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: 1408410
Sex: F
Age: 19
State: IL

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no known drug allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received Janssen vaccine and passed out/threw up after receiving vaccine. She told us ahead of time that she occasionally passes out with blood draws, but never had any issue after a vaccine. About 3-5 minutes after the vaccine, the patient turned very pale and passed out in her chair. She did not fall on the floor but slumped to the side as we held her in place. After she came to she threw up. We had called 911 because it took her a while to wake up. EMS arrived and she was already feeling much better. They took her blood pressure and cleared her. Patient waited another 30 minutes after they left to make sure she was still feeling okay.

Other Meds: unknown

Current Illness:

ID: 1408411
Sex: F
Age: 26
State: CA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Less than 50% of the vaccine dose was administered and a full dose was immediately given in the opposite arm according to CDC Medication Error and Deviation Guidelines.

Other Meds:

Current Illness:

ID: 1408412
Sex: M
Age: 17
State: CA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
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: none

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

Symptoms: no adverse outcomes

Other Meds: none

Current Illness: none

ID: 1408413
Sex: F
Age: 14
State: PA

Vax Date: 06/15/2021
Onset Date: 06/15/2021
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: Tylenol 325mg

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The mom mentioned that the pt was experiencing fever of 102 which was not going down even after taking motrin. The pt fainted almost and the pts heart was having rapid heart beat. She had soreness as well and was concerned about heart conditions linked with this vaccine whether this was the situation.

Other Meds: None that we know off

Current Illness: None that we know off

ID: 1408414
Sex: M
Age: 32
State: IA

Vax Date: 06/12/2021
Onset Date: 06/12/2021
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: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Patient was seen by primary care physician and opthamologist. Patient was diagnosed with shingles (also ocular shingles). Patient reported a rash from top of head to eye, and from nose to ear on the right side of the body. He experienced swollen lymph nodes on the right side and eye swelling. He lost half of his vision in the right eye that has still not returned at this time. In addition to the shingles, he experienced an excrutiating mgiraine (10/10 on pain scale) which he described as the worst he has ever experienced. He also expreinced joint pain and fatigue. At this time, he is being treated with a course of valacyclovir.

Other Meds: Sertraline 50mg: 1qdaily

Current Illness: N/A

ID: 1408415
Sex: F
Age: 18
State: CA

Vax Date: 06/17/2021
Onset Date: 06/17/2021
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: NONE

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

Symptoms: THE PATIENT WAS GIVEN A PFIZER AS A 2ND DOSE WHEN 1ST DOSE WAS MODERNA. SHE WAS OBSERVED FOR 15 MINUTES AND THERE WERE NO ADVERSE EVENTS NOTED. THE MISTAKE WAS NOTICED WHEN THE PATIENT WAS CHECKING OUT.

Other Meds: NONE

Current Illness: NONE

ID: 1408416
Sex: M
Age: 43
State: MA

Vax Date: 04/07/2021
Onset Date: 04/11/2021
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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Heart palpitations started 4/11/21 and have continued consistently to this reporting date.

Other Meds: None

Current Illness: None

ID: 1408417
Sex: F
Age: 83
State: ND

Vax Date: 01/21/2021
Onset Date: 05/14/2021
Rec V Date: 06/17/2021
Hospital: Y

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

Lab Data:

Allergies: ALENDRONIC ACID, ADHESIVES, PENICILLIN, ENVIRONMENTAL, LATEX, LISINOPRIL, METFORMIN

Symptom List: Pharyngeal swelling

Symptoms: Case was hospitalized. **date of 2nd vaccine was 2/11/2021

Other Meds: unknown

Current Illness: unknown

ID: 1408418
Sex: F
Age: 68
State: CA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
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: Compazine Haloperidol Atorvastatin Lisinopril PCN Sulfa Flonase

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt had a 2nd dose Pfizer order 0.3 mL for June 16, 2021 prior to discharge. Pharmacy inadvertently used Janssen COVID Vaccine in lieu of Pfizer, and gave 0.3 mL of Janssen (Wrong Drug/Wrong Dose). Pt monitored for reaction. Pt informed of the wrong medication/wrong dose. MD aware. ID contacted. Pt discharged home.

Other Meds:

Current Illness:

ID: 1408419
Sex: M
Age: 78
State: PA

Vax Date: 05/20/2021
Onset Date: 05/27/2021
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: statins

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient came in for 2nd dose and mentioned a rash showed up on arm approximately 7 days after immunization and resolved on its own. Rash was about 1 inch from the injection site.

Other Meds: none

Current Illness: none

ID: 1408420
Sex: M
Age: 20
State: WI

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: SYR
Vax Site: LA

Lab Data:

Allergies: NONE

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

Symptoms: Vaccine was administered to patient. He had a history of fear of needles, fainting, etc. Approximately 5 minutes after administration, patient did faint with possible seizure activity. Paramedics were called. No further adverse events were observed. Patient was conversational and walked out on his own power.

Other Meds: NONE

Current Illness: NONE

ID: 1408421
Sex: F
Age: 18
State: TX

Vax Date: 06/07/2021
Onset Date: 06/11/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: On June 7th, I took the Second Dose Moderna, after that I have fever on the next two day, which is the 8 and the 9. Nothing happens on the 10, however after my mom came home from work she recognized a strange circle on my neck, it seems like an Adam?s apple. But it is really big. And I visited my doctor at the 14th the same month at 3:45, at first he suspect that I have a Thyromegaly. And I took the Blood Test. However after a several day, the test came out and it says I have a Hyperthyroidism. He advice me to report to VAERS and give me an orders to take the Thyroid Ultrasound, and the Thyroid Uptake Scan. I already made appointments, and I will do it the next 2 weeks.

Other Meds: None

Current Illness: None

ID: 1408422
Sex: F
Age: 17
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: At around 9:25 am on Thursday, June 17th, 2021, seventeen-year-old patient walked into the vaccination site. She was accompanied by two guardians, along with 14 other minors. The minors came in for their 2nd shot of Pfizer Covid-19 vaccines. Patient signed all necessary consent forms and pre-vaccination checklist requirements with guardian and entered the vaccination section at around 9:35 am. The Pfizer vaccine was administered at 9:39 am. Observation nurse reported that around 10:06 am the patient complained about having a severe headache, ?seeing stars?, feeling very dizzy, and not feeling well. Nurse assisted patient to lay down on the mat in case the patient may faint. Charge nurse obtained a pulse oximetry reading of 95% and a pulse of 96. Charge nurse checked if the patient experienced any symptoms of hives/redness, shortness of breath, or any difficulty breathing or swallowing. The patient complained to observation nurse that she was having a hard time breathing, severe headache, and chest pain. Observation nurse instructed patient to be calm and to relax. Charge nurse instructed the patient to take deep slow breaths to help increase O2 levels but the patient complained to the observation nurse that she cannot breathe through her nose. At 10:15 am charge nurse continuously monitored the patient?s B/P, pulse, and O2 level readings. The BP reading was 117/64 with a pulse of 78 and an O2 level of 100%. At approximately 10:16 am, patient started showing signs of change in LOC and lost consciousness for a few seconds. First responder paramedics from the first minor incident were still at the scene waiting for the 2nd ambulance to arrive. The first responder paramedic did a sternum rub using his knuckles with a closed fist to the center of the patient?s chest and immediately after the patient gasped for air and regained consciousness. The patient remained in a sitting position on the floor to be able to breathe easier. At approximately, 10:18 am charge nurse took another BP reading of 121/76, a pulse of 96, and O2 level of 99%. At approximately 10:20 am, patient started exhibiting a change in LOC and was very disoriented again. Observation nurse kept calling the patient?s name but did not get a response. This lasted for around 30 seconds while the patient gasped for air before becoming responsive again. At this time observation nurse observed that patient could not recall her name and did not know how she got there. At approximately 10:22 am, charge nurse took another BP reading of 165/133, a pulse of 122, and an O2 level of 96%. At around 10:24 am, the charge nurse took another BP reading of 112/78 and pulse of 112 with an O2 level of 96%. The second ambulance arrived at approximately 10:26 am and took over. The second ambulance?s first responder paramedics left with patient at approx. 10:29 am and took her to hospital for further observation.

Other Meds: none

Current Illness: none

ID: 1408423
Sex: M
Age: 32
State: OH

Vax Date: 06/16/2021
Onset Date: 06/16/2021
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: None

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

Symptoms: Pt said he didn't feel so well a couple of minutes after administering his first Covid Moderna vaccine at 2:10 PM on 6/16/2021. Pt then staggered toward a chair and slumped down in chair. Pharmacy called 911. Pt was given supportive care and became alert in about 15 seconds. Pt taken to counseling where he vomited for approximately 8 minutes. Squad arrived and patient cared for by EMS. Patient taken to hospital, fully responsive.

Other Meds: Information not available

Current Illness: None

ID: 1408424
Sex: F
Age: 23
State: TX

Vax Date: 04/22/2021
Onset Date: 06/01/2021
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: none

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

Symptoms: bruising to abdomen , thighs

Other Meds: none

Current Illness: none

ID: 1408425
Sex: M
Age: 55
State: UT

Vax Date: 06/09/2021
Onset Date: 06/09/2021
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: NKDA

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

Symptoms: Patient received vaccine off site - the vaccine was transported in a certified vaccine pack out cooler with a data logger at refrigerated temperature (2 to 8 C). A temperature excursion occurred while vaccine was off site between 1052 to 1222 with temperature between 1.6 C and 2.0 C. It was unclear the exact time the patient received the vaccine but the vaccinator estimated that patient received vaccine between 1100 and 1135. Patient received the 2nd dose of vaccine dose of vaccine drawn from the vial and the vial was opened only a few minutes prior to that. Contacted manufacturer for guidance the have excursion data for an unopened vial stored at 0 to 1 C which states 'no restriction in duration provided the product is not expired'. Since the vial had been opened briefly before the dose was drawn for this patient we discussed the situation with our overseeing physician and recommendation was to notify patient of excursion and let patient decide if he would like to be revaccinated. Notified patient of the situation the next day via Spanish translator (he is Spanish speaking) and also asked if we could remember the time he received the vaccine and he thought it was just before 1100. Patient decided not to be revaccinated at this time.

Other Meds:

Current Illness:

ID: 1408426
Sex: M
Age: 41
State: OR

Vax Date: 06/04/2021
Onset Date: 06/05/2021
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: BEES - ANAPHYLACTIC

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

Symptoms: PATIENT STATED THAT HE RECEIVED THE VACCINE ON FRIDAY, AT THE END OF THE DAY ON SATURDAY, HIS CHEST STARTED TO FEEL HEAVY AND HE HAS LABOR BREATHING. HE WOKE UP SUNDAY AND DIDN'T FEEL WELL. HE TOOK A NAP AT AROUND 4PM ,THEN WOKE UP AND COULDN'T BREATH WITH HEART PALPITATIONS. HE WAS ABLE TO ARRIVE TO THE EMERGENCY ROOM AND TRIED TO WALK HIMSELF IN. HE COLLAPSED ON THEIR YARD.

Other Meds: SILDENAFIL, FLOMAX, LEVOTHYROXINE

Current Illness: NONE

ID: 1408427
Sex: M
Age: 27
State: GA

Vax Date: 06/17/2021
Onset Date: 06/17/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt passed out 5 minutes after shot

Other Meds:

Current Illness:

ID: 1408428
Sex: F
Age: 50
State: NY

Vax Date: 06/17/2021
Onset Date: 06/17/2021
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: About 20 minutes after patient received the vaccine her face appeared red and blotchy. Patient stated itching all over her body and itching in the mouth. Patient was advised to go to emergency department (ED) at Hospital, 1.5 blocks away from the store. Pharmacy staff contacted patient about a half hour later and patient stated that she was in the ED being checked out.

Other Meds:

Current Illness:

ID: 1408429
Sex: F
Age: 70
State: NV

Vax Date: 03/12/2021
Onset Date: 04/04/2021
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: none

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

Symptoms: Approximately 1 month later, severe joint flare up resulting in almost total disability patient now on a walker and physical therapy required

Other Meds: omeprazole 40 mg valacyclovir 500 mg depakote 1000 mg vitamins d, b, c gabapentin, hydrocodone-acetaminophen, baclofen, meloxicam

Current Illness: none

ID: 1408430
Sex: F
Age: 35
State: TX

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

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: pt began having abdominal and back pain the next day after vaccination, pt presented to emergency room the day after , pt had inflamed gallbladder where they removed it during surgery

Other Meds: methotrexate

Current Illness:

ID: 1408432
Sex: F
Age: 30
State: AZ

Vax Date: 06/10/2021
Onset Date: 06/12/2021
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: LA

Lab Data:

Allergies: None known

Symptom List: Unevaluable event

Symptoms: Beginning day two my face and neck, which are typically completely clear, broke out into bumps resembling heat rash. This breakout has yet to clear following my normal routine. The only change in my normal activities in that time was the vaccine. The breakout may have started earlier, but I had no need to check a mirror while resting from other side effects.

Other Meds: None

Current Illness: None

ID: 1408433
Sex: F
Age: 40
State: MA

Vax Date: 06/14/2021
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: N/A

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

Symptoms: Arm near injection site is red, itchy, tender, and warm to the touch. Began 2 days after vaccine. Has not resolved yet.

Other Meds: Balsalazide disodium, magnesium glycinate

Current Illness: N/A

ID: 1408434
Sex: F
Age: 48
State: IL

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 06/17/2021
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: UNKNOWN

Symptom List: Injection site pain, Pain

Symptoms: PATIENT REPORTED HAVING A SORE,RED AREA AROUND VACCINATION SITE 1 DAY AFTER HER VACCINATION. PATIENT STATES SHE TOOK BENADRYL FOR 3 DAYS WITH NO RELIEF. PATIENT SOUGHT MEDICAL ATTENTION AND WAS PRESCRIBED AN ANTIBIOTIC. HER CONDITION WAS RESOLVED

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1408435
Sex: F
Age: 41
State: CA

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/17/2021
Hospital:

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

Lab Data:

Allergies: Over the counter NyQuil/DayQuil (cold/flu medicine), Wheat, Dairy.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Within 10min of the shot I experienced hot flashes all over my body. Then dizzy, nausea, diarrhea, body shakes, rapid heartbeats, tingling hands/feet.

Other Meds:

Current Illness: Muscle pain due to heavy weights.

ID: 1408436
Sex: F
Age: 41
State: WI

Vax Date: 05/24/2021
Onset Date: 06/14/2021
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: Gluten Soy Shellfish

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

Symptoms: I was about 5 to 6 weeks pregnant and I lost the baby on June 7th. About 3 weeks after the covid shoot. I didn't even get the chance to see my Dr

Other Meds: Na

Current Illness: None

ID: 1408437
Sex: F
Age: 36
State: MT

Vax Date: 04/14/2021
Onset Date: 04/15/2021
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: Sulfa drugs

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pretty typical as others have reported... Fatigue, body aches, fever. But the most surprising was what I thought was horrible heartburn around 5pm the day after I got the second dose (about 25 hours post vaccine). It was the worst heartburn I'd ever felt; intense, deep chest pain. It lasted until I went to bed that night, around 9pm. I didn't really give it a second thought until now when there's all this news about myocarditis following vaccination, so I thought I'd at least report it somewhere.

Other Meds: Women's once per day vitamin

Current Illness: None

ID: 1408438
Sex: M
Age: 74
State: FL

Vax Date: 04/13/2021
Onset Date: 05/01/2021
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: na

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: tinnitis

Other Meds: entresto carvidilol

Current Illness: none

ID: 1408439
Sex: M
Age: 19
State: CA

Vax Date: 06/17/2021
Onset Date: 06/17/2021
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: none

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

Symptoms: Patient felt faint, said this happens to him when he gives blood and layed down on the floor. I asked him to put his knees up. after about five minutes he said he felt better and sat up in a chair but I looked at him and noted that he was sweating. He felt dizzy again and layed down a second time. I took his blood pressure at 3:40pm it was 144/92 57. I gave him some water. He said he felt better and left with his two friends at about 4:45pm

Other Meds: unknown

Current Illness: none known

ID: 1408440
Sex: M
Age: 17
State: CT

Vax Date: 06/14/2021
Onset Date: 06/16/2021
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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Chest Pain and SOB

Other Meds:

Current Illness: None

ID: 1408441
Sex: F
Age: 61
State: CA

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:

Symptom List: Injection site pain

Symptoms: Patient received her second dose of her Covid shot (Moderna). After vaccination, patient stated that she felt very anxious, light-headed and had a headache. Tried to get up and stated that she almost fell and began crying. Counseled the patient on potential effects of the vaccine and offered to call emergency services, which she declined. She stated that she would have someone else pick her up since she felt like she couldn't drive and felt dizzy. Patient tolerated 1st vaccine and no allergic reaction present. Patient left under her own power from the pharmacy for her ride. Sent message to prescriber as well regarding patient and incident.

Other Meds:

Current Illness:

ID: 1408442
Sex: F
Age: 37
State: PA

Vax Date: 06/15/2021
Onset Date: 06/16/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: General malaise and feeling feverish, but no fever. Fairly Severe pain at the injection site. Rash below the injection site that is raised, red, itchy, painful to the touch and seems to be getting larger each day.

Other Meds: None

Current Illness: None

ID: 1408443
Sex: F
Age: 25
State:

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient felt weak and anxious as the vaccine was given, asked to lay down, and we helped her onto a mat, gave a bottle of water and in 5 minutes patient was back in chair, waited 30 minutes, felt ok and left

Other Meds:

Current Illness:

ID: 1408444
Sex: F
Age: 67
State: CA

Vax Date: 03/23/2021
Onset Date: 05/15/2021
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: Keterolac

Symptom List: Tremor

Symptoms: I am not absolutely sure that my symptoms are related to my Covid vaccine but I clearly did not have any of them before my Covid vaccine. I began having peripheral binocular diplopia and cannot recall the exact date in May. I tried using lubricating eye drops to see if it would help and did this for several weeks. I am a retired nurse and hoped this would work. It did not and since then I have had 2 seizures - one focal motor in my right foot on 6/12/21 lasting for 40 seconds and one involving my right chin musculature on 6/15/21 lasting 60 seconds which I watched in a mirror which was frightful as it was something cannot be repeated voluntarily.

Other Meds: Cymbalta for CRPS Type 1 Topamax for CRPS Type 1 Questran granules for bile acid diarrhea Lotensin 20 mg Tylenol

Current Illness: I have long standing complex regional pain syndrome of rt. foot

ID: 1408445
Sex: M
Age: 27
State: LA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient was administered a higher concentration dose of Pfizer due to improper preparation. The vaccine vial was prepared with 1.4mL of normal saline instead of 1.8mL. Patient was informed and pharmacist contacted Pfizer for more information on monitoring the patient. Patient later reported a headache, which is unsurely related to the higher concentration dose than approved.

Other Meds:

Current Illness:

ID: 1408446
Sex: F
Age: 12
State: AZ

Vax Date: 06/17/2021
Onset Date: 06/17/2021
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: None

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

Symptoms: Patient fainted and had a slight seizure

Other Meds: None

Current Illness: none

ID: 1408447
Sex: F
Age: 19
State: IL

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Patient had fainted roughly 2-5 minutes after vaccination. Patient had been told to wait for 15 minutes after vaccination but was thirsty and went to her car to grab some water. When outside, patient felt dizzy and fainted, falling and hurting her head and leg. Ambulance was called but patient refused any care and wanted to go home. We had the patient call a friend/family to pick her up. When asked, patient reported not having eaten today and vaccination was given approximately at 2:30 pm.

Other Meds: None

Current Illness: None

ID: 1408646
Sex: M
Age: 35
State: CA

Vax Date: 06/12/2021
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: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I started feeling chest pain couldn?t breath. Next day chest pain and head felt dizzy and not good at night I felt anxiety like I was going stop breathing. Chest pain continued with some hard breathing. Now on this day I?m feeling better with minor chest pain.

Other Meds: Losartan

Current Illness: N/A

ID: 1408647
Sex: F
Age: 15
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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: At around 9:25 am on Thursday, June 17th, 2021, a fifteen-year-old patient walked into the vaccination site. She was accompanied by two guardians, along with 14 other minors. The minors came in for their 2nd shot of Pfizer Covid-19 vaccines. Patient signed all necessary consent forms and pre-vaccination checklist requirements with guardian and entered the vaccination section at approx. 9:38 am. The Pfizer vaccine was administered at 9:45 am. Patient was one of the first minor patients of the group that complained of a severe headache to observation nurse. Observation nurse gave Gatorade to the patient and she took a sip of Gatorade and was calm afterward. One of the patient?s guardians instructed her to head back to the van with the rest of the group. At approximately 10:33 am observation nurse notified charge nurse that another minor patient was having a reaction to the vaccine in the parking lot area. One of our site specialists was the first to attend to patient. Site specialist stated that she saw the patient walking with one of her guardians in the parking lot and looked like she was about to faint. Charge nurse hooked up patient to the pulse oximetry and called 911 at approx. 10:34 am. The patient?s O2 level was 83 with a pulse of 107. The charge nurse observed that the patient was under a lot of stress and was hyperventilating and unable to verbalize how she was feeling. Shortly after, the patient fainted due to hyperventilation. Observation nurse advised the patient to calm down and take deep breaths but the patient did not comply and continued rapid breathing. The patient started to vomit and made some gurgling sounds in her mouth and the charge nurse with the help of site specialist laid the patient on her left side. Shortly after, the patient stopped breathing. Observation nurse administered the epi-pen on the patient?s right thigh. Immediately after administering the epi-pen, patient started to breathe again with an O2 level of 98 with a pulse of 110; but the patient was still unconscious and unresponsive. At approx. 10:36 am first responder paramedics arrived at the scene and took the patient to hospital for further evaluation.

Other Meds: none

Current Illness: none

ID: 1408648
Sex: M
Age: 56
State: CA

Vax Date: 06/17/2021
Onset Date: 06/17/2021
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: Risperdone

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

Symptoms: Patient is a 56 year old male who has completed a 15 minute observation period with the following signs and symptoms of an adverse reaction: dizzyness . #1 in series administered. Vitals: 06/17/21 1714 06/17/21 1725 06/17/21 1745 06/17/21 1809 BP: 115/77 117/78 128/78 111/75 Pulse: 79 88 90 75 Resp: 15 18 15 18 SpO2: 96% 96% 96% 97% Action(s) taken: monitored for 45min. No improvement. refused to go to ED or urgent care. Still feels dizzy, advised to go to ED. Patient agreed.Called paramedics. Blood sugar checked,445. Sent to ED Patient advised to discuss second dose considerations with a clinician and have a driver for 2nd dose appt

Other Meds: busPIRone (BUSPAR) 5 mg Oral Tab Take 1 tablet by mouth 2 times a day ARIPiprazole (ABILIFY) 20 mg Oral Tab Take 1 tablet by mouth daily Insulin Regular hum U-500 conc (HUMULIN R U-500, CONC, KWIKPEN) 500 unit/mL (3 mL) SubQ Insulin Pen I

Current Illness: diabetes, history of falls

ID: 1408649
Sex: F
Age: 39
State: LA

Vax Date: 06/15/2021
Onset Date: 06/15/2021
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: Clindamycin

Symptom List: Pain in extremity

Symptoms: Headache (4 hours), migraine (20 hours, treated with 600 mg ibuprofen); fatigue (36 hours)

Other Meds: Oral contraceptive

Current Illness: None

ID: 1408650
Sex: M
Age: 14
State: OR

Vax Date: 06/17/2021
Onset Date: 06/17/2021
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: PATIENT IS UNDERAGE. LOOKED UP RECOMMENDATION ON CDC WEBSITE. PATIENT STILL ADVISED TO GET 2ND DOSE OF MODERNA.

Other Meds: NONE

Current Illness: NONE

ID: 1408651
Sex: M
Age: 23
State: GA

Vax Date: 06/09/2021
Onset Date: 06/10/2021
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: Patient awoke at 2:30 am after getting vaccine with uncontrollable shaking. Went to ER and blood pressure was also high. Given Ativan to decrease shaking and calm patient. Diagnosed with allergic reaction to vaccine by ER staff.

Other Meds:

Current Illness:

ID: 1408652
Sex: F
Age: 11
State: MN

Vax Date: 05/13/2021
Onset Date: 05/13/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Patient and Guardian gave the incorrect DOB. Consent form had a date of birth of 12 years but the actual age was 11 years. The error was found after the fact through the Immunization Information system.

Other Meds:

Current Illness:

ID: 1408653
Sex: M
Age: 63
State: PA

Vax Date: 04/30/2021
Onset Date: 05/01/2021
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: none

Symptom List: Vomiting

Symptoms: itch and pain at injection site, feeling of numbness around site and into shoulder exacerbated by rubbing/scratching

Other Meds: bubropion xl 150mg sertaline 50mg lisinopril 5mg

Current Illness: none

ID: 1408655
Sex: F
Age: 52
State: NH

Vax Date: 05/05/2021
Onset Date: 05/10/2021
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: I got hives after both shots.... the first was on 4/14/21 and got hives 5 days later... they never went away. The second covid19 shot was 5/5/21 and 2 days after the hives flared up again! They have never gone away!! Mostly on my legs and arms...

Other Meds:

Current Illness:

ID: 1408656
Sex: M
Age: 38
State: WI

Vax Date: 01/29/2021
Onset Date: 02/01/2021
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: Carba mix

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

Symptoms: A small vesicular rash appeared shortly after both doses, on the anterior left abdomen just below the waistline. Skin scraping was negative for fungus. It did not appear to be bacterial. It spontaneously resolved a few weeks after each dose. Sensorineural hearing loss occurred about two weeks after the second dose of the vaccine. This was confirmed by audiometric testing which showed a significant unilateral hearing loss in the right ear. A prednisone taper was started followed by two transtympanic injections of dexamethasone over the next six weeks. There was no improvement. A hearing aid is now required.

Other Meds:

Current Illness: None

ID: 1408657
Sex: F
Age: 61
State: PA

Vax Date: 06/11/2021
Onset Date: 06/12/2021
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: IVP dye

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Hi. The second pfizer EW0177 injection was given to me on 6/11/21 and the next morning i had a ringing in my right ear and numbness in the left side of my face. Thought i had a stroke called doctor and was sent to emergency rm. The ruled out a stroke but did not know why. I also have a floating black ring in my right eye. I have an eye appt. To see what going on w my eye. Since the first injection my hair is falling out in handfulls. Please contact me with any help with all of this. I am very distraught and concerned.

Other Meds: Lisnoprl,rosuvatatn,anastrozole,metoprolol,b12,D3,ginkgo biloba,Bilbao, magnesium,zinc, C1000MG,turmeric,fish oil,multivitamin,Tylenol

Current Illness: Covid on march 26 2021

ID: 1408658
Sex: F
Age: 75
State: TX

Vax Date: 04/26/2021
Onset Date: 05/10/2021
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: Tetanus anti-toxin

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

Symptoms: I am having hot flashes/episodes at least 10 times a day (including in the middle of the night), lasting 5 - 10 minutes each. Nothing severe or debilitating, but unpleasant now that we has entered summer. Just unusual, since I am 75. Not getting worse, not getting better. Been going on 5 - 6 weeks. I'm guessing May 10 as the starting date, tho' it could have been sooner. I did have the usual 100+ temp the next day after the second shot.

Other Meds: Synthroid, premarin, trazodone, glucosamine/chondroitin, tumeric, Vitamin B, Vitamin D-3. Caltrate,

Current Illness: None

ID: 1408659
Sex: F
Age: 22
State: TX

Vax Date: 05/15/2021
Onset Date: 05/15/2021
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: RA

Lab Data:

Allergies: Penicillins

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

Symptoms: Patient stated she experienced rash and swelling of the throat. Patient stated she took Benadryl after reaction appeared apparent and it seemed to help the reaction

Other Meds: N/A

Current Illness: N/A

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm