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: 1400071
Sex: F
Age: 18
State: CO

Vax Date: 06/10/2021
Onset Date: 06/11/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Paresthesias of arms and knees concern for vaccine reaction vs GBS Brain/cervical unremarkable via MRI Spinal tap not c/w with GBS. Headache

Other Meds:

Current Illness: has a history of arthritis and low back pain

ID: 1400072
Sex: F
Age: 67
State: CA

Vax Date: 04/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/15/2021
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: bactrim cipro cortisine flagyl iodinated radiocontrast agents lamisil

Symptom List: Anxiety, Dyspnoea

Symptoms: persistent R sided back pain beginning 2 weeks ago. Pt states she has had R sided "lung pain" most notable to her back. Pain is exacerbated with deep inspiration. She endorses persistent joint pain s/p receiving her second dose of COVID vaccine 2 months ago. Denies associated fever, recent travel, or hormone therapy.

Other Meds:

Current Illness:

ID: 1400073
Sex: U
Age:
State: LA

Vax Date:
Onset Date:
Rec V Date: 06/15/2021
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: On 6/9/2021 she developed symptoms of severe sore throat,productive coughing,fatigue and nasal/chest congestion. No fever

Other Meds:

Current Illness:

ID: 1400074
Sex: M
Age: 82
State: OH

Vax Date: 06/14/2021
Onset Date: 06/15/2021
Rec V Date: 06/15/2021
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: hives on left hip, itching on hand

Other Meds:

Current Illness:

ID: 1400075
Sex: M
Age: 16
State: TX

Vax Date: 04/29/2021
Onset Date:
Rec V Date: 06/15/2021
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 known allergies

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

Symptoms: This is an administration error. No adverse events reported. Vaccine given to patient under age of 18 contrary to MFG recommendations

Other Meds: No known additional meds

Current Illness: No known illnesses

ID: 1400076
Sex: M
Age: 13
State: SC

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/15/2021
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: Patient received NaCl instead of reconstituted vaccine

Other Meds:

Current Illness:

ID: 1400077
Sex: M
Age: 14
State: NJ

Vax Date: 06/11/2021
Onset Date: 06/14/2021
Rec V Date: 06/15/2021
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: Seasonal allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: fever, chest pain, elevated troponin, and EKG changes consistent with myocarditis.

Other Meds: fluticasone (Flonase) 50 mcg/ACT Nasal spray acetaminophen 160 mg/5mL Oral suspension

Current Illness: None

ID: 1400078
Sex: M
Age: 54
State: NY

Vax Date: 03/22/2021
Onset Date: 03/24/2021
Rec V Date: 06/15/2021
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: Reports bilateral tinnitus that began about 36h after vaccine, worsened to a maximal symptom after 3 days. Ringing in ears as well as reduced hearing. Has persisted following the vaccine. seen by ENT with no resolution. Following second vaccine had swelling and stiffness of hands which has also persisted.

Other Meds: None

Current Illness: None

ID: 1400079
Sex: F
Age: 46
State: CO

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/15/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt reports the same night as her vaccination (which was her second dose of COVID vaccine) she threw up all night long, experienced fatigue, sweats, chills, hot flashes, HAs, brain fog, severe dizziness, diarrhea, coughing, congestion, THROAT SWELLING, AND DIFFICULTY SWALLOWING. No SOB or tongue or lip swelling. She says that her symptoms have been improving over the last 4 days, but that her throat swelling is still present. She had a negative exam and SpO2 95%. Advised her to avoid any COVID vaccines in the future unless she has seen an allergist and they have cleared her to receive subsequent COVID vaccines. Prescribed her Prednisone 40mg Once daily x 5 days for suspected allergic reaction. OF INTERESTING NOTE: PT REPORTED THIS AS HER SECOND DOSE OF THE VACCINE, BUT UPON FURTHER RESEARCH, ACCORDING TO THE SYSTEM , THE DOSE SHE REC'D ON 6/10/21 WAS HER 4TH DOSE OF PFIZER COVID VACCINE. THAT IS NOT A TYPO. SHE HAS RECORDS FOR 4 DIFFERENT VACCINATIONS OF THE PFIZER COVID VACCINE THAT DO NOT SEEM TO BE DUPLICATED INFORMATION.

Other Meds: None

Current Illness: None

ID: 1400080
Sex: M
Age: 24
State: OK

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1400081
Sex: F
Age: 68
State: TX

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: My arm was swore and the same day i had cough. I had blisters and it became bump

Other Meds: losartan, vasrtan, triemterinite hctz

Current Illness: none

ID: 1400082
Sex: M
Age: 64
State: IN

Vax Date: 04/15/2021
Onset Date: 04/21/2021
Rec V Date: 06/15/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Numbness and tingling in left arm persists to this day.

Other Meds: Xanax

Current Illness: None

ID: 1400083
Sex: M
Age: 32
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1400084
Sex: F
Age: 14
State:

Vax Date: 06/07/2021
Onset Date: 06/08/2021
Rec V Date: 06/15/2021
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: Breakthrough menstrual bleeding (spotting) while on oral contraceptives

Other Meds: Desogen birth control pills

Current Illness:

ID: 1400085
Sex: M
Age: 19
State: SC

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/15/2021
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: patient was given only diluent/no vaccine

Other Meds:

Current Illness:

ID: 1400086
Sex: F
Age: 61
State: MI

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/15/2021
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: headace, dizziness, nauseated, ringing in ears, eye focus, "heavy" arms and legs

Other Meds:

Current Illness:

ID: 1400087
Sex: F
Age: 54
State: NC

Vax Date: 06/02/2021
Onset Date: 06/03/2021
Rec V Date: 06/15/2021
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: NKA

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

Symptoms: uticaria on left arm where vaccine was given. Arm was red, itchy, and swollen. Symptoms started the day after vaccine was given. Provider referred patient to an allergist

Other Meds: ashwaganda, duloxetine, magnesium, multiple vitamin, fish oil, rhodiola

Current Illness: none

ID: 1400088
Sex: M
Age: 15
State: NC

Vax Date: 06/10/2021
Onset Date: 06/11/2021
Rec V Date: 06/15/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: The patient is a 15-year-old male with no past medical history who was in his normal state of health when he received a dose to the Pfizer COVID-19 vaccine on June 10th 2021. The day following vaccine he developed fevers and chills which she treated with Tylenol. On the morning of June 12 he developed chest pain and nausea which progressively worsened throughout the day. That day he presented to an outside hospital emergency department where he was found to have elevated troponin and EKG with ST segment elevation. He was then transferred to the hospital pediatric ICU for further care. On admission to the PICU treatment was started with IV Toradol. Echocardiogram was performed and revealed mildly decreased left ventricular systolic function. His peak troponin level was 27.43. He remains hemodynamically stable and was transferred to the pediatric floor. By 6/14/2021 his chest pain had resolved and he continued to improve with NSAID therapy alone. His troponin down trended to 2.62 on day of discharge. Repeat echo on day of discharge showed improving but still mildly diminished systolic function. Repeat ECG at discharge showed persistent ST elevation. He was discharged with a prescription to continue ibuprofen 600 mg 3 times daily and follow-up with pediatric cardiology in 1 to 2 weeks.

Other Meds: Nothing prior to or at the time of vaccination. He took some Tylenol when he developed fever the day after the vaccine.

Current Illness: None

ID: 1400089
Sex: F
Age: 55
State: OH

Vax Date: 03/05/2021
Onset Date: 03/08/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies: Seasonal allergies.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I was having shortness of breath and it started during walk. So then at the end of the month it got worst. I had my chemo appt on 04/01/202when I went in for my next chemo appt, they thought I may have had a blood clot. My pulse oxygen was at 90%. They admitted me into the hospital 04/02/2021, then they ran a lot test. I have seen a Pulmonologist and he put me on Steroids, this was after my second visits.

Other Meds: I was taking Loratadine, Vitamin B-12, Biotin, Glucosamine Chondroitin , Vitamin D3 and Cymbalta. I also take Herceptin and Perjeta for my chemo. Every now and then I take tylenol.

Current Illness: No

ID: 1400090
Sex: M
Age: 71
State: OH

Vax Date: 02/02/2021
Onset Date: 02/18/2021
Rec V Date: 06/15/2021
Hospital: Y

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

Lab Data:

Allergies: Lisinopril, Claratin

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

Symptoms: First episode Feb 18 (16 days after first Covid vaccine): fainting, shortness of breath at onset of light exercise (called Dr., advised to drink more water). Second episode: Feb. 23, one day after second Covid-19 shot: inflamed left calf, redness of skin. Dr. and ER visit Feb. 24, diagnosed with critical DVT and multiple pulmonary embolisms. ER put me on heparin IV drip, Overnight stay in hospital, discharged with Eliquis blood thinner prescription. Continuing that med for life, per hematologist

Other Meds: Valsartan, Tadalafil

Current Illness:

ID: 1400091
Sex: F
Age: 35
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/15/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1400092
Sex: M
Age: 22
State: WA

Vax Date: 04/15/2021
Onset Date: 05/03/2021
Rec V Date: 06/15/2021
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 Covid19 even with the Pfizer vaccine EUA 04/15/2021-05/03/2021

Other Meds:

Current Illness:

Date Died: 05/20/2021

ID: 1400093
Sex: M
Age: 57
State: MI

Vax Date: 05/04/2021
Onset Date: 05/20/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Died suddenly, autopsy pending

Other Meds: Trazodone, certrizine, naproxen

Current Illness:

ID: 1400094
Sex: M
Age: 53
State: WA

Vax Date: 05/09/2021
Onset Date: 05/12/2021
Rec V Date: 06/15/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Nearly constant headache, back of head, almost a buzzing sensation

Other Meds: 10 mg Lisinopril - daily

Current Illness: None

ID: 1400095
Sex: F
Age: 1
State: MI

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Vaccination was 6 days post expiration upon administration. No adverse reactions noted.

Other Meds: None

Current Illness: None

ID: 1400096
Sex: F
Age: 34
State: NY

Vax Date: 05/24/2021
Onset Date: 05/25/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Extreme menstrual cramping and lower back pain, pain in left ovary only accompanied by light menstrual bleeding.

Other Meds: Lo-overal birth control pill

Current Illness: None

ID: 1400097
Sex: F
Age: 35
State: PA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/15/2021
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: Known allergy to apples, amoxicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: At 10 minutes post-vaccine, tingling in fingers/hands. At 12 minutes, intense dizziness, difficult speaking clearly, racing heart and light-headedness. About 30 minutes post-vaccines some mild facial hives, itchy nose and stuffy nose.

Other Meds: OTC Benedryl, 50 mg OTC Allegra

Current Illness: None

ID: 1400098
Sex: M
Age: 27
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/15/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1400099
Sex: M
Age: 54
State: VA

Vax Date: 06/10/2021
Onset Date: 06/11/2021
Rec V Date: 06/15/2021
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: Taken @ 7.30pm. By noon the next day, strong muscle aches over all body, a temperature of 102.00 (with Tylenol) and body weakness that lasted 24 hours, fatigue. Painful injection site that lasted several days.

Other Meds: Metoprolol 100mg FAMOTIDINE 20MG 150mg Losartan 50mg Diltiazem 120mg Montelukast (singular) 10mg

Current Illness: none

ID: 1400100
Sex: F
Age: 44
State: VA

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

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

Lab Data:

Allergies: pain meds oxycodone etc. gluten allergy

Symptom List: Nausea

Symptoms: Knot on injection site, fatigue, Soreness, Headache.

Other Meds: vitamin d vitamin k magnesium

Current Illness: None

ID: 1400101
Sex: F
Age: 30
State: MI

Vax Date: 06/09/2021
Onset Date: 06/14/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies: penicillin, sulfa drugs

Symptom List: Injection site pain

Symptoms: My period started a week early (I've been keeping track on my fit bit for well over a year), which never happens. At most it will come late but never early. Currently I am going through the worst cramping I have ever experienced and the duration is killing me. Starting when I woke up at 6:30a to now, 3:58p I have had non stop debilitating and fairly consistent abdominal cramping. Now I have had bad cramps a few times in my life, but they won't ever last over an hour.

Other Meds: adderal

Current Illness: ADHD?

ID: 1400102
Sex: F
Age: 55
State: SC

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/15/2021
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: patient received only diluent/no vaccine

Other Meds:

Current Illness:

ID: 1400103
Sex: F
Age: 12
State: NJ

Vax Date: 05/29/2021
Onset Date: 05/29/2021
Rec V Date: 06/15/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: shellfish

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

Symptoms: Started vomiting 2hrs after vaccination. Went to ER who initially obtained CBC with stable Hgb and sent home with Zofran. Patient continued to have bloody emesis so presented back to ER where they did CXR which was normal, gave IVF bolus, zofran, repeat CBC with Hgb 12.4 and transferred to another hospital for higher level of care. At the hospital, Initially made NPO and placed on IV fluids in preparation for possible endoscopy. Repeat labs showed stable hemoglobin compared to outside hospital. GI consulted and determined that hematemesis was most likely due to Mallory Weiss tear. Recommended carafate before meals, chloraseptic spray as needed for sore throat, continuing IV Protonix and IV zofran as needed, and gradually advancing her diet. On HD#3, she had another episode of hematemesis after eating solids. Overnight, tolerated liquids and solids without any further episodes of emesis. Tolerated transition from IV to PO meds and maintained hydration off of IV fluids. Due to symptom improvement, GI did not recommend endoscopy at this time and recommended that she be discharged on 1 week course of carafate, 2 month course of omperazole, and zofran as needed with plans for GI follow-up in 1-2 months. Had another episode of hematemesis at home after discharge. Went back to hospital and admitted again. The patient underwent upper endoscopy which showed no source of upper GI bleed. ENT was consulted and performed a nasopharyngolaryngoscopy which was negative for an ENT source of bleeding. She remained stable without an identifiable source of bleeding. Mom was comfortable with her being discharged home with close follow up by PCP. Pt seen on 6/7/21 at pediatrician's office for ER F/U. Pt reported she was still vomiting, 2x so far that day. The day before vomited 4x during the day and continued until the night. No more bright red blood in vomit. Describes vomit as blue and pink colors now. Pt does take a light green tablet that is her levothyroxine. Threw up the blue colored vomit immediately after taking this medication. Instructed to take zofran when feeling nauseous. Seen again by pediatrician on 6/10/21- Currently, per mom pt is still vomiting. Last time she vomited was last night. Pt is taking omeprazole. Pt vomited 5-6x yesterday. Decreased appetite, but has been eating some crackers and rice. Complaining of stomach pain after eating and vomiting. Pt used zofran once and it helped a little. Pt denies self induced vomiting. Pt has ben observed by family when vomiting and they do not report any self induced vomiting. Pt denies trying to lose weight. Pt never vomits up food, always liquid. Vomit is different colors, can be pink or blue. No more red color in vomit, only pink. Pt drinks water and gatorade. Pt denies feeling any burning before vomit, but feels burning sensation after vomiting. Pt has been having BMs, not regularly and hard. Taking one capful of miralax at night. Instructed for next five days, instructed to take zofran pill 1hr before dinner. F/U with GI. Seen again by pediatrician on 6/15/21- Per mom and pt she is still vomiting about 5-6 times a day. Pt went to GI yesterday, given lansoprazole 30mg qd and told to continue zofran.. Pt is now able to eat all her meals, takes zofran 1hr before dinner. Pt has vomited 1hr after dinner and has only vomited liquids. Hematemesis has resolved. Still has some blue colored vomit, most likely from levothyroxine medication she takes daily. Stopped taking Miralax 3 days ago. Pt had a soft BM earlier this morning. Pt states she has occasional stomach pains after vomiting, takes a while to calm down but then resolves. Described as lower abdominal. Pt has nausea before vomiting, after vomiting takes 15-30mins for nausea to resolve. Pt states she had a headache with a heavy sensation when vomiting. No headaches at night, but does vomit 3-4x overnight. LMP: 2wks ago. Recommended to go to ophthalmologist to r/o papilledema. WIll contact hospital to get results of any bloodwork done inpatient (reviewed - only CBC done inpt).. F/U in 1wk. Ordered MRI brain w/contrast. CMP. lipase, amylase, celiac disease panel. All results pending.

Other Meds: levothyroxine 88 mcg tablet

Current Illness: none

ID: 1400104
Sex: M
Age: 59
State: ME

Vax Date: 03/31/2021
Onset Date: 04/04/2021
Rec V Date: 06/15/2021
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: sulfa, quinolones, probenecid, aspirin, dapsone, nitrofurantoin (all due to glucose-6 phosphodiesterase deficiency)

Symptom List: Tremor

Symptoms: Joints filled with fluid in the absence of trauma, 100ml of fluid drained from the knee two to three weeks following vaccination, steroids injected into knee and oral steroid treatment given.

Other Meds: coumadin, amlodipine, metoprolol tartrate, sildenafil

Current Illness:

ID: 1400105
Sex: F
Age: 69
State: CA

Vax Date: 03/01/2021
Onset Date: 06/15/2021
Rec V Date: 06/15/2021
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: clindamycin pcn sulfa

Symptom List: Erythema, Pruritus

Symptoms: presents for evaluation of persistent mid-sternal chest pain since 0800 this morning. Pt states over the past few days she has felt generally weak. Today while she was walking, she developed mid-sternal CP. She called the Nurse line who recommended evaluation in the ED. Denies talking aspirin or any other medications today. Denies associated SOB.

Other Meds:

Current Illness:

ID: 1400106
Sex: M
Age: 11
State: NH

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/15/2021
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: Facility MD obtained consent for patient's mother. Patient received vaccine based upon facility list provided. When entering information, it was noted that patient is currently age 11. Facility MD was notified that patient received vaccine and is currently outside of the age range for approved age. Patient's mother was notified. Mother and MD have no concerns at this time and if patient does not display any side effects, they would like patient to potentially receive the second dose.

Other Meds:

Current Illness:

ID: 1400107
Sex: F
Age: 22
State: TX

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/15/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Patient was given vaccine that was past 12 hours of viability but less than 18 hours since first puncture. We called moderna and they directed us to the state. The state directed back to us as whether to re administer. Currently we are consulting with our company as to the best course of action.

Other Meds:

Current Illness:

ID: 1400108
Sex: F
Age: 30
State: KY

Vax Date: 06/12/2021
Onset Date: 06/15/2021
Rec V Date: 06/15/2021
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: Fatigue/headache and left sided lymph node swelling on her neck since getting her second covid shot in the left arm 3 days ago. Pfizer

Other Meds:

Current Illness:

ID: 1400109
Sex: F
Age: 16
State: KS

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/15/2021
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: NKDA

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

Symptoms: Administered 0.03mL instead of 0.3mL IM. After the dose was administered the error was noted but there was not enough vaccine left in vial to administer the remaining dose. No adverse event or reaction. Will plan to administer remaining dose when we receive additional doses.

Other Meds:

Current Illness:

ID: 1400110
Sex: M
Age: 20
State: MI

Vax Date: 06/15/2021
Onset Date:
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies: none known

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

Symptoms: patient experienced vasovagal syncope for about 30 seconds

Other Meds: not sure

Current Illness: none

ID: 1400111
Sex: M
Age: 31
State: IL

Vax Date: 05/15/2021
Onset Date: 06/11/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: On 6/11/2021 after my 2nd injection, I received muscular pains in my left arm. After applying pressure to it, it felt much worse. On 6/13 I went to a walk-in clinic to have it checked out. The NP prescribed 7 days of Naproxen 500mg and to use hot/cold treatment as needed. At the time of this form being filled out, I have a tingling sensation in my left hand and forearm, due to the Naproxen after doing research. The condition has not worsened.

Other Meds: Ibuprofen

Current Illness:

ID: 1400112
Sex: M
Age: 14
State: CA

Vax Date: 06/12/2021
Onset Date: 06/14/2021
Rec V Date: 06/15/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Patient is a 14 year old male with no past medical history who was transferred from an outside hospital ED for new onset chest pain that started 2 days after he received his second dose of the COVID vaccine, with ST elevation EKG changes concerning for pericarditis. EKG upon admission at another facility also demonstrated diffuse ST elevation. Echocardiogram was normal. Troponin values at the outside hospital and at other facility were both normal. During his admission he was started on ibuprofen TID and famotidine BID. His chest pain resolved and he was discharged home with specific return precaution and follow-up appointments with cardiology in 2 weeks and his PMD in 1 week.

Other Meds: None

Current Illness: mild sore throat

ID: 1400113
Sex: F
Age: 92
State: NM

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/15/2021
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 was given vaccine that was past 12 hours of viability but less than 18 hours since first puncture. We called moderna and they directed us to the state. The state directed back to us as whether to re administer. Currently we are consulting with our company as to the best course of action.

Other Meds:

Current Illness:

ID: 1400114
Sex: F
Age: 15
State: SC

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received NaCl instead reconstituted vaccine

Other Meds:

Current Illness:

ID: 1400115
Sex: F
Age: 47
State: AZ

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 06/15/2021
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: Gluten Cipro

Symptom List: Vomiting

Symptoms: Sore arm, headache, fever, vomiting, nausea, fatigue lasted for 36 hours. After this, 2 more weeks I experienced brain fog, nausea and stomach acid. I had to take pepcid ever day. I could not drive for two weeks after getting the second shot. My legs felt like they weighed 50lbs a leg. It felt like I could barely lift my legs and get brain fog. When these symptoms would go away, I experienced a lot of painful joint aches. Really bad waves of dizziness (not vertigo). Up until now, I still have leg pain which usually happens at night. The last one I had was on Mothers day. Really sore legs. That was really scary and I felt like I had MS. I have had this pain the last two nights. I had really pain in my joint in my first shot but then it went away. This second shot happened 8 weeks ago and my legs are still hurting. Everything else has resolved but the leg pain. I have never felt this in my life and I feel so scared. I feel spastic and sore.

Other Meds: verapamil, 80mg, 2xday singulair, 10mg, 1xday progesterone drops, 4mg, once a day 3 weeks of the month on a gradual increment estrogen cream every 4 days probiotic (Megaspore biotic), 2xday zyrtec, 10mg, 1xday

Current Illness: vestibular migraine asthma

ID: 1400116
Sex: F
Age: 48
State: TX

Vax Date: 06/11/2021
Onset Date: 06/15/2021
Rec V Date: 06/15/2021
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: Patient called to complain of an increased heart rate (180) BP of 142/100 hot flashes and headache for 4-5 days. She has gone to the ER for this. They gave her some things to try and will have a follow up tomorrow.

Other Meds:

Current Illness:

ID: 1400117
Sex: F
Age: 63
State: MD

Vax Date: 03/20/2021
Onset Date: 03/27/2021
Rec V Date: 06/15/2021
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: I saw my doctor on April 6th, 2021 and he said that the vaccine was the reason I wasn't feeling well.

Other Meds: Prescriptions Supplements

Current Illness:

ID: 1400118
Sex: F
Age: 15
State: OK

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/15/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1400119
Sex: M
Age: 13
State: MN

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/15/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Unauthorized age group.

Other Meds: N/A

Current Illness: N/A

ID: 1400120
Sex: F
Age: 50
State: MD

Vax Date: 03/12/2021
Onset Date: 03/14/2021
Rec V Date: 06/15/2021
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: Fatigue muscle aches

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm