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: 1376534
Sex: M
Age: 73
State: PA

Vax Date: 02/24/2021
Onset Date: 02/27/2021
Rec V Date: 06/06/2021
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: irregular heart rate, Digenoused 6/3/2012 with pvc. Additional exams scheduled week of 6/14 thru 6/17

Other Meds: calcium 20mg

Current Illness: none

ID: 1376535
Sex: F
Age: 21
State: SC

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/06/2021
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: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1376536
Sex: M
Age: 36
State: WA

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 06/06/2021
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: None

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

Symptoms: 12 hours after second dose patient experienced following symptoms: headache, fever, chills, body aches, pain at injection site. All symptoms subsided in 28 hours after injection except headache which persisted for about 4 days. 12 days after second dose patient experienced intense pain and redness at site of injection leading to loss of mobility in left arm, and outbreak of hives across torso, upper arms and legs, which have persisted for 5 days (to date of Adverse Event report). Arm pain subsides with 400 mg ibuprofen taken daily. Pharmacist recommended Benadryl for hives, taking 25 mg Diphenhydramine HCI once daily with little improvement in symptoms. Patient recalls no previous history experiencing acute or chronic urticaria. Hives are moderately itchy, mostly painless, and have gradually increased to 2-3 inches in diameter.

Other Meds: None

Current Illness: None

ID: 1376537
Sex: M
Age: 63
State: OH

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

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Zoster lesions appeared on 6/5/2021 on my left arm...same arm used for both Covid vaccine injections...about six weeks out from second dose. I had prodromal symptoms for few days before rash appeared. As the appearance of the shingles rash occurred on a weekend, I was seen by MD at an Urgent Care Center to get started on antivirals asap. She prescribed Valacyclovir 1gm TID for 7 days orally and Mometasone 0.1% cream topically to lesions BID.

Other Meds: Sinemet 25/100 1 1/2 tablets at 6 AM, 10AM, 2 PM and 1/2 tab at 6 PM Clonazepam .5 mg 1/2 tablet at bedtime along with 20 mg Melatonin (for Parkinson's related REM sleep behavior disorder) Multivitamin 81 mg ASA Tagamet 200 mg twi

Current Illness: None

ID: 1376538
Sex: F
Age: 51
State: FL

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

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

Lab Data:

Allergies: Sulfa, Lactose to dairy

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

Symptoms: Severe migraine headache, blurred vision and dizziness and nauseous and passing out for 5 days so far

Other Meds: Amlodipine 5 mg (Lisinopril 10 mg) (Sambucol)

Current Illness:

ID: 1376539
Sex: F
Age: 62
State: SC

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/06/2021
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: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1376540
Sex: F
Age: 39
State: IN

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 06/06/2021
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: Heart palpitations and shortness of breath for approximately 6 hours in duration

Other Meds: Vienva (oral contraceptive), Spironolactone, Levothyroxine, omeprazole OTC

Current Illness:

ID: 1376541
Sex: F
Age: 47
State: CA

Vax Date: 04/01/2021
Onset Date: 04/07/2021
Rec V Date: 06/06/2021
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: On April 7, 7 days after receipt of my second dose my heart rate started going up. at the time of the second dose my resting heart rate had been in the mid 50s for many years. On May 27 my blood work came back with a signal of hyperthyroidism and my doctor put me on atenolol to control my heart rate. Diagnosis is presumed to be graves disease (all symptoms are consistent and new), ultrasound is planned for June 17

Other Meds: Retin-A and iron supplements

Current Illness: none

ID: 1376542
Sex: M
Age: 12
State: MO

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
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: Needle disconnected from syringe when administering dose as patient jerked away during administration. Full dose was not received.

Other Meds:

Current Illness:

ID: 1376543
Sex: M
Age: 39
State: GA

Vax Date: 05/26/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
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: Systemic: Allergic: Rash Generalized-Severe

Other Meds:

Current Illness:

ID: 1376544
Sex: M
Age: 62
State: OR

Vax Date: 05/12/2021
Onset Date: 05/13/2021
Rec V Date: 06/06/2021
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: In the first two weeks after injection, feeling exhausted, muscle aches, generally feeling poorly. The most compelling issue is that these symptoms are identical to those of when I had what I believe to be Covid in 2/28-4/2/20. Test for antibodies in 9/20 however was negative. Today, 6/6/21, was the first day I felt ?normal? since the injection. I am scheduled for my second injection on 6/9/21, and am going to NOT receive it due to the possibility of worse reaction to injection number 2. Please be aware, I am an ardent vaccine proponent, and have not shared this information with those outside my family nor posted it on social media.

Other Meds: None

Current Illness: None

ID: 1376545
Sex: F
Age: 30
State: NC

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 06/06/2021
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: Aspirin, Ceftin and Tamiflu

Symptom List: Rash, Urticaria

Symptoms: Fever and chills 8-10 hours after receiving the injection. Significant reduction in breast milk supply (from 30+ ounces pumped per day to less than 2 ounces).

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1376546
Sex: F
Age: 21
State: TX

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

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

Lab Data:

Allergies: none

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

Symptoms: Patient came in for Chickenpox vaccine but received Janssen Covid vaccine. She already received Pfizer Covid vaccine on 3/29 and 4/19/2021.

Other Meds: None

Current Illness: none

ID: 1376547
Sex: M
Age: 18
State: TX

Vax Date: 06/06/2021
Onset Date: 06/06/2021
Rec V Date: 06/06/2021
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: NKDA

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

Symptoms: ABOUT 1-2 MINUTES AFTER THE SHOT, PATIENT WAS DISORIENTED, STRETCHED OUT /PASSED OUT FOR A MINUTE, HAD SHORTNESS OF BREATH AND WAS LATER TRANSPORTED TO THE ER

Other Meds: NOT KNOWN

Current Illness: NOT KNOWN

Date Died: 06/04/2021

ID: 1376548
Sex: F
Age: 90
State: WI

Vax Date: 06/01/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
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: HCTZ, furosemide, indapamide, metoprolol, PCN, propranolol. reactions not known.

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

Symptoms: Pt developed GI upset and weakness on 6/2, followed by chills and emesis 6/3. Was found deceased on the toilet on the morning of 6/4/21.

Other Meds: bumetanide, pramipexole, lidocaine patch, asa, vitamin D, Multaq, calcium +D, potassium, benefiber, bystolic, alphagan, hydrocodone/apap, latanoprost, omeprazole, acetaminophen

Current Illness: Admitted 5/10-5/12/21 post syncopal episode. Found to be orthostatic. Potassium supplement added. Reportedly had a few short asympt runs of V tach in hospital.

ID: 1376549
Sex: F
Age: 25
State: FL

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
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: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Additional Details: When patient was given vaccine she appeared calm, She told me she did not like needles. Said she had Tetnus vaccine in recent past and was more anxious about that than she needed to be. Said she had scheduled thios vaccine 1 hour prior and wanted to get it over with. She moved outside vaccine area to seat. Approx. 2 min later,she approached drop off counter,asking for water and said felt faint. She fell and her face hit base of a plastic floor stand. Mouth bleeding,

Other Meds:

Current Illness:

ID: 1376550
Sex: F
Age: 76
State: FL

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

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

Lab Data:

Allergies: NKA

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

Symptoms: bright pink discoloration, itchy and sore injection site, patient used cold compresses and light messages. Immunization was administered on 5-24-21 and patient is still having slight discoloration, itching and soreness around injection site as of 6-5-21 when patient asked us to report her adverse reactions. We suggested that patient would follow up with her physician. Patient indicated that it was getting a little better every day and she did not feel that she needed to check with her physician.

Other Meds: Vitamin D, Vitamin B12, probiotics, sleep aid

Current Illness: none

ID: 1376551
Sex: F
Age: 70
State: ND

Vax Date: 02/10/2021
Onset Date: 04/18/2021
Rec V Date: 06/06/2021
Hospital: Y

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

Lab Data:

Allergies: no results found

Symptom List: Ear pain, Hypoaesthesia

Symptoms: was hospitalized for Covid. **date of second vaccine was 3/10/2021

Other Meds: unknown

Current Illness: unknown

ID: 1376552
Sex: F
Age: 39
State: KS

Vax Date: 05/13/2021
Onset Date: 06/06/2021
Rec V Date: 06/06/2021
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: Numbness of injection site 3 weeks and 3 days later. Tingling needle like numbness around injection site.

Other Meds:

Current Illness:

ID: 1376553
Sex: F
Age: 33
State: TX

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
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: Fainting / Unresponsive-Mild, Systemic: Vomiting-Mild, Additional Details: Patient fainted but woke up very quick. Vomitted once the started feeling better. No signs and symptoms of allergic reaction. We called 911 and was checked on site. The 911 personales reported no issue but patient caregiver asked that patient to be checked at the ER.

Other Meds:

Current Illness:

ID: 1376554
Sex: M
Age: 40
State:

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/06/2021
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: PATIENT EXPERIENCED SYNCOPE, LOSING CONSCIOUSNESS BRIEFLY. FELL OUT OF CHAIR AND REGAINED CONSCIOUSNESS ROUGHLY 15 SECONDS LATER.

Other Meds:

Current Illness:

ID: 1376555
Sex: F
Age: 40
State: IA

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
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: Needle/plunger malfunction, minimal partial dose given due to rest leaking around connection. Full dose repeated 10 minutes later. Patient tolerated injections well, no issues at injection sites.

Other Meds:

Current Illness:

ID: 1376556
Sex: M
Age: 39
State: FL

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

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

Lab Data:

Allergies: No allergy documented

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

Symptoms: upon getting vaccinated, patient started filling dizzy, lightheaded, dry mouth, excessive sweating. we gave water and 1 tablet on Tylenol 500mg tablet with water. patient started feeling better after 5 minutes.

Other Meds: Tylenol 500mg tablet

Current Illness:

ID: 1376557
Sex: F
Age: 17
State: NV

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
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: Patients first dose received April 13, 2021, 2nd dose received June 3, 2021.

Other Meds:

Current Illness:

ID: 1376558
Sex: M
Age:
State: VA

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

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

Lab Data:

Allergies: No known

Symptom List: Injection site pain, Menorrhagia

Symptoms: On Saturday. May 29, I experienced pain similar to appendicitis. I drove to the nearest ER where after 29 minutes, I could barely walk from pain. After 2-3 hours of testing, it was found that my right kidney had a renal infarct and that I had lost up to 25% of my kidney to necrosis. I am not sure if this is an adverse reaction to the vaccine, but I wanted to enter it into the system just to be safe.

Other Meds: Effexor, Synthroid, daily acetaminophen, Flonase, Claritin, as needed

Current Illness: None

ID: 1376559
Sex: F
Age: 42
State: OH

Vax Date: 03/05/2021
Onset Date: 05/31/2021
Rec V Date: 06/06/2021
Hospital: Y

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

Lab Data:

Allergies: Nuts Codeine Expectorant Some decongestants

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

Symptoms: Event - stroke without known precursors Treatment- currently in inpatient rehab Outcome - unknown if I will regain full use of right side 3 days at hospital and now currently in inpatient rehab with unknown discharge date

Other Meds: Advair 230-21 ProAir Xyzal

Current Illness: n/

ID: 1376560
Sex: F
Age: 19
State: MA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
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: Flushed / Sweating-Mild, Additional Details: patient said she was prone to passing out from anxiety of getting vaccines and within 3 minutes of receiving vaccine patient said she felt like she was going to pass out and did seem to black out for a few seconds. 911 was called but patient refused treatment and was fully recovered before leaving EMT recommended patient take antiaxiety medication before receiving another vaccine

Other Meds:

Current Illness:

ID: 1376561
Sex: M
Age: 14
State: NJ

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Janssen COVID 19 vaccine administered to a patient under the age of 18. Patient had no symptoms.

Other Meds: none

Current Illness: none

ID: 1376562
Sex: F
Age: 18
State: MA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
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: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Medium

Other Meds:

Current Illness:

ID: 1376563
Sex: F
Age: 37
State: DC

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
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: Systemic: Chills-Mild, Systemic: Confusion-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Mild, Systemic: Shakiness-Mild

Other Meds:

Current Illness:

ID: 1376564
Sex: F
Age: 38
State: MD

Vax Date: 05/21/2021
Onset Date: 06/01/2021
Rec V Date: 06/06/2021
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: Upset stomach for 1 week then broke out with shingles.

Other Meds:

Current Illness:

ID: 1376565
Sex: F
Age: 58
State: OH

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

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

Lab Data:

Allergies: none known

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

Symptoms: Tonight I had a woman call regarding her 58 yo daughter. She stated that yesterday I gave her the Moderna vaccine and now she has severe facial swelling. She was wondering if it was related to the vaccination. I recommended that she go to the emergency room. She then asked what Keflex was for and that the patient had been receiving for a tooth infection. She again stated that the facial swelling was severe and I again recommended the emergency room.

Other Meds: unknown

Current Illness: unknown

ID: 1376566
Sex: F
Age: 47
State: MA

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Fainting / Unresponsive-Severe, Systemic: Hypotension-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: numbness on left arm

Other Meds:

Current Illness:

ID: 1376567
Sex: F
Age: 34
State: MD

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

Symptom List: Tremor

Symptoms: Severe stomach pain and cramps, diarrhea, nausea, vomiting, hives. The onset was approximately 4 hours after receiving the vaccine. The peak of pain was approximately 12 hours after injection. Hives remain on abdomen and thighs 48 hours later.

Other Meds: None

Current Illness: None

ID: 1376568
Sex: F
Age: 47
State: GA

Vax Date: 12/22/2020
Onset Date: 01/12/2021
Rec V Date: 06/06/2021
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: Allergies: Pistachios, Septra, Macrobid, Percocet Sensitivities: Gluten/Wheat, Latex, Tide Detergent

Symptom List: Erythema, Pruritus

Symptoms: Unsure if this was covid related or vaccine related: 1) exposed to covid within 3 days of vaccine #2 2) 3 days of mild cough and sinus drainage without loss of taste or smell, no breathing difficulty, temps 97 - 99 (Jan 17 - 19, 2021). 3) Next week increasing chest tightness and irregular heartbeat 4) Cardiology Appt: holter monitor with > 5000 PVCs in 24 hrs and a few episodes of short-lived arrhythmias. Cardiac Stress Test normal and Echo negative for cardiomyopathy. Started on Metoprolol (weight gain and fatigue, intermittent PVCs and occasional arrhythmias), changed to Acebutolol (less side effects and fewer PVCs). 5) Next Cardiology visit scheduled for October 20, 2021.

Other Meds: Vitamin K2 + D3 B-complex Hormone Replacement Therapy

Current Illness: Exposure to Covid-19 within 3 days of second vaccination.

ID: 1376569
Sex: M
Age: 37
State: CA

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/06/2021
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: Nausea-Medium, Additional Details: Possible Vasovagal reaction, out for a very short time, then had nausea, a bit confused, shakiness, headache

Other Meds:

Current Illness:

ID: 1376570
Sex: F
Age: 14
State: WA

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/06/2021
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: Patient received 2nd shot and was standing nearby when she started feeling nauseous. She took a seat and started to become pale. She felt sick in her stomach and was responding to questions. Pharmacy staff gave her a bottle of water and bag to vomit in (but did not vomit). Staff also checked her blood pressure resulting in 109/68 HR 65. She felt better and left. Pharmacy staff called mom to follow up around 3:30pm. Mom said she was doing better, but feeling tired.

Other Meds: none

Current Illness:

ID: 1376571
Sex: F
Age: 55
State: VA

Vax Date: 03/30/2021
Onset Date: 04/05/2021
Rec V Date: 06/06/2021
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: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 6days after first dose my right wrist and right knee became swollen and painful. After about 10 days, my knee was no longer swollen but it still ?clicks? when I walk up stairs or hills. My right wrist in the joint area remains severely painful to the touch and when in use, especially when using my thumb. A bump formed on the interior wrist bone and grew larger day-by-day and then either disappeared or grew into my wrist bone. Joints in my fingers - especially on my right hand are achy.

Other Meds: Magnesium 300mg, passionflower tincture, collagen powder, fiber powder, l-glutamine powder.

Current Illness: N/A

ID: 1376572
Sex: M
Age: 13
State:

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/06/2021
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: When reconstituting for Pfizer covid vaccine only 0.8ml of 0.9% sodium chloride diluent was used instead of the required 1.8ml amount. Patient was given vaccine and were notified the same day about the issue. Currently no side effects have been reported or noted

Other Meds:

Current Illness:

ID: 1376573
Sex: F
Age: 22
State: ME

Vax Date: 06/06/2021
Onset Date: 06/06/2021
Rec V Date: 06/06/2021
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: None

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

Symptoms: The patient stood up to signal something was wrong, and she immediately sat back down. As I went over to her, she was leaning over out of her chair at which time she fainted, and I had her lieing on the groung. she woke up 5-10 seconds later and didn't know what had happeneded and was upset. We moved to the immunization room and elevated her legs while applying ice packs to the back of her neck. She drank water and ate an apple. Within 45 minute she was feeling a lot better.

Other Meds: Albuterol inhaler as needed, carbamazepine, and birth control

Current Illness: None

ID: 1376574
Sex: F
Age: 58
State: CA

Vax Date: 05/04/2021
Onset Date: 05/05/2021
Rec V Date: 06/06/2021
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: Abdominal Pain-Severe, Additional Details: Patient came and received the second dose of Pfizer vaccine on may 27th. Tried to contact patient to make sure she is feeling good after the second dose but no response

Other Meds:

Current Illness:

ID: 1376575
Sex: F
Age: 56
State: PA

Vax Date: 05/15/2021
Onset Date: 05/17/2021
Rec V Date: 06/06/2021
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: My left arm began hurting about 48 hours after the shot. I am still experiencing soreness 3 weeks later. I also began experiencing joint pain - knees, hips, elbows, ankles, fingers, feet - about a week later. My pain is only getting worse.

Other Meds: Naproxen- 2 tablets

Current Illness: None

ID: 1376576
Sex: F
Age: 63
State: OH

Vax Date: 05/18/2021
Onset Date: 05/20/2021
Rec V Date: 06/06/2021
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: Zoloft, Non-steroidal anti-inflammatories, Mupirocin, Sulfa

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

Symptoms: 05/20/21 Approximately 5:30 pm, during meal, consumed steak, rice, corn. Felt like "air bubbles" in throat; felt like "throat was closing", patient coughed. Symptoms resolved in "maybe" 3 to 4 minutes.

Other Meds: Hydroxychloroquine, Doxycycline Hyclate, Topiramate, Librax, Metamucil, Trazodone, Vitamin D, Mutlivitamin, Refresh Eye Drops, Famotidine, Amlodipine, Valsartan.

Current Illness: none

ID: 1376577
Sex: F
Age: 35
State: CA

Vax Date: 06/06/2021
Onset Date: 06/06/2021
Rec V Date: 06/06/2021
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: A 36 year old patient. Received her first dose Pfizer (LOT#: EW0187 Exp: 8/2021) at 0922 on 6/06/21. At approximately 1035 patient came back to facility with a complaint of stomach pain. Patient was walked in by Lead RN and Co-lead RN. Patient stated she started to feel dizzy after being vaccinated. Patient stated that she didnt feel it was worth notifying EMT when she was in observation. Patient left vaccination site after completing her 15 minutes of observation. Patient waited at home for an hour after noticing she was feeling warmer and returned to facility for an assessment. Patient denies signs and symptoms of hives, rash, swelling, discoloration, or anaphylaxis. Patient denies shortness of breath. Patient stated that she only had coffee for breakfast. Patient was given a snack and water. Patient was asked to stay an extra 30 minutes for further observation. Patient agreed to stay. EMT took patient vital signs at 1040. BP:128/88, HR: 82, O2: 100%, temp: 98.6. EMT retook vital signs at 1045. BP: 128/93, HR: 82, O2: 100%. EMT retook vital signs at 1050. BP: 124/90, HR: 80 O2: 100%. EMT retook vital signs at 1102. BP: 124/90 HR: 82, O2: 100%. Patient stated that she was feeling a lot better and was no longer feeling any of her initial symptoms. Patient was advised to call 911 in case of any severe allergic reaction. Patient was encouraged to follow up with her PCP. Patient was encouraged to sign up for Vsafe. Patient refused to sign up for Vsafe. Patient refused to stay for the full 30 minutes of observation. Patient was advised to stay and told she was leaving against medical advice. Patient verbalized understanding. Patient left vaccination site at 1105 unassisted and with a steady gait.

Other Meds:

Current Illness:

ID: 1376578
Sex: F
Age: 38
State: TX

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 06/06/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: METALLIC TASTE IN MOUTH STARTING THE DAY AFTER VACCINATION, AND HAS CONTINUED SINCE THEN.

Other Meds:

Current Illness:

ID: 1376579
Sex: F
Age: 34
State: NC

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/06/2021
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: NAUSEA, FEVER/CHILLS, SHAKES/TREMORS. PT HAS NOT TRIED ANY RX OR OTC TREATMENTS

Other Meds:

Current Illness:

ID: 1376580
Sex: F
Age: 14
State:

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

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

Lab Data:

Allergies:

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

Symptoms: When reconstituting for Pfizer covid vaccine only 0.8ml of 0.9% sodium chloride diluent was used instead of the required 1.8ml amount. Patient was given vaccine and were notified the same day about the issue. Currently no side effects have been reported or noted

Other Meds:

Current Illness:

ID: 1376581
Sex: M
Age: 62
State: FL

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
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 Low

Other Meds:

Current Illness:

ID: 1376582
Sex: M
Age: 24
State:

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 06/06/2021
Hospital:

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

Lab Data:

Allergies: seafood allergy

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

Symptoms: fever, sweating, headache, cough, bloody nose, congestion, fatigue, difficulty eating, muscle weakness, slept for over 24 hours in total two days after vaccine

Other Meds: vitamins

Current Illness: none

ID: 1376583
Sex: F
Age: 42
State: CA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/06/2021
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: no adverse event happened after vaccination but there was an error in the covid -19 vaccine brand given. Pt should have received Moderna instead of Pfizer

Other Meds: NONE

Current Illness: NONE

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm