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: 1396078
Sex: M
Age: 4
State: NH

Vax Date: 06/10/2021
Onset Date: 06/11/2021
Rec V Date: 06/14/2021
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: zyrtec, tamuflu

Symptom List: Dysphagia, Epiglottitis

Symptoms: Had vaccine on Thurs 6/10/21 afternoon. By friday 6/11/21 afternoon 100.5 f fever. Gave motrin to treat the fever. Woke up on Sat 6/12/21 with a swollen upper arm, red, painful, tight and sensitive to the touch. Called doc at 9:30am to ask them about the reaction. They instructed to motrin and draw a circle around the redness. However, when informed that the entire upper arm was red, they had us come in. We saw a PA and instructed us to give him motrin, tylonal alternating. Give him clariton during day and benadryl at night. We kept ice packs on it and by monday (6/14/21) the injection site is less swollen, redness is slowly clearing and not as painful.

Other Meds: none

Current Illness: none

ID: 1396079
Sex: F
Age: 40
State: IL

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 06/14/2021
Hospital: Y

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

Lab Data:

Allergies: Bactrim

Symptom List: Anxiety, Dyspnoea

Symptoms: The night of the vaccine I spiked a fever of 103.0 that lasted 3 days along with chills, vomiting and body aches. On May 10th I started having problems breathing, I was having coughing fits, trouble getting air and was brought to the emergency room on on May 11th. They did chest xrays, have me albuterol treatments and steroids and sent me home. I tried to go to work on May 13th ( I work at a doctors office) and I was immediately sent to the hospital as I went into respiratory distress with my oxygen levels in the low 80's. I was given more steroids, IV steroids and sent home with an inhaler. I went to my primary care physician for a follow up on May 17th I was still having trouble breathing, was given 2 breathing treatments at the doctors office and then they called an ambulance for me to take me to the hospital for respiratory distress. I was admitted to the hospital for 4 days where I was given 2 IVs, more chest x-rays, a CT, I.V. steroids, epinephrine, and breathing treatments every 3-4 hours or as needed. At one point they considered intubating me to let my lungs rest as I could not breathe and would cough until I vomited. No one could figure out the cause and assume it was a vaccine reaction. I was then sent home with at home Duo nebulizer treatments, inhaled steroids, and cough syrup. I also had a lung function test done.

Other Meds: Carbamazepine, Trazodone, Levothyroxine, Singular, Colazapam, Labetalol

Current Illness: None

ID: 1396080
Sex: M
Age: 46
State: IA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/14/2021
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: grasses, weeds, some foods during allergy season; typically reaction is wheezing. He had mild flu symptoms after his first dose but no allergy symptoms.

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

Symptoms: Patient was waiting in our observation area when he began to experience dizziness, cold sweats and tunnel vision. He lay down on the floor, and our technician asked him if he was OK. I immediately went out to him, and he told me he was already feeling better. I had him put his feet up on the chair, and he told me that he thought this reaction was due to anxiety. He was talking and breathing normally. I offered to check his blood pressure and get him some water, but he declined. He rested on the floor for approximately 5 minutes and then said he was feeling well enough to go.

Other Meds: unknown

Current Illness: unknown

ID: 1396081
Sex: F
Age: 21
State: KY

Vax Date: 06/12/2021
Onset Date: 06/13/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies: Pneumococcal vaccine Varicella vaccine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 12 hours after vaccination- fever, fatigue, chills treated with ibuprofen 24 hours after vaccination- fever continued to treat with ibuprofen. Stomach pains/diarrhea

Other Meds: Escitalopram Norethindrone

Current Illness: N/a

ID: 1396082
Sex: M
Age: 23
State: MA

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

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

Lab Data:

Allergies: None known

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

Symptoms: Patient received the immunization and roughly 5 minutes later he passed out. Patient hit his nose on our bench and had to go to the hospital to get stitches. Patient didn't have a concussion. Patient went to urgent care and was taken care of and released the same day.

Other Meds: None known

Current Illness: None

ID: 1396083
Sex: M
Age: 18
State: OH

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/14/2021
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: NO ADVERSE EVENT REPORTED

Other Meds:

Current Illness:

ID: 1396084
Sex: F
Age: 72
State: FL

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 06/14/2021
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: I just allergic to Sulphur.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I felt a cold coming on before I took the shot the previous day. The shot was given to me because I did not have a fever. Upon returning home I could not stop coughing and thought about going to the ER but did not. I went to the Pharmacy and the Pharmacist recommended taking some DM Cough medicine. I finally contacted my Doctor via tele-services and we discussed the fever, cough and why I was feeling bad.

Other Meds: I only took my normal medications.

Current Illness: I wasn't sure if I was coming down with a cold at the time of the vaccination or possibly allergies (pollen in the air).

ID: 1396085
Sex: F
Age: 46
State: CA

Vax Date: 06/04/2021
Onset Date: 06/11/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies: Lact-ai

Symptom List: Pharyngeal swelling

Symptoms: Covid Arm: large red lesion around the injection site, pain on left arm, shoulders, hips

Other Meds: None

Current Illness: None

ID: 1396086
Sex: M
Age: 60
State: ID

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received incorrect second dose. He should have received Moderna but received Pfizer.

Other Meds: N/A

Current Illness: N/A

ID: 1396088
Sex: M
Age: 30
State: RI

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/14/2021
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: trees;: sinus reaction

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pfizer vaccine reconstituted with 0.8 ml vs 1.8 m. of diluent. Patient received a more concentrated dose. On 6/12 patient was notified of issue. RN called patient who reported the following, reports feeling well at this time, denies any sxs of anaphylaxis or SE of Pfizer, pt speaking in full sentences.Informed pt we do not expect he will experience any adverse effects but we will still monitor and check in with him, reviewed expected SE of the COVID Pfizer vaccine and how to manage them. Writer reviewed with red flags when needing to seek ED level of care. Patient called again on 6/13 and reports the following: reports feeling well today, no rash at injection site, arm is a little sore but thats it, no other symptoms. Advised wil call tomorrow, pt verbalized understanding. On 6/14 patient contacted and reports, Patient reports he is feeling well.

Other Meds: Montelukast Sodium 10 mg, 1 tab, once daily; MriaLax once a day, Fluticasone Propionate 50 mcg/inh spray, once daily; Albuterol 90 mcg/inh, 2 puffs, q.4h prn.

Current Illness: N/A

ID: 1396089
Sex: M
Age: 35
State: TX

Vax Date: 06/11/2021
Onset Date: 06/12/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies: Tramadol and MS Contin.

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

Symptoms: No side effects from first shot. Second shot was different. Got my second shot about 2PM and around 1-2 AM I was getting ready for bed. At first I was just feeling tired but then I started shaking uncontrollably and muscles in my neck and back were spazzing out. I lost all control of my body and fell over, convulsing for an unknown amount of time. I apparently foamed and/or drooled all over myself. I woke out of this effect around 3:30 AM. This was Friday/Saturday. Its Monday now. I still cannot stand straight and cannot create complex thoughts in my mind. I had a hard time perceiving colors for the first day and a half to two days after the seizure or stroke I suffered. I still have a migraine that feels like an elephant is sitting inside my skull. I still cannot perform complicated thoughts nor can I do complicated things with my hands because of a lack of motor skills. I successfully pulled every muscle in my back and neck and cannot stand upright. I'm 35 and now need a cane. Its already been 3 days and things really have not changed. Won't catch me lining up for a booster shot. NO THANK YOU. I did not seek medical attention because lets face it the healthcare system is a joke I would have needed a ride to a hospital, increasing my odds of getting the virus, to have them hold me as long as they can to stab me and poke me and take samples, give me no results, and a humungo bill. I will die before I go to a hospital ever again because the amounts of testing I required at the time would have covered back and neck and brain scans of various types and those tests are stupid expensive and 99% of the time I've ever got one they said oh I'm sorry we don't know what's wrong go see my friend who is a specialist blah blah blah and its the "doctor-go-round" where you blow all your money on morons that only care about lining their pockets.

Other Meds: None.

Current Illness: None. My Nystagmus doesn't count.

ID: 1396090
Sex: F
Age: 74
State:

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 06/14/2021
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 has a history of chronic panic attack . Present with signs and symptoms of anxiety. Patient reports feeling light headedness and dizziness after vaccine. Vitals all in normal limits . After being asked patient reports feeling better. Patient walk.

Other Meds:

Current Illness:

ID: 1396091
Sex: F
Age: 49
State:

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

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

Lab Data:

Allergies: omeprazole

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

Symptoms: Patient was anxious and tachycardic prior to vaccine administration. This was her second vaccine dose. She had experienced altered mental status, tachycardia and hypertension after her first dose so was advised to get her second dose in Urgent Care. Her BP and HR continued to increase after administration of the second dose. She was admitted to the Clinical Decision Unit in Urgent Care where her symptoms improved. She did receive epinephrine, antihistamines and Solumedrol. The patient did have consultation with an allergist after the first dose, who felt that the patient's symptoms were unlikely due to an allergic reaction.

Other Meds: pantoprazole, naproxen

Current Illness:

ID: 1396092
Sex: M
Age: 13
State: CA

Vax Date: 06/11/2021
Onset Date: 06/12/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Headache, vomiting, chest pain

Other Meds: None

Current Illness:

ID: 1396093
Sex: F
Age: 71
State: IA

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 06/14/2021
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, shingles shot.

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

Symptoms: Injection site red & swollen, fever, tired, headache, chills, joint pain, swollen lymph nodes, rash on chest & back - lasted 3 days.

Other Meds: Levothyroxine, multivitamin, calcium, biotin, vit D, glucosamine.

Current Illness: None.

ID: 1396094
Sex: M
Age: 17
State: MI

Vax Date: 04/13/2021
Onset Date: 04/20/2021
Rec V Date: 06/14/2021
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: Allergy: Amoxicillin (rash, hives)

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

Symptoms: Approximately 6-7 days after the first dose of COVID vaccine (Pfizer) patient had low grade fever (100.8) malaise, and not feeling well. Progressed to chest pain and slight SOB. Continued low grade fever controlled with Tylenol and Motrin. Was seen in urgent care and tested for COVID. COVID PCR negative. EKG done (abnormal). Suggested covid 19 pneumonia and follow up with PCP. Was seen in ER that evening for increasing chest pain, SOB. Chest xray done. EKG not done. No labs sent. COVID PCR done. Negative. Improved at home with rest, Tylenol, Motrin. Sunday afternoon, was taken to ER for chest pain, increased SOB, and not feeling well. BP elevated, CXR done, EKG done, and bloodwork done. Troponin negative, D Dimer negative, labs WNL. No acute MI. Suggested pericarditis based on EKG results. Follow up suggested with cardiologist. Echo and EKG done on Tuesday May 4. Improving pericarditis/myocarditis. Final EKG done on Friday 5/7.

Other Meds: Multivitamin 3 days per week

Current Illness: None

ID: 1396095
Sex: F
Age: 21
State: TX

Vax Date: 06/13/2021
Onset Date: 06/14/2021
Rec V Date: 06/14/2021
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: "Either cashew or local honey"

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

Symptoms: The patients mother called and stated that her daughter is experience rapid heart rate of 120 bpm or greater, fatigue, nausea, and vomiting. She was instructed to seek medical attention. The patients provider is seeing her on 6/14/21. Outcome is still pending.

Other Meds: Unknown

Current Illness: Unknown

ID: 1396096
Sex: M
Age: 51
State: NY

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/14/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)

Other Meds:

Current Illness:

ID: 1396097
Sex: F
Age: 65
State: TX

Vax Date: 01/16/2021
Onset Date: 01/17/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies: No.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I had fever of almost 101, chills, very tired, I slept for almost 24hrs, bad headache, nauseated, vomiting.

Other Meds: Yes.

Current Illness: No.

ID: 1396098
Sex: M
Age: 30
State: TX

Vax Date: 06/12/2021
Onset Date: 06/14/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient came in having tenderness under left armpit. Upon examination, patient had what looked like a swollen lymph node. Patient had swelling of about the size of a baseball at left armpit. This was compared to his right side which looked normal. Instructed patient to seek a physician for further examination.

Other Meds: N/A

Current Illness: N/A

ID: 1396099
Sex: U
Age: 37
State:

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 06/14/2021
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: Patient complained of headache after see another patient transported to the medics. Patient blood pressure was slightly elevated, reassess after 30mins normal limits . After drinking a bottle of water patient reports headache improved.

Other Meds:

Current Illness:

ID: 1396100
Sex: M
Age: 82
State: NJ

Vax Date: 01/28/2021
Onset Date: 01/30/2021
Rec V Date: 06/14/2021
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: Unevaluable event

Symptoms: The first thing was I had no feeling in my arm, shoulder, and hand. Still have no feeling in my arm. Tremendous pain in my back, upper and lower back. Went to the hospital and thought I had a stroke. Went to see another doctor for it. Could not get rid of the pain and was given steroids' to help. The pain left after two weeks, but occasionally still appears. Still cannot use hand, arm, or shoulder.

Other Meds: Tylenol

Current Illness: none

ID: 1396101
Sex: F
Age: 58
State: NY

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 06/14/2021
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: dog and cat dander allergy

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

Symptoms: Symptoms of dizziness and feeling in a fog all day long. Dizziness is intermittent, aggravated by movement, turning, and laying down to try to exercise. Also describes having a constant headache and 'feeling drained and difficulty concentrating.'

Other Meds: B-Vitamin, HCTZ, Xyzal, Levothyroxine, Singulair, Multivitamin

Current Illness: None

ID: 1396102
Sex: F
Age: 48
State: CT

Vax Date: 03/29/2021
Onset Date: 04/01/2021
Rec V Date: 06/14/2021
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: Heart palpitations, PVC, PACs. Constantly.

Other Meds: Levothyroxine Verapamil

Current Illness:

ID: 1396103
Sex: F
Age: 17
State: FL

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/14/2021
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: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1396104
Sex: M
Age: 74
State: MO

Vax Date: 02/22/2021
Onset Date:
Rec V Date: 06/14/2021
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: patient has had a red, sore knot in arm at site of administration since shot in Feb. He had hoped it would be gone but it is not. He said the knot is now about 1 and 1/2 inches below administration site and is about the size of a tennis ball. He is going to be seen in a few weeks by his PCP.

Other Meds:

Current Illness:

ID: 1396105
Sex: F
Age: 65
State: TX

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 06/14/2021
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: No.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: This event lasted 12hrs. I chills, fever, headache and very fatigue.

Other Meds: Yes.

Current Illness: No.

ID: 1396106
Sex: F
Age: 21
State: MD

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/14/2021
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: Patient was very nervous at the time of vaccine. After the vaccine was administered, the patient went to sit for 15 minutes afterwards and her whole body was shaking. We assessed the patient, provided her water and orange juice and monitored her. She declined for us to call the hospital and stated that she was nervous about getting the vaccine. She initially felt flushed but as we sat and talked to her, the shaking subsided and the patient felt fine to leave. She declined getting her blood pressure or blood sugar checked. We had her stand up slowly and assessed her gait to make sure she was feeling okay, and she appeared to be standing normally. She stated that she felt fine to leave. She said that she was not driving and that her husband was going to come and pick her up.

Other Meds:

Current Illness:

ID: 1396107
Sex: F
Age: 26
State: MS

Vax Date: 04/16/2021
Onset Date: 04/29/2021
Rec V Date: 06/14/2021
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: n/a

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

Symptoms: I had cramps and heavy bleeding during my period after receiving the vaccine. I was also 2 days late getting my period. I have been tracking my period for 13 years now and I have a vary regimented cycle. I am not on birth control of any sort. And I also use a fertility monitor to track my fertility.

Other Meds: pre-natal vitamins

Current Illness: n/a

ID: 1396108
Sex: M
Age: 82
State: NJ

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 06/14/2021
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: Migraine headaches, extremely bad for six straight weeks. Did not see a doctor for it. Eventually they went away on their own.

Other Meds: tylenol

Current Illness: Type 2 diabetes

ID: 1396109
Sex: F
Age: 57
State: WA

Vax Date: 01/28/2021
Onset Date: 02/07/2021
Rec V Date: 06/14/2021
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: 2/7/21, left lower leg pain and swelling and tenderness, began to migrate around shin and up calf. Extreme tenderness and it began to travel up my leg. Went to vascular Dr. on 2/17, did US rules out DVT, but diagnosed with severe phlebitis. compression socks and elevation. Went back on 2/24/21 as continued to progress up now into thigh. did another US, rules out DVT and phlebitis continues to be the diagnosis.

Other Meds: Womens vitamins, calcium, D3, B12

Current Illness: None

ID: 1396110
Sex: M
Age: 31
State: MA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/14/2021
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: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Patient reported being dizzy after the vaccine dose, sat down after vaccine, and then patient briefly lost consciousness for aprox 10-20 seconds. Ambulance was called, BP/BG/EKG taken, patient eventually agreed to be admitted, leaving with the paramedics. Patient had reported not eating anything this morning prior to the vaccine.

Other Meds:

Current Illness:

ID: 1396111
Sex: F
Age: 65
State: NY

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/14/2021
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: Penicillin

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

Symptoms: Nausea, headache, muscle spasms all over, and pain from fingers, shoulders down to heels.

Other Meds: Lisinopril, diclofenac

Current Illness: None

ID: 1396112
Sex: F
Age: 48
State: FL

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 06/14/2021
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: I wake up almost every day now with tingling, numbness or pain in my hands. The right hand is worse than the left hand. Sometimes I am unable to open a basic water bottle as my grip strength is seriously compromised. The evening of the vaccine I went to bed early as I was super tired. I woke up in the morning and felt flu-ish which I knew could be expected. But my hands were cramped and it was hard to get them to open. For two days I couldn't type or hold a fork--I had to manipulate my hands with something other than my hands to stretch them out and get them to open and to stop shaking. It's been a bit over a month now and I'm still waking up with my hands sore, numb, asleep, cramped or a combination of all of these. There has not been one day that I haven't woken up like that. I have to type a lot for my work and it has compromised how much I can do at any one time. My hands need a lot of breaks. I am an avid knitter but I haven't been able to do that at all since my second vaccine shot on May 10th and I struggle to do other things that require grip and dexterity as well - like carrying a bag or using a hammer.

Other Meds: none

Current Illness: none

ID: 1396113
Sex: F
Age: 66
State: IN

Vax Date: 05/12/2021
Onset Date: 05/13/2021
Rec V Date: 06/14/2021
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: Sulfa

Symptom List: Erythema, Pruritus

Symptoms: Constant cough developed within 24 hours. Dry non productive. Shortness of breath Lasted 6 weeks now Husband same symptoms but worse

Other Meds: Estradiol

Current Illness: None

ID: 1396114
Sex: F
Age: 52
State: CA

Vax Date: 01/01/2021
Onset Date: 02/01/2021
Rec V Date: 06/14/2021
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: Sulfa Levaquin

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

Symptoms: I had pain in my ear. Went to MD. Dx with fugal infection. Hearing then decreased?went to audiologist for follow up- had more hearing loss, Not sure if related but CDC called me and asked me to fill out form

Other Meds: Vitamin B12 Vitamin D

Current Illness: None

ID: 1396275
Sex: F
Age: 47
State: AL

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 06/14/2021
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, codeine, shellfish.

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

Symptoms: I woke up around 3:30 AM 01/26/2021 and I was running fever, my temperature was as high as 102.4. I ended up sleeping in the recliner because I was sweating. I had a massive headache, achiness, and I really couldn't eat anything. I slept for about 36 hours in a recliner. This lasted for two days. Fatigue and fever. After 36 hours I felt normal. My NP kept calling and checking on me to see if fever went down. No medical care.

Other Meds: Topiramate, Bupropion, Buspar, Yaz.

Current Illness: None.

ID: 1396276
Sex: F
Age: 14
State: TX

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/14/2021
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: Moments after receiving the vaccination, the patient temporarily lost consciousness. I was able to keep the patient from any harm and with the mom, monitored the patient for many minutes as the patient returned to normalcy. patient was given granola and water and monitored for a half hour.

Other Meds:

Current Illness:

ID: 1396277
Sex: M
Age: 21
State: VA

Vax Date: 06/08/2021
Onset Date: 06/10/2021
Rec V Date: 06/14/2021
Hospital: Y

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

Lab Data:

Allergies: Cefzil

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

Symptoms: Patient developed myopericarditis 2 days after the second COVID-19 vaccine dose.

Other Meds: Amitriptyline, fexofenidine, fluticasone, montelukast, omeprazole

Current Illness: None

ID: 1396278
Sex: M
Age: 26
State: PA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/14/2021
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: Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium

Other Meds:

Current Illness:

ID: 1396279
Sex: F
Age: 50
State: NM

Vax Date: 01/19/2021
Onset Date: 01/26/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies: Metformin

Symptom List: Pain in extremity

Symptoms: One week after vaccine at 9 am I felt a rash on my arm it burn it was hot and then I had abdominal pain spasm on my stomach on Feb 24 I stayed home from work. My intestines were hurting I was inflamed Brain fog and vertigo I had to quit work because it hasn't stopped and went to the doctor and said my IBS flared up. I went to the ER and the doctor there advised to wait on taking 2nd dose for right now. In the ER they did a CT scan but they didn't see anything big.

Other Meds: hbp medication 50 mg 2x a day for tachycardia

Current Illness: None

ID: 1396280
Sex: F
Age: 40
State: LA

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies: I am allergic to sulfa.

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

Symptoms: I had a sore arm. I had a really bad headache and a serve fever. I had to sleep it off for at least 3-4 hrs. I am due January 16th.

Other Meds: Yes I was taking prescriptions.

Current Illness: No other illnesses.

ID: 1396281
Sex: F
Age: 18
State:

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 06/14/2021
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 fainted approximately 15 minutes postvaccination. Felt better after drinking some water and was released to home.

Other Meds:

Current Illness:

ID: 1396282
Sex: M
Age: 23
State: KS

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 06/14/2021
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: After 1st shot, I experienced adverse mental effects and a sore arm. After 2nd shot, I experienced flu-like symptoms, fever, chills, headache, fatigue

Other Meds: magnesium zinc D vitamin, D3 Vitamin, B complex

Current Illness:

ID: 1396283
Sex: F
Age: 26
State: OH

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/14/2021
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: Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Shakiness-Medium, Systemic: Visual Changes/Disturbances-Medium, Systemic: Weakness-Medium

Other Meds:

Current Illness:

ID: 1396284
Sex: M
Age: 53
State: TX

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/14/2021
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: NO KNOWN ALLERGIES

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: PATIENT RECEIVED MODERNA COVID19 ON 5/13/2021 AND WAS GIVEN PFIZER COVID19 ON 6/14/2021

Other Meds:

Current Illness: NONE

ID: 1396285
Sex: F
Age: 65
State: NJ

Vax Date: 05/07/2021
Onset Date: 05/10/2021
Rec V Date: 06/14/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: PATIENT CALLED THE PHARMACY TO REPORT PAIN IN HER ARM AFTER THE FIRST INJECTION. SHE SAYS THE PAIN STILL REMAINS AFTER 3 WEEKS. I ADVISED HER TO ICE THE ARM AND TAKE TYLENOL OR MOTRIN FOR THE PAIN.

Other Meds:

Current Illness:

ID: 1396286
Sex: M
Age: 19
State:

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 06/14/2021
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: Patient had syncopal episode within 15 minutes of vaccination. Felt better after drinking some juice and was released to home.

Other Meds:

Current Illness:

ID: 1396287
Sex: M
Age: 27
State:

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 06/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Itchiness increased to upper and lower extremities. No hives or rash noticed.

Other Meds:

Current Illness:

ID: 1396288
Sex: F
Age: 19
State: MI

Vax Date: 06/08/2021
Onset Date: 06/10/2021
Rec V Date: 06/14/2021
Hospital: Y

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: Patient developed myopericarditis two days following second dose administration. Patient had two days of chest pressure in the substernal chest

Other Meds: Levonorgestrel-ethinyl estradiol

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm