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: 1368298
Sex: M
Age: 36
State: KS

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 06/02/2021
Hospital: Y

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: Symptoms began around 8:30PM on 05/27/21. started feeling sick, getting chills and fever, back and joint pain. That went throughout the night and was the same all day Friday. Saturday at 4:00 am woke up vomiting and experiences chest pain. By 9 AM the chest pain was so extreme that I had my wife take me to the ER. Where they said I was having a heart attack. I have been at Hospital in the ICU since then.

Other Meds: workout supplements, no other medications

Current Illness: none

ID: 1368299
Sex: F
Age: 43
State: CA

Vax Date: 04/21/2021
Onset Date: 05/09/2021
Rec V Date: 06/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt called on 5/9/21 at 8:47am. Pt got 1st dose Moderna at EBC site on 4/21/21 on left arm. Pt states having pain at injection site since 4/21/21 but is not getting worse. Pt took tylenol but didn't help with the pain. Advised pt to contact PCP outside county system for an evaluation and pt verbalized understanding.

Other Meds:

Current Illness:

ID: 1368300
Sex: F
Age: 35
State: MN

Vax Date: 05/10/2021
Onset Date: 05/10/2021
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 allergic to Penicillin, Sulphur, and Keotek.

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

Symptoms: The day within 10 minutes I started feeling hot and feverish. Then I started to feel lumping and cramping in my left breast and it persists and it turned in to nausea, vomiting, and dizziness. I also felt body cramping and both of breasts became extremely hard and was not comfortable. I also had muscle aches along with a mild fever for about a week. The pain was persistent. Then on day 2, the headaches started and I couldn't sleep because every time I moved the headache would cause me to vomit. So, I couldn't. My vision was blurry and I was not sure if it was due to the headache or the vaccine. I ended up going to the ER on 05/16/2021 for cramping in my left leg which was down by my ankle and was bruised. I'm still experiencing heart palpitations, tiredness, cramps still happen in my breasts, and there are still moments when my vision goes in and out.

Other Meds: No

Current Illness: No

ID: 1368301
Sex: F
Age: 48
State: IN

Vax Date: 05/21/2021
Onset Date: 05/30/2021
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The night of vaccine unable to sleep due to fever and body aches. Continued fever and body aches the next day May 22. Started to feel better May 23, but still not quite right. Felt completely back to normal Monday, May 24. Sunday May 30 I started have itchy blisters on elbows and hands. This has spread to 70 % of my body and they are now painful and blood filled.

Other Meds: 75 MCG of Synthroid every morning 2000 IU vitamin D every evening

Current Illness:

ID: 1368302
Sex: M
Age: 78
State:

Vax Date: 03/17/2021
Onset Date: 05/01/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: D69.6 - Thrombocytopenia (HCC)

Other Meds:

Current Illness:

ID: 1368303
Sex: M
Age: 21
State: VA

Vax Date: 04/22/2021
Onset Date: 05/29/2021
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:

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

Symptoms: Pfizer COVID-19 vaccine EUA on 04/22/2021 and tested positive via nasal swab PCR on 05/29/2021

Other Meds:

Current Illness:

ID: 1368304
Sex: F
Age: 47
State: MN

Vax Date: 04/09/2021
Onset Date: 04/26/2021
Rec V Date: 06/02/2021
Hospital: Y

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 hospitalized within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1368305
Sex: F
Age: 11
State: KS

Vax Date: 05/13/2021
Onset Date: 05/01/2021
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:

Symptom List: Pharyngeal swelling

Symptoms: Patient was provided vaccine, however was only 11 at time of vaccine which is currently an unauthorized age. Contacted parent/guardian and informed him of error and advised that pt should not receive dose #2 until either she turns 12 years old or the vaccine is authorized for her age group.

Other Meds:

Current Illness:

ID: 1368306
Sex: M
Age: 53
State: ID

Vax Date: 04/28/2021
Onset Date: 04/29/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: THE PATIENT SAID HIS ARM WAS SORE THE DAY HE GOT HIS SHOT. HE SAID 2 TO 3 DAYS LATER IT BECAME REALLY SORE TO THE POINT OF HURTING. HE SAID HE HAS A PHYSICAL JOB AND HE COULD HAVE EASILY INJURED HIS SHOULDER AT WORK THE DAY HE GOT HIS VACCINE, BUT DOES NOT REMBER INJURING ARM/SHOULDER. THE PATIENT PRESENTED TO THE PHARMACY FOR HIS SECOND VACCINE (OVER A MONTH LATER) AND HIS SHOULDER IS STILL HURTING. HE SAYS IT HURTS WHEN HE LIFTS IT UP, IF FEELS WEAK, AND HE HEARS/FILLS A 'POP'.

Other Meds:

Current Illness:

ID: 1368307
Sex: F
Age: 65
State: WA

Vax Date: 03/29/2021
Onset Date: 03/29/2021
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: Penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Little brown, purple, and red spots (lots of red spots) allover the body. Little blood vessels broke. Pt has not been feeling good since receiving the shot. Pt did not hit her legs but had a very painful legs and when she looked down she had blood vessels broking. Has red blood vessels on face and legs only. Pt has been feeling tired and no energy and was not able to work some days.

Other Meds: None

Current Illness: None (covid in November - but result was negative)

ID: 1368308
Sex: M
Age: 31
State: GA

Vax Date: 05/26/2021
Onset Date: 05/26/2021
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: 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: PROTEIN POWDER, MULTIVITAMIN

Current Illness: NONE.

ID: 1368309
Sex: M
Age: 71
State:

Vax Date: 03/02/2021
Onset Date: 03/06/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: Reynaud's syndrome with edema of hands and feet

Other Meds: allopurinol, ramipril, atorvastatin, amlodipine besylate, metformin, aspirin daily, multivitamin, fish oil, fiber supplement

Current Illness:

ID: 1368310
Sex: F
Age: 72
State:

Vax Date: 03/11/2021
Onset Date: 04/18/2021
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: R65.10 - SIRS (systemic inflammatory response syndrome) (CMS/HCC).

Other Meds:

Current Illness:

ID: 1368311
Sex: F
Age: 29
State: CA

Vax Date: 05/05/2021
Onset Date: 05/08/2021
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: Pt called call center on 5/8/21 . Pt got pfizer vaccine on 5/5/21. Pt complains of fever 102F onset 5/6/21 and took tylenol and fever is gone as of today. Left arm has swelling on 5/7/21 and on 5/8/21 left arm at the injection site started a rash with redness at the site. Pt spoke with external pcp. advised pt to follow-up with PCP. Ed precautions provided to patient.

Other Meds:

Current Illness:

ID: 1368312
Sex: M
Age: 49
State: FL

Vax Date: 05/24/2021
Onset Date: 05/25/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: PATIENT SAYS HE DEVELOPED CHEST TIGHTNESS THAT IS FELT SOMETIMES ON RIGHT OR LEFT SIDE OF BREASTBONE. SAYS SYMPTOMS DEVELOPED THE DAY OF THE 2ND VACCINE DOSE. PATIENT ADVICED TO CONTACT CDC AND FAMILY DOCTOR. HAS NOT BEEN EVALUATED BY MEDICAL DOCTOR BEFORE COMING TO PHARMACY

Other Meds:

Current Illness:

ID: 1368313
Sex: M
Age: 80
State: KY

Vax Date: 02/25/2021
Onset Date: 05/25/2021
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: NKDA

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

Symptoms: COVID-19 - patient admitted for 5 days of shortness of breath. Tested COVID+ upon admission, Received vaccine in March. Patient admitted 5/25, still inpatient but improving. Allergies (drug/food and reaction):NKDA Date of Vaccination:02/03/2021 and 02/25/2021 Dose: 1 and 2 Vaccine Manufacturer: Pfizer Lot #: 1st dose 2/3 Lot # EL9269 2nd dose 2/25 Lot # EN6203 Clinic Administering Vaccine: Healthcare Injection site: L deltoid Description of event/reaction: Pt was hospitalized for COVID-19 after receiving vaccination Date of Clinic Visit or Hospitalization: 5/24/2021 Reason for clinic visit or hospitalization: hypoxia COVID-19 positive test result: Yes ; if Yes, date 5/22/2021 Plans to monitor (include medications if prescribed):Treatment with dexamethasone, remdesivir, tocilizumab

Other Meds: doxycycline, atorvastatin, tamsulocin, levothyroxine, carvedilol, folic acid, hydralazine, metformin, B-12, Vitamin D3, lisinopril, amlodipine, aspirin, furosemide

Current Illness: macrocytic anemia

ID: 1368314
Sex: M
Age: 46
State: TN

Vax Date: 03/20/2021
Onset Date: 03/27/2021
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: Amoxil, Keflex

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

Symptoms: inflammation and pain in multiple joints including hands, feet, and spine

Other Meds: esomeprazole, lisinopril, metformin, tadalafil, tamsulosin

Current Illness: HTN, HLD, GERD

ID: 1368315
Sex: F
Age: 19
State: MT

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

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Vomiting and Diarrhea.

Other Meds:

Current Illness:

ID: 1368316
Sex: F
Age: 39
State: NC

Vax Date: 05/18/2021
Onset Date: 05/20/2021
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: Codeine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Initial Arm pain, Fever like chills and nausea for the day after, which subsided a day later. Starting 2 days after vaccine there was joint pain in the ankles and wrists. This progressively got worst for about a week and then muscle cramping also started. About a day after muscle cramping started burning sensation in thighs and upper arms added to reaction. Now 15 days later and still having pain and uneasy sensations. When to Primary Care where steroids were administered hoping to provide relief and stop the progression of symptoms from worsening.

Other Meds: Junel

Current Illness: none

ID: 1368317
Sex: F
Age: 60
State:

Vax Date: 02/12/2021
Onset Date: 03/14/2021
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: - Bell's palsy

Other Meds:

Current Illness:

ID: 1368318
Sex: M
Age: 59
State: CA

Vax Date: 05/21/2021
Onset Date: 05/23/2021
Rec V Date: 06/02/2021
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: NKDA

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

Symptoms: He got his shot on 5/21/21 and on 5/23/21 awoke with profound deafness in both ears.

Other Meds: Many meds - he is on dialysis and diabetic and HTNsive.

Current Illness: CKD on dialysis and diabetic and HTNsive.

ID: 1368319
Sex: F
Age: 68
State: WA

Vax Date: 04/22/2021
Onset Date: 05/24/2021
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: Unevaluable event

Symptoms: patient reported sudden non-purulent bumps on left foot and right heel starting approximately may 24th. she then noticed dumps on right hand and thumb underneath the nail. patient reports they are painful and non-pruritic. reported to pharmacy at 6/2/21. referred to primary care provider.

Other Meds:

Current Illness:

ID: 1368320
Sex: F
Age: 51
State: FL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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: PCN

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

Symptoms: Patient received dose from refrigerated vial of vaccine 16 hours after initial puncture to vial. Vial punctured on 6/1/2021 2:20 pm; dose drawn and given 6/2/2021 9:14am; Vaccine Exp date: 6/23/2021. No known adverse reaction to the patient.

Other Meds:

Current Illness: unknown

ID: 1368321
Sex: M
Age: 12
State: IL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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: Patient is under the age of 12. Father stated on form 12 years of age with DOB incorrect. Once we billed insurance they denied claim. Insurance states patient's DOB in system is exact date.

Other Meds:

Current Illness:

ID: 1368322
Sex: F
Age: 71
State: GA

Vax Date: 01/08/2021
Onset Date: 01/20/2021
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: Sulfur.

Symptom List: Injection site pain, Menorrhagia

Symptoms: I woke up and 1/2 my mouth and my tongue felt numb and tingling as if I had Novocain and it was wearing off. Woke up the next day and it was still there so I called the NP. She said to go and get a CAT scan in the morning and it didn't show anything. Later in the afternoon I noticed I was dropping things and dragging my feet and got concerned it was a stroke so I drove down to a larger medical center and they did a contrast CAT scan and that showed nothing. So then they did an MRI and they found a clot. So they put me on Plavix, blood thinner and all that stuff. After a couple of days my hand and foot were fine but the numbness and tingling in my mouth is still there till now. All of this wasn't real pronounced so I didn't think it was a stroke but it was. They sent me to a Neurologist and Cardiologist.

Other Meds: Trasadone 50mg, Wellbutrin 300mg, Hormone replacement patch, Turmeric extract, K2D3, CoQ10, Probiotic, Astazanthin, systemic enzymes, fibrocon, niacin, Krill oil.

Current Illness: No

ID: 1368323
Sex: F
Age: 47
State: PA

Vax Date: 04/10/2021
Onset Date: 04/17/2021
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: Cat, Dust, Mold, Cleaner chemicals.

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

Symptoms: Cramps in calf and upper thigh caused me to go to ER. Pain when at rest or during bathing. After using a lotion there was a pain like a scratch, burn, or abrasion localized. Received leg cramp info.

Other Meds: Benadryl, Unisom, Doxyoymine, Ibuprofen, Tylenol for OTC and nothing else

Current Illness: none

ID: 1368324
Sex: F
Age: 63
State: NH

Vax Date: 05/29/2021
Onset Date: 05/29/2021
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: Codeine, Ibuprofen, stuffy sinuses from some pollens, dust, cat fur, certain perfumes, fresh mowed grass, and some chemicals used for cleaning or insecticides

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: All symptoms come in waves, shaky, light headed, heat moving across body irregular heartbeat, fatigue, extremely dry mouth and sinuses, squirrelly stomache odd sensations

Other Meds: Vitamin D-3, Albuterol inhaler

Current Illness: Allergies listed above and a boil on skin weeks prior

Date Died: 04/14/2021

ID: 1368325
Sex: F
Age: 61
State: NY

Vax Date: 03/30/2021
Onset Date: 03/30/2021
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: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Reaction began within a few hours of vaccination. Patient had fever, chills and diarrhea within a few hours of receiving the vaccine. By 4:30am on 3/31 she could not walk and her legs went numb. An ambulance was called and the EMTs had to carry her out of the house. She was taken to Hospital where they started treating her for an infection but her fever went up over 103F so they ventilated her to try to control the fever. They did blood tests during that time and got the infections disease unit trying to figure out what was causing her symptoms. Doctors diagnosed sepsis. They continued to do blood test and cultures but could not determine the cause. They did MRIs as follow-ups because she was not responding. The fever never went down. She was awake for a few days (ventilator still in) and then started getting worse again. This is about 1.5 weeks post vaccination. They did an MRI and found a bleed on her brain and the infection had spread to her heart valves. Symptoms began within hours of vaccination. She was take to the hospital the morning after the vaccine and never came home. Patient died after 2 weeks in the ICU.

Other Meds: Methotrexate

Current Illness:

ID: 1368326
Sex: F
Age: 72
State:

Vax Date: 05/05/2021
Onset Date: 05/09/2021
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: Per doctor's notes 5/12/21: She got her second COVID vaccine last week and did get hives a few days later. The hives are resolving and she has not had any further issues. No difficulty breathing, tongue swelling. She will use Zyrtec or Claritin for hives, but her symptoms have been improving overall.

Other Meds:

Current Illness:

ID: 1368327
Sex: F
Age: 16
State: GA

Vax Date: 05/18/2021
Onset Date: 05/24/2021
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: Latuda - itches from it

Symptom List: Nausea

Symptoms: She was having a sore throat. I took her to the primary care doctor for it. They put her on antibiotics. She just got done with the medicine yesterday.

Other Meds: 2 eye drops - Cyclopentol; Prednisolone; ACTEMRA - an injection (on the Sunday before) - it was a second one - one her meds for her eyes; Metformin; Essexor; Oxcarbazepine; Guanfacine; Buspirone; Folic Acid; Juneul

Current Illness: Strep throat - she was off antibiotic by time of vaccine

ID: 1368328
Sex: F
Age: 29
State: NY

Vax Date: 03/10/2021
Onset Date: 03/11/2021
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: Bee Venom Shortness Of Breath Penicillins Hives

Symptom List: Injection site pain

Symptoms: In ED on 3/11 0246 with the following Chief complaint - I got the johnson and johnson covid vaccine 3/10 at 4pm and now I can't stop throwing up" c/o emesis, fever, body aches. HR 140s. pt is A/O x3. + nasuea, chills fever 101.2. denies throat swelling or SOB. pt presents with swelling at vaccine site and rash to both shoulder blades She does feel lightheaded and dizzy. Denies any recent illnesses. Denies any prior intolerance to vaccines. Fever 101.7F Patient has low-grade fever but nontoxic-appearing. Blood work shows mild leukocytosis with left shift likely reactive otherwise within normal limits. After 3 L of IV fluids she remains persistently tachycardic in the high 130s to 140s. Additional information for Item 18: She states she was feeling fine prior to her vaccine, denies any recent illness, sick contacts, recent travel, CP, SOB, abd pain, dysuria. After eating and drinking patient states she feels a little nauseous and having some indigestion so was given some more Zofran and Maalox. She continues to be presenting tachycardic in the 130s. Given the rest of the reassuring ED work-up I think this is likely autoimmune response to the vaccine however given her current heart rate I cannot discharge her safely. Will admit her to medicine team for observation. SIRS, likely 2/2 vaccine - hold off on antibiotics for now without clear source of infection, procalcitonin negative - tylenol prn for fever Principal Problem: SIRS (systemic inflammatory response syndrome) Active Problems: Tachycardia Asthma 3/12 discharge summary She was given 3L IVF bolus in the ED -- still tachycardic in the 110s, fever has improved. There was concern for adverse reaction to vaccine and she was given prednisone 60 mg x 1 in the ED. Her symptoms have improved and she is able to tolerate PO without vomiting. Of note, she says her entire family had a respiratory viral illness approx 1 year ago which her PCP suspected was COVID 19, but were unable to be tested at the time. Fever has resolved, has been afebrile x24 hours, leukocytosis has resolved tachycardia has improved although still HR in the 110's with ambulation, ordered an echo however patient did not want to stay wanted to follow-up with PCP and have this done there. Vital signs have been stable, patient states back to her baseline and feeling great. Would like to go home.

Other Meds: acetaminophen albuterol inhaler Additional information for Item 9: ibuprofen 200 MG

Current Illness: none

ID: 1368329
Sex: M
Age: 20
State: WA

Vax Date: 05/05/2021
Onset Date: 05/29/2021
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: Pfizer COVID-19 vaccine EUA on 05/05/2021 and tested positive via nasal swab PCR on 05/29/2021.

Other Meds:

Current Illness:

ID: 1368330
Sex: F
Age: 25
State: CA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
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: Patient states they got their 1st Pfizer COVID vaccine on 4/19/2021. Patient got swollen tongue when at home the same day. Patient visited the urgent care regarding symptoms on the same day; was prescribed oral steroid medication, prednisone, and took for 7 days. After taking prednisone, swollen tongue has subsided partially. Noted patient has no known allergies and is currently taking contraceptives orally. Patient scheduled urgent care visit 5/8/2021 for consultation for 2nd dose.

Other Meds:

Current Illness:

ID: 1368331
Sex: F
Age: 46
State: TX

Vax Date: 03/09/2021
Onset Date: 03/10/2021
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: Iodine, Ibupropheno, AAS, Penicillin family's

Symptom List: Tremor

Symptoms: Irregular periods (ICD-10 - N92.6) since 13 March, 2021, with a one stop between days May 01 - 10, and bleeding continued until the current date. The treatment indicated are Sprintec 28 0.25-35 MG-MCG (1 tablet Orally Once a day for 60 days)no good results so far. Among the symptoms: swelling of the left arm and hand right after the application of the vaccine, low fever for 2 days, change in oxygenation in the blood for 8 days (varying between 93 and 95%), swelling of the legs in the ankles, muscle pain and weakness in the legs, headache. The frame spans 84 days. And the tiredness, fatigue and aches and pains and swelling in the legs continue as well as continued period.

Other Meds: Not

Current Illness: Not

ID: 1368332
Sex: F
Age: 30
State: MN

Vax Date: 04/11/2021
Onset Date: 04/12/2021
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: lidocaine

Symptom List: Erythema, Pruritus

Symptoms: I felt like I had the flu, I also had tingling , hand pain. and 2 days later I had breathing problems.

Other Meds: adderall, danazol, valium, martazapine

Current Illness: No

ID: 1368333
Sex: F
Age: 27
State: FL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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: N/A

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

Symptoms: Patient received vaccine at approximately 3:10PM. After receiving she seemed fine and was able to walk to the waiting area. After approximately 1-2 minutes she reported to her boyfriend that she did not feel well and "needed some water." Immediately following she began to lose consciousness and went completely limp with her eyes rolled back, according to her boyfriend who caught her and placed her on the ground. The boyfriend also reported some muscle tremors occurring during this. After another minute the patient regained consciousness and was awake and oriented to person and place but not time. She was able to see properly and was vocalizing effectively. 911 was called immediately following initial loss of consciousness and EMS arrived to collect vitals. Patient was given a few sips of water. No medications were given. Following EMS assessment, patient was hypotensive and unable to stand on their own; EMS transported the patient to the emergency department.

Other Meds: Lorazepam

Current Illness: N/A

ID: 1368334
Sex: F
Age: 38
State: MA

Vax Date: 05/17/2021
Onset Date: 05/20/2021
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: No

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

Symptoms: Severe nausea, vomiting

Other Meds: Prozac 40mg, prenatal vitamin, doxylamine pyridoxine 10mg

Current Illness: No

ID: 1368335
Sex: F
Age: 21
State: MT

Vax Date: 05/27/2021
Onset Date: 05/28/2021
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: Sore arm, Body aches, & Headache.

Other Meds:

Current Illness:

ID: 1368336
Sex: F
Age: 58
State: IL

Vax Date: 01/04/2021
Onset Date: 01/06/2021
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: Codeine

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

Symptoms: Patient states that her mouth became "raw" about 48 hours after vaccination. States that some spots on the inside of her cheeks were so raw that the skin would peel right off. States she had a lot of swelling inside of her cheeks and described them as "chipmunk" cheeks.

Other Meds: Zetia, Zocor, Omeprazole, Ziac, Ambien

Current Illness: None

ID: 1368337
Sex: F
Age: 70
State:

Vax Date: 01/25/2021
Onset Date: 02/02/2021
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: U07.1 - COVID-19 virus RNA detected.

Other Meds:

Current Illness:

ID: 1368339
Sex: M
Age: 65
State: CA

Vax Date: 05/17/2021
Onset Date: 06/02/2021
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: LA

Lab Data:

Allergies: BACTRIM

Symptom List: Pain in extremity

Symptoms: Patient presented to this hospital ER with symptoms of stroke. Neurologist asked that we report to VAERS due to proximity to his vaccination timeline.

Other Meds: ASPIRIN 81MG DAILY, CEPHALEXIN 500MG TWICE A DAY

Current Illness:

ID: 1368340
Sex: F
Age: 45
State: CA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
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: Pt call call center on 5/7/21. Stated pt got Pfizer on 5/6/2021 and then pt has headache(pain score 6-10), vomiting, body aches from this morning. Pt is taking tylenol for symptoms. Scheduled UC visit. ED precautions instructed to patient

Other Meds:

Current Illness:

ID: 1368341
Sex: F
Age: 32
State: NJ

Vax Date: 05/11/2021
Onset Date: 05/13/2021
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: I do not have any allergies.

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

Symptoms: I have not had any issues with my pregnancy. My expected date of delivery is 07/09/2021. My adverse event occurred two days after I received my second dose. I woke up and couldn't really see. I had vision, but I couldn't see clearly. I did not have any other side effect though. I went to my OBGYN because they weren't sure if it was onset of rapid pre-eclampsia. They ruled that out and told me to go home and rest. The vision issue only lasted the day after I received my vaccine. The morning after my event, everything was fine. My doctor said that it may have been a "not typical" migraine.

Other Meds: I take a prenatal vitamin, calcium, magnesium, baby aspirin and a Unisom.

Current Illness: I did not have any other illnesses.

ID: 1368342
Sex: M
Age: 63
State:

Vax Date: 03/20/2021
Onset Date: 04/02/2021
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: U07.1 - COVID-19

Other Meds:

Current Illness:

ID: 1368343
Sex: F
Age: 69
State: AZ

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

Lab Data:

Allergies: NKA

Symptom List: Vomiting

Symptoms: observed injection site that afternoon when removing bandage: my upper arm was full of tiny pinpoint dots, injection site was swollen/hard. I was busy that day finishing payroll and preparing for trip . I did not notice so much in the morning, I drove to visit family for a few days. Upon return home, I read the paperwork provided by the clinic after I had received the shot...and began examining my body for tiny blood spots. Now, with each shower etc I would notice random spots and try to remember if they had been there before... My doctor was retiring and called last weekend to followup on a lab test he had previously ordered to take in May. During that conversation I asked him about the random spots, and he made an appt for me to see the PA the next day and do my urine sample for the lab order. PA ordered bloodwork for low platelet counts, which I had had previously, and urine test for abnormal immunofixation.

Other Meds: multi vitamim with biotin, vit D, certirazine

Current Illness: none known

ID: 1368344
Sex: F
Age: 57
State: MD

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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: Feeling faint 180/90 85 98% on R/A

Other Meds:

Current Illness:

ID: 1368345
Sex: M
Age: 19
State: VA

Vax Date: 04/28/2021
Onset Date: 05/01/2021
Rec V Date: 06/02/2021
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: Hazelnut, banana, pistachio

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

Symptoms: 19 year old with no significant past medical history presented to the ED with c/o chest pain. He was noted to have chest pain starting on 4/30. Patient stated that he had 2nd COVID vaccine on 4/29. He was noted to have one episode of vomiting and developed coughing. He has been c/o of sharp chest pain for the past two days. He was noted to have arm pain. He had chest pain when he breaths. He took advil and noted to have slight improvement in his pain. He was noted to have an elevated troponin and CK. Cardiology was consulted. His initial troponin came back 4.49 with a CPK of 294. Serial troponins were obtained. Troponin peaked to 44.8 and CPK to 1345, Echo showed newly reduced LVEF of 55%. Diagnosed with myopericarditis possibly related to the Covid vaccine and pt was transferred to the Hospital for cardiac MRI and further work-up. Upon transfer to the hospital, cardiac MRI was performed and showed acute myocarditis with no evidence of pericardial thickening or pericarditis. It also showed left ventricular function was at the lower limits of normal with a calculated left ventricular ejection fraction of 50% and no focal wall motion abnormality. He was treated with colchicine 0.6mg, pepcid 20 mg, and ibuprofen 600mg for the myocarditis and oral morphine 15mg and tylenol 1,000mg for chest pain. He was counseled on avoiding strenuous activity for the next 3 months and following up with cardiology upon discharge.

Other Meds: None noted

Current Illness: None noted

ID: 1368346
Sex: F
Age: 21
State: IL

Vax Date: 04/23/2021
Onset Date: 05/27/2021
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: Pfizer COVID-19 vaccine EUA on 04/23/2021 and tested positive via nasal swab PCR on 05/27/2021

Other Meds:

Current Illness:

ID: 1368347
Sex: M
Age: 43
State:

Vax Date: 05/06/2021
Onset Date: 05/07/2021
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: Pt called call center on 5/7/21.pt states pt got 2nd covid vaccine Moderna 5/6/2021 (unknown site) and pt got rash with burning sensation on stomach and pt feels very tired and sleepy and body aches. Pt said he felt hot last night @11pm but pt didn't check his temperature. Pt is taking Aspirin for symptoms now. Noted pt also has ili symptoms:cough at this day. Pt was advised to go to ED for further evaluation

Other Meds:

Current Illness:

ID: 1368348
Sex: F
Age: 35
State: AZ

Vax Date: 01/06/2021
Onset Date: 02/03/2021
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: Augmentin

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

Symptoms: Dizziness/vertigo occurred within 2-5 minutes after receiving the 2nd dose of COVID19(Moderna) vaccine. I was told to consume fluids and eat without relief. I had to be driven home by a co-worker. My dizziness has persisted daily until present with no relief. I have also developed worsening anxiety within the last month.

Other Meds: gabapentin as needed

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm