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: 1377757
Sex: M
Age: 2
State: MT

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 06/07/2021
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: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Gave wrong injection

Other Meds: None

Current Illness: None

ID: 1377758
Sex: F
Age: 63
State: ND

Vax Date: 12/28/2020
Onset Date: 01/26/2021
Rec V Date: 06/07/2021
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: I am allergic Fiorinal, Actonel, Sulfa, Vioxx.

Symptom List: Anxiety, Dyspnoea

Symptoms: On Tuesday, January 26, 2021, I had chills nausea and headache at 2:00AM. Then the night of the 27th, Jan, 2021, I started to coughing and my bronchial tubes were tight. Then I started on my inhaler for my asthma. Inhalers: Advair and Ventolin. I wrote these symptoms in my health file portal to my doctor and she later prescribe me prednisone 20 mg. I took 2 tablets starting on January 29, 2021.

Other Meds: Tylenol

Current Illness: none

ID: 1377759
Sex: M
Age: 24
State: IL

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 06/07/2021
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: Penicillin

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

Symptoms: Patient informed paramedic of arm tingling, paramedic informed patient that he will check back with him in a couple minutes. 5 minutes after, paramedic witnessed the patient having a seizure for 10 seconds. During seizure, patient hit car in front of him. Paramedic stated that patient had flexion and eyes rolled back. Patient came to and asked paramedic what happened. Patient does remember seizing. Patient went into ambulance and was given snacks due to blood sugar of 95. Patient states he is currently on a keto diet. Patient informed staff that someone will be picking him up and refused to go to hospital with EMT.

Other Meds:

Current Illness:

ID: 1377760
Sex: F
Age: 61
State: AL

Vax Date: 03/30/2021
Onset Date: 05/18/2021
Rec V Date: 06/07/2021
Hospital: Y

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

Lab Data:

Allergies: No Known Allergies

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient presented to PCP on 05/18/2021 office from group home with C/O cough, runny nose, lethargic, fever, lungs rattling, uncontrollable shaking. Patient had a seizure the night before and had been having weak spells and coughing and fever since that time. Patient admitted to hospital on 05/18/2021 and chest Xray showed pneumonia. Patient tested for COVID-19 on 05/21/2021 after learning of potential exposure at group home and result was positive.

Other Meds: Aspirin, Tegretol XR, Colace, Estrace, Amaryl, Mobic, Glucophage, Mylicon, Prilosec, Dilantin, Lyrica, Topamax, Desyrel, Zyrtec, Breztri inhaler, Ayr nasal spray

Current Illness: unknown

ID: 1377761
Sex: F
Age: 57
State: NC

Vax Date: 05/28/2021
Onset Date: 05/30/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies: Causative agent: VANCOMYCIN Event: DRUG INTOLERANCE Signs/symptoms: ITCHING,WATERING EYES (9/5/16@01:26) RASH (9/5/16@01:26:52) DRUG INDUCED FLUSHING (DRUG INDUCED FLUSHING)

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

Symptoms: Unexplained bilateral knee pain - no prior history of knee arthritis/pain

Other Meds: 2) ACETAMINOPHEN 325MG TAB TAKE TWO (2) TABLETS BY MOUTH ACTIVE EVERY 6 HOURS FOR PAIN. 3) AMLODIPINE BESYLATE 5MG TAB TAKE ONE (1) TABLET BY ACTIVE MOUTH DAILY FOR BLOOD PRESSURE 4) ASPIRIN 81MG EC TAB TAKE ONE (1)

Current Illness: UTI with probable sepsis treated with ceftriaxone dose to 2g q 24hr

ID: 1377762
Sex: F
Age: 49
State: CA

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

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

Lab Data:

Allergies: None

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

Symptoms: Cannot lift arm past parallel, sore injection site, sore shoulder in a 5 inch diameter

Other Meds: Amoxicillin-clavulanate

Current Illness: None

ID: 1377763
Sex: F
Age: 36
State: NY

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
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: Pyrexia, White blood cell count decreased

Symptoms: The day after the second dose was injected, my upper left arm was red, warm, painful, and swollen. The swelling was beyond the injection site and involved the whole muscle. The adverse event began to clear three days after the second dose was received. The redness, pain, warmth, and swelling was significantly reduced.

Other Meds: Procardia

Current Illness: None

ID: 1377764
Sex: F
Age: 43
State: VA

Vax Date: 04/05/2021
Onset Date: 04/07/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies: Apples, peaches, cherries, pineapple, mangos, hazelnut, severe allergies to environmental allergens (pollen, animals, etc.)

Symptom List: Pharyngeal swelling

Symptoms: Lots of fatigue 2 days after vaccine, sharp stabbing pain on left side that afternoon underneath breast, struggling to breathe, went to ER, ER thought it was blood clot in lung, found to have normal lung, take ibuprofen, pain lasted most of the day, more pain when breathing in, pain gradually faded but occasionally flared up for 2 weeks after the first adverse event. Had been having some mild symptoms previous to that, medical people concluded it was inflammation exacerbated by vaccine. Palpitations, rapid heart rate.

Other Meds: Allegra (allergies)

Current Illness: Not feeling well, but did not know of any specific illness.

Date Died: 05/20/2021

ID: 1377765
Sex: F
Age: 66
State: MI

Vax Date: 02/02/2021
Onset Date: 04/30/2021
Rec V Date: 06/07/2021
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: Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: My mother was the patient in question She had a Moderna Covid Vaccine in Feb/March of 2021. She then had 2 doses of Rituxan on April 28th of 2021. After her second dose of the medication, she tested positive for covid 3 days later. She was hospitalized on May 8th and was not able to recover. She passed away on May 20th. The Drs at the Hospital in told me the rituxan essentially wiped the vaccine from her body. The reason I'm reporting this is to warn others in her position about the possible side effects. My mom had a very false sense of security.

Other Meds: Rituxan

Current Illness: Rheumatoid Arthritis

ID: 1377766
Sex: F
Age: 63
State: DC

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/07/2021
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: Iodine, shellfish,legumes,nuts.mustard,Amoxicillin ,sulfa drugs and sulfa, Cefdinir, Macrobid

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Fever 102.1 Redness and swelling at injection site Headaches

Other Meds:

Current Illness:

ID: 1377767
Sex: M
Age: 32
State: KY

Vax Date: 03/23/2021
Onset Date: 03/26/2021
Rec V Date: 06/07/2021
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: NKA

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

Symptoms: Pt s/p vaccine on 3/23/2021. Began w/ back pain on 3/25-3/26/2021 and was noted to have progression even after 4/21 vaccine. S/p MRI c/w lumbar discitis/osteomyeltis and bx negative. On empiric abx. Thought to be related to prior fall possibly but with vaccine 48 hrs prior to back pain development will submit. No cultures were ever positive.

Other Meds: Buspar, Truvada

Current Illness: none

ID: 1377768
Sex: M
Age: 19
State: NM

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 06/07/2021
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: pt received pfizer covid shot, after about 5 minutes he passed out while sitting in the waiting area.........laid pt down and took blood pressure which was normal 120/73.......put an ice pack back of his neck.......pt then wanted to try to leave with his father but his stomach hurt and proceeded to throw up. ...pt then left the store with his father.

Other Meds: none

Current Illness: none

ID: 1377769
Sex: F
Age: 47
State: OR

Vax Date: 03/26/2021
Onset Date: 03/29/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies: I am not allergic to anything.

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

Symptoms: Three days after receiving the vaccination, I woke up and my heart rate was racing. It was around 160-170 BPM's. My blood pressure was up to 210/116. I wasn't even able to walk around my house. I went to the hospital and they performed an EKG and blood work. All of my tests came back normal. My event lasted about a week before I started to feel better. I was given some blood pressure meds until everything went back to normal.

Other Meds: I was taking Tylenol 500mg tablets.

Current Illness: I did not have any other illnesses.

ID: 1377770
Sex: M
Age: 66
State: TX

Vax Date: 04/03/2021
Onset Date: 05/28/2021
Rec V Date: 06/07/2021
Hospital: Y

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: penicillins

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

Symptoms: Vaccine was given on 4/3/21. Pt. presented to this facility with chest pain, pneumonia, hypotension on dehydration on 5/28/21

Other Meds: insulin, glargine; lisinopril; metoprolol succinate; venlafaxine

Current Illness: none known

ID: 1377772
Sex: F
Age: 40
State: OR

Vax Date: 01/17/2021
Onset Date: 01/25/2021
Rec V Date: 06/07/2021
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: wheat, dairy, beans, pineapple, oysters, seasonal allergies

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

Symptoms: On 1/25/21, 7 days after receiving first shot, developed rash at injection site. Hot, itchy, welt like, size a little larger than an egg. This lasted approx 3 days before slowly resolving. Treated with a hydrocortisone ointment. Developed erythema nodosum on right calf at same time, and another on the front of left shin early February 2021.

Other Meds: nexium, falmina 0.1mg/0.02mg, vitamin D3

Current Illness: NA

ID: 1377773
Sex: F
Age: 40
State: MD

Vax Date: 03/03/2021
Onset Date: 04/06/2021
Rec V Date: 06/07/2021
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: no

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

Symptoms: Chest pain, from time to time difficulty breathing , from time to time pain the heart area every 30 sec.

Other Meds: Levothyroxine 112

Current Illness: no

ID: 1377774
Sex: F
Age: 63
State: WI

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/07/2021
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: Neomycin, Erythromycin, Sulfa drugs

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

Symptoms: Headache, dizziness, chills, fever, eye movement, nausea, chest pain, muscle weakness and pain, falls.

Other Meds: Loratidine, Oxybutin, Simvastatin, Levothyroxine, Metoprolol, Pantoprazole

Current Illness: No

ID: 1377775
Sex: F
Age: 25
State: OR

Vax Date: 05/29/2021
Onset Date: 05/29/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: CLAIMANT ALLEGES THAT SHE FELL TO THE GROUND AFTER TAKING COVID SHOT. THE CUSTOMER SUFFERED A LACERATION TO THE LIP

Other Meds: Unknown

Current Illness: Unknown

ID: 1377776
Sex: F
Age: 21
State: NC

Vax Date: 04/01/2021
Onset Date: 04/05/2021
Rec V Date: 06/07/2021
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: The first week widespread hives on arms/back/legs for 2 up to 7 hours at a time. After the first week random locations of arms/legs. hives are itchy and spread when itched. React to Benadryl. This has been ongoing nearly every day for 2.5 months since 4 days after vaccine.

Other Meds:

Current Illness:

ID: 1377777
Sex: F
Age: 37
State: OR

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

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Arm (site of vaccination) swollen, erythematic, tender, painful.

Other Meds: Loratadine, Mirena

Current Illness: None

ID: 1377778
Sex: M
Age: 12
State: IL

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 06/07/2021
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: Diffuse hives appeared on patients body several hours after receiving his first Covid vaccine. Dad not sure if was less than 4 hours after vaccination. He had no breathing issues or vomiting. The hives lasted for 2-3 days.

Other Meds:

Current Illness:

ID: 1377779
Sex: M
Age: 47
State: AL

Vax Date: 03/26/2021
Onset Date: 05/20/2021
Rec V Date: 06/07/2021
Hospital: Y

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

Lab Data:

Allergies: No known allergies

Symptom List: Unevaluable event

Symptoms: Patient presented to PCP office on 5/20/21 from residence at group home with C/O body aches, fever up to 100.2, runny nose, sore throat, wheezing, and coughing. Known exposure to COVID-19 at group home. Rapid test done in office positive for COVID-19. Patient admitted to hospital on 05/20/21 and chest Xray positive for ground-glass opacities consistent with COVID pneumonia.

Other Meds: Claritin, Protonix, Colace, Ferrous sulfate, MVI, Symbicort, Zovirax, Flonase nasal spray

Current Illness: unknown

ID: 1377780
Sex: F
Age: 65
State: VT

Vax Date: 03/26/2021
Onset Date: 04/02/2021
Rec V Date: 06/07/2021
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: Sertraline analogues venlafaxine latex pantoprazole phenazopyridine sulfas codeine

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

Symptoms: Approximately one week after the first injection, this patient with known psoriasis developed pustules on hands and lower legs. This was biopsied and shown to be a variation of psoriasis (psoriasiform dermatitis) on 4/23/21.

Other Meds: alprazolam aspirin atenolol bupropion Vit D 3 cyclobenzeprine dexlansoprazole metformin nortriptyline adalimumab

Current Illness:

ID: 1377781
Sex: F
Age: 35
State: OK

Vax Date: 06/06/2021
Onset Date: 06/07/2021
Rec V Date: 06/07/2021
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: No Known Drug Allergies

Symptom List: Injection site pain, Pain

Symptoms: Patient received the vaccine on 6/6/2021 at 4 pm. This morning (6/7/2021) the patient woke up with a fever and chills. She got up to go to the bathroom and experienced a seizure. Patient reports that her husband was home during the seizure and he reports that it lasted for 4 minutes. Patient hit her head on the floor at the beginning of the seizure and reports having a horrible headache and sore neck currently. Advised patient to go to the doctor to be checked out.

Other Meds: Lithium ER 300 mg taking two tablets by mouth twice daily Citalopram 20 mg taking one tablet by mouth once daily Alprazolam 0.5 mg taking one tablet by mouth three times a day

Current Illness:

ID: 1377782
Sex: M
Age: 13
State: WA

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
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

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever - up to 102 - lasted until yesterday - it was back down to normal yesterday. He has had a sore arm - at injection site; the arm also was hard - a lump that was a little bit palpable - which is gone now; - body aches - gone now, chills, difficulty swallowing. He didn't have trouble breathing, but he felt his throat tighten when he swallowed (still has this); upper right abdominal pain - that is the real bad symptom still. His eyes hurt when he moved them around. Fatigue. He's been glued to the couch since Friday. I had given Advil and Tylenol. After the prolonged fever, I eventually called into the doctor's office. The pediatrician said it was common and said to wait it out but seek treatment if it got worse. He is able to eat but is awful nauseous. He is eating what sounds good. The pain stays the same when he eats.

Other Meds: no

Current Illness: no

ID: 1377783
Sex: M
Age: 26
State: OR

Vax Date: 05/24/2021
Onset Date: 05/28/2021
Rec V Date: 06/07/2021
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:

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

Symptoms: Chest pain over 1 day

Other Meds:

Current Illness:

ID: 1377784
Sex: F
Age: 64
State: AZ

Vax Date: 04/07/2021
Onset Date: 04/09/2021
Rec V Date: 06/07/2021
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: Allergic to cucumbers, milk, raw onion trees, mold, dust

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: For the past six weekends patient gets severe fever of coldness shaking and lies on a full length heating pad to warm up. Then experiences fever of hotness sweating and cannot cool down. Muscle aches, joint aches and hurts to touch the skin and exhaustion. The aches and fever last 4 - 6 hours and the next day all she can do is sleep.

Other Meds: NP Thyroid Medication Vitamin B12 & Optimized Folate L-Methyl folate

Current Illness: No illnesses

ID: 1377785
Sex: F
Age: 44
State: CO

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fever of 99.1, along with full body muscle aches on 4 June, treated with 800mg of ibuprofen. Fever of 99.6 along with some muscle aches in arms and legs on 5 June, treated with 800 mg of ibuprofen. Intermittent muscle spasms in arm/shoulder near injection, started early morning of 7 June, has not stopped yet (been 10 hours since it began)

Other Meds: None

Current Illness:

ID: 1377786
Sex: F
Age: 64
State: TN

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/07/2021
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: None

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

Symptoms: The day I got it I had Headache body aches fever, chills, urine smelled like sewer fever went up to 104 in the night my legs couldn't hold me up I was hallucinating and thought I was going to die. Next day Tylnol kept fever to 101. still had Headache and body aches no energy Saturday was washed out n no energy n headache. Sunday a headache n today Monday a headache still and urine still smells bad

Other Meds: Baby Aspirin,1 daily. Plavix 75 mg, 1 daily. Bupopion HCL SR 150mg 2 daily. Metphormin HCL 500mg 2 daily. Buspirone HCL 10 MG 2 daily. Carvedilol 25mg 2d daily. Cyclobenzaprine 10 mg 3 times daily. Protonix 40 mg 1 daily. Lipitor 40 mg 1 da

Current Illness: Diabetes Heart ,degenerative disc n neuropathy

ID: 1377787
Sex: F
Age: 45
State: GA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Nausea

Symptoms: Patient reported palpitations, throats feels "funny", heart fluttering, heavy chest @ 9:19a. EMS called @ 9:22a. Diphenhydramine 12.5 mg PO administered @ 9:23a. Symptoms resolved in throat per patient @ 9:28a. Patients blood pressure was elevated at 9:20a at 154/111, pulse 85, O2 Sat 97% on outside air, respirations 16. EMS arrived at 9:32a. Patient not transported to hospital. EMS departed. Patients status when leaving was A+O x 4, clear speech, walking, all symptoms resolved.

Other Meds: Protonix

Current Illness: None

ID: 1377788
Sex: M
Age: 17
State: MI

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 06/07/2021
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: 17 YEAR OLD RECEIVED MODERNA BRAND VACCINE. IT WAS REALIZED WHEN HE CAME BACK FOR HIS 2ND DOSE. FAMILY UNDERSTAND HIS VACCINATION SERIES IS COMPLETE.

Other Meds:

Current Illness:

ID: 1377790
Sex: M
Age: 28
State: OR

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies: NA

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

Symptoms: 5 minutes after initial injection I became increasingly lightheaded, nauseous, dizzy, disoriented, and fatigued. 10 minutes after initial injection I experienced a short fainting event in passenger seat of vehicle. Immediately after regaining composure I began sweating profusely and became very pale/flushed color in face at which point I exited the vehicle and flagged EMS to assist me. EMS monitored blood pressure and blood saturation before releasing me on my own recognizance approximately 25 minutes later. Tingling sensation felt in left arm after fainting approximately 10 minuets after initial injection. Next 48 hours after injection I experienced severe body chills, body aches, headache, nausea, loss of appetite, and night sweats. 72 hours after injection I am close to fully recovered but still experience fatigue and night sweats.

Other Meds: NA

Current Illness: NA

ID: 1377791
Sex: M
Age: 12
State: CA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
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: unknown

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

Symptoms: Patient reported feeling nauseous and vomited a few minutes after receiving his second dose of pfizer. Pt looked pale and reported feeling lightheaded. Pt did not show any signs of respiratory distress: no swelling of the throat, face or mouth observed. Vital signs were within limit: BP 125/72, HR 60, RR 12 (at 3:45pm), BP 120/74, HR 62, RR 13 (at 3:45). Patient reported feeling better after vomiting. Observation nurse took vital signs, offered water and Gatorade. Pt left our site at 3:50 (Patient's mother was driving).

Other Meds: unknown

Current Illness: unknown

ID: 1377792
Sex: F
Age: 50
State: AL

Vax Date: 03/24/2021
Onset Date: 05/20/2021
Rec V Date: 06/07/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin, Aspirin

Symptom List: Tremor

Symptoms: Patient presented to PCP from group home residency on 05/20/2021 complaining of fever up to 100.9, body aches, sore throat, runny nose with known exposure to COVID-19. Rapid test in office was positive for COVID-19. Chest Xray findings consistent with COVID pneumonia. Patient admitted to hospital on 05/20/2021.

Other Meds: Mobic, Singulair, Synthroid, Prinivil, Advair, Flonase, Albuterol neb, Seroquel, Zoloft, Glucophage, Zyrtec

Current Illness: unknown

ID: 1377793
Sex: F
Age: 33
State: MO

Vax Date: 06/02/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
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: N/A

Symptom List: Erythema, Pruritus

Symptoms: I noticed a large bump in my left armpit, which I realized was swollen lymph nodes. Today (6/7/2021) I noticed the swelling going down.

Other Meds: Oral birth control, over-the-counter iron supplement, over-the-counter store brand allergy

Current Illness: Chest congestion with runny nose and cough

ID: 1377794
Sex: F
Age: 30
State: KS

Vax Date: 01/08/2021
Onset Date: 01/16/2021
Rec V Date: 06/07/2021
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: No allergies to medication, food or other products.

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

Symptoms: On the the 16th of January I started feeling like a had a virus. The next day I started to cough and shortness of breath and was feeling like I was going to pass out. I also had diarrhea and lactic acidosis.

Other Meds: No medications at the time of vaccination.

Current Illness: No known illnesses.

ID: 1377795
Sex: F
Age: 38
State: WI

Vax Date: 02/16/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
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: Vicodin, environmental (unspecified)

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

Symptoms: Pt received both doses of the Moderna COVID-19 vaccines, one on 1/19/21 and the second on 2/16. No lot number is located either in patient chart or state vaccine electronic registry (WIR). For location, there was only a number listed, "11029", on both entries. Writer will be unable to obtain any further vaccination information. Pt then tested positive after a trip. Pt was negative on 5/27/21, and then tested positive via PCR on 6/4/2021 at an outpatient drive through testing site. Pt reports chest congestion, altered taste and smell, and fatigue, since 5/31/2021. No other symptoms, pt was not ill enough to be hospitalized. Sample will be submitted via state testing for variant testing.

Other Meds: bupropion, Nuvaring, fluticasone Nasal, Advair Diskus

Current Illness:

ID: 1377796
Sex: M
Age: 50
State: CT

Vax Date: 03/03/2021
Onset Date: 03/21/2021
Rec V Date: 06/07/2021
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: Nkda

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt had vaccine on March 3 then Pt had posterior pain, extreme malaise and waves of nausea and dizziness about 2 weeks after injection.slight fever. Otherwise previously healthy . Seen by MD March 25. Second shot March 31. In Middlesex ED April 3 with same complaints. Ct scan revealed liver cyst aspirated. Continues to this day with abd pain, malaise, waves of nausea and dizziness.

Other Meds: VitD3

Current Illness: No illness

ID: 1377797
Sex: M
Age: 15
State: CA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Chest pain, headache, shortness of breath. Now with convulsive movements and periods of unresponsiveness. Work up for seizures and encephalopathy in progress. Dx studies: troponin, BNP, EKG, chest CT, head CT (all negative), CRP (elevated). Currently in Pediatric ICU and work up in progress (6/7)

Other Meds: None

Current Illness: None

ID: 1377798
Sex: F
Age: 18
State: TX

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/07/2021
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: patient received vaccine and fainted about 5 minutes later. She hadn't eaten prior and believe event actually due to low blood sugar. Called patient later, she was fine

Other Meds: none known

Current Illness: none

ID: 1377799
Sex: M
Age: 28
State: CA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Pain in extremity

Symptoms: About 5 minutes into his post-vaccination observation, patient felt unwell and tried to get up to get help. We are on-site pharmacy located inside the Health Center. At the time, a nurse is monitoring patients at the observation area. He noticed the patient was pale and he reached over to grab the patient as he was about to fall/faint. The nurse took him back into one of the patient's room. His blood pressure was very low. Patient was given 2 boxes of apple juices and some Gatorade. He rested for another 30 minutes and he felt better. Then he left.

Other Meds: Unknown

Current Illness: None provided by patient

ID: 1377800
Sex: F
Age: 27
State: TX

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient directed to table #1 to receive vaccine. Patient stated that she has anxiety when getting shots but was ok after 1st dose. After administering 2nd dose patient stated she was a little light headed. Nurse encouraged pt. to stay seated and remember to breathe. Patient started drinking her orange juice and stated she was ok. Patient continued to close her eyes and nurse asked if she was ok and patient stated "I feel it coming, I'm about to pass out." Patient then started to lean in chair and with nurse beside her for safety notified nurse lead and post ob nurses for assistance. This nurse responded to station one to assist. V/S taken immediately. BP94/47 P52 Ox 99% T97.3 RR20 BS85. Patient began to respond appropriately. Assisted patient in to a laying position. Patient continuously monitored following incident for 30 minutes. Remained AOx4. Patient stated she was feeling better. Assisted in to chair by nurses. VS rechecked BP 104/69 P59 O2 98% Pt. was accompanied by mother and released after stabilized.

Other Meds: Birth Control

Current Illness: N/A

ID: 1377801
Sex: F
Age: 42
State: WA

Vax Date: 01/03/2021
Onset Date: 01/05/2021
Rec V Date: 06/07/2021
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: None

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

Symptoms: 3 days after vaccine, I got really rapid heart rate, high heart rate, muscle spasms, fatigue, chest pain, shortness of breath. Over the next 4 days it increased dramatically. I visited my PCP and I had blood work done and that is when I was diagnosed with graves disease. I was back in normal range and got my second dose and then it raised my labs, about April 22nd, 2021 2 weeks after my second vaccine, my labs showed my levels to have increased again. May 11th and June 4th I visited Endocrinologist. On Jan 13th diagnosed with Graves Disease.

Other Meds: None

Current Illness: None

ID: 1377802
Sex: F
Age: 56
State: KY

Vax Date: 05/15/2021
Onset Date: 06/01/2021
Rec V Date: 06/07/2021
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: penicillin, sulfa antibiotics

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

Symptoms: Patient initially had redness and warmth at the injection site, this went away after a week. Recently the patient has noticed some loss of mobility with the left shoulder accompanied with pain in the shoulder joint.

Other Meds: Atenolol 50mg, Zolpidem 5mg, Alprazolam 0.25mg

Current Illness: acute otitis media treated with antibiotics on 4/10/21

ID: 1377803
Sex: F
Age: 27
State: GA

Vax Date: 03/21/2021
Onset Date: 03/23/2021
Rec V Date: 06/07/2021
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: NKDA

Symptom List: Vomiting

Symptoms: Epigastric pain, gastroesophageal reflux disease, Hiatal hernia

Other Meds: Trazadone, Buspar

Current Illness: None

ID: 1377804
Sex: F
Age: 75
State: FL

Vax Date: 06/02/2021
Onset Date: 06/03/2021
Rec V Date: 06/07/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: The day after the patient recieved the vaccine she developed hives and itching all over her body. The patient went to her MD and was given benadryl and has recovered from her hives.

Other Meds: none according to patient, only taking levothyroxine

Current Illness: none

ID: 1377805
Sex: F
Age: 51
State: FL

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 06/07/2021
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: Prednisone, penicillin, tramadol,

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

Symptoms: Initially slight headache, 5hrs later difficulty moving from waist down, 4/18/21 - tingling from waist down, went to ER no reflex response in both knees, 4/19/21 tingling in both arms, over a period of six days severe headache, lower body weakness, nausea. When discharged still lower body weakness. Since that time in May experienced 5/2021 complex hemiplegic migraine, lower body weakness waist down. Presently 6/2021 still lower body weakness and severe hemiplegic migraine, blurred vision.

Other Meds: Gabapentin 300mg, Lisinopril 2.5mg,Aspirin 81mg, Integra Plus capsule, Metformin 500mg, Metoprolol Tart 25mg, Pantoprazole Dr 40mg, Atorvastatin 20mg, Senna laxative,

Current Illness:

ID: 1377806
Sex: F
Age: 37
State: CA

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 06/07/2021
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: Benadryl Aspirin Ibuprofen Pertaicil

Symptom List: Injection site swelling, Limb discomfort

Symptoms: After the vaccination I felt very tired. I felt like I had a fever, I took my temperature and it was a 104 degrees. My head started to hurt and I started to throw up. My body started to ache as well. I consulted my doctor and he told me that people that have diabetes had these types of symptoms. He advised for me to a Aleve for the symptoms. The symptoms lasted for about 5 days and then the symptoms subsided.

Other Meds: Metformin HTC Thyroid Medication

Current Illness:

ID: 1377807
Sex: F
Age: 66
State: MN

Vax Date: 03/15/2021
Onset Date: 03/18/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies: Severe seasonal allergies Lactose intolerant Lisinoprin Food intolerances to some grains

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

Symptoms: Swollen joints Tired intermittent Rare but out of breath sometimes. Worse after 2nd Treated with med pack of prednisone No help.

Other Meds: Losartan Triamterene Klor con M20x2 Humilog Lantus Oxycodone EGCG SamE Glucosamine/chondroitin CoQ10

Current Illness: Felt amazing. 15k to 20 k of steps 6x per week.

ID: 1377808
Sex: F
Age: 47
State: MI

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/07/2021
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: Demerol, meperidine, protamine sulfate, reglan, depakote, droperidol, troadol, adhesive bandages, aimovig, ergotamine, fioricet, rice, corn, soy, peanuts, halothane, imitrex, inderal, maxalt, naprosyn, sudafed, valproic acid, cafergot, topamax, amoxicillin, augmentin, cefuroxime, lyrica, midrin, prednisone, hydrocodone (Qualitest), pseudoephedrine

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

Symptoms: Pt reported fatigue, headache, myalgias, and chills. Per appointment, pt is experiencing a fibromyalgia flare, has a migraine, and reports "burning pain on upper arms and lower extremities" to the point that she has been unable to wear clothing that touches her arms due to the pain.

Other Meds: albuterol, xanax, baclofen, zyrtec, cyanocobalamin, pradaxa, pristiq, cardizem, benadryl, neurontin, norco, atarax, mirena, synthroid, emla cream, magnesium, proamatine, singulair, omega-3 fatty acids, prilosec, zofran, phenergan, zocor, tr

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm