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: 1381758
Sex: F
Age: 60
State: HI

Vax Date: 02/18/2021
Onset Date: 02/01/2021
Rec V Date: 06/08/2021
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: I'm allergic to ampaceillin and infeds.

Symptom List: Dysphagia, Epiglottitis

Symptoms: I had an increase in Herpes outbreaks.

Other Meds: I was taking multi-vitamins.

Current Illness: No.

ID: 1381759
Sex: M
Age: 69
State: NJ

Vax Date: 02/03/2021
Onset Date: 06/05/2021
Rec V Date: 06/08/2021
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: nsaids

Symptom List: Anxiety, Dyspnoea

Symptoms: bell's palsy

Other Meds: lipitopr prednisone

Current Illness:

ID: 1381760
Sex: F
Age: 33
State: IL

Vax Date: 04/09/2021
Onset Date: 04/16/2021
Rec V Date: 06/08/2021
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: I received my first vaccine May 11 and a week later I started having ringing in my ears along with pressure and pain. I saw my primary doctor, a walk in doctor, and finally an ENT for it. I was afraid to get my 2nd dose but I went ahead with it and I still have ringing in both of my ears.

Other Meds: None

Current Illness: None

ID: 1381761
Sex: F
Age: 10
State: WI

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

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

Lab Data:

Allergies: NA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Given to 10 year old

Other Meds: NA

Current Illness: NA

ID: 1381762
Sex: U
Age: 60
State:

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 06/08/2021
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: Nausea 2nd vaccine. Reported same with first vaccinet lasted 2 HR. Feels OK to go home.

Other Meds:

Current Illness:

ID: 1381763
Sex: F
Age: 71
State: AZ

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 06/08/2021
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: No, just chemical sensitive

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

Symptoms: Immediately I could taste the vaccine and my arm is sore, I couldn't sleep, I woke up at 2am with severe pain and vomiting. I did more dry heaving than throwing up. The next day I had a fever of 99.9, and I couldn't eat then diarrhea started and lasted a couple weeks along with headaches. I just don't feel good and haven't but don't know if it's vaccine related.

Other Meds: Untrod 25mcg, Metoprolol 25mg, B, C

Current Illness: No

ID: 1381764
Sex: F
Age: 11
State: MN

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: patient misrepresented her age twice, once on registration then again when verbally asked.

Other Meds:

Current Illness:

ID: 1381765
Sex: M
Age: 46
State: VA

Vax Date: 04/07/2021
Onset Date: 05/18/2021
Rec V Date: 06/08/2021
Hospital:

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

Lab Data:

Allergies: Might be allergic to medications based on Sulfa products (don't know yet)

Symptom List: Pharyngeal swelling

Symptoms: I experienced a bit of soreness to my left arm, my arm felt a little bit warm to touch. I also felt tired and some fever on the second day. The pain went away in 3-4 days.

Other Meds:

Current Illness:

ID: 1381766
Sex: F
Age: 54
State:

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 06/08/2021
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: 1251 Dizziness BP 144/88, HR 88, poc glucose 79, resp 17 sats 98% 1300 expressed Dizziness improved states she is ok to go home. She is accompanied. S/S to call 911 and seek immediate care discussed. They verbalized understanding.

Other Meds:

Current Illness:

ID: 1381767
Sex: F
Age: 17
State: VA

Vax Date: 05/13/2021
Onset Date: 05/15/2021
Rec V Date: 06/08/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no allergies prior to episode

Symptom List: Diarrhoea, Nasal congestion

Symptoms: see prior

Other Meds: Rifampin 300mg as directed JUnel 1/20 (birth control)

Current Illness: Here is full timeline: See for routine visit on 4/21. Given flu shot and meningitis vaccine. Ordered TB test due to travel history Quantiferon gold was positive. Chest xray was negative Rifampin was prescribed May 11th and she started it May 12th. COVID vaccine was given 5/13/21. She first began to feel ill on May 15th. She had throat pain and it hurt to swallow. She then had headaches that were severe. The week after, she started having fevers and sweats. She noticed left sided neck swelling and felt fullness of her lymph nodes. She also felt generalized abdominal pain. Her symptoms were on and off. -On 6/1/21, she felt very sick with headaches and body aches. On 6/2/21, she felt nauseous and then had severe abdominal pain. She was feeling very bloated. She felt chills. She then vomited what she thinks was blood. She had neck pain and had trouble moving her head normally. Her mom called our clinic for an appt but then drove her to the ER. --In the ER, she was noted to have hypotension. Lowest BPs were 80s/40s. In the ER, she had a temperature of 102.7. She was given a dose of ceftriaxone in the ER and three saline boluses. She was also noted to have elevated liver enzymes to the 300s and lymphopenia. Patient was admitted to the ICU for hypotension. A urine culture was negative. Blood cultures were negative. A respiratory viral panel and COVID test were negative. Acute CMV and EBV were negative. No hepatitis panel was done. --She was discharged on 6/3/21. Doctors suspected that her symptom

ID: 1381768
Sex: F
Age: 49
State: GA

Vax Date: 06/04/2021
Onset Date: 06/05/2021
Rec V Date: 06/08/2021
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: HEADACHE NAUSEA VOMITING MALAISE WARMTH AND TO INJECTION SITE SWELLING

Other Meds: NONE

Current Illness: NONE

ID: 1381769
Sex: F
Age: 31
State:

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/08/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Patient had itching after vaccine no swelling of tongue no SOB, no throat closing. Administered benadryl 25mg po patient tolerated well. 20 minutes later patient stated she felt fine.

Other Meds:

Current Illness:

ID: 1381770
Sex: M
Age: 40
State:

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 06/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Lightheadedness; 1243 lightheaded BP 154/90, HR 100,resp 16, sats 98% 1258 expressed lightheaded resolved left ambulating for home. First Vaccine.

Other Meds:

Current Illness:

ID: 1381771
Sex: U
Age:
State: NY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: rash accoured couple of days after my second maderna shot,, called doctor orded anti biatic for shingles, for one week dose , didnt work came bown with neuro shingles perscribed (gabapentin) sub for neurontin. 90 pills for 3 times a day finished june 7th.

Other Meds:

Current Illness:

ID: 1381772
Sex: F
Age: 70
State:

Vax Date: 02/06/2021
Onset Date: 02/08/2021
Rec V Date: 06/08/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Developed left inguinal lymphadenopathy and subsequent left lower extremity cellulitis for which hospitalization was required. The pt received antibiotics and was discharged from the hospital. As of June 8, 2021, she has persisting lymphadenopathy.

Other Meds:

Current Illness:

ID: 1381773
Sex: F
Age: 67
State: MO

Vax Date: 03/29/2021
Onset Date: 03/30/2021
Rec V Date: 06/08/2021
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: contrast dye Reglan erythromycin

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

Symptoms: Sore arm, headache, slight fever, nausea, body aches, and prominent dark black/blue circles around my eyes with extremely puffy eyes. The above symptoms except for eyes resolved in about 4 to 5 days. Eyes are still somewhat more prominently darker and puffy currently, but feeling well. Virtual visit with doctor regarding my eyes, sent picture of my eyes: Stated possible immune stimulation coagulation response with dehydration, consume more fluids which I did. Feeling well at present.

Other Meds: Verapamil, losartan, atorvastatin, levothyroxine, baby aspirin, CoQ10, Plant Fusion plant-based calcium with vit D-3, vit K2, magnesium, strontium, silica, boron, vanadium, fish oil/omega-3

Current Illness: none

ID: 1381774
Sex: M
Age: 59
State: CA

Vax Date: 05/03/2021
Onset Date: 05/05/2021
Rec V Date: 06/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: severe myalgia lasting over 3 weeks, elevated inflammatory markers persisting 3 weeks after vaccination

Other Meds:

Current Illness:

ID: 1381775
Sex: F
Age: 39
State: CA

Vax Date: 05/07/2021
Onset Date: 05/28/2021
Rec V Date: 06/08/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I?m experiencing some side effect that im worried and it has been bothering me. 3 weeks later I woke up with a sore arm again where the vaccine site was it was very sore feels like I have a bruises on that spot. And had chills. And I also have some pain behind my left legs calf tingling feel and tingling feel on left arms like it was falling asleep feel some numbness and fingers hurts like a burning sensation on knee feels mostly in my legs lightheaded join pain muscle pain little chest pain some pins and needles feeling on hands.

Other Meds:

Current Illness: No

ID: 1381776
Sex: F
Age: 28
State: AR

Vax Date: 04/15/2021
Onset Date: 04/17/2021
Rec V Date: 06/08/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Participant was 5 weeks pregnant when she got the shot due date would have been December 9, 2021. April 17th around five o clock started to experience strange feeling so she just continued to rest, said she was spotting heavy and participant got an ultrasound 2 days later and later on during the day said she heavy bleeding still. On April the 22nd the doctor told her she had a miscarriage.

Other Meds: primatial vitamin

Current Illness: none

ID: 1381777
Sex: F
Age: 14
State: AL

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

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Immediately following first does of covid vaccine patient became unresponsive, diaphortic. Pt did have a pulse and spontaneous breathing. Pt responded to ammonia capsule by opening her eyes . She complained of sudden onset of chest and abdominal pain . Pt states she became dizzy, lightheaded immediately following the injection. Then developed chest tightness and abdominal pain and nausea . Pt rated abdominal pain 10 0n 1-10 scale. Pulse 88 resp 36 Tx at mobile clinic: Ammonia capsule, benadryl 25 mg PO Pts weight 40.1 kg Tx in ED: Prevacid , Tylenol with great relief ,symptoms resolved

Other Meds: Prevacid

Current Illness: None

ID: 1381778
Sex: M
Age: 34
State: CA

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/08/2021
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: vaccine administration error. 2nd dose of Moderna vaccine was administered before the recommended 24 days from 1st dose. 2nd dose was administered 21 days after 1st dose.

Other Meds:

Current Illness:

Date Died:

ID: 1381779
Sex: M
Age: 71
State: MO

Vax Date: 02/19/2021
Onset Date: 05/30/2021
Rec V Date: 06/08/2021
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: amiodarone, statins-Hmg-Coa reductase inhibitors

Symptom List: Unevaluable event

Symptoms: Patient was experiencing cold symptoms, with symptom onset about 10 days before he fell very ill, on 5-30-2021. His wife called EMS, and he was taken to the ER and then admitted to the Hospital on 5-30-2021 experiencing generalized weakness, confusion and having suffered a fall in his home. Upon admission, he was in respiratory distress. His medical records indicate Acute Hypoxemic Respiratory failure and COVID19 Pneumonia. He passed away on 06-01-2021.

Other Meds: Ellquis, Spironolactone, Entresto, glycopyrrolate, etc.

Current Illness: No acute illnesses reported at time of vaccine

ID: 1381780
Sex: F
Age: 34
State: TX

Vax Date: 05/10/2021
Onset Date: 05/22/2021
Rec V Date: 06/08/2021
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: 5/10/21-25/12/21: dizziness, fatigue, headache 5/15/21, onward: ear fullness 5/22/21, onward: sudden tinnitus 5/26/21, onward: dizziness, tinnitus, ear fullness

Other Meds: Ibuprofen, Claritin

Current Illness: None

ID: 1381781
Sex: M
Age: 78
State: KY

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient came in to our pharmacy to get his "first dose" of the covid vaccine. It wasn't until the patient came to get their second dose and produced two cdc cards that we then found out they had already completed the Pfizer series. Pfizer dose one 2/11/21 (EL9267) and Pfizer dose two 3/4/21 (EL9261)

Other Meds:

Current Illness:

ID: 1381782
Sex: F
Age: 67
State: MI

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 06/08/2021
Hospital:

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

Lab Data:

Allergies: I am allergic to penicillin, Prilosec, and Zintec.

Symptom List: Injection site pain, Menorrhagia

Symptoms: They started just an hour after after the vaccine I had swelling in my neck, arm, throat area and chest. I also had hives. Ringing in my ear. All lasted until I went to the ER that evening, All improved after they gave me prednisone and Benadryl. I was sent home that next morning. Still today I have ringing in my left ear and feels like something is in it.

Other Meds: I was taking Nordasc 5mg.

Current Illness: No

ID: 1381784
Sex: F
Age: 15
State: TX

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/08/2021
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: none reported

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

Symptoms: After getting vaccine, pt states "I can't hardly hear, I can't hardly see" to the primary nurse. Provider was sent for, and pt was placed in supine position; pt then reported anytime she saw blood or needles, she felt lightheaded. VS 1524: 91/58; 60; 16; 96% on room air. Pt awake, alert, oriented to person/place/time/situation the entire visit. During VS check, pt reports she is feeling better, back to "normal." Pt placed in upright position and given an apple juice to drink. Pt also reports she hasn't had a thing to eat/drink today. Repeat VS 1535 94/67; 74; 16; 95% on room air. Pt then ambulated to waiting area where she was observed for an additional 5 minute by provider.

Other Meds: Unknown

Current Illness: none reported

ID: 1381785
Sex: F
Age: 82
State: CA

Vax Date: 01/28/2021
Onset Date: 05/06/2021
Rec V Date: 06/08/2021
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: unknown

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: COVID Infection Post Vaccine

Other Meds: unknown

Current Illness: unknown

ID: 1381786
Sex: M
Age: 38
State: TX

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/08/2021
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: vaccine that was drawn up in syringe past the 6 hour window was inadvertently mixed with newly drawn up vaccine. Patient may have rec'd expired vaccine or non-expired vaccine. We contacted Pfizer, CDC and our Facility vaccine experts and the conclusion made was that microbiological contamination was the primary concern and patient was advised to watch for signs of infection at site or fever and report to us if any other symptoms occur. We were advised revaccination is not required.

Other Meds:

Current Illness:

ID: 1381787
Sex: M
Age: 13
State: CA

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 06/08/2021
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: right axillary lymphadenopathy, fever for 7 days (low grade), fatigue, lower leg pain

Other Meds: none

Current Illness: none

ID: 1381788
Sex: F
Age: 40
State: MO

Vax Date: 01/26/2021
Onset Date: 03/06/2021
Rec V Date: 06/08/2021
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: In march, I had a prescription to take Macrobid as a preventative for a UTI. I had taken it in the past with no problems. I took it on Saturday evening and in the morning I had a really bad cough, shortness of breath, body aches, fever. I had to call in sick to work, The next day on Monday, I felt completely better, I felt like I hadn't been sick at all. I took Macrobid again on the 16th of march and the same thing happened, I woke up the next morning on the 17th with shortness of breath and body aches this time was worse than the first. By the 18th I felt mostly back to normal. I was tested for Covid which came back negative on the 18th. My doctors said over the phone could have been an acute reaction to the Macrobid.

Other Meds: Macrobid (one time dose), Ritalin 20mg (1x daily), Zoloft 150mg (1x daily), spironolacrone 50mg (1x daily) acyclovir 50mg (1x daily) 10 mg zyrtec, naproxen

Current Illness: None

ID: 1381789
Sex: M
Age: 12
State:

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/08/2021
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: Injection site pain

Symptoms: Patient collapsed to the floor and sustained a seizure <1min. patient states LOC. parent of the patient states no prior hx of seizure.

Other Meds: none

Current Illness: n/a

ID: 1381790
Sex: F
Age: 41
State: IL

Vax Date: 05/25/2021
Onset Date: 06/02/2021
Rec V Date: 06/08/2021
Hospital:

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

Lab Data:

Allergies: Avocado

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

Symptoms: 8 days after the shot, I got a large, red, very hot, itchy rash that still has not gone away after two weeks. Symptoms still include spreading of rash (not nearly as red though), it's still hot to the touch and itchy.

Other Meds: Birth Control

Current Illness: N/A

ID: 1381791
Sex: F
Age: 30
State: CA

Vax Date: 02/12/2021
Onset Date: 03/01/2021
Rec V Date: 06/08/2021
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: none

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

Symptoms: Pt had COVID infection with loss of taste and smell 1/2021. Completed last dose of Pfzier COVID vaccine 2/12/21. One month later noted distorted odor with foods, continues to have parosmia now without improvement

Other Meds: None

Current Illness: None but s/p COVID infection with loss of taste and smell 01/2021

ID: 1381792
Sex: F
Age: 16
State: UT

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 06/08/2021
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: ADMINISTRATION ERROR: vaccine dose administered to a person too young to meet EUA requirements. 16yo female received Janssen COVID19 vaccine, but the vaccine is currently only approved for patients age 18+. Error identified by patient's parents. Currently patient has not reported any serious ADEs, but is self-reporting fever, chills, and body ache.

Other Meds:

Current Illness:

ID: 1381793
Sex: M
Age: 33
State: NY

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/08/2021
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: Erythema, Pruritus

Symptoms: Abdominal pain

Other Meds:

Current Illness:

ID: 1381794
Sex: M
Age: 43
State: TN

Vax Date: 03/09/2021
Onset Date: 03/31/2021
Rec V Date: 06/08/2021
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: Wheat

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

Symptoms: A few weeks after the first shot, I started waking up in the mornings and couldn't go back to sleep. After the second shot, things got worse, and I started realize that it was sleep apnea. I went to the doctor and I am currently being evaluated for central sleep apnea. My breathing stops, and then I wake when I need to grasp for air. I am healthy guy that works out and in good shape. This came out of nowhere and I am worried it has to do with taking the Moderna vaccine.

Other Meds: Flecainide, Lisinopril

Current Illness: N/A

ID: 1381795
Sex: M
Age: 74
State: OR

Vax Date: 05/13/2021
Onset Date: 05/28/2021
Rec V Date: 06/08/2021
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: discomfort, tired, swelling, warm to touch all around the injection site on left arm. This was all happening on the 28th of June about a week after the second shot. Did not have any side affects right after the second they came later on the 28th of May.

Other Meds: Dexamathazone, Bumatine, Allpurinolol, Vitamin D, Flaxseed oil, and multivitamin, Acyclovir

Current Illness: Gout and cancer

ID: 1381796
Sex: F
Age: 43
State: TX

Vax Date: 03/01/2021
Onset Date: 03/20/2021
Rec V Date: 06/08/2021
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: Penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vertigo and dizziness onset about 2 minutes of receiving 2nd shot. Sudden tingling in nose and weird taste in mouth. Racing heart. Pharmacist administered Epi Pen, and I was transported to the ER via Ambulance. Vertigo, dizziness, giddiness ever since. Shortness odd breath, not resolved yet either. Developed Atypical Pneumonia 6 weeks after second shot. Leg pain when resting. Heart palpitations, and heart pounding. Unusual heavy, long and incredibly painful Menstruation after first shot. Feeling of difficulty swallowing after second shot for several days. Feeling of "electrical" mini shots in random places of my left side (inner thigh, underside of arm, in my eye etc.). Off and on ear sounds left ear. Joint/foot pain left foot after first shot.

Other Meds: Prenatal

Current Illness: None

ID: 1381797
Sex: F
Age: 18
State: UT

Vax Date: 04/29/2021
Onset Date: 05/31/2021
Rec V Date: 06/08/2021
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: Superficial thrombophlebitis

Other Meds:

Current Illness:

ID: 1381798
Sex: F
Age: 15
State: PA

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/08/2021
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: no allergies

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

Symptoms: Patient received 1st covid 19 immunization which was Pfizer and while patient was waiting the required 15 minutes, the patient fainted for a couple of seconds

Other Meds: unknown

Current Illness: no other illnesses

ID: 1381799
Sex: M
Age: 53
State:

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 06/08/2021
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: Pain in extremity

Symptoms: I had came home the next night after work and took a bath and starting itching with dry skin.

Other Meds: None

Current Illness: None

ID: 1381800
Sex: F
Age: 61
State: CO

Vax Date: 03/06/2021
Onset Date: 04/28/2021
Rec V Date: 06/08/2021
Hospital:

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

Lab Data:

Allergies: Penicillin; sulfa drugs

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

Symptoms: I started getting symptoms of UTI - I was treated with an antibiotic starting on 4/28/2021 - for five days. And then a few days later, it came back after I finished the antibiotic. I started on another antibiotic on May 8th. That took care of it. But after I finished with it, on May 19th, I had a fever that continued until May 24th. A urinalysis showed it wasn't UTI. No treatment.

Other Meds: Vit D 5000 IU; Multi-Vitamin; 500 mg of Calcium twice a day; Turmeric; Cinnamon capsules; Elemental Magnesium; B-Complex; Fish Oil Generic for Prevised - 30 mg - once a day; Fenofibrate - 200 mg once a day;

Current Illness: no

ID: 1381801
Sex: F
Age: 67
State: OH

Vax Date: 02/18/2021
Onset Date: 02/22/2021
Rec V Date: 06/08/2021
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: Three days after first shot, patient experienced intense itching/burning sensation inside her arms. We thought it was a reaction to her chemo, so we stopped the chemo regime. However, a few weeks later after she received the 2nd shot, the same itching/burning sensation returned more intensely. It continued for several weeks.

Other Meds: Several. She was being treated for ovarian cancer.

Current Illness: Ovarian Cancer

ID: 1381802
Sex: M
Age: 61
State: CA

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/08/2021
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: Lisinopril , ASA

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

Symptoms: reports numbness and tingling on L hand radiates to elbow continues with symptoms at this time. Motor skills intact

Other Meds: developed numbness and tingling from hand to elbow

Current Illness: Lung CA

ID: 1381803
Sex: M
Age: 48
State: GA

Vax Date: 04/27/2021
Onset Date: 05/05/2021
Rec V Date: 06/08/2021
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: None

Symptom List: Vomiting

Symptoms: Tinnitus; continuous ringing of the ears. Was not a previous symptom.

Other Meds: Lisinopril - HCTZ 10-12.5 MG

Current Illness: None

ID: 1381804
Sex: F
Age: 14
State: FL

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/08/2021
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: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient had no reaction from her first Pfizer vaccine. A few minutes after her second dose, she stated itching on her injection arm and in her legs. 10 ml of Benadryl was administered at around 2:45 pm. She stated headache and pain in her neck and head, but no difficulty breathing. She took ibuprofen (given to her by her grandmother). She was monitored until 3:30 pm and indicated her symptoms had resolved and she was feeling much better. Counseled her grandmother to monitor her closely this evening and to administer another dose of Benadryl if needed.

Other Meds: n/a

Current Illness: none known

ID: 1381805
Sex: F
Age: 37
State: CA

Vax Date: 05/26/2021
Onset Date: 05/28/2021
Rec V Date: 06/08/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: I have HSV. I experienced the worse outbreak I have ever had with it.

Other Meds: Levothyroxine, depo-provera, phentramine

Current Illness: None

ID: 1381806
Sex: F
Age: 38
State: LA

Vax Date: 06/07/2021
Onset Date: 06/08/2021
Rec V Date: 06/08/2021
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: PT HAD HARD LUMP AT VACCINATION SITE THAT SHE NOTICED AFTER SHE WOKE UP THE MORNING FOLLOWING VACCINE ADMINISTRATION. SHE SAID IT WAS PAINFUL.

Other Meds:

Current Illness:

ID: 1381807
Sex: M
Age: 83
State: CO

Vax Date: 04/13/2021
Onset Date: 06/04/2021
Rec V Date: 06/08/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Patient received first dose of COVID-19 vaccine (Moderna) on 4/13/21. The second dose of COVID-19 vaccine was Pfizer-BioNTech, which was administered on 6/4/21.

Other Meds: Unknown

Current Illness: no

ID: 1381808
Sex: M
Age: 29
State: WI

Vax Date: 04/02/2021
Onset Date: 04/30/2021
Rec V Date: 06/08/2021
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: amoxicillin

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

Symptoms: back pain after vaccine chest pain went to ER 6/1/2021 approx. nothing found diagnosed with muscle pull and now headache (believe it could be due to vaccine)

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm