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: 1379319
Sex: F
Age: 32
State: FL

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

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Dizziness.

Other Meds: I only take omeprazole every day and centrum and hair skin nails. In the morning I got dizzy and the tension went down and now, around 8:30 pm at night, I got dizzy again.

Current Illness: None

ID: 1379320
Sex: F
Age: 12
State: WA

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

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

Lab Data:

Allergies: Latex and adhesive

Symptom List: Anxiety, Dyspnoea

Symptoms: Ten minutes after shot she began complaining of tightness in throat and chest. Monitored for 45 min and then began throwing up at 7 pm. Vomited rest of evening and all the next day. Went to ER and given an injection of epinephrine. Sent home. Continued to vomit and went back into ER and admitted to hospital.

Other Meds: Melitonin

Current Illness: UTI - unknown at the time of vaccination.

ID: 1379321
Sex: F
Age: 31
State: NY

Vax Date: 05/01/2021
Onset Date: 05/26/2021
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: None

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

Symptoms: Itching, swelling on hands with skin peeling

Other Meds: None

Current Illness: None

ID: 1379322
Sex: M
Age: 16
State: CA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: PATIENT RECEIVED 1ST DOSE, THEN SAT IN OBSERVATION AREA WITH HIS MOM. PATIENT SLUMPED IN CHAIR AND HAD FAINTED - MOM YELLED FOR HELP. I CAME OVER TO HELP THE PATIENT DOWN TO THE GROUND AND ASSESS. A BYSTANDER CALLED 911. PATIENT WAS PALE, HAD A PULSE. PATIENT HAD A PULSE AND WAS BREATHING, COLOR STARTED TO COME BACK TO HIS FACE. HE WOKE UP AND PULSE WAS ABOUT 60-64BPM. PATIENT KNEW WHERE HE WAS. THE AMBULANCE CAME AND TOOK HIM TO THE HOSPITAL.

Other Meds: N/A

Current Illness: N/A

ID: 1379323
Sex: F
Age: 35
State: NV

Vax Date: 04/27/2021
Onset Date: 04/27/2021
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:

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

Symptoms: Less than an hour after I received the shot, I started feeling nauseous, dizzy, lightheaded, confused/brain fog (I literally felt drunk), hot and cold flashes and generally unwell. The next day, I woke up with a sore throat and a head cold. The brain fog, bad nausea, internal temp issues and general unwell feeling lasted through Saturday. The SCARIEST part was that it felt like my heart hurt when I was breathing on the third day. I currently have a shoulder injury, so I took ibuprofen and the heart pain went away.

Other Meds: Over the counter allergy meds and birth control pill

Current Illness: None

ID: 1379324
Sex: M
Age: 12
State: FL

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

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: Chest Pain due to Myocarditis

Other Meds: None

Current Illness: None

ID: 1379525
Sex: F
Age: 35
State: NV

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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Less than an hour after I received the shot, I started feeling nauseous, dizzy, lightheaded, confused/brain fog (I literally felt drunk), hot and cold flashes and generally unwell. The next day, I woke up with a sore throat and a head cold. The brain fog, bad nausea, internal temp issues and general unwell feeling lasted through Saturday. The SCARIEST part was that it felt like my heart hurt when I was breathing on the fourth day. The entire experience was the exact same as the first shot, except that it took a little longer to feel sick and that my heart hurt MUCH worse. It was terrifying, because it hurt to breathe and I literally feared for my life. I currently have a shoulder injury, so I took ibuprofen (800 mg) and the heart pain went away and stayed away. I also experienced visual hallucinations!! It was kind of scary because I live alone. I strongly believe my body responded to the vaccine with inflammation - hence the heart issues and hallucinations. I'm really concerned about these things for future covid vaccines, so please contact me about this. Thanks!

Other Meds: Over the counter allergy meds and birth control pill

Current Illness: None

ID: 1379526
Sex: F
Age: 38
State: CA

Vax Date: 05/14/2021
Onset Date: 05/21/2021
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: Ceclor

Symptom List: Pharyngeal swelling

Symptoms: Rash at injection site 1 week after vaccine received. Rash about 3 inches in diameter, warm to the touch, slightly itchy.

Other Meds: Lexapro Multi vitami

Current Illness: None

ID: 1379527
Sex: F
Age: 34
State: CA

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

Lab Data:

Allergies: None known

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Started as a slight headache and soar arm and increased to a pulsating headache with so much pressure it caused me to vomit, arm swelled a little with 2 red spots and pain increase quite a bit at spot the shot was given and arm was shaking a bit and hurt to put it straight. Headache persisted for almost 8 hours and felt immense pressure, hurt to keep my left eye open when headache was at its most severe. Took 2-Excedrin extra strength and a hour later took 4-200mg ibuprofen. The pressure from the headache started to subside and it getting better now. When finally open my left eye again it was blurry and unable to focus for about 5 mins

Other Meds: Prozac oma

Current Illness: Depression, bipolar, anxiety

ID: 1379528
Sex: F
Age: 51
State: VA

Vax Date: 05/27/2021
Onset Date: 06/01/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Sharp pain in chest especially when inhaling; clicking at left of sternum with heart beat; unable to get deep breath. Given IV anti-inflammatory.

Other Meds:

Current Illness:

ID: 1379529
Sex: F
Age: 20
State: IN

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: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: symptoms: fever (up to 102) chills headache dizziness naesous body aches treatment: ibuprofen outcome: miserable, couldn?t sleep or eat and the fever wouldn?t break. the ibuprofen made the headache go away

Other Meds: prozac magnesium vitamin b complex

Current Illness: none

ID: 1379530
Sex: M
Age: 23
State: PA

Vax Date: 06/02/2021
Onset Date: 06/04/2021
Rec V Date: 06/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Patient started having generalized weakness, fatigue, fever and headache after the second dose of his Moderna Covid-19 vaccine. These symptoms persisted throughout the next day. However, two days after the second Covid-19 shot patient developed severe chest pain that resulted in presentation in the ED. There was associated shortness of breath and diaphoresis. He was treated with Colchicine and Ibuprofen. He was also started on metoprolol because he had an 11-beat run of non-sustained ventricular tachycardia. He was discharged home on the fourth day to follow up with cardiology as outpatient.

Other Meds: Not applicable

Current Illness: None

ID: 1379531
Sex: F
Age: 20
State: WA

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

Lab Data:

Allergies: nka

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

Symptoms: patient experienced syncope, fainted 5 minutes after recieving vaccinefor 1 minute then came back conscious

Other Meds: na

Current Illness: none

ID: 1379532
Sex: M
Age: 58
State: VA

Vax Date: 03/01/2021
Onset Date: 04/13/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Headaches, nausea, shingles

Other Meds: Diabetic meds and multivitamins

Current Illness: Diabetic, previous bouts of shingles

ID: 1379533
Sex: F
Age: 33
State: FL

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

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

Symptoms: Allergy all over the body, swollen lips and face, itchy rash.

Other Meds:

Current Illness:

ID: 1379534
Sex: F
Age: 48
State: ID

Vax Date: 01/12/2021
Onset Date: 01/12/2021
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: Gluten Dairy

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

Symptoms: Extreme fatigue. Slept for 18 hours after receiving the vaccination.

Other Meds: Estradiol Vaginal insert 10 mcg 2x/week Pantoprazole 40 mg qd Levothyroxine 50 mcg qd Singular 10 mg qd Escitalopram oxalate 20 mg qd Fluticasone 2 sprays/nostril qd Meloxicam 7.5 mg bid Multivitamin 2 qd Calcium w/ vital D 500/200 qd Magne

Current Illness: Covid-19

ID: 1379535
Sex: F
Age: 53
State: CA

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

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

Symptoms: welts began to appear on arm and shoulder within about 1.5 hours -2 hours after injection. Hot, swollen, welts

Other Meds: none

Current Illness: none

ID: 1379536
Sex: F
Age: 40
State: MA

Vax Date: 02/25/2021
Onset Date: 02/25/2021
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: Sulfa, Cipro, and morphine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: The day of my first shot I felt sick for a few days normal symptoms then when I got the second shot I had severe symptoms and was in bed for four days with fever chills high temperature dehydration horrible flu like symptoms. Since I have had the second vaccination I have been sick Pretty continuous and have had some weird issues such as ringworm that has spread all over my body

Other Meds: Methadone, cetirizine, Depo-Provera shot

Current Illness: I was tested multiple times more than five times for Covid because I was having symptoms of it and every test came back negative however my doctor treating me as though I had it because I was showing all symptoms of it

ID: 1379537
Sex: F
Age: 36
State: NC

Vax Date: 05/24/2021
Onset Date: 06/07/2021
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: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: At first only moderate arm pain and soreness, fatigue and nausea and headache lasting 24 hours. Then two weeks of being totally fine. Then suddenly woke up on the 14th day feeling like I had been shot in the arm by a gun. Limited mobility in arm and shoulder, extreme pain at injection side and in shoulder. Range of motion that hurts feels similar to rotator cuff injury (which I?ve had before and therefore can identify.) The two weeks in between there were no symptoms. I don?t know if these are related, but just in case- I also woke up with a headache and rib pain on my right side. My elbow on injection site side now feels painful but I do have pain there sometimes anyway. Soreness from shoulder down to wrist. I am a bartender and had to go home early from work due to the pain. I am concerned this will not go away. Could it be SIRVA? Could SIRVA suddenly show up two weeks *after* an injection? Thank you.

Other Meds: Lamotrigine 200 mg / day in am

Current Illness: None

ID: 1379538
Sex: F
Age: 45
State: NV

Vax Date: 06/05/2021
Onset Date: 06/07/2021
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: Penicillins, azythromycin, Vicodin, dairy, 70% of the environment

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

Symptoms: Swelling in my lower body- legs swelled so much, my knees disappeared.

Other Meds: None

Current Illness: None

ID: 1379539
Sex: M
Age: 63
State: FL

Vax Date: 06/04/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Iodine

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

Symptoms: Fever, muscle aches, dizziness, drowsiness, heart palpitations,

Other Meds: Metoprolol 25mg Esomeprazole 40 mg

Current Illness: None

ID: 1379540
Sex: M
Age: 54
State: TN

Vax Date: 05/06/2021
Onset Date: 05/08/2021
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: Allergic to penicillian

Symptom List: Unevaluable event

Symptoms: Shingles area appeared two days after the second shot. Didn't connect what it was thought maybe an insect sting. After a week of getting worse I went to a clinic and said it was shingles. Was prescribed Valtrex and later developed gout flare-up and sores in my mouth and on my private area. Getting better but not all side-effects have gone away yet.

Other Meds: None other than daily vitamin which was not taken that day.

Current Illness: none

ID: 1379541
Sex: F
Age: 40
State: LA

Vax Date: 04/30/2021
Onset Date:
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:

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

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 1379542
Sex: M
Age: 13
State: IL

Vax Date: 06/06/2021
Onset Date: 06/06/2021
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: Penicillin

Symptom List: Injection site pain, Pain

Symptoms: Fever, chills, headache, difficulty hearing starting the night of the shot and so far the next day as well. Given Tylenol every 6 hours.

Other Meds:

Current Illness:

ID: 1379543
Sex: M
Age: 67
State: CA

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

Lab Data:

Allergies: nka

Symptom List: Injection site pain, Menorrhagia

Symptoms: At 1540 RN came to Lead office and informed Co-Lead that she had erroneously vaccinated client two days before his second dose of Moderna was due. Co-Lead went to the vaccination room, verified client's identity, and confirmed Client's first dose of Moderna was given on 5/12/2021, and therefore, his second dose was due 6/9/2021. On the back of the vaccination card, the reminder erroneously listed today, June 7, 2021, as the return date and this is why Ancillary and Vaccinator proceeded with the vaccination. Moderna, lot# 027C21A vaccine was given to client at 1536. Using vaccinator to translate into Spanish, the RN informed client that a VAERS and VERP report would be filed, and client verbalized understanding. RN then educated the vaccination team that client's info should always be screened for the appropriateness of receiving a second dose by verifying when the first dose was received, and not to rely on what the vaccination card says. Co-lead also educated check-in RN, Co-Lead Ancillaries, and Ancillary working with vaccinator regarding the importance of verifying each client's first vaccination date before sending them upstairs for their second dose. Co-lead verified that she would reiterate the importance of date verifications with all ancillary staff. Client was informed VAERS and VERP would be submitted.

Other Meds: none

Current Illness: none

ID: 1379544
Sex: F
Age: 27
State: NM

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 06/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Rapid heart rate. 120 standing, 100 resting for first few days. Chest pain since second shot.

Other Meds:

Current Illness:

ID: 1379545
Sex: M
Age: 51
State: MO

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient was given vaccine that was mixed >6 hours prior to injection but less than <24 hours. It was stored in the refrigerator before administration.

Other Meds:

Current Illness:

ID: 1379697
Sex: F
Age: 42
State: WA

Vax Date: 04/28/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKMA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Body rash. Diagnosis: Shingles

Other Meds:

Current Illness: None

ID: 1379698
Sex: M
Age: 72
State: AZ

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

Lab Data:

Allergies: No known allergies

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

Symptoms: The patient stated that he needed his second vaccine and at first said the thought he first received the Pfizer injextion. I spoke to him and told him we have all 3 vaccines but the only 2 vaccines that required 2 shots was the Pfizer and then Moderna. I told him he needed to get the same vaccine for both and he then stated Moderna. I asked him if her was sure and he said yes. He didn't have his card upon the initial visit. We vaccinated him with Moderna and when he returned with his card it indicated he received the Pfizer for the first vaccine. We observed his for the 15 minutes without any adverse reactions.

Other Meds: n/a

Current Illness: None known

ID: 1379699
Sex: M
Age: 65
State: WA

Vax Date: 03/01/2021
Onset Date: 03/09/2021
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:

Symptom List: Nausea

Symptoms: Dizzy

Other Meds:

Current Illness:

ID: 1379700
Sex: M
Age: 17
State: TX

Vax Date: 06/04/2021
Onset Date: 06/07/2021
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: Allergic to cats

Symptom List: Injection site pain

Symptoms: Red & Itchy Rash on arms & torso

Other Meds: None

Current Illness: None

ID: 1379702
Sex: M
Age: 29
State: CA

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

Lab Data:

Allergies: None

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

Symptoms: Patient collapsed a few minutes after receiving the vaccine and injured his chin. Patient was up walking around until time of collapse, and remained laying down until paramedics came. Patient was transported to the hospital via ambulance.

Other Meds: None

Current Illness: None

ID: 1379703
Sex: M
Age: 23
State: AZ

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Gluten Allergy

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

Symptoms: The vaccine was given about 1/2 hour past the 6 hour window tine frame. The Pfizer vial was mixed at 10:50am and the vaccine was given between 5:10 and 5:30pm.

Other Meds: none known

Current Illness: None known

ID: 1379704
Sex: M
Age: 13
State: MO

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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient was given vaccine that was mixed >6 hours prior to injection but less than <24 hours. It was stored in the refrigerator before administration.

Other Meds:

Current Illness:

ID: 1379705
Sex: F
Age: 50
State: FL

Vax Date: 05/26/2021
Onset Date: 05/27/2021
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: None

Symptom List: Erythema, Pruritus

Symptoms: Tingling/numb feeling on left side of face only. Forehead, cheek, left eye, left side of my lips.

Other Meds: Progesterone

Current Illness: None

ID: 1379706
Sex: M
Age: 62
State: WV

Vax Date: 02/12/2021
Onset Date: 02/01/2021
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: none

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

Symptoms: Ringing in ear (mostly left ear) since (more or less) receiving the second dose of the Moderna Covid19 vaccine.

Other Meds: none

Current Illness: none

ID: 1379707
Sex: M
Age: 71
State: MT

Vax Date: 03/04/2021
Onset Date: 03/05/2021
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: NKDA

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

Symptoms: Patient developed weakness in his left hand the following morning, with inability to move or manipulate with hand such as pick up utensils starting morning of 3/5/2021. This did slowly improve and pt underwent PT for this. He has had changes in energy and cognition as well.

Other Meds: bupropion HCl 300 mg daily, metformin 500 mg PO BID, omeprazole 20 mg PO DAILY, prednisone 10 mg PO DAILY, tamsulosin 0.4mg daily

Current Illness: none

ID: 1379708
Sex: M
Age: 34
State: MT

Vax Date: 03/26/2021
Onset Date: 04/19/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Emblematic stroke in vision and language centers of brain causing blurred vision and aura as well as facial droop and slurred speach.

Other Meds: Daily vitamin, zyrtec

Current Illness: None

ID: 1379709
Sex: M
Age: 15
State: MO

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: 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: Patient was given vaccine that was mixed >6 hours prior to injection but less than <24 hours. It was stored in the refrigerator before administration.

Other Meds:

Current Illness:

ID: 1379710
Sex: M
Age: 12
State: AZ

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None Known

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

Symptoms: The vaccine was administered after the 6 hour expiration window. The vial was mixed that day at 10:50am and administered between 5:00-5:10pm.

Other Meds: None Known

Current Illness: None Known

ID: 1379712
Sex: F
Age: 19
State: CO

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

Symptom List: Pain in extremity

Symptoms: My arm broke out in red rash and hives. Over the next couple days it spread all the way to my ankles.

Other Meds:

Current Illness:

ID: 1379713
Sex: M
Age: 21
State: MO

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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Patient was given vaccine that was mixed >6 hours prior to injection but less than <24 hours. It was stored in the refrigerator before administration.

Other Meds:

Current Illness:

ID: 1379714
Sex: F
Age: 12
State: NV

Vax Date: 06/03/2021
Onset Date: 06/06/2021
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: Not sure what maker, received together Dtap and MCV4 (Meningococcal). One in each arm

Other Meds: None

Current Illness: None

ID: 1379715
Sex: F
Age: 41
State: MO

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient was given vaccine that was mixed >6 hours prior to injection but less than <24 hours. It was stored in the refrigerator before administration.

Other Meds:

Current Illness:

ID: 1379716
Sex: F
Age: 41
State: VA

Vax Date: 06/04/2021
Onset Date: 06/05/2021
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: Cephalosporins

Symptom List: Vomiting

Symptoms: Pain, redness, swelling, itching, and heat around the injection site

Other Meds: Nortiptyline, esomeprazole, ibuprofen, melatonin, IUD

Current Illness: None

ID: 1379717
Sex: F
Age: 23
State: VA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: 4/30 - Five minutes after the vaccine, I passed out. I felt uncontrollably shaky and my vision went white. I was not anxious prior to getting the vaccine and felt terror afterwards. 5/1 - I developed severe depression and suicidal ideation. I reported to those around me that I did not feel safe. I am not diagnosed with depression and did not experience depression prior to the vaccine. I felt suicidal, completely hopeless, anxious, and was uncontrollably bursting into tears without an identifiable trigger. 5/2 - I developed shooting pain in my legs and arms. It felt like a pulsating, stabbing pain that throbbed. It was unlike any pain I had experienced ever before. 5/3 - I developed a metallic taste in my mouth that could not be washed away with water or food. It was extremely noticeable. 5/4 - My period came a week early. I have been on birth control for seven years and have never experienced any changes in my menstrual cycle. I made no other lifestyle or health changes other than the vaccine. The period was extremely heavy, full of clots, and was painful. It lasted longer than usual, until about 5/9. 5/16 - I developed another period only a week after the first period. This period was equally as heavy and long-lasting. It remained until about 5/21. Following the vaccine, I began suffering from heart palpitations, leg cramps, and random pains. I did not experience these prior to the vaccine. I cannot identify the date these symptoms began, but it was within the first week of taking the vaccine.

Other Meds: Sprintec birth control

Current Illness: None

ID: 1379719
Sex: F
Age: 48
State: TX

Vax Date: 03/21/2021
Onset Date: 03/23/2021
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: Percocet, Levoquin, Welbutrin

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

Symptoms: Bladder pain went to er(meds given) Superficial blood clot on right thigh(meds given) Calf pain right leg ***Er with bilateral pulmonary embolism ( hospital 3 nights) ***Dvt right leg(on warfarin)

Other Meds: Advil as needed

Current Illness: Lupus

ID: 1379720
Sex: F
Age: 12
State: NV

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Augmentin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Nausea and vomiting started just after midnight, every 30 minutes, then increased to constant every 5 minutes by 0500. 0630 intractable and heart rate in 130s. Taken to ER where 2 boluses of fluids and Zofran given. 1200 she still could not get an ice chip down without vomiting and heart rate remained between 110-140. Admitted to pediatric floor for observation and fluids. About 1600 she was able to hold down spoonful of fluids. By 1900 she was totally back to feeling good and was able to hold down mac-n-cheese, ice cream, crackers with no nausea.

Other Meds: Keflex 500mg BID

Current Illness: None

ID: 1379721
Sex: F
Age: 35
State: MO

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

Lab Data:

Allergies:

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

Symptoms: Patient was given vaccine that was mixed >6 hours prior to injection but less than <24 hours. It was stored in the refrigerator before administration.

Other Meds:

Current Illness:

ID: 1379722
Sex: F
Age: 63
State: AZ

Vax Date: 05/07/2021
Onset Date: 05/12/2021
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: Prednisone Iodine Morphine Raspberries Avocado

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

Symptoms: Severe psoriatic arthritis inflammation in left knee leading to swelling, difficulty in bearing weight and walking, pain with any pressure on the knee. The adverse event continues to worsen rather than resolve.

Other Meds: Tiazac Maxine Lisinopril Synthroid Estradiol Enbrel

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm