 05/21/21, the fingers on her right hand, excluding her little finger and thumb, were swollen and "stuck in place". Pt described what sounds like "trigger finger". She took Ibuprofen and Tylenol during the day and was back to normal the next morning. Subsequently, patient stated that on the morning of her child's vaccines, 05/28/21, she experienced this issue again on only one finger. I observed no edema and the patient appeared to move all digits on both hands without difficulty.

Other Meds: Started Depo-Provera the same day, 05/20/2021

Current Illness: None

ID: 1365112
Sex: M
Age: 35
State: NY

Vax Date: 04/27/2021
Onset Date: 05/10/2021
Rec V Date: 06/01/2021
Hospital: Y

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: none

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

Symptoms: Pt was at work, laying tile, and developed sudden onset of chest, back, neck and left arm pain, with associated dizziness around 10:15AM 5/10/21. He sat down for bit and symptoms persisted. He vomited x1 and went home, assuming he had developed the same "24 GI bug" his daughter had over the weekend. Once home he continued to feel unwell. He called his mother who proceeded to call EMS. EKG revealed anterior and inferior STE and he was taken directly to cardio lab for emergent coronary angiography, where he was found to have total thrombotic occlusion of midLAD, treated with drug-eluting stents.

Other Meds: acetaminophen

Current Illness: none

ID: 1365113
Sex: M
Age: 18
State: MA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
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: Amoxicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Nausea/Vomitting, fever for approximately 24 hours

Other Meds:

Current Illness:

ID: 1365114
Sex: F
Age: 49
State: ID

Vax Date: 04/06/2021
Onset Date: 04/19/2021
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: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Heart palpitations and chest pressure, still in diagnostic stages, prescribed Holter Monitor for 48h and consultation with cardiologist

Other Meds: Propranolol, Venlafaxine, Cozaar, Hydrochlorothiazide, Ritalin, Vitamin B Complex multivitamin

Current Illness: None

ID: 1365115
Sex: M
Age: 18
State: MI

Vax Date: 04/13/2021
Onset Date: 04/13/2021
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:

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

Symptoms: Shortly after patient received vaccination, he lost consciousness. He slumped in his char, nearly falling to the floor, but was caught by a nearby patient who noticed patient falling. Patient was assisted by staff to lie down on a cot. At that time he regained consciousness and was able to state his name. Staff attempted to check his blood pressure, but the electronic cuff was unable to measure b/p despite multiple attempts. Because of this, and persistent pallor, drowsiness and low pulse, EMS (who was standing by in the parking lot) was requested to enter the building to assess the patient. After evaluating him within the vaccination site for approximately 30 minutes, patient was transported to the hospital due to persistent low pulse and low blood pressure.

Other Meds:

Current Illness:

ID: 1365116
Sex: F
Age: 30
State: WI

Vax Date: 04/14/2021
Onset Date: 04/20/2021
Rec V Date: 06/01/2021
Hospital: Y

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:

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

Symptoms: Patient hospitalized for delivery of a healthy baby girl. The baby weighed 7 pounds 2.5 ounces. Per doctor's notes: Her postpartum course was complicated by delayed postpartum hemorrhage requiring Methergine, Cytotec, and Hemabate, which controlled bleeding.

Other Meds:

Current Illness:

ID: 1365117
Sex: F
Age: 24
State: OH

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

Lab Data:

Allergies: No

Symptom List: Unevaluable event

Symptoms: Eyes went bright red, Heart rate went up to 187 on my fitness watch, 150 heart rate by the time the paramedics arrived, I couldn?t feel my arms or legs, I had a high blood pressure and sugar level of 220. Went to the hospital and ran tests. Fever of 99.9-100.5 for two days straight. There was a red, warm, and inflammation in my left arm for two days. My heart felt like it was pounding out of my chest and I had a high rate for 5 days straight. I would be sitting down and it would be at 100.

Other Meds: No

Current Illness: None

ID: 1365118
Sex: F
Age: 38
State: OR

Vax Date: 05/17/2021
Onset Date: 05/19/2021
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:

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

Symptoms: Persistent headaches for 10+ days.

Other Meds:

Current Illness:

ID: 1365119
Sex: F
Age: 54
State: UT

Vax Date: 05/28/2021
Onset Date: 05/31/2021
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: Eggs, shellfish

Symptom List: Injection site pain, Pain

Symptoms: Severe back pain on the same side as given Covid shot. Sent me to the ER. Cankers in mouth on same side as given Covid shot

Other Meds: HRT/Dotti .05mg, Spironolacton 75mg, Soolantr 1%

Current Illness: None

ID: 1365120
Sex: F
Age: 47
State: CA

Vax Date: 05/15/2021
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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: eye pain, dry eye

Other Meds: None

Current Illness:

ID: 1365121
Sex: F
Age: 27
State: MA

Vax Date: 05/30/2021
Onset Date: 05/31/2021
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: N/A

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

Symptoms: Rash, swelling, itching, seems to be bigger than yesterday

Other Meds: Fluoxetine HCL 20 MG Methylphenidate ER 36 MG Hydroxyzine HCL 25 MG Multivitamin

Current Illness: N/A

ID: 1365122
Sex: M
Age: 19
State: MI

Vax Date: 04/07/2021
Onset Date: 05/31/2021
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: Amoxicillin Hives ? Pcn [Penicillins]

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: HPI This is a 19-year-old male that presents for complaint of witnessed seizure-like activity. He arrives by EMS. Patient is currently awake alert and oriented ?3. Today, he was out on the golf course with friends. It was a normal day and he returned home. When he got home, he was complaining of a headache to his mother. She gave him Motrin. Mother then heard a noise from the other room and found the patient on the floor unresponsive, displaying tonic-clonic activity, and eye rolling into the back of the head. This lasted for 4-5 minutes per mother. EMS arrived on scene he was postictal. Patient is never had this happen before. He denies any illicit substance, alcohol or medication use. Review of Systems Constitutional: Negative for chills, fatigue and fever. HENT: Negative for facial swelling and trouble swallowing. Respiratory: Negative for cough, shortness of breath and wheezing. Cardiovascular: Negative for chest pain and palpitations. Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting. Genitourinary: Negative for dysuria and frequency. Musculoskeletal: Negative for back pain and neck pain. Skin: Negative for rash and wound. Neurological: Positive for seizures and syncope. Negative for weakness, light-headedness and headaches. Psychiatric/Behavioral: Negative for confusion. The patient is not nervous/anxious.

Other Meds: none

Current Illness: none

ID: 1365123
Sex: F
Age: 54
State: MD

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: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient developed hives with itching to left upper arm 5 minutes after receiving vaccine. Patient BP was elevated, but stable. To reduce itching and swelling, patient was given 50mg of Bendryl. Hives then spread to right arm, chest, abdomen, and then developed swelling. 9-1-1 was called. Paramedics responded and transported patient to Medical Center.

Other Meds:

Current Illness:

ID: 1365124
Sex: F
Age: 11
State: OR

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

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

Symptoms: Parent and Patient put down on the consent form that the patient's birthday was date, making them 12 years old. The immunization records show the patient's birthday is date, making them 11 years old. The new FDA age limit for the Pfizer vaccine is 12 years old. The patient does not meet the age limit per the FDA.

Other Meds:

Current Illness:

ID: 1365125
Sex: F
Age: 61
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
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:

Symptom List: Nausea

Symptoms: Dizziness.

Other Meds:

Current Illness:

ID: 1365126
Sex: F
Age: 52
State: OR

Vax Date: 03/08/2021
Onset Date: 04/16/2021
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:

Symptom List: Injection site pain

Symptoms: Three weeks ago I started having muscle pain in my right shoulder where my second dose of the vaccine was. That pain went up to my neck so I had to go to the doctor. I have been having a lot of muscle pain in my shoulders and both arms for about three weeks. The night of May 31 I could not sleep because of the pain in my left arm (on a scale of 1-10, 10), where my first dose of the vaccine was. I had to get up and take a 600ml Tylenol for the pain. The pain was relieved but I still have it.

Other Meds: Tylenol and Ibuprofen

Current Illness: None

ID: 1365127
Sex: F
Age: 29
State: CO

Vax Date: 01/12/2021
Onset Date: 01/14/2021
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: nkda

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

Symptoms: Severe migraine-type headache starting 1.5-2 days after injection, constant (without any moments of relief at all) until about 2/21/21. I discussed it with my primary healthcare provider on 2/3/21 and my topiramate was increased to 3 pills per day, and when that didn't help I saw another provider who does botox therapy for migraines on 2/12/21 and he said I didn't qualify for injections but he placed me on atenolol everyday, which did stop the headache. I am still taking both medications at the doses I was placed on as I still get a migraine if I miss a dose. Prior to my covid shot I was already on a daily low dose of topiramate for migraines because I got on average 3-5 per month that lasted about 1 day each.

Other Meds: Sprintec; Topiramate 25 mg QHS; baclofen 10 mg BID; ibuprofen 800mg TID PRN

Current Illness: none

ID: 1365128
Sex: F
Age: 59
State: PA

Vax Date: 01/11/2021
Onset Date: 01/11/2021
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: Benadryl Beta adrenergic blockers

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

Symptoms: 35 minutes after injection, tingling and swelling of bottom lip; tingling felt on tongue but no swelling. Tingling lasted for 10 minutes and swelling lasted for about 12 hours. No hives, shortness of breath.

Other Meds: Atorvastatin Vitamin B complex Citalopram Coenzyme Q10 Multivitamin Ramipril Vitamin D

Current Illness: None noted

ID: 1365129
Sex: F
Age: 43
State: MA

Vax Date: 05/21/2021
Onset Date: 05/23/2021
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: Amoxicillin allergy two years ago. 12 days after taking 10 day amoxicillin prescription i developed a full body rash.

Symptom List: Tremor

Symptoms: Sharp pain in ear that comes in goes morning after shot that lasted two days. Slightly swollen front inner part of right shoulder (NOT the arm that was injection) just outside bra strap, two days after shot up to present. Right arm also felt tingly. I took Ibuprofen once last week as well as yesterday and today to see if that would help with inflammation; so far it has not.

Other Meds:

Current Illness:

ID: 1365130
Sex: F
Age: 45
State: AR

Vax Date: 04/16/2021
Onset Date: 04/24/2021
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: NKDA

Symptom List: Erythema, Pruritus

Symptoms: PT had myocardial infarction 6 days after 2nd Pfizer dose

Other Meds: Omeprazole 40mg

Current Illness: none

ID: 1365131
Sex: F
Age: 57
State: AL

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 06/01/2021
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: Narcotics Steroids Clindamycin Sandostatin Dicyclomine

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

Symptoms: She experienced fever, chills, vomiting, nausea, and muscular pain. Also started getting chest pain and shortness of breath. Went to hospital 02/22/2021. They ran an EKG, echocardiogram, stress test, chest x rays, and CAT Scan. They did a lot of blood work. They found a pulmonary embolism. She was hospitalized for 3 days. Put on blood thinners.

Other Meds: Vitamin D Vitamin C

Current Illness:

ID: 1365132
Sex: F
Age: 42
State: WA

Vax Date: 05/21/2021
Onset Date: 05/24/2021
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

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

Symptoms: Heart racing, shortness of breath which leads to mild headache; noticed approximately Monday, May 24 Miscarriage symptoms began on Tuesday May 25th

Other Meds: pre natal vitamins

Current Illness: none

ID: 1365133
Sex: F
Age: 82
State: NJ

Vax Date: 05/18/2021
Onset Date: 05/21/2021
Rec V Date: 06/01/2021
Hospital: Y

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

Lab Data:

Allergies: PENICILLIN

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 5/21/21 - HEART RATE 33%, - 911 CALLED - BECAME DELUSIONAL, PATIENT WAS FULLY AWARE OF EVERYTHING - END RESULT PACEMAKER AND STILL DELUSIONAL. HOSPITAL STAY FRIDAY 5/21/21 - 5/27/21 NEVER HAD HEART RATE ISSUES PRIOR

Other Meds: Ramipril - (generic - Altace 5 MG) - (Blood Pressure) - 1 x a day AM BYDUREON BCISE 2MG/0.85 AUIJ - 1 x per/week given every fri Atoryastatin 10mg ? (Cholesterol) ? 1 x a day PM Prednisone - (respiratory) 10 mg -1 x a day Clopidogrel

Current Illness:

ID: 1365134
Sex: F
Age: 44
State: ME

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: I evaluated patient, following her shot today. She had 2nd dose Moderna at about 11:40 AM. She was complaining of generalized itching, throat tightness, and shortness of breath following her shot. She has a h/o multiple drug & environmental allergies. She has used an epipen many times before, last was about a year ago for a bee sting. She had her 1st dose Moderna last month and had pruritus and throat swelling, but this feels worse. Last time she took Benadryl here, and was monitored for about 2 hours. She refused an epipen that time or to go to the ED. On exam, she is mildly anxious, constantly scratching at neck, chest, and lower back. Lungs remain clear, but somewhat diminished. Heart regular. No rash, except for redness from scratching/excoriation. Patient had her atrovent inhaler and took two doses. She had taken Benadryl & Pepcid around 9 AM this morning. By 12:20 PM the patient said she was feeling worse. She agreed to treatment with an epipen, which she self-administered. EMS was called, and arrived around 12:35 PM. She was taken quickly to the ambulance and then to ED.

Other Meds:

Current Illness:

ID: 1365135
Sex: F
Age: 13
State: MI

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

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

Symptoms: Very pale, pupils dilated, non responsive, passed out immediately after vaccination

Other Meds: unknown

Current Illness: unknown

ID: 1365136
Sex: F
Age: 40
State: MI

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: none

Symptom List: Pain in extremity

Symptoms: Patient was given the Moderna vaccine for her 2nd Covid-vaccine and was originally given the Pfizer vaccine for her first dose. At this time no adverse effects have been reported

Other Meds:

Current Illness:

ID: 1365137
Sex: F
Age: 51
State: CO

Vax Date: 02/13/2021
Onset Date: 02/15/2021
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: None

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

Symptoms: So it started like, I got the shot on Saturday so either Sunday or Monday my neck was really sore and my neck had a lump about the size of a pecan on my neck. I ended up calling the VA and they told me to go to urgent care. The DR at urgent care gave me antibiotics and I was on them about two weeks. I went into my DRs office and they didn't really know what it was. It took about a month and a half for the lump to go down. It was really sore, but once it started going down it was as sore.

Other Meds: I do not know the names of any of them right now: Insulin, allergy medicine, cholesterol medicine

Current Illness: No.

ID: 1365138
Sex: M
Age: 11
State: OR

Vax Date: 05/14/2021
Onset Date: 05/14/2021
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: The parent put down on the patient's form that the child's birthdate was date, making the child 12 years old. The immunization records show the child's birthdate is date, making the child 11 years old and not meeting the age limit per the FDA.

Other Meds:

Current Illness:

ID: 1365139
Sex: F
Age: 63
State: IL

Vax Date: 04/07/2021
Onset Date: 04/28/2021
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: none

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

Symptoms: patient complains of swollen lymph nodes under right arm

Other Meds: trazodone and phentermine

Current Illness: none

ID: 1365140
Sex: M
Age: 32
State: AZ

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NONE

Symptom List: Vomiting

Symptoms: SECOND DOSE GIVEN 62 DAYS AFTER FIRST DOSE

Other Meds: NONE

Current Illness: NONE

ID: 1365141
Sex: M
Age: 34
State: KS

Vax Date: 05/11/2021
Onset Date: 05/20/2021
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: Shingles outbreak. Rash across left side of torso and chest and back. Nerve pain ongoing for a couple weeks now Never had shingles before. Outbreak due to physical/mental stress factors is very unlikely.

Other Meds: Levothyroxine

Current Illness:

ID: 1365142
Sex: F
Age: 53
State: NJ

Vax Date: 05/10/2021
Onset Date: 05/11/2021
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: nuts yeast

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

Symptoms: left back side of rib cage through top of bottoms had spot/patch bruises

Other Meds: Singulair advair topomax and imitrex

Current Illness: Migraines

ID: 1365143
Sex: M
Age: 54
State: AZ

Vax Date: 05/22/2021
Onset Date: 05/22/2021
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: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: symptom: Hiccups time course: 36 hours

Other Meds: Lisinopril 5mg

Current Illness: N/A

ID: 1365144
Sex: M
Age: 62
State: GA

Vax Date: 05/01/2021
Onset Date: 05/19/2021
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: transaminits with elevated total bilirubin

Other Meds: None

Current Illness: sinusitis

ID: 1365145
Sex: F
Age: 58
State: AZ

Vax Date: 04/19/2021
Onset Date: 04/20/2021
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: penicillin,

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

Symptoms: Since April 20th, I have had chest compression pain, raising heartbeat, difficulty breathing, severe pain in chest, throat, and face

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm