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: 1367815
Sex: F
Age: 11
State: GA

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/02/2021
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: Patients mother gave the wrong DOB at time of initial vaccine. Patients mother was present and stated the patients birthday was 2008, but in actuality, the patients birthday is 2009. This was discovered on 06/02/2021 when the patient was due back for second immunization. The patients mother stated today that the child was 12 and was born in 2009. Upon more questioning, we discovered the patient is not 12 and was not born in 2008 and that the patient is currently 11 years old. Staff instructed patients mother to not return for second dose until patient was 12.

Other Meds:

Current Illness:

ID: 1367818
Sex: F
Age: 56
State: CA

Vax Date: 05/26/2021
Onset Date: 05/31/2021
Rec V Date: 06/02/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: hydrocodone

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient admitted to hospital 5/31 with worsening of baseline weakness, also found to have UTI.

Other Meds: modafinil, tizanidine, simvastatin, lactulose, clonazepam, gabapentin, levothyroxine, glatopa, glatiramer

Current Illness:

ID: 1367819
Sex: F
Age: 31
State: MI

Vax Date: 04/08/2021
Onset Date: 04/29/2021
Rec V Date: 06/02/2021
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: I am allergy to Pencillia.

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

Symptoms: After taking that your are was sore.

Other Meds: I was taking prenatal vitamins and Tylenol.

Current Illness: None

ID: 1367820
Sex: F
Age: 44
State: TX

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/02/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Medication error; incorrect interval between doses 1 and 2. Given 22 days apart. No adverse reactions reported. Error discovered when client requested updated vaccination card.

Other Meds: Unknown

Current Illness: Unknown

ID: 1367821
Sex: M
Age: 69
State: MI

Vax Date: 03/04/2021
Onset Date: 03/23/2021
Rec V Date: 06/02/2021
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: Case had a physical in late 2020 that was unremarkable. He saw his PCP and had EKG done on 3/23/21 and showed Atrial Fib. PCP was concerned and referred him to Dr who diagnosed him with Atrial Fib as well. He had his second dose of Moderna vaccine on 4/1/21. Has has since been placed on Eliquis. indicated that Dr could not rule out this was due to the Moderma vaccine and requested it be reported to VARES.

Other Meds: Benicar

Current Illness: None

ID: 1367822
Sex: F
Age: 58
State: CA

Vax Date: 01/09/2021
Onset Date: 02/19/2021
Rec V Date: 06/02/2021
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: Erythromycin Donnatol

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

Symptoms: Chronic upper bilateral leg pain and stiffness

Other Meds: Omeprazole Probiotics Zoloft Lipitor Advil Tylenol Vit D

Current Illness: None

ID: 1367823
Sex: M
Age: 11
State: AZ

Vax Date: 05/29/2021
Onset Date: 05/29/2021
Rec V Date: 06/02/2021
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: Patient given vaccine at age 11 due to mom inputting incorrect dob on vaccine convent form. No adverse reactions noted during the waiting period after vaccine given.

Other Meds:

Current Illness:

ID: 1367824
Sex: F
Age: 44
State: FL

Vax Date: 05/30/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Sore arm started about 6 hours later and lasted about 24 hours Dizziness started within half an hour intermittent for 48 hours Extreme sensitivity to normal noises and lights started 20 hours after, lasted 4 hours Shooting, intermittent pain in upper left quadrant of chest, started 6 hours after, ongoing, 30 hours out also occasionally in right shoulder/chest, and left side of neck Partial PARALYSIS of left arm starting about 3 hours after, significant worsening 40 hours after and ongoing

Other Meds: Armour thyroid

Current Illness: none

ID: 1367825
Sex: F
Age: 45
State: GA

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 06/02/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: VACCINE ADMINISTRATION WAS GIVEN WITH A 5/8" NEEDLE. A 1" NEEDLE SHOULD HAVE BEEN USED. PATIENT WAS CONTACTED TWO DAYS LATER. PATIENT HAD NO ADVERSE EFFECTS FROM THE SHORTER NEEDLE. PATIENT FELT WELL AND HAD NO COMPLAINTS.

Other Meds: PANTOPRAZOLE, GABAPENTIN, WELLBUTRIN, SEROQUEL, LAMOTRIGINE, TRAZADONE

Current Illness: NONE.

ID: 1367826
Sex: F
Age: 57
State: MT

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient was given an undiluted COVID-19 vaccine (Pfizer). Medication was given with no diluent to dilute the vaccine vial and 0.3 mL of the vial contents were administered to the patient.

Other Meds:

Current Illness:

ID: 1367827
Sex: M
Age: 54
State: PA

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

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

Lab Data:

Allergies: none

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

Symptoms: At 12-00pm the pharmacist gave patient a J & J Covid Vaccine. He asked him to sit down for 15 minutes. At approximately 12-10PM Patient yelled for assistance. At the time the pharmacist ran over to the chair. Patient siaf that he was going to pass out. His eyes rolled back and it seemed like a seizure, at that point he began to pass out. The pharmacist assisted him to the floor. He was unresponsive on the floor for 10 seconds. After 10 seconds he regained consiouness. He said he felt fine. We called the ambulance. They came 15 minutes later. The pharmacist did his vitals pulse: 60 respirations:16 blood pressure 115/70. At that time the ambulance came and assisted him to the hospital.

Other Meds: none

Current Illness: none

ID: 1367828
Sex: F
Age: 67
State: NV

Vax Date: 03/03/2021
Onset Date: 03/08/2021
Rec V Date: 06/02/2021
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: Sulfa drugs

Symptom List: Rash, Urticaria

Symptoms: Hives developed about 5 days after 1st dose but ended. Hives developed after 2nd dose and still exist 3 months later. Already taking antihistamine. Doctor prescribed Singulair, but it does not seem to help.

Other Meds: Levothyroxine, claritin, viramin D, calcium, mutivitamin

Current Illness:

ID: 1367829
Sex: F
Age: 36
State: NY

Vax Date: 05/30/2021
Onset Date: 05/30/2021
Rec V Date: 06/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Within 5 minutes of vaccination patient was sweating, flushed, and nauseous. She did previously report she did not like shots and had felt the needle go in when her dose was administered. Was given a cool compress, cold water, and layed down on some chairs for observation. Patient quickly recovered and was feeling normal in less than 10 minutes.

Other Meds:

Current Illness:

ID: 1367830
Sex: F
Age: 11
State: CA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/02/2021
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: Per patients mother/guardian, mom thought it would be okay for the patient to receive the vaccination due to the fact that the patient was going to be 12 in September, and felt that the benefits outweighed the risks. Mother/Patient also attested that patient was 12 years of age/older

Other Meds:

Current Illness:

ID: 1367831
Sex: F
Age: 34
State: TX

Vax Date: 05/24/2021
Onset Date: 05/31/2021
Rec V Date: 06/02/2021
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: Sulfa, Zithromax

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

Symptoms: Covid arm- swelling itching pain

Other Meds:

Current Illness:

ID: 1367834
Sex: M
Age: 11
State:

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt received first dose of Pfizer vaccine at age 11. Pt and father presented for second dose and was declined due to age.

Other Meds:

Current Illness:

ID: 1367835
Sex: M
Age: 49
State: NY

Vax Date: 04/05/2021
Onset Date: 04/25/2021
Rec V Date: 06/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: I developed Bell's Palsy, paralysis on my left side of my face. This occur 3 weeks after I receive my first dose of the Pfizer vaccine. I could not close my left eye, inability of smile, drooling, facial distoration, difficulties in eating.

Other Meds:

Current Illness:

ID: 1367836
Sex: F
Age: 19
State: VA

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

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

Lab Data:

Allergies: Amoxacillin- hives

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Seizure activity noted within 30 minutes of vaccination. Pt known to have functional neurologic disorder and pseudoseizures daily (sometimes back-to-back). Pt alert and orientedx4. Pt dizzy and states she did not eat lunch today. Provided with water and granola bar. Second seizure noted 20 minutes later. Pt stayed for observation for additinal 40 minutes following second seizure. Client refused transportation to hospital and clients brother came to pick her up.

Other Meds: Zoloft, Olanzapine, Aurovela

Current Illness:

ID: 1367837
Sex: F
Age: 62
State: CA

Vax Date: 05/11/2021
Onset Date: 05/12/2021
Rec V Date: 06/02/2021
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: Per chart note from 6/1/21, pt had hives day after COVID vaccine w/extensive erythema, lip swelling. She was admitted to hospital for 4 hrs & treated w/Benadryl & steroids. Pt will not receive 2nd dose

Other Meds:

Current Illness:

ID: 1367838
Sex: F
Age: 47
State: MA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Pt stated her tongue felt funny a little tingly-Mild, Additional Details: Pt refused 911. stated her tongue felt a little numb and "funny." but not swollen just different feeling

Other Meds:

Current Illness:

ID: 1367839
Sex: F
Age: 21
State: MI

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

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

Symptoms: Systemic: see additional comments-Medium, Additional Details: pt was given expired vial of moderna; it was punctured on may 30 2021

Other Meds:

Current Illness:

Date Died: 05/25/2021

ID: 1367840
Sex: F
Age: 87
State:

Vax Date: 02/20/2021
Onset Date: 04/17/2021
Rec V Date: 06/02/2021
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:

Symptom List: Unevaluable event

Symptoms: death vision loss Acute cerebrovascular accident acute hyponatremia

Other Meds:

Current Illness:

ID: 1367841
Sex: F
Age: 45
State: MI

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Systemic: see additional comments-Medium, Additional Details: pt was given expired vial of moderna. vial was punctured may 30 2021 at 11am and was not disposed of before we closed.

Other Meds:

Current Illness:

ID: 1367843
Sex: M
Age: 39
State: MI

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

Symptom List: Injection site pain, Pain

Symptoms: Systemic: see comments-Medium, Additional Details: pt was given expired vial of moderna vaccine; the vial was punctured at 11 am on May 30 2021 and shot was given June 1.

Other Meds:

Current Illness:

Date Died: 05/29/2021

ID: 1367844
Sex: M
Age: 83
State:

Vax Date: 03/25/2021
Onset Date: 05/23/2021
Rec V Date: 06/02/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: death weakness E87.1 - Hyponatremia

Other Meds:

Current Illness:

ID: 1367845
Sex: F
Age: 48
State: MI

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: see comments-Medium, Additional Details: pt recieved an expired vial of moderna; vial was punctured on may 30 2021 at 11 am and was not disposed of correctly that night. pt was given the open vial today June 1st.

Other Meds:

Current Illness:

ID: 1367846
Sex: M
Age: 28
State: MI

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Systemic: see comments-Medium, Additional Details: pt received expired vial of moderna; vial was punctured at 11am on May 30 2021 and the vaccine was given today June 1 2021. the open vial was not disposed of correctly end of day May 30 2021.

Other Meds:

Current Illness:

ID: 1367847
Sex: F
Age: 48
State:

Vax Date: 03/06/2021
Onset Date: 05/25/2021
Rec V Date: 06/02/2021
Hospital:

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

Lab Data:

Allergies: Dairy, Soy, Egg, Peanuts, Wheat

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Shingles

Other Meds: Zyrtex and Nasonex

Current Illness: None

ID: 1367848
Sex: M
Age: 24
State: IN

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium, Additional Details: Pt fainted after 3 mins of getting vaccine. He asked for water and passed out. His head jerked every 3 seconds slightly for 25 seconds. Alcohol was provided under nose but provided no relief. After 25 seconds of LOC, he woke up. He drank water and caprisun, and felt better.

Other Meds:

Current Illness:

ID: 1367849
Sex: F
Age: 41
State: TX

Vax Date: 05/02/2021
Onset Date: 05/02/2021
Rec V Date: 06/02/2021
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: Site: Pain at Injection Site-Severe. Additional Details: Pain in arm, unable to lift arm without pain.

Other Meds:

Current Illness:

ID: 1367850
Sex: F
Age: 77
State:

Vax Date: 02/25/2021
Onset Date: 05/14/2021
Rec V Date: 06/02/2021
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:

Symptom List: Injection site pain

Symptoms: I63.9 - Cerebrovascular accident (CVA), unspecified mechanism (CMS/HCC) E87.1 - Hypo-osmolality and hyponatremia R29.810 - Facial weakness

Other Meds:

Current Illness:

ID: 1367851
Sex: M
Age: 16
State: FL

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild

Other Meds:

Current Illness:

ID: 1367853
Sex: F
Age: 25
State: PA

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Fainting / Unresponsive-Medium

Other Meds:

Current Illness:

ID: 1367854
Sex: M
Age: 0
State: NJ

Vax Date: 05/04/2021
Onset Date: 05/05/2021
Rec V Date: 06/02/2021
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: none

Symptom List: Tremor

Symptoms: office visit 5/16/2021- left leg swelling along with erythema along with increased vascularity, no warmth or tenderness, full ROM office visit 5/19/2021- left leg purple and swollen, basic CBC done in office was normal office visit 5/30/2021- left leg cellulitis, given Augmentin 400mg/ml 2.5ml BID x 10 days, sent for bloodwork (CBC, EBV, CRP ), sent for X-Ray & Ultrasound, refer ortho ; parent informed us they "saw PA, at Dr.'s office, who rubbed and massaged leg for 30 seconds and child was screaming whole time" office visit 6/1/2021- leg still swollen, parent advised to take patient to ER for be evaluated.

Other Meds: prescribed at the 5/4/2021 visit- first-Lansoprazole 3mg/ml 2ml BID

Current Illness: diagnosed with Acid Reflux at 5/4/2021 visit

ID: 1367855
Sex: F
Age: 82
State:

Vax Date: 01/28/2021
Onset Date: 02/05/2021
Rec V Date: 06/02/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: I63.9 - Cerebrovascular accident (CVA), unspecified mechanism (CMS/HCC)

Other Meds:

Current Illness:

ID: 1367856
Sex: M
Age: 13
State: NC

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: Mom reports that patient has a history of fainting after vaccine administration. Patient complained of feeling dizzy and lightheaded after receiving Covid vaccine. Patient fell from standing position and hit his forehead against store aisle. NP was called by Pharmacist, to assist/evaluate. Patient alert and oriented upon NP arrival. BP 116/60, pulse 76, O2 sat 99% on room air. Patient with normal neuro exam. Patient returned to baseline.

Other Meds:

Current Illness:

ID: 1367857
Sex: M
Age: 17
State: GA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Systemic: Fainting / Unresponsive-Severe, Systemic: patient had a seizure about 5 mins following adminstration-Severe, Systemic: Seizure-Severe, Additional Details: ems was called and patient was evaluated and pt was cleared with normal vitals and alert from ems parent refused to go to er i tried calling to follow up with patient and now answer on best contact number

Other Meds:

Current Illness:

ID: 1367858
Sex: F
Age: 30
State: CT

Vax Date: 05/30/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium

Other Meds:

Current Illness:

ID: 1367859
Sex: F
Age: 67
State: OH

Vax Date: 04/09/2021
Onset Date: 05/28/2021
Rec V Date: 06/02/2021
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: penicillin

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

Symptoms: red itchy rash on left side of trunk of my body spreading to armpit and neck

Other Meds:

Current Illness: sore throat

ID: 1367860
Sex: F
Age: 15
State: TX

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Hypotension-Medium

Other Meds:

Current Illness:

ID: 1367862
Sex: F
Age: 20
State: OH

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Pain in extremity

Symptoms: Systemic: Dizziness / Lightheadness-Medium

Other Meds:

Current Illness:

ID: 1367863
Sex: M
Age: 16
State: MA

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/02/2021
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: Error: Patient Too Young for Vaccine Administered

Other Meds:

Current Illness:

ID: 1367864
Sex: F
Age: 32
State: CA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Stomach aches-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Pt started feeling lightheaded 1-2 minutes post-vaccination at 2:50PM and fell down on her backpack. Pt was conscious and mouth showed mild bleeding. RPh on duty had pt lie down on floor with both legs raised on chair and continuously monitored pt's BP and pulse. Pt's BPM was 109/73 and pulse was 88 at 3PM. Of note, pt reported PMH of vertigo x7 years and attributed her lightheadedness to anxiety. At 3:20PM, pt recovered and was able to stand and walk on her own.

Other Meds:

Current Illness:

ID: 1367865
Sex: F
Age: 29
State: NY

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Fainting/Unresponsive-Mild.

Other Meds:

Current Illness:

ID: 1367866
Sex: F
Age: 48
State: NH

Vax Date: 05/11/2021
Onset Date: 05/28/2021
Rec V Date: 06/02/2021
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: sulfa antibiotics

Symptom List: Vomiting

Symptoms: extremely heavy period

Other Meds: Lutera birth control pills

Current Illness: obesity

ID: 1367867
Sex: F
Age: 55
State: DC

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 06/02/2021
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: Site: Pain at Injection Site-Severe, Site: Swelling at Injection Site-Mild, Systemic: Joint Pain-Severe, Additional Details: sweeling of the leg the left leg twoce the size of right leg. body ches.

Other Meds:

Current Illness:

ID: 1367868
Sex: F
Age: 74
State: MD

Vax Date: 03/09/2021
Onset Date: 03/11/2021
Rec V Date: 06/02/2021
Hospital:

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

Lab Data:

Allergies: NKDA, no known allergies to foods, latex, environment

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

Symptoms: Concerningly patient had her first Moderna COVID-19 vaccination on 3/9/2021. I actually saw her in the office on 3/12/2021 for low back pain. She was having a hard time bearing weight and had fallen multiple times. This had started prior to her vaccine. She reports that after the vaccine, approximately 2 to 3 days after she had the vaccine, she had sudden onset lower extremity weakness that was extreme. This was acutely worse than when I saw her in the office. She reports her lower legs were almost paralyzed and she was unable to walk. She did not seek medical attention or contact my office regarding the symptoms. Patient reports she was basically bedbound for 3 to 4 weeks and then symptoms very suddenly stopped. She did talk to her cardiologist about that at her routine follow-up and they recommended she hold off on getting the second Moderna vaccine. Her strength has recovered, she estimates she has approximately 60 to 70% of her lower extremity strength at this time. She continues to have mild back pain however this has almost resolved as well. Denies falls or trauma around the time of her pain and weakness. Patient does report follow-up with her neurologist in the next few weeks and will discuss further with them

Other Meds: Fosamax, Lisinopril , Metformin, Amiodarone, Xanax, ASA, Atorvastatin, Plavix, Co-Q10, Zetia, Gabapentin, Glucosamine, Chondroitin, Magnesium Oxide, Multivitamin, Metoprolol Succinate XL, Omeprazole, Nitroglycerin, Sertraline

Current Illness: Low back pain reported 03/12/2021

ID: 1367869
Sex: F
Age: 60
State: MA

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

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1367871
Sex: M
Age: 34
State: CA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Stomach aches-Mild, Systemic: Flushed / Sweating-Medium, Additional Details: Pt started feeling lightheaded and signs of flushing at 3:05PM post-vaccination. RPh had pt lie down on the floor and continiously monitored BP and pulse. BP and pulse were 96/55; 52 and 122/74; 80 at 3:08PM and 3:17PM, respectively. Pt had no relevant PMH and attributed his lightheadness to anxiety and witnessing his partner experience vertigo post-vaccination. Pt fully recovered and left the pharmacy at 3:35PM. Pt's temp was 95.5 F at 3:24 PM.

Other Meds:

Current Illness:

ID: 1367872
Sex: F
Age: 46
State: IN

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/02/2021
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: 104.5 fever, severe headache, left leg and left arm pain and numbness, body aches, chills

Other Meds: Olmesartan and Contrave

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm