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: 1406766
Sex: M
Age: 53
State: MA

Vax Date: 06/14/2021
Onset Date: 06/15/2021
Rec V Date: 06/17/2021
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: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt reports 24 hours after receiving the covid vaccine hives developed on her face, lips, eyes & forehead. Pt reports swelling ti eyes as well. Pt states the hives resolved on there own w/ out using any OTC medication apprx 12 hrs after they appeared. Pt reports an itchy scratchy throat as well. Slightly swollen eyes & scratchy throat & muscle aches were still reported 3 days post vaccination

Other Meds: N/A

Current Illness: None

ID: 1406767
Sex: M
Age: 45
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/17/2021
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:

Symptom List: Anxiety, Dyspnoea

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

Other Meds:

Current Illness:

ID: 1406768
Sex: M
Age: 32
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at a regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406769
Sex: M
Age: 36
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: 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: 1406770
Sex: F
Age: 52
State: MN

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: I am allergic to antibiotics.

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

Symptoms: I had severe shortness of breath and chest pains.

Other Meds: I am taking prescriptions.

Current Illness: Lupus

ID: 1406771
Sex: M
Age: 18
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406772
Sex: M
Age: 55
State: MA

Vax Date: 04/20/2021
Onset Date: 06/08/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Shingles like itchy rash on my stomach and upper thigh. Left side. Lasted around 10 days. Not a major issue but worth noting. I've had mild to moderate shingles in the past.

Other Meds:

Current Illness:

ID: 1406773
Sex: F
Age: 62
State: CT

Vax Date: 01/29/2021
Onset Date: 02/15/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Pharyngeal swelling

Symptoms: Constance ringing in the ears (Tinnitus) 24/7 and it has persist every since.

Other Meds: Yes, Lisinopril, Fish oil, Muti-vitamin.

Current Illness: No

ID: 1406774
Sex: F
Age: 51
State: MI

Vax Date: 04/15/2021
Onset Date: 04/25/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: PENICILLIN

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: CHILLS, NASAL CONGESTION, DRY COUGH, HOARSENESS, SHORTNESS OF BREATH WITH EXERTION, FATIGUE

Other Meds: LOSARTAN, BENZONATATE, AMLODIPINE, OMEPRAZOLE, FLUOXETINE

Current Illness:

ID: 1406775
Sex: F
Age: 42
State: MN

Vax Date: 12/21/2020
Onset Date: 04/01/2021
Rec V Date: 06/17/2021
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: hydrocortisone, codeine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: In April noticed late period, May was spotting the whole month, profound fatigue and left pelvic pain. June longer, heavy period and spotting again after period over.

Other Meds: Allegra, probiotic, multivitamin

Current Illness: None

ID: 1406776
Sex: F
Age: 17
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406777
Sex: M
Age: 66
State: NY

Vax Date: 03/03/2021
Onset Date: 03/20/2021
Rec V Date: 06/17/2021
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: after about two weeks after second dose developed systemic body inflammation. C- reactive protein (149). I have been struggling since then. Dr. diagnosed as "polymyalgia rheumatica" treated with prednisone and meloxicam. I never have any arthritis or problems like this before the vaccine.

Other Meds: jardiance, januvia, metoprolol, pravastatin, lisinopril, aspirin

Current Illness: none

ID: 1406778
Sex: F
Age: 35
State: VA

Vax Date: 05/21/2021
Onset Date: 05/29/2021
Rec V Date: 06/17/2021
Hospital: Y

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

Lab Data:

Allergies: Sulfa drugs

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

Symptoms: On 5/29/21 vomiting, on 5/30/21 noticed fatigue, nausea and dark urine, on 6/1/21 went to urgent care who referred to ER. 6/1 labs bilirubin 4.2, alkaline phos 186, ALT 396, AST 142. Performed CT and MRCP on 6/1 and 6/2 and found no blockages. Liver biopsy on 6/4 (see detail in Item 19). Labs relatively stable during hospital stay 6/1-6/4. Repeat labs 6/12: bilirubin 7.4, alkaline phos 186, ALT 184, AST 80. Diagnosed on 6/16 with "autoimmune cholangitis" started high dose steriods (60mg) on 6/16 and naltrexone 50mg for itching on 6/16 and ursodiol 300mg 3x times a day. Submitted report on 6/17.

Other Meds: Daily Lexapro 20MG, Daily Colace 300MG, One time 5/29/21 Ducolax 15MG

Current Illness: Gallbladder removal December 2013.

ID: 1406779
Sex: M
Age: 32
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/17/2021
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: Pfizer Vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted, and recommended dose repeated.

Other Meds:

Current Illness:

ID: 1406780
Sex: M
Age: 37
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: 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: 1406781
Sex: F
Age: 80
State: PA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 06/17/2021
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: Dose 1 caused arthritic and neuropathy pain in hands. Dose 2 increased the symptoms in 2 days. Was told by the administrator at the pharmacy that it could bring back rheumatoid arthritis. PCP office confirmed patients are reporting neuropathy.

Other Meds: Sulfasalazine, Tramadol

Current Illness: Inflammatory Arthritis and Neuropathy

ID: 1406782
Sex: M
Age: 47
State: TX

Vax Date: 03/01/2021
Onset Date: 03/13/2021
Rec V Date: 06/17/2021
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: Nonw

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

Symptoms: Moderate heart and chest pain for 2weeks 24hrs post vaccination. No history of any health issues.

Other Meds: Claritin

Current Illness: None

ID: 1406783
Sex: F
Age: 46
State: CO

Vax Date: 03/28/2021
Onset Date: 03/28/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Ear pain, Hypoaesthesia

Symptoms: the vaccine was administered in the Left Gluteus Medius

Other Meds: unknown

Current Illness: unknown

ID: 1406784
Sex: F
Age: 34
State: OK

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

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

Other Meds:

Current Illness:

ID: 1406785
Sex: M
Age: 45
State: WY

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: penicillin

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

Symptoms: The evening of the 2nd dose, I had a fever of 100.4, the next day both my sciatic nerves felt like they were on fire. I couldn't even type an email, my hands and fingers hurt so bad. Strong fatigue, nauseous, headaches. On the Feb of 17th, my lymph nodes got swollen and they are still swollen. My head was light headed. Lymph nodes were so swollen in my arm pits that I had to lift my arms above my head to breathe. Experienced high blood pressure

Other Meds: ibuprofen, Vitamin B

Current Illness: none+++++++++++++++++++++++++++++++++

ID: 1406786
Sex: F
Age: 21
State: OK

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/17/2021
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: 1406787
Sex: M
Age: 67
State: VA

Vax Date: 03/21/2021
Onset Date: 05/20/2021
Rec V Date: 06/17/2021
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: 8 weeks after second shot, I developed 2 superficial blood clots in my left leg. At the time, I was taking a daily low-dose of aspirin as recommended by my doctor for people my age. I experienced a little over a week of pain before the clots dissolved. I have no history of blood clots.

Other Meds: Metformin, Losartan, Hydralazine, Exalgo, Vitamin D, low dose aspiring

Current Illness: None, other than long term management of high blood pressure and pre-diabetic.

ID: 1406788
Sex: M
Age: 15
State: NY

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 06/17/2021
Hospital: Y

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: amoxicillin

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

Symptoms: myopericarditis

Other Meds: none

Current Illness: none

ID: 1406789
Sex: F
Age: 71
State: LA

Vax Date: 03/05/2021
Onset Date: 06/09/2021
Rec V Date: 06/17/2021
Hospital: Y

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

Lab Data:

Allergies: Iodine, ampicillin, sulfa

Symptom List: Injection site pain, Pain

Symptoms: Patient has been on Revlimid since 2012 with no issues which had the potential to increase coagulopathy. Patient has been on appropriate prophylaxis with aspirin daily with no previous clots. Patient got second dose of Moderna COVID vaccine on 3/5/21. Beginning ~2 weeks ago (late May) from current admission (6/10), patient began developing right leg swelling. Patient underwent lower extremity ultrasound at outside hospital on 6/9 and was found to have extensive deep vein thrombosis throughout right leg. Patient started on Eliquis and referred to the hospital. Patient started on argatroban for concerns of post-COVID vaccine coagulopathy.

Other Meds: Lenalidomide, albuterol, amitriptyline, apixaban, aspirin, atorvastatin, benazapril, cholecalciferol, gabapentin, glipizide, metformin, venlafaxine

Current Illness:

ID: 1406790
Sex: M
Age: 54
State: PA

Vax Date: 05/15/2021
Onset Date: 05/18/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: no known drug allergies

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reported that he has been experiencing decreased range of motion (limited range past shoulder height), increased pain and soreness with movement, and decreased strength to lift weights that were previously easily lifted. Stated that these symptoms started 2-3 days after he received the vaccine. Stopped by the pharmacy counter 6/12/21 to inquire as to whether this could be related to the vaccine.

Other Meds: unknown

Current Illness: unknown

ID: 1406791
Sex: F
Age: 40
State: OK

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 06/17/2021
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: 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: 1406792
Sex: M
Age: 20
State: LA

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/17/2021
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: transported to ER, fluids given

Other Meds:

Current Illness:

ID: 1406793
Sex: F
Age: 26
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/17/2021
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 a regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406794
Sex: F
Age: 55
State: OK

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

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1406795
Sex: F
Age: 47
State: ID

Vax Date: 02/03/2021
Onset Date: 04/12/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Clyndomyacin Morphine Amoxicillan Penicillin Pineapple

Symptom List: Nausea

Symptoms: Top of left hand formed a blood clot

Other Meds: Metformin Amlodopine Olmesartan Hydrchlorithiazide Vitamin D3 Multi-Vitamin

Current Illness: Hypertension PCOS

ID: 1406796
Sex: F
Age: 60
State: FL

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Denies

Symptom List: Injection site pain

Symptoms: 61 y/o with past medical history of Diabetes who presents with shortness of breath, nervousness and possibly elevated glucose. Patient states that she did not take any of her prescribed medications this am or check her glucose. Patient states that she had Cuban coffee, caf? con leche and pastelitos (Cuban pastries) prior to arrival. Patient states that this is the first dose in the two-dose series (Pfizer). Patient states that she received the vaccination to the left arm. Patient denies previous reaction to vaccinations in the past. Patient denies sore throat, difficulty swallowing, chest pain or rash. NP and Paramedics at patient side. Patient vitals within normal limits (156/81, 127/85, 132/79, 146/82, 133/85 BP, O2 Sats 96-99% RA, 86-98 HR). Patient glucose markedly elevated (202). Patient placed on 2 L O2 by nasal cannula. Within 5 mins of observation patient states that she is feeling better. Patient states that prescribed medication is on her person. NP instructed patient to take prescribed Metformin. Patient states was nervous to get the vaccination and didn?t want to take medications. Patient states also didn?t want to check sugar in case it was high. Glucose rechecked 25 mins post medication administration. Patient glucose decreased to 194. Advise patient needs to seek further medical evaluation/Fire Rescue. Patient denies need for transport and states that she wants to go home. Patient signed Against Medical Advice form. Patient walked off site with husband at side.

Other Meds: Metformin Gabepetin Diclofenac

Current Illness: Denies

ID: 1406797
Sex: M
Age: 22
State: OK

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/17/2021
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: 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: 1406798
Sex: F
Age: 14
State: MO

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 06/17/2021
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:

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

Symptoms: An unknown quantity of vaccine leaked from arm.

Other Meds:

Current Illness:

ID: 1406799
Sex: F
Age: 48
State: NC

Vax Date: 03/05/2021
Onset Date: 03/23/2021
Rec V Date: 06/17/2021
Hospital: Y

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

Lab Data:

Allergies: PCN

Symptom List: Tremor

Symptoms: Grand mal seizure

Other Meds: Magnesium and Vit D

Current Illness: None. Felt like I was coming down with something 3/22 but no fever.

ID: 1406801
Sex: M
Age: 48
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

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

Other Meds:

Current Illness:

ID: 1406802
Sex: M
Age: 24
State: OK

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 06/17/2021
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: 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: 1406803
Sex: M
Age: 34
State: OK

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at a regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406804
Sex: M
Age: 34
State: WI

Vax Date: 06/04/2021
Onset Date: 06/13/2021
Rec V Date: 06/17/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine dose 2 caused severe fever, headache, muscle pain. Fever persisted for ~3-4 days, peaking on day 2. 9 days post vaccine developed sudden allergy and broke out in hives on neck, hands, belt line that spread to head, shoulders, chest, legs, groin, hands and arms. Throat swelling at day 10 post vaccination, and again on day 12. Now required to carry epi-pen. Sought medical treatment on day 10, and started on course of steroids and antihistamines. After sever throat swelling on evening of day 11, returned to dr. to receive more antihistamine prescriptions and epi-pen prescription.

Other Meds: Daily vitamin

Current Illness: none

ID: 1406805
Sex: M
Age: 63
State: OK

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

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

Lab Data:

Allergies:

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

Symptoms: 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: 1406806
Sex: M
Age: 12
State: VA

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/17/2021
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: amoxicillin, azithromycin

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

Symptoms: Patient was experiencing burning sensation in calves 4 hours after vaccination but has resolved. The following morning, patient was taken to urgent care for back pain between the shoulder blades (writhing in pain and crying)

Other Meds: None

Current Illness: None

ID: 1406807
Sex: M
Age: 12
State: MD

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Pain in extremity

Symptoms: GAVE INJECTION TO MINOR WHEN THE CDC GUIDELINES SAYS TO ONLY ADMIN TO ADULTS 18 YEARS AND OLDER AND THE PATIENT IS 12 YEARS OLD.

Other Meds: NONE

Current Illness: NONE

ID: 1406808
Sex: F
Age: 53
State: TN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Headaches that continued for two weeks. went to ER . Stroke on Left side of brain. Was hospitalized

Other Meds: Amloditine 5mg, Atorva,statin 80mg , Benazepril 40 mg, Gabapentin 100mg , Jardiance 10mg , Naproxen 500 , Omeprazole 40mg, asprin 81 mg , Albuterol hfa 90 mcg two puff as needed, Flovent 110 twice a day one a day vitamin, Flonase

Current Illness: none

ID: 1406809
Sex: F
Age: 58
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: 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: 1406810
Sex: F
Age: 17
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid,client contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406811
Sex: F
Age: 12
State: OK

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/17/2021
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: Pfizer vaccine administered after being stored at a regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406813
Sex: M
Age: 17
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: 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: 1406814
Sex: M
Age: 20
State: OK

Vax Date: 06/11/2021
Onset Date: 06/14/2021
Rec V Date: 06/17/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: diagnosis and hospitalized with myocarditis

Other Meds: none

Current Illness: none

ID: 1406815
Sex: M
Age: 16
State: OK

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/17/2021
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 contact and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1406816
Sex: M
Age: 72
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/17/2021
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: 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: 1406817
Sex: F
Age: 60
State: WA

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 06/17/2021
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: nitrofurdantoin

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

Symptoms: Starting on the day of the vaccine, nothing significant. The next day, I started having palpitations and arrythmias. I waited a day or 2 to see if it would go away and it did not go away and made an appt to see her. The doctor wanted to try a natural inflammatory supplement called Curcuim and Oscillococcinum. It did not help. I went to see an acupunturist and it help tremendously and reduced my arrythmias by 50% by the 2nd session. I did a total of 5 sessions. I went back to the doctor and was put on Hawthorne Supreme (another herbal supplement). It seems to be helping a little. I do not feel comfortable getting the 2nd vaccine dose.

Other Meds: Progesterone, estrogen, testoterone hormonal replacement therapy

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm