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: 1386323
Sex: M
Age: 27
State: OH

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/09/2021
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: I CALLED THIS PATIENT AND HE SAID HE FELT NAUSEOUS LAST NIGHT. HE SAID IT MAY HAVE BEEN DUE TO WHAT HE ATE. BUT OTHER THAN THAT, JUST A SORE ARM TODAY.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1386324
Sex: M
Age: 16
State: PA

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
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: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: OVER ADMINISTERED PFIZER VACCINE

Other Meds: N/A

Current Illness: N/A

ID: 1386325
Sex: M
Age: 17
State: NJ

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
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: NO ADVERSE EVENT , BUT DEVIATION OF THE APPROVED AGE GROUP

Other Meds: NONE

Current Illness: NONE

ID: 1386326
Sex: M
Age: 37
State: CA

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Severe tingling ,mostly upper and lower extremities which has not improved after 6 weeks now. Upper extremities weakness, weak grip (right hand) which is better now.

Other Meds:

Current Illness:

ID: 1386327
Sex: M
Age: 56
State: MA

Vax Date: 04/30/2021
Onset Date: 05/10/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: Peanuts, shellfish, Sulfa

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

Symptoms: Facial numbness, traveling down to neck, throat, and Shoulder. Muscle twitching, mainly at night.

Other Meds: Lisinapril 7.5mg

Current Illness: none

ID: 1386328
Sex: F
Age: 40
State: CA

Vax Date: 04/30/2021
Onset Date: 05/12/2021
Rec V Date: 06/09/2021
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: NO KNOWN ALLERGIES

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

Symptoms: Patient presented to Urgent Care on 6/2/2021 with 3 week history of right lower quadrant abdominal pain. Patient was transferred to Emergency Department for rule out of appendicitis. In Emergency Room, patient had a CT performed that showed a "large non-occlusive thrombus filling significant potion of the inferior vena cava." Patient was admitted to the hospital (6/2/2021) and discharged home on 6/5/2021. Patient is now on anticoagulant: Xarelto. Pt now having palpitations and lightheadedness for which she has a follow up appointment with her Primary Care Doctor today (6/9/2021).

Other Meds: FERROUS SULFATE LEVOTHYROXINE MULTIVITAMIN VITAMIN D

Current Illness: NONE

ID: 1386329
Sex: M
Age: 74
State: CA

Vax Date: 02/17/2021
Onset Date: 03/24/2021
Rec V Date: 06/09/2021
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: pt developed bells palsy. neg MRI. diagnosed in the ER.

Other Meds: methIMAzole (TAPAZOLE) 5 mg Oral Tab hydroCHLOROthiazide 12.5 mg Oral Tab Atorvastatin (LIPITOR) 40 mg Oral Tab Apixaban (Eliquis) 5 mg Oral Tab Famotidine (PEPCID) 40 mg Oral Tab Atenolol (TENORMIN) 25 mg Oral Tab Lisinopril (PRINIVIL/ZEST

Current Illness: Bells Palsy

ID: 1386330
Sex: F
Age: 65
State: OH

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: no allergies

Symptom List: Pharyngeal swelling

Symptoms: patient called to state that her heart was racing. She did not take her anxiety med earlier and she was very nervous at the time of the vaccine. After a few hours she was still having the racing heart . I told her to reach out to her physician. I just wanted to make sure she was safe.

Other Meds: klonopin, ropinirole, paroxetine , pantoprazole

Current Illness: unknown

Date Died: 05/06/2021

ID: 1386331
Sex: F
Age: 94
State: MI

Vax Date: 03/24/2021
Onset Date: 04/01/2021
Rec V Date: 06/09/2021
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: There are two adverse events. First is that the skilled nursing facility (SNF) clinical staff incorrectly listed the patient as unvaccinated when requesting SNF patients be vaccinated by the local health department. The patient was previously vaccinated with Moderna on 1/26 (Lot # 004M20A). This should be listed as a vaccine administration error. Second- Approximately, 1 week after being vaccinated with Janssen on 3/24/2021, the patient tested positive for COVID-19 (4/1/21). At the time, the patient was documented to have an asymptomatic infection, picked up on weekly surveillance testing due to a large outbreak at the nursing facility. I was informed on 6/9/21 that the patient had been referred to hospice on 5/4/21 and died on 5/6/21. The medical records are not yet available (pending from the SNF and hospice agency) but the referral was made due to her COVID illness leading to worsening of her general health status. During this period from 4/1 to 5/4, she remained at the SNF. Notably, she was not hospitalized and did not present to the emergency department for care.

Other Meds:

Current Illness: Exposed to COVID during outbreak at her skilled nursing facility

ID: 1386332
Sex: F
Age: 73
State: CO

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

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

Lab Data:

Allergies: penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Swollen lymph nodes began the day of vaccination (4/2/21) and have still not resolved as of today, 6/9/21. Client also reports ongoing intermittent pain in the arm where vaccination was administered (right arm). Has been working with primary care provider.

Other Meds: lisinopril, vitamin D, Amlodipine, crestor

Current Illness: stomach virus- vomiting

ID: 1386333
Sex: F
Age: 63
State: WA

Vax Date: 02/13/2021
Onset Date: 02/15/2021
Rec V Date: 06/09/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Loud ringing in ears since Vaccination. Dr has referred me to hearing specialist.

Other Meds: estrodial 10mcg

Current Illness: None

ID: 1386334
Sex: M
Age: 17
State: CA

Vax Date: 04/29/2021
Onset Date: 05/03/2021
Rec V Date: 06/09/2021
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: Crab

Symptom List: Rash, Urticaria

Symptoms: 5/2/21: After playing soccer, got home, ate dinner, then ~9p had sharp left chest pain and pain above clavicle with deep breatning. Took one 500 mg Tylenol, then 10 mins later took ProAir (albuterol) 2 puffs felt better 10-15 mins after, so unsure which helped, or if resolved spontaneously 5/3/21: ~7p c/o fast heart rate (mom read 72 bpm on home BP monitor). Took ibuprofen 200 mg and 2 puffs ProAir, felt somewhat better, and went to evening soccer practice. When picked up, c/o occipital headache and chills (which he experienced post-exercise for weeks prior to vaccination, calls it his "normal chills"). Took Tylenol 500 mg and Advil 200 mg, went to bed, felt better in am.

Other Meds: Allegra Calcium Citrate-Vitamin D Vitamin D

Current Illness: Positional orthostatic hypotension Exercise-induced dizziness and nausea

ID: 1386335
Sex: F
Age:
State: PA

Vax Date:
Onset Date:
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: OVER ADMINISTERED PFIZER VACCINE

Other Meds: N/A

Current Illness: N/A

ID: 1386336
Sex: M
Age: 49
State: IN

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/09/2021
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: N/A

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

Symptoms: PHARMACY LEFT PFIZER VACCINE VIALS IN THE FREEZER FOR LONGER THEAN 2 WEEKS AT A TEMPERATURE (-25 AND -15 DEGREES C). WE GAVE DOSES OUT OF THESE VIALS, RENDERING THEM POSSIBLY LESS EFFECTIVE.

Other Meds: N/A

Current Illness: N/A

ID: 1386337
Sex: M
Age: 50
State: MN

Vax Date: 06/07/2021
Onset Date: 06/08/2021
Rec V Date: 06/09/2021
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: swollen supraclavicular lymph node on right side where shot was administered. pt said it started about 24 hours after the shot

Other Meds:

Current Illness:

ID: 1386338
Sex: M
Age: 52
State: RI

Vax Date: 05/05/2021
Onset Date: 05/06/2021
Rec V Date: 06/09/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: 06/09/2021 Client presented to clinic for 2nd dose but wanted to ask questions first. He states about 24hrs after receiving the 1st covid shot, he has had headache ,ears hurt, and bumps and they bust open on his head. He showed me his head several grape size bumps with scabs. The one on top of his head busted and ran down the back of his neck and he got the biggest one. He showed it to me it is a large bump the size of a large egg and is ozzing yellow/clear puss on the rt back of his neck. I told him I have not heard of that being a reaction, and he needs to go directly to his PCP or the emergency room. It could possibly be staff and it is urgent he see a Dr. today. Client states he has seen PCP. He was headed to the clinic to see if she would see him or send him to the ER. I will follow up with him on Friday morning to see if he received medical attention.

Other Meds: unknown

Current Illness: none

ID: 1386339
Sex: F
Age: 54
State: MT

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 06/09/2021
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: watermelon

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

Symptoms: 101 fever, chills, body ache, headache, fatigue. Treated with bufferin. Incapacitating for about 24 hrs... Fever broke after that and severity of symptoms decreased over the next 24 hrs. Day 3 back to 90% of normal.

Other Meds: Vitamin D, Flonase, magnesium, albuterol

Current Illness: none

ID: 1386340
Sex: F
Age: 51
State: IN

Vax Date: 05/02/2021
Onset Date: 05/03/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: fever for a day on the second day (around 14-16 hours after the 2nd dose), weak energy, pain issue when opening mouth or eat (like the temporomandibular joint disorder, and whenever I opened my mouth for about an inch, I would feel the pain, not to mention eating, has to eat soft food and chew slowly) for a month by now, and will go to see doctor for the reason next week.

Other Meds:

Current Illness:

ID: 1386341
Sex: M
Age: 12
State: CA

Vax Date: 06/07/2021
Onset Date: 06/08/2021
Rec V Date: 06/09/2021
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: temp 101.2 next day, 2 cm tender right axillary adenopathy, 1 cm area of erythema at injection site

Other Meds: none

Current Illness: none

ID: 1386342
Sex: M
Age: 20
State:

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

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

Lab Data:

Allergies:

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

Symptoms: It is suspected that the patient received an inadequate dose at this administration. They presented and were potentially injected with an empty syringe (no air, just empty vanish-point). The care team has attempted to contact the patient to determine if they have had any symptoms after injection, but have not been able to get in touch with the patient. We will continue to try to contact the patient.

Other Meds:

Current Illness:

ID: 1386343
Sex: F
Age: 62
State: MO

Vax Date: 01/18/2021
Onset Date: 02/21/2021
Rec V Date: 06/09/2021
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: any medication in the mycins family reglan sulfa drugs doxycycline

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

Symptoms: The morning of February 21, 2021, I started having severe burning in my chest and in my back. It prevented me from sleeping without sitting up. I did not report to work for 3 days. I thought it was gastrointestinal since I already had covid in November 2020. After having another covid test on March 1, 2021, after being fully vaccinated, I tested positive for covid again. That prevented me from having a scheduled colonoscopy. I eventually had my routine colonoscopy on April 2, 2021 at the Clinic.

Other Meds: Bio identical hormone replacement therapy E2.7E32.8P25D28TE5mg Zyrtec 10mg, 1xday Niacin 1000mg, 2xday Cranberry capsule 500mg, 1xday Methyl Folate 5-MTHF, 1xday L-Carnitine 500mg, 1xday Aspirin 81mg, 1xday Turmeric 500mg, 1xday Multivitami

Current Illness:

ID: 1386344
Sex: F
Age: 70
State: PA

Vax Date: 06/08/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: penicillin; codine

Symptom List: Unevaluable event

Symptoms: fever, chills, body aches, headache, fatigue, extremely sore at injection site (swollen and bruised) -- worse than mederna shot.

Other Meds: synthroid; avorstatin; metformin

Current Illness: 2nd moderna shot in April

ID: 1386345
Sex: F
Age: 64
State: WA

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 06/09/2021
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: Cafergot, Metformin,

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

Symptoms: sores in mouth on gums, roof, cheeks. dry lump in throat that ached and water wouldn't quench it.

Other Meds: Propranolol 120 mg one time daily, Triamterene-HCTZ 37.5-25 one in morning, Vitamin D 1000UT, Calcium magnesium zinc one tab daily, fluticasone proprianate nasal suspension 50 mcg/act, Gabapentin 800mg two in am two in pm, Januvia 50mg one

Current Illness: Diabetes, Obesity, Migraines, Inflammation, mild COPD, Sleep Apnea, High Blood Pressure, Acid Reflux, Edema in legs and feet, neuropathy in legs and feet, DJD

ID: 1386346
Sex: F
Age: 26
State: PA

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/09/2021
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: Some fruit (apples, avocados, bananas)

Symptom List: Injection site pain, Pain

Symptoms: Vasovagal syncope after roughly 13 minutes post-injection. Syncope lasted a few seconds (roughly 10 seconds) according to family that helped me. Head went backwards and eyes rolled back in head and then head/body slowly moved forward/sideways. Treatment or follow-up was not provided by anyone at pharmacy location even though family asked for assistance. I left after the 15 minute mark that I was required to stay for. My head felt very tight for the rest of the day, like a rubber band was squeezing my head around both temples.

Other Meds: N/A

Current Illness: N/A

ID: 1386347
Sex: F
Age: 61
State: HI

Vax Date: 03/24/2021
Onset Date: 04/03/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Bell's Palsy

Other Meds: Hydrochlorothiazide

Current Illness:

ID: 1386349
Sex: F
Age: 35
State: OH

Vax Date: 05/11/2021
Onset Date: 05/12/2021
Rec V Date: 06/09/2021
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: Lymph node in armpit swelled up to the point of hardness and difficulty in moving arm. I called doctor after a few days, but did not visit office.

Other Meds: Prenatal vitamin Hair, skin, and nails vitamins

Current Illness:

ID: 1386350
Sex: F
Age: 16
State: OH

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/09/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient fainted immediately following her shot

Other Meds: humalog & birth control

Current Illness: Diabetes

ID: 1386351
Sex: F
Age: 31
State: SC

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: none listed

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: The patient had received a Pfizer vaccine at the above mentioned clinic. She went back to work. Approximately two hours later, the patient reportedly passed out. She was taken by ambulance to a local hospital.

Other Meds: none listed however according to pharmacist on duty at the COVID vaccine clinic at this patient's work site, pt was allegedly taking 20 different medications. she had reportedly taken a migraine injection the previous day

Current Illness: none listed

ID: 1386352
Sex: F
Age: 0
State: TX

Vax Date: 06/01/2021
Onset Date: 06/03/2021
Rec V Date: 06/09/2021
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: NKDA

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

Symptoms: patient developed vomiting and diarrhea after receiving Rotateq #2 led to fever and UTI

Other Meds: Nexium 5 mg packet nystatin ointment for diaper rash

Current Illness: seen for fussy infant GERD

ID: 1386353
Sex: F
Age: 33
State:

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/09/2021
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: It is suspected that the patient received an inadequate dose at this administration. They presented and were potentially injected with an empty syringe (no air, just empty vanish-point). The care team talked with the patient and they stated they had no signs or symptoms of a reaction and had no pain at the injection site. They stated they had some symptoms after their first dose. The patient was told that they will be rescheduled for their 2nd dose.

Other Meds:

Current Illness:

ID: 1386354
Sex: M
Age: 18
State: NJ

Vax Date: 06/02/2021
Onset Date: 06/05/2021
Rec V Date: 06/09/2021
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: Shortness of breath, chest pain, palpitations

Other Meds: Amlodipine 5mg once daily Adderall XR 20mg once daily

Current Illness:

ID: 1386355
Sex: M
Age: 38
State: OR

Vax Date: 05/28/2021
Onset Date: 05/31/2021
Rec V Date: 06/09/2021
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: sulfa

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

Symptoms: Pt had uneventful 1st Pfizer COVID vaccine on 5/28. 5/31 he presented to our hospital after a V fib cardiac arrest. Pt did well with immediate CPR and cardioversion on the scene but he had no hx of major heart disease. Minor LV dysfunction ( LV 45%). It turned out on that the next day 6/1 pt developed fever and then COVID was checked and was positive. He then developed true covid and was treated. Echo revealed a new dilated CM with reduced EF. I feel his arrest was more likely related to the active covid or his DCM but wanted to report in case given the temporal association

Other Meds: Imuran, coreg, Enyvio, Pravastatin, Depakote,melatonin, Lexapro, coumadin

Current Illness: None known at the time but tested positive for COVID on 6/2/21

ID: 1386356
Sex: F
Age: 11
State: OR

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 06/09/2021
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: No Known Allergies

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

Symptoms: No adverse reactions occurred. Patient was given the vaccine too early at age 11 years old.

Other Meds:

Current Illness: None

ID: 1386357
Sex: M
Age: 39
State: PA

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Tremor

Symptoms: OVER ADMINISTERED VACCINE

Other Meds: N/A

Current Illness: N/A

ID: 1386358
Sex: M
Age: 42
State: FL

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 06/09/2021
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: Pain in left arm, fever, tiredness

Other Meds:

Current Illness:

ID: 1386359
Sex: F
Age: 29
State: PA

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/09/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: patient threw up outside the store and fell down

Other Meds:

Current Illness:

ID: 1386360
Sex: F
Age: 51
State: NY

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
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: Sulfa

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

Symptoms: Patient received 2nd dose of Pfizer via left deltoid. Approximately 25 minutes later, patient was coughing and had difficulty speaking in full sentences and had audible wheezing. Pt also complaining of pruritis to injection site. Approximately 27 minutes post vaccination, pt's 02 sat went from 99% RA to 95% RA. At that point, pt was given supplemental 02 via NRB, pt took her own 12.5mg Benadryl tablet and was given a cold pack. Pt conditioned worsened, Epinephrine autoinjector IM given to right thigh. 02 sat went back up to 99%. EMS arrived on site, pt received duoneb and IV Benadryl 37.5mg, IVP 125mg Solu-medrol. Pt able to speak in full sentences upon departure to ED. Vital signs: 1650 bp 160/98, HR 104, 02 99% RA, RR 10. 1700: bp 160/85, 02 95% RA, HR 107, RR 10. VS after Epinephrine administered, 02 sat returned to 99% on NRB, HR 140, regular rate. VS by EMS 144/84, 02 sat 98% NRB, HR 84.

Other Meds: Unable to obtain

Current Illness: none

ID: 1386361
Sex: F
Age: 18
State: IN

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PHARMACY LEFT PFIZER VACCINE VIALS IN THE FREEZER FOR LONGER THAN 2 WEEKS AT TEMPERATURE (-25 AND -15 DEGREES C). WE GAVE DOSES OUT OF THESE VIALS, RENDERING THEM POSSIBLY LESS EFFECTIVE

Other Meds: N/A

Current Illness: N/A

ID: 1386362
Sex: M
Age: 15
State:

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/09/2021
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: It is suspected that the patient received an inadequate dose at this administration. They presented and were potentially injected with an empty syringe (no air, just empty vanish-point). The care team has attempted to contact the patient to determine if they have had any symptoms after injection, but have not been able to get in touch with the patient. We will continue to try to contact the patient.

Other Meds:

Current Illness:

ID: 1386363
Sex: F
Age: 39
State:

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 06/09/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Sever lower back pain. Tremendous difficulty walking.

Other Meds:

Current Illness:

ID: 1386364
Sex: F
Age: 63
State: WA

Vax Date: 02/13/2021
Onset Date: 03/18/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Pain in extremity

Symptoms: Woke to a pounding in my chest heart, very high blood pressure and heart rate. Have never had any of those symptoms before. High heard rate and shortness of breath lasted three weeks blood pressure became normal again in a week. Resting heart rate 107 Blood tests normal EKG Normal so no obvious cause or reason why this was happeneing. Any movement made me winded.

Other Meds: Estradial

Current Illness: none

ID: 1386365
Sex: M
Age: 15
State: PA

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: OVER ADMINISTERED PFIZER VACCINE

Other Meds: N/A

Current Illness: N/A

ID: 1386366
Sex: F
Age: 13
State: WA

Vax Date: 06/06/2021
Onset Date: 06/07/2021
Rec V Date: 06/09/2021
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: Myalgias and low grade fever on first day. Chest pain requiring ER visit on second day. Exam, ECG, lab work, echo consistent with pericarditis

Other Meds: Multivitamin

Current Illness: None

ID: 1386367
Sex: F
Age: 40
State: NM

Vax Date: 03/30/2021
Onset Date: 05/18/2021
Rec V Date: 06/09/2021
Hospital: Y

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

Lab Data:

Allergies: bydureon, glipizide, ibuprofen, lisinopril, metformin

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

Symptoms: patient started having headache a week after vaccination. Within 6 weeks, patient was found to have headache on the left side of her head, and then developed right sided blurry vision and RUE numbness/weakness. Per EMS, patient was having word-finding difficulty. Last known normal: 19:10 5/17/21. Patient got diagnosed with acute ischemic stroke that required tPA.

Other Meds: Tacrolimus, Mycophenolic acid, Jardiance, Ezetimibe, Insulin, Labetalol, Nifedipine

Current Illness:

ID: 1386368
Sex: F
Age: 65
State: OR

Vax Date: 03/25/2021
Onset Date: 06/06/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: 3/28/21: 3 days after the shot, started having extreme heart palpitations that was painful and kept the patient up at night. Lasted for 3 days Shortly after the heart related adverse event, patient started experiencing pain in her side that would "come and go" for months until 6/6/21, when the pain did not go away but was so severe that she started becoming nauseous from it. Patient went to the hospital where they found a clot to her kidney that cut circulation, resulting in the loss of part of her kidney

Other Meds:

Current Illness:

ID: 1386369
Sex: F
Age: 51
State: FL

Vax Date: 03/16/2021
Onset Date: 03/22/2021
Rec V Date: 06/09/2021
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: buspirone, erythromycin, muscle relaxer elaxin, shrimp, feathers, trees, grass

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: On January I had some blood tests done and my set rate was 111, white blood count 9.6, red blood count 4.01, hemoglobin 13.9, hemacrit 40.2 On 03/22/2021 after having the first dose my set rate 128, white blood count 12.1, red blood count 3.67 which is low, hemoglobin 12.9, and my hemacrit 36.1, platelets 153 On 05/06/2021 after having the second dose my set rate 122, white blood count 14.3, red blood count 3.63 which is low, hemoglobin 12.6, hemacrit 35.2, platelets 624. I still have stomach problems sometimes.

Other Meds: Insulin 5 units, 500 Zinc, vitamin c and vitamin d, dexamethasone liquid form, meloxicam 15 mg, propranolol 40 mg, melatonin, probiotic, 600 mg Lopan, generic ambient 10 mg, anxiety medication 7.5, Hydrochlorothiazide25 mg, b12, nasal antih

Current Illness: None

ID: 1386370
Sex: F
Age: 19
State: NY

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
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: Patient experienced severe dizziness. I comforted her and told her she would be alright. I then had her lay down on the ground and I elevated her feet on a chair.

Other Meds: Not available

Current Illness: None

ID: 1386371
Sex: M
Age: 21
State: CA

Vax Date: 05/22/2021
Onset Date: 05/24/2021
Rec V Date: 06/09/2021
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: n/a

Symptom List: Injection site swelling, Limb discomfort

Symptoms: A couple days following the injection, began experiencing chest pain and shortness of breath while trying to sleep. Symptoms remained for three continuous days following onset. Symptoms were prevalent enough to lead to an impromptu doctor visit, and an ER visit the following day.

Other Meds: Cetirizine: 10mg Vitamin D: 50,000 IU Lithium: 300mg Adderall: 10mg Breo Ellipta: 100mcg

Current Illness: n/a

ID: 1386372
Sex: F
Age: 59
State: NC

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 06/09/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Around 4 am on the 27th of January I started having a sever headache and liquid stool diahrrea and nausea. That last for about 24 hours, the headache stayed around for several days. I did not see anyone regarding symptoms.

Other Meds: 10mg melatonin/night

Current Illness: no

ID: 1386373
Sex: F
Age: 18
State: NY

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/09/2021
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: unknown

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

Symptoms: Patient received vaccination seemed okay went to get a drink of water. Sat down in waiting room and said she was going to pass out. I ran out she passed out for 30 seconds. She was completely out I shook her arm called her name several times. She came to and was very clammy and sweating. Her skin went pale. She vomited. I laid her down on the floor.

Other Meds: unknown

Current Illness: While patient was lying down recovering we spoke. Since the birth of her child she hasn't been able to keep food down and the baby is 11 weeks old. She didn't have a primary provider and said goes to urgent care when needed. I stressed importance of primary care provider to follow up on care.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm