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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1388854
Sex: F
Age: 20
State: KY

Vax Date: 04/21/2021
Onset Date: 06/08/2021
Rec V Date: 06/10/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: TESTED POSITIVE WHEN FULLY VACCINATED

Other Meds:

Current Illness:

ID: 1388855
Sex: F
Age: 43
State: AZ

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 06/10/2021
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: codeine, coumadin, levaquin

Symptom List: Anxiety, Dyspnoea

Symptoms: Per patient at injection site of right arm constant aching pain that does not go away, no relief by any rest or ibuprofen, patient states decreased right arm ROM, unable to extend posteriorly. started since given vaccine 3/5/2021

Other Meds:

Current Illness: none

ID: 1388856
Sex: M
Age: 61
State: PA

Vax Date: 06/06/2021
Onset Date: 06/06/2021
Rec V Date: 06/10/2021
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:

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

Symptoms: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1388857
Sex: F
Age: 24
State: TX

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: Shellfish

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: C/o Dizziness. Patient noted to be leaning toward floor to pick up water from floor. Patient V/S assessed. She is very alert, oriented x4/ V'S 117/67 P62 T98 R18 PO2 99% on room air. Patient's parents were contacted as per request by patient. Once patient's parents arrived at site, nurse escorted patient out of facility. Ambulating with no difficulty. No fatigue noted.

Other Meds: No OTC, Prozac, Aldactone

Current Illness: None

ID: 1388858
Sex: F
Age: 63
State: OR

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/10/2021
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: Patient was triaged and stated she needed her 2nd "Moderna vaccine. the Service line was doing a clinic and based on triage form repsonses she was given the Moderna vaccine. Chart historical data was not reviewed prior to administering the vaccine. Patient did not have a physical proof copy of vaccination history. "I don't have it" . No adverse reaction noted

Other Meds:

Current Illness:

ID: 1388859
Sex: M
Age: 27
State: MO

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

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild

Other Meds:

Current Illness:

ID: 1388860
Sex: M
Age: 26
State: CA

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 06/10/2021
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: penicillin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I had fatigue, headaches vertigo and had fever.

Other Meds: conadline; blue box

Current Illness: none

ID: 1388861
Sex: F
Age: 22
State: MD

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Patient was in lobby sitting on knees, reports nausea and felt like she was going to pass out. B/P 82/48, pulse 64. Patient was placed in lab chair with legs elevated and provided juice. Patient recovered and was released to care of her mother. Upon release, patient's B/P was 102/62 which patient reports is her normal, pulse was 80.

Other Meds: Methimazole 15mg daily

Current Illness: None

ID: 1388862
Sex: M
Age: 21
State: NE

Vax Date: 04/13/2021
Onset Date: 06/08/2021
Rec V Date: 06/10/2021
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: TESTED POSITIVE WHEN FULLY VACCINATED

Other Meds:

Current Illness:

ID: 1388863
Sex: F
Age: 61
State: MD

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 06/10/2021
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: Bactrim

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Left side of body - left breast sensitive, left kidney pain, whole left side numb after sleeping on that side. Arthritic pain increased significantly. Numbness went away after a couple days. All other symptoms except arthritic pain subsided but still feel a little. Significant arthritic pain still the same as of now.

Other Meds: Valsartan 80 mg, prednisone 3 mg, methotrexate 5 mg, frolic acid, amlodopine besyfate 5mg, aspirin 81 mg, tylenol extra strength

Current Illness: Osteoarthitis

ID: 1388864
Sex: M
Age: 33
State: IL

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Hypotension-Medium, Systemic: Shakiness-Mild, Additional Details: Patient came in for 2nd dose of pfizer vaccine on 6/9/21. He complained he was feeling dizzy after the shot,checked his blood pressure and ot was 90/45. Gave him a bottle of water, rechecked his blood pressure and it was 80/40. He asked if we can call 911, paramedic showed up in less than 5 min, no epinephrine was given to the patient. Paramedic said everything looks fine, he had a syncopy after the shot. His final blood pressure was 130/90. He was escortrd out,willl follow up with him on 6/9/21.

Other Meds:

Current Illness:

ID: 1388865
Sex: F
Age: 60
State:

Vax Date: 12/23/2020
Onset Date: 06/04/2021
Rec V Date: 06/10/2021
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: Employee reported to Health Services that she tested Positive for Covid on 6/4/2021, after having 2 doses of Covid Vaccine. 12/23/2020 & 1/13/2021

Other Meds:

Current Illness:

ID: 1388866
Sex: M
Age: 45
State: PA

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 06/10/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Fever, ache, chills for 12-15 hours on April 21, 2021. Then, developed sever gout flare on April 18, 2021, which lasted 3 weeks. No prior gout diagnoses.

Other Meds: welbutrin

Current Illness: none

ID: 1388867
Sex: F
Age: 21
State: AZ

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 06/10/2021
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: Severe pain starting at location of shot, spreading through entire arm over course of 30 minutes, then through rest of body over the next 30 minutes. Severe period like cramps on right side of abdomen, naseua, severe eye pain in left eye, trouble focusing, head pain, trouble sleeping, dizziness, all lasting until 1 pm next day after several hours of sleep.

Other Meds:

Current Illness:

ID: 1388868
Sex: M
Age: 42
State: NY

Vax Date: 06/07/2021
Onset Date: 06/08/2021
Rec V Date: 06/10/2021
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: Site: Pain at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1388869
Sex: M
Age: 21
State: OH

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

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

Lab Data:

Allergies:

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

Symptoms: TESTED POSTIVE WHEN FULLY VACCINATED

Other Meds:

Current Illness:

ID: 1388870
Sex: F
Age: 33
State: PA

Vax Date: 01/11/2021
Onset Date: 03/12/2021
Rec V Date: 06/10/2021
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: Latex

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

Symptoms: Had miscarriage. Pregnancy was noted not to be progressing as it should be on March 4th, had repeat on March 12th which showed the pregnancy was not progressing and degenerating. Had to take Cytotec on Monday March 15th. After 2 f/u had retained fetal tissue, had to take cytotec again - cannot remember exact date - then finally repeat showed things had improved.

Other Meds: Pre-natal vitamins

Current Illness: Miscarriage Dec 4th - chemical pregnancy

ID: 1388871
Sex: F
Age: 52
State: IL

Vax Date: 04/17/2021
Onset Date: 05/04/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: tramadol, clindamycin, penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I woke up on 5/4/21 at 5:20 pm and everything was spinning. I was so scared I couldnt walk, I was moving from side to side. It wouldn't go away, everything was spinning. My friend took me to the ER. I had to use a wheelchair. I went into the ER, they ran tests, gave me mescaline, it helped but I had to rest because I was still dizzy. It took about a week to go away.

Other Meds: gabapentin, neosporin, permerain, folic acid

Current Illness: no

ID: 1388872
Sex: F
Age: 74
State: MA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 06/10/2021
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: Starting on the day of the vaccine 1st dose, that night I had severe throbbing headaches, right arm soreness and pain. I slept most of the day. I took Astelin nasal spray to help with the headache. A week later, my upper right arm still had swelling and a rash appeared. I had these symptoms for 3 to 4 weeks and I called the doctor to notify them about my symptoms. The doctor basically advised me to give it time and lots of rest. I was well enough by week 4 to get the second dose of the vaccine.

Other Meds: Metoprolol tartrate 50mg twice a day Atorvastatin 10mg once a day Aspirin 81mg once a day lorazepam 0.5mg as needed Astelin nasal spray

Current Illness: none

ID: 1388873
Sex: F
Age: 65
State: OH

Vax Date: 06/05/2021
Onset Date: 06/08/2021
Rec V Date: 06/10/2021
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: Extreme weakness and tiredness (do not want to get out of bed but did anyway, have to work...), pain, swelling and redness at injection site continues 5 days after injection

Other Meds:

Current Illness:

ID: 1388874
Sex: F
Age: 15
State: CO

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/10/2021
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: Amoxicillin, Neosporin

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

Symptoms: VACCINE WAS STORED IN FREEZER LONGER THAN MANUFACTURER RECOMMENDED, CAUSING IT ADMINISTRATION TO BE BEYOND THE USE DATE.

Other Meds:

Current Illness:

ID: 1388875
Sex: F
Age: 25
State:

Vax Date: 04/07/2021
Onset Date: 06/04/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Patient tested Positive For Covid -19

Other Meds:

Current Illness:

ID: 1388876
Sex: F
Age: 63
State: WA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: MSG

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

Symptoms: Light headed, swollen glands on left side of throat, hurts to swallow, thick tongue, chills, not feeling well, fast heart beat and face is tingly .

Other Meds: Hydrochlorothiazide 25 mg, Montelukast 10 mg Cetirizine 10 mg Multi vitamin (alive)

Current Illness: none

ID: 1388877
Sex: F
Age: 18
State: MI

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

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

Lab Data:

Allergies: no

Symptom List: Injection site pain, Pain

Symptoms: About 5 to 10 minutes after vaccination she started fainting and was unconscious for couple of minutes. We tried to engage the patient and called 911 . EMS came in and took care of the patient and patient left the pharmacy without any problems . I called yesterday to find out how she is and she is doing fine.

Other Meds: Unknown

Current Illness: none

ID: 1388878
Sex: M
Age: 14
State: MD

Vax Date: 06/02/2021
Onset Date: 06/05/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs and Peanuts

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient developed vomiting and fever s/p 2nd vaccine. On day 3 s/p 2nd covid19 vaccine, developed chest pain.

Other Meds: No medications currently

Current Illness: None

ID: 1388879
Sex: F
Age: 68
State: MN

Vax Date: 03/24/2021
Onset Date: 06/08/2021
Rec V Date: 06/10/2021
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: Pt currently has Covid 19

Other Meds:

Current Illness:

ID: 1388880
Sex: F
Age: 13
State: IN

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: Site: Pain at Injection Site-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: Numbness of left arm(vaccination arm)

Other Meds:

Current Illness:

ID: 1388881
Sex: F
Age: 50
State: CA

Vax Date: 02/02/2021
Onset Date: 02/05/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: No Allergies to medications, food, or other products.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I had a significant pain my arm. I woke up in the morning with an extremely high fever. After checking my fever it went higher the Next day but slowly digressed over the span of 4days.

Other Meds: I was taking prescriptions.

Current Illness: No Other illnesses at the time of vaccination and up to one month prior.

ID: 1388882
Sex: M
Age: 43
State: MI

Vax Date: 05/05/2021
Onset Date: 05/06/2021
Rec V Date: 06/10/2021
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: laytex

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

Symptoms: Fever 102 F next day, lymph node on left arm pit (same arm as shot was given) swelled up about the size of a golf ball and lasted a week.

Other Meds: Fish oil 1200mg with 360mg omega-3, D3 50 mcg

Current Illness:

ID: 1388884
Sex: M
Age: 47
State: CA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 06/10/2021
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: Nausea

Symptoms: On 4/26 around 4pm 2 Moderna vaccine doses were drawn up for immediate administration to patients with the evening appointments that day. By 7pm the last 2 appointments did not show up. The pharmacist placed the 2 syringes in the fridge to report as waste the next day in inventory counts. This pharmacist did not work the next morning. On 4/28, the pharmacist working the afternoon shift thought the 2 drawn up syringes were from that morning and administered one to patient patient. Moderna manufacturer was contacted on 4/29 to advise on next steps and if re-vaccination was required since greater then 12 hours passed after puncture. They advised that the reason for the 12 hour window after puncture of the vial is because it does not contain preservative and to avoid potential infection it should be disposed of after 12 hours, however the vaccine is viable for 30 days in the fridge at manufacturer?s temperature. The vaccine administered was within the 30-day window, in date and remained in the fridge the entire time. The patient was called two times after their vaccination to check in for any adverse event or signs of infection. The patient said they were fine, only a sore arm for a few days, no signs of infection or other adverse reaction. The 1st dose was not re-administered. Patient was administered the 2nd vaccine on 5/26, 28 days later. The pharmacy updated their procedures for immediate vaccine disposal before leaving for the evening and other procedures such as clear labels and individual draws to avoid this same error. All staff were retrained.

Other Meds: None listed

Current Illness: None listed

ID: 1388885
Sex: F
Age: 40
State: PA

Vax Date: 06/01/2021
Onset Date: 06/03/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: latex

Symptom List: Injection site pain

Symptoms: patient had tingling on face starting on 6/3/21, on 6/4/21 broke out in rash, on 6/5/21 rash broke open to open sores\ 6/10/2021 diagnosed with shingles

Other Meds: unknown

Current Illness: unkown

ID: 1388886
Sex: F
Age: 40
State: NY

Vax Date: 03/31/2021
Onset Date: 05/06/2021
Rec V Date: 06/10/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: pt started with arm pain that would not go away. On May 6, 2021 her arm swelled up to 3 times its size. She went to an urgent care and was diagnosed with a blood clot. She was given a prescription for Eliquis. She was not hospitalized and is doing OK now. She reported this to us on 06/10/2021

Other Meds:

Current Illness:

ID: 1388887
Sex: M
Age: 63
State: AL

Vax Date: 04/22/2021
Onset Date: 06/04/2021
Rec V Date: 06/10/2021
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: Nerve damage Pain at time of injection by nurse. Currently experiencing pain and phantom shot replication.

Other Meds: Flomax, Zyrtec

Current Illness: Spinal stenosis

ID: 1388888
Sex: M
Age: 63
State: VA

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 06/10/2021
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: Tremor

Symptoms: Within 2 hours of 1st Pfizer COVID injection pt had sudden onset left-sided paralysis with facial droop and slurred speech and then brief loss of consciousness with loss of bowel and bladder function. This happened on 5/21/2021. His wife is here giving the history. Him and his wife have the first Covid injection by Pfizer on 5/21/2021 at 3:30 PM at pharmacy. Within 2 hours they were back home sitting on the porch relaxing and he had the sudden onset of stroke like symptoms as noted above. EMS was called. Apparently by the time EMS arrived he had recovered to baseline and they advised him he did not have to go to the hospital for evaluation if he did not want to apparently. Since that time he has had no further stroke like symptoms but has continued to feel a bit foggy in the head with a slight dizziness.

Other Meds: Lisinopril, Aspirin, REquip

Current Illness: NONE

ID: 1388889
Sex: F
Age: 62
State: MO

Vax Date: 05/12/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: NKDA

Symptom List: Erythema, Pruritus

Symptoms: Pt has previous hx of severe Covid infection without any medical records from the hospital stay (unaware what treatment she received) more than 6 months ago. Patient's husband reported on behalf of patient, she experienced COVID arm (red, swollen , knot present and very sore), extreme fatigue and fever greater than 103F for a couple of days post vaccination, She felt run down and "sickly" for approximately 2 weeks post-vaccinations and refused the second dose.

Other Meds: unknown

Current Illness: none/unknown

ID: 1388890
Sex: M
Age: 44
State: CA

Vax Date: 04/14/2021
Onset Date: 06/03/2021
Rec V Date: 06/10/2021
Hospital: Y

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: Ibuprofen

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

Symptoms: On June 3rd, 2021 I was admitted to the hospital with multiple pulmonary embolisms in both lungs in multiple spots. No family history or any other medical history that would cause this.

Other Meds: Lisinopril 20 mg

Current Illness: None

ID: 1388891
Sex: M
Age: 58
State: MN

Vax Date: 03/16/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Pt is currently hospitalized with Covid 19

Other Meds:

Current Illness:

ID: 1388892
Sex: F
Age: 45
State: MI

Vax Date: 06/07/2021
Onset Date: 06/08/2021
Rec V Date: 06/10/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: I started feeling bad on Monday night. I rested on Tuesday. By Tuesday night, I tried to get up, felt hot and faint, and nearly passed out in my bedroom. I did fall down and hyperextended my knee and scraoed my feet, so now I can hardly walk. Thankfully, my boyfriend ran in the room and grabbed me. I got up again to go to the bathroom and felt hot and faint, so I put a cold washcloth on my head and laid in the bathroom. I stopped taking Tylenol, but I am still feeling weak, faint, and dizzy nearly 72 hours later. I've tried to walk around a little bit, but I'm still feeling like I could faint - weak, off, dizzy. I've tried to rest and drink lots of fluids. Frankly, I'm scared of how I feel.

Other Meds: I took 3 500 mg Tylenol 8 hours apart, starting at 3 pm day of vaccine. I stopped yesterday.

Current Illness: I am waiting to see a rheumatologist. I had a positive ANA test for lupus in March. I called my family physician and the intake person at the rheumatology office to ask if I should get the vaccine with a potential autoimmune illness.

ID: 1388893
Sex: F
Age: 51
State: CA

Vax Date: 02/01/2021
Onset Date: 05/01/2021
Rec V Date: 06/10/2021
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: None

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

Symptoms: Had 2 weeks of vaginal bleeding that started in May. I received vaccine in feb. My last period was over 18 months before the bleeding started.

Other Meds: None

Current Illness: None

ID: 1388894
Sex: F
Age: 31
State: WA

Vax Date: 03/19/2021
Onset Date: 06/05/2021
Rec V Date: 06/10/2021
Hospital: Y

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: Pt received COVID-19 vaccination from Pfizer on 3/19 and 4/9 at the immunization clinic at the LIbrary hospital. On 6/5 she presented to the hospital with stroke like symptoms, workup now consistent with an acute demyelinating process suspected to be tumefactive MS but could also be consistent with ADEM. Unclear that this is related to vaccination.

Other Meds:

Current Illness:

ID: 1388895
Sex: M
Age: 31
State: CA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 06/10/2021
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: Pain in extremity

Symptoms: Patient reported feeling dizzy 10 minutes post-administration of first Pfizer dose. Had patient sit down and take off mask to make sure patient is breathing adequately. Took patient's blood pressure twice; both WNL 5 minutes apart. Provided patient with some water and snacks while he was waiting in our facility for 30 minutes. Then patient and his sisters decided to leave afterwards.

Other Meds: Telmisartan

Current Illness: N/A

ID: 1388896
Sex: M
Age: 79
State: MO

Vax Date: 05/18/2021
Onset Date: 06/02/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Reported by wife; Husband (client) had chest pressure two weeks after Covid-19 Vaccine around June 2nd and has not experienced that pressure before, wife says. Wife explained it was so severe the husband was taken via ambulance to hospital.

Other Meds: unknown

Current Illness: TYPE 2 DIABETES HX OF OPEN HEART SURGERY

ID: 1388897
Sex: U
Age: 16
State: IA

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 06/10/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient, had difficulty filling out the form. Birth date looks like 2004 on the form but might be different. No adverse events reported from the vaccination. Patient did not have identification, including insurance to verify.

Other Meds:

Current Illness:

ID: 1388898
Sex: F
Age: 39
State: CO

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/10/2021
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: VACCINE WAS STORED IN FREEZER LONGER THAN MANUFACTURER RECOMMENDED, CAUSING ITS ADMINISTRATION TO BE BEYOUND THE USE DATE.

Other Meds:

Current Illness:

ID: 1388899
Sex: M
Age: 17
State: VA

Vax Date: 06/06/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
Hospital: Y

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: Myocarditis with chest pain and ST segment elevation. Elevated troponin. Runs of ventricular tachycardia. Hospitalization to pediatric cardiac intensive care unit. Presented to ED 6/9 and currently in the intensive care unit.

Other Meds:

Current Illness:

ID: 1388900
Sex: M
Age: 17
State: MI

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Site: Pain at Injection Site-Mild, Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: LOSS OF VISION SHORT TERM-Mild, Systemic: Flushed / Sweating-Mild

Other Meds:

Current Illness:

ID: 1388902
Sex: M
Age: 17
State: CA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/10/2021
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

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

Symptoms: 17 year old patient presented to clinic with parent to receive first covid vaccine, patient received Moderna instead of Phizer. Parent was informed and no additional signs and symptoms reported per parent.

Other Meds: no

Current Illness: no

Date Died: 03/21/2021

ID: 1388903
Sex: M
Age: 70
State: TX

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 06/10/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: The vaccine was administered at 12:30 pm on Saturday, March 6, 2021. That night around 7:00 pm he called to tell me that his arm was hurting. That was the last time anyone heard from him. Two days later on the evening of Monday, March 8, 2021, he was found unresponsive in his home. When the ambulance arrived they found he had a temperature of 115 degrees. He was taken to the emergency room and placed in the critical care unit. It was determined that he suffered an anoxic brain injury and would never recover. He passed away on March 21, 2021.

Other Meds:

Current Illness:

ID: 1388904
Sex: F
Age: 37
State: CA

Vax Date: 04/22/2021
Onset Date: 05/15/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Pt c/o having heart palpitations and shortness of breath post 3 to 5 days after receiving pfizer vaccine.

Other Meds: N/A

Current Illness: N/A

ID: 1388905
Sex: F
Age: 29
State: CO

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 06/10/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: Within 15 minutes of vaccine there was tingling sensation in the mouth. Within 40 minutes of the vaccine there was tongue swelling, a metallic taste, and dry mouth. April 25, 2021 (10 a.m.) - Right half of face, right arm and right leg all went numb and tingly (Paresthesia). April 26, 2021 (evening) - slight shortness of breath, Dry mouth continued, sharp upper back pain April 28, 2021 (evening) - Shortness of breath, throat swelling, Dry mouth continued, sharp upper back pain. April 29th - Prescribed 40 mg of prednisone for 5 days (I felt good while on the prednisone), advair and albuterol May 4th - Symptoms returned after the prednisone dose was complete - On and off tingling/numbness of arms and right leg (Paresthesia), sharp pain in left calve and foot, shortness of breath, sharp back pain (upper), stomach pain (sharp), heart palpitations, dizzy, light headed. - These symptoms continue until present day (June 10, 2021). 21 Day dose of prednisone has been prescribed and a referral to a pulmonary doctor. June 10, 2021 - breath test came back abnormal indicating asthma -

Other Meds: zyrtec

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm