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: 1409967
Sex: F
Age: 20
State: NJ

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/18/2021
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: DIZZY, SWEATY, FINGERS TINGLING

Other Meds:

Current Illness:

ID: 1409968
Sex: F
Age: 54
State:

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/18/2021
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: She states she did not eat breakfast but this is normal for her and had coffee this morning, nothing else out of the ordinary. Was very anxious feeling before the vaccine. Pt to ER for dizziness after she received covid vaccine About 5 minutes afterwards she began feeling more anxious, as well as dizzy and lightheaded, vomiting once. No LOC noted. At this point feeling a little "foggy" which has persisted. She has been ambulatory and has no focal weakness or other problems. No history of reactions to other vaccines in the past. Lightheadedness Vasovagal episode . Nausea,Vomiting. ED visit,Monitoring at vaccine site

Other Meds:

Current Illness:

ID: 1409969
Sex: M
Age: 68
State: NJ

Vax Date: 03/27/2021
Onset Date: 03/29/2021
Rec V Date: 06/18/2021
Hospital: Y

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: Pt reported some left arm pain that began about 24 hours after the injection. Assuming it was a typical reaction we provided reassurance and warm compresses. He progressively then expressed that the pain was radiating down the entire arm to his fingers and that he is unable to sleep. He then appeared confused with inability to dress himself, getting lost in the house and not knowing how to get to bathroom. We checked his blood sugar and blood pressure which were at his baseline. He complained of excruciating pain that did not respond to Aleve, Indomethacin, Tramadol or local lidocaine. He described it as knifes in his arm. He did not seem weak but he had no coordination to eat with arm or button his coat. After watching this for 2 weeks with no improvement we went to the emergency room on March 19, 2021. He is uninsured so we were really trying to avoid going in but he was only getting more confused. He was admitted and had several tests listed below without any acute causes found. He was given Gabapentin in the hospital and that settled his pain for the first time in 2 weeks. He was discharged on March 20th as the treating doctor felt he might benefit from spinal tap but was not sure.

Other Meds: Metformin Insulin injections daily Amlodipine Atorvastaten Omeprazole Hydrochlorothiazide/Lisinopril Tenofovir Vitamin B complex Indomethacin prn

Current Illness: Known Prostate cancer with previous radiation therapy with Lupron Depo in January 2021

ID: 1409970
Sex: F
Age: 43
State: KY

Vax Date: 06/14/2021
Onset Date: 06/15/2021
Rec V Date: 06/18/2021
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: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1410001
Sex: F
Age: 54
State: NY

Vax Date: 04/17/2021
Onset Date: 05/09/2021
Rec V Date: 06/18/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Submandibular glands are inflamed but currently benign. A right ear infection was detected on onset and treated with antibiotics for 5 days. However, glands have remained inflamed. 6/5/2021-pressure on the right side of the chest by the heart necessitated an emergency room visit.

Other Meds: Synthroid, 150 mcg.

Current Illness: none

ID: 1410002
Sex: F
Age: 49
State: CT

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 06/18/2021
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: Penicillin, Streptomyocin, Aspirin products, nuts and fruits with red pigment

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

Symptoms: The next day after my left arm got really swole and it begin to tingle. I reached out to my PCP who advised I see a Specialist and gave an Anti-inflammatory but it did nothing. A couple week later around 2:30am I woke up out of my sleep with severe shakes in my chest area, my arms and hands go so clammy and I felt so anxious I couldnt sit still and was pasing back and forward. I had the sense of feeling choked. The shakes were so bad causing me to get up and walk around. At 4am I went for a walk in the neighborhood because I still could not stop shaking and remain still. I was so adjitated around 6am I got up and began to drive to the beach then all of the sudden after about 20 minutes I had to pull over because my arms from elbow down went numb and I couldn't drive. I was still so jittery and shaky but was able to make it to the ER where I was monitor for about 5 hrs. CBC and Urinalysis were done but everything seemed normal. For about 10 days I had that shaky feeling, tightness in my chest area and just felt really crappy. My PCP perscribed a few different Anti-anxiety meds but I had an allergic reaction to those so I could not take any of those either. I have an appointment with the Neurologist 7/26.

Other Meds: Gardiance, Ganuvia, Lipitor, Fish Oil, Vit D., Zinc, Singular

Current Illness: no

ID: 1410003
Sex: M
Age: 17
State: IN

Vax Date: 05/17/2021
Onset Date: 06/03/2021
Rec V Date: 06/18/2021
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: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient admitted to hospital on 6/16/2021. Patient was experiencing chest pain with intermittent shortness of breath for two weeks prior to presenting to emergency department. Troponin on admission 0.98, increased to 1.35 on following day then decreased to 0.85. ECHO was within normal limits. Patient discharged on 6/18/2021 and will have repeat troponin/ECHO in 4 weeks. Patient received Pfizer Covid vaccine on 4/26 and 5/17/2021.

Other Meds: COVID vaccine (Pfizer) on 4/26/2021 and 5/17/2021

Current Illness: none

ID: 1410004
Sex: M
Age: 47
State: NJ

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/18/2021
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, SHELLFISH, PET

Symptom List: Pharyngeal swelling

Symptoms: Pt reported reaction to first dose of fever chills and skin break out on LLE. Client presented with open circular lesions from rash on the Left lower leg with no complaint of pain nor discomfort at this time. 2nd dose administered on left arm. Vitals WNL and client remains stable at this time.

Other Meds:

Current Illness:

ID: 1410005
Sex: F
Age: 36
State: MD

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash Generalized-Medium, Systemic: Hypertension-Severe

Other Meds:

Current Illness:

ID: 1410006
Sex: M
Age: 69
State: FL

Vax Date: 01/22/2021
Onset Date: 05/17/2021
Rec V Date: 06/18/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: First vaccine arm little sore Second vaccine arm little sore AND extra tired with chills

Other Meds: Amlodipine10 mg Carvedilol. 25 mg (2x) Clonidine .2 mg (3x) Terazosin 20 mg

Current Illness: None

ID: 1410007
Sex: F
Age: 59
State: TX

Vax Date: 04/21/2021
Onset Date: 06/03/2021
Rec V Date: 06/18/2021
Hospital: Y

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: Patient admitted 6/6 for confusion 3 days after surgery. Pre-op COVID neg on 6/2 but pos when re-tested on admission. Treated with abx and steroids. Required supplemental O2. Recovered and upon DC was on RA. DCd home.

Other Meds:

Current Illness:

ID: 1410008
Sex: F
Age: 76
State: MD

Vax Date: 04/01/2021
Onset Date: 04/16/2021
Rec V Date: 06/18/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Pt was admitted on 4/16/21 to hospital from the ED for shortness of breath, after receiving second dose of vaccine on 4/1/21

Other Meds:

Current Illness:

ID: 1410009
Sex: M
Age: 28
State: SC

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/18/2021
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: Systemic: Chest Tightness / Heaviness / Pain-Medium, Additional Details: patient described what feels like heartburn but also chest tightness that started day of vaccination and has continued daily, suggested provider follow up and patient has not called back to report visit resuts.

Other Meds:

Current Illness:

ID: 1410010
Sex: F
Age: 63
State: NY

Vax Date: 02/12/2021
Onset Date: 02/17/2021
Rec V Date: 06/18/2021
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: Buttock pain Nausea Left Breast Pain

Other Meds: amlodpine Vitamin D Magnesium Biotin

Current Illness: UTI

ID: 1410011
Sex: F
Age: 22
State: KY

Vax Date: 06/17/2021
Onset Date: 06/18/2021
Rec V Date: 06/18/2021
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: No Known Allergies

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

Symptoms: H/A, fever, body aches, chills, sore throat and rt-sided chest pain the day after receiving the vaccine on 6/17/2021

Other Meds: albuterol HFA 108 mcg/Act inhaler, fluticasone 50 mcg/act nasal spray, medroxyprogesterone injection,

Current Illness: Diagnosed with Covid-19 on 5/5/2021.

ID: 1410012
Sex: F
Age: 48
State: NH

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 06/18/2021
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: Gluten, ivory soap, bee stings

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

Symptoms: Immediately after injection, left arm was tingling. During 15 minute wait cold tingling sensations moved across face, lips, tongue, then on to right arm. During ride back to work right after injection, had cold tingles throughout body, cold water sensations running down head. Had lunch when returned to work, but tasted burnt. lips/tongue burning sensations and cold tingles throughout body continued, and have not gone away since. Arm soreness began later that same day and persisted for several days. April 26 lymph nodes under left arm very swollen and painful for about 1 week. Second shot spoke to military doctor at vaccine site, who recommended I still receive the shot, said it was rare, but possible it may have triggered MS, but to follow up with my doctor at already scheduled June appointment if still having sensations. Second shot did not change tingling sensations, 9 hours later fatigue body aches which continued to next day, and also 102 fever next day. Body and face cold tingles persist today (they are constant and move around all over body in single points that last for a second or two in whatever spots they are in), they are not painful, but that has been my fear that they will turn into pain at some point. The tingles seem to worsen with anxiety (become colder, more pronounced). Lip & tongue burning sensations are also constantly there. All of this was reported to V-safe since first shot check in.

Other Meds: Levothyroxine, Sprintec, Vitamin D

Current Illness: none

ID: 1410013
Sex: F
Age: 65
State: NY

Vax Date: 03/06/2021
Onset Date: 03/31/2021
Rec V Date: 06/18/2021
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: penicillin and prednisone

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

Symptoms: pt says she had headache and body chills that lasted until he next day but then a few weeks later she started feeling achy in the lower half of her body. This progressively has got worse each day to where it has almost becoming debilitating. Every day the pain comes early afternoon and gradually get worse throughout the evening. She takes Advil for the pain. She went to her PCP on 4/29/21. She had extensive blood work with normal results. Patient says the pain in her body and especially her legs continue to get worse every day.

Other Meds: Synthroid

Current Illness:

ID: 1410014
Sex: M
Age: 81
State:

Vax Date: 02/24/2021
Onset Date: 06/11/2021
Rec V Date: 06/18/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: PT ADMITTED TO HOSPITAL FOR COVID PNEUMONIA ON 6/17/21. RECIEVED PFIZER VACCINES ON 1/29/21 AND 2/24/21 (UNSURE WHERE THESE WERE RECEIVED). 1.5 WEEK HISTORY OF DECLINE IN FUNCTION INCREASED CONFUSION, CHRONIC PAINS, DECREASED ENERGY, SUBJECTIVE CHILLS, CONGESTION AND DECREASED APPETITE. SAT 89% ON RA UPON ARRIVAL. PUT ON 8L/NASAL CANNULA. REMOTE HX OF LYMPHOMA S/P RADIATION AND CHEMO 3 YEARS AGO. WILL GET REMDESIVIR AND DEXAMETHASONE HERE

Other Meds:

Current Illness:

ID: 1410015
Sex: F
Age: 67
State: IL

Vax Date: 12/30/2020
Onset Date: 02/01/2021
Rec V Date: 06/18/2021
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: Shingles like rash on back and on upper right arm appeared mid to late February of 2021. I still have ?scar? from rash on upper right arm. If it was shingles, it was mild. Not very itchy but raised red swollen bumps lasted for weeks. The rash areas were about 2? x2?.

Other Meds:

Current Illness:

ID: 1410016
Sex: M
Age: 17
State: VA

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: Hives that developed 24 hours after receiving the vaccine, no respiratory symptoms. Treated with Benadryl.

Other Meds: Sertraline and Aspirin

Current Illness: ACL repair

ID: 1410017
Sex: F
Age: 26
State: PA

Vax Date: 06/10/2021
Onset Date: 06/11/2021
Rec V Date: 06/18/2021
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: Latex; Ondansetron; Penicillins; Colophony (Rosin); Lactose; Metoclopramide; Oxycodone; Fragrance

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

Symptoms: Within 8 hours of my 2nd dose of the Moderna COVID19 vaccine, I?d developed: a fever that stayed within .5 either way of 100F; swelling & pain in all lymph nodes; widespread joint pain, with joints frequently attempting to hyper-extend; pain on the front & both sides of ribs. These symptoms all either mostly or completely resolved themselves within 5-6 days of at-home care (rest, lots of water, & ibuprofen). These symptoms are the same as what I I experienced after the 1st dose of the Moderna COVID19 vaccine, and only lasted about 24-36 hours longer than my symptoms from the 1st dose. Within 39 hours of the 2nd dose, I also developed numbness in my left pinky & ring fingers, with loss of sensation & tingling. This symptom has remained ever since. While it sometimes varies in degrees of sensation loss, it never fully resolves & reappears at will, with no discernible pattern. As of today, there is now also swelling in those fingers. This symptom is similar to what I experienced after the 1st dose of the Moderna COVID19 vaccine (also in the left arm), but not exactly the same - after the 1st dose, I experienced numbness in the left thumb & index fingers with loss of sensation & tingling, and there was no accompanying swelling - and also has not fully resolved, with only about 95% sensation recovered in those two fingers.

Other Meds: Sertraline; Cetirizine; Omeprazole; Norethindrone; Azelastine HCL & Fluticasone Propionate Nasal Spray; Ibuprofen

Current Illness:

ID: 1410018
Sex: M
Age: 27
State: TX

Vax Date: 05/05/2021
Onset Date: 06/15/2021
Rec V Date: 06/18/2021
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: Bell?s Palsy Paralysis and swelling on the left side of the face Prednisone for treatment

Other Meds: Amlodipine Lisinopril Atomoxetine Zolpidem ER Hydrochlorothiazide Lorazepam

Current Illness: None

ID: 1410019
Sex: F
Age: 72
State: NY

Vax Date: 04/05/2021
Onset Date: 04/12/2021
Rec V Date: 06/18/2021
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: penicillin, codeine

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

Symptoms: lost feelings in left arm (2 finger)

Other Meds: zocor

Current Illness: no

ID: 1410020
Sex: M
Age: 29
State: GA

Vax Date: 04/02/2021
Onset Date: 04/06/2021
Rec V Date: 06/18/2021
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: Gluten allergy

Symptom List: Injection site pain, Pain

Symptoms: Cough, Sore throat, Twitching eyes, Extrapyramidal & movement disorder, Tremor

Other Meds: Perphenazine, lamotrigine, benzotropine,

Current Illness: None

ID: 1410021
Sex: F
Age: 48
State: MD

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 06/18/2021
Hospital: Y

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

Lab Data:

Allergies: Amoxicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Abdominal pain the day after second dose of vaccine, relieved with Ibuprofen. The same pain returned 2 months later on June 15th and was diagnosed as appendicitis. The patient underwent emergency appendectomy on June 15th.

Other Meds: Duloxetine, bupropion, gabapentin, valtrex, hydroxyzobe, zolpidem, Tylenol, ibuprofen

Current Illness:

ID: 1410022
Sex: F
Age: 69
State: MD

Vax Date: 05/22/2021
Onset Date: 05/23/2021
Rec V Date: 06/18/2021
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: POSITIONAL VERDIGO, DIZZYNESS, NAUSEA

Other Meds: BLOOD PRESURE- OMOSARTIN, AMLODAPIN, BAYER ASPRIN

Current Illness: NONE

ID: 1410023
Sex: F
Age: 29
State:

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/18/2021
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: minocyclin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Intense nausea (no vomiting) shortly after 2nd dose of vaccine, lasting about 32 hours Acute arm pain at injection site, lasting about 24 hours Headache Fatigue/Lethargy

Other Meds: n/a

Current Illness: n/a

ID: 1410024
Sex: M
Age: 77
State: GA

Vax Date: 01/19/2021
Onset Date: 02/03/2021
Rec V Date: 06/18/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Lung right upper lobe ( Malignant )cells present ) Lymph node (Left level 4 )level 7

Other Meds: high blood pressure med

Current Illness: Sinus problem

ID: 1410025
Sex: F
Age: 22
State: KY

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

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

Lab Data:

Allergies: No known allergies

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

Symptoms: H/A, fever, body aches, chills, N/V and rt-sided chest pain (had spasms) the day after (on 6/18/2021) the vaccine was given (on 6/17/2021). Patient was diagnosed with Covid on 5/5/2021.

Other Meds: albuterol HFA 108 mcg/act inhaler, benzonatate 100 mg tid prn, fluticasone 50 mcg/act nasal spray, medroxyprogesterone injection, promethazine-dextromethorphan 6.25-15 mg/5 ml syrup 4 times daily as needed.

Current Illness: Diagnosed with Covid-19 on 5/5/2021.

ID: 1410026
Sex: F
Age: 55
State: IL

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 06/18/2021
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: Nausea

Symptoms: First COVID-19 Vaccine given was Pfizer and the Second COVID-19 vaccine given was Moderna- no signs or symptoms reported via patient

Other Meds:

Current Illness:

ID: 1410027
Sex: F
Age: 42
State: FL

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/18/2021
Hospital:

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

Lab Data:

Allergies: N/a

Symptom List: Injection site pain

Symptoms: PATIENT WAS GIVEN A VACCINE THAT WAS OUTSIDE OF THE ALLOWABLE TIMEFRAME OF A RECONSTIUTED VACCINES. WHICH MAY HAVE AFFECTED THE EFFICACY. PATIETN WAS INFORMED , INCEDNT REPORTS WERE SUBMITTED. PATIENT VOICED UNDERSTANDING. WILL RETURN ON 6/18/2021 TO REPEATED DOSE 2 VACCINE.

Other Meds: N/a

Current Illness: NONE

ID: 1410028
Sex: F
Age: 68
State: MN

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 06/18/2021
Hospital:

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

Lab Data:

Allergies: Cephalexin

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

Symptoms: Red, itchy rash on arms, legs, chest, and face 1-2 days after 2nd vaccine

Other Meds: Atenolol 25mg

Current Illness: N/A

ID: 1410029
Sex: F
Age: 71
State: MD

Vax Date: 04/12/2021
Onset Date: 04/14/2021
Rec V Date: 06/18/2021
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:

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

Symptoms: Pt was admitted from the ED with acute respiratory failure on 4/14/21, after receiving the vaccine on 4/12/21

Other Meds:

Current Illness:

ID: 1410030
Sex: M
Age: 12
State: DE

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/18/2021
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: Bactria Dairy Tree nuts Peanuts Sunflower Sesame Wheat Meat Soy

Symptom List: Tremor

Symptoms: Wheezing and chest pain beginning one hour after shot

Other Meds: Singular Flovent Zyrtec Flonase

Current Illness: None

ID: 1410031
Sex: F
Age: 49
State: ME

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 06/18/2021
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: Penicillin

Symptom List: Erythema, Pruritus

Symptoms: I had fever and chills approximately and hour after receiving the vaccine. That evening my hands went numb and tingling and lower back pain. My lower lip swelled up and went numb the next evening and within the week my legs become stiff and painful. The numbness and tingling in hands, lower back pain and stiffness and pain in legs is still ongoing. I also have been experiencing significant memory loss and extreme fatigue. I have informed the cdc app consistently of my adverse affects. I have an auto immune disease called APLS and thrombocytopenia. Ever since receiving the vaccine I have experienced adverse side effects which have now put me under close drs care. My blood work since the vaccine has now come back very concerning to my doctors and I have now been put on warfarin for life; which has included injections of lovenox twice daily. This has been life changing for me and I am quite traumatised over what I am now experiencing. I now have to travel an hour and 45 minutes to an anticoagulation clinic two to three times a week to be closely monitored. This was not my life before receiving the vaccine.

Other Meds: None

Current Illness: none

ID: 1410032
Sex: F
Age: 39
State: PA

Vax Date: 04/24/2021
Onset Date: 06/05/2021
Rec V Date: 06/18/2021
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: I missed my period this month and so have many of my friends that got the vaccine

Other Meds: None

Current Illness: None

ID: 1410033
Sex: F
Age: 5
State: IA

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/18/2021
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: Extra doses of kinrix and mmrv were administered, the patient's guardian was notified.

Other Meds:

Current Illness:

ID: 1410034
Sex: F
Age: 49
State: MN

Vax Date: 04/09/2021
Onset Date: 04/19/2021
Rec V Date: 06/18/2021
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

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Stiff neck, joint swelling in second and third toe on right foot. Top of right foot swelling. Left big toe swelling. Joint pain in left knee. Swelling and joint pain in both wrists and elbows. Doctor said it was fatigue on 5/4 visit, told me to take Tylenol. May 12, right pointer and middle finger severe swelling, all other symptoms still present. Lab work done. Diagnosis was possible Lyme disease, prescribed Doxycycline for 21 days. Symptoms not improved. Referred to Rheumatologist May 28. Diagnosis was unsure, education materials given were for Spondyloarthropathy. Prescribed 10mg of Prednisone daily. Inflammation is decreased approximately 10am -8pm.

Other Meds: None

Current Illness: None

ID: 1410035
Sex: F
Age: 48
State: ME

Vax Date: 06/04/2021
Onset Date: 06/05/2021
Rec V Date: 06/18/2021
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: patient called today stating she developed nausea and fatigue that has lasted over a week from the first shot. she also has a rash on her shoulder from the injection site. Moderna covid vaccine

Other Meds:

Current Illness:

ID: 1410036
Sex: F
Age: 51
State: FL

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/18/2021
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

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

Symptoms: Itchy, burning eyes, redness in the eyes, bumps forming around the eyes. Gave benadryl, didn't work.

Other Meds: Benadryl

Current Illness:

ID: 1410037
Sex: F
Age: 68
State: CO

Vax Date: 02/14/2021
Onset Date: 02/15/2021
Rec V Date: 06/18/2021
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: Day 1. Dead arm. Couldn?t lift arm from hanging down to any height. Felt like an impingement for 3.5 months. Sharp stabbing pain in shoulder area, moving from injection site to front, side and top. This slowly subsided at the 3.5 month mark. This was repeated in arm #2. This vaccine was given on 3/14/2021. My right shoulder is still quite painful. Had the same symptoms in both arms. My left shoulder is now 90% pain free.

Other Meds: HCTZ, synthroid, potassium,, echinacea, St. John ?s wort, aspirin, flax seed oil, vit. D, multi vitamin.

Current Illness: None

ID: 1410038
Sex: M
Age: 11
State: WV

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/18/2021
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: No adverse event, but vaccination was administered outside authorized age range. Parents reported to nursing home staff when signing child up that he was 12 years of age. Age discrepancy was noticed when entering the vaccination into the VAMS system. Parents were called and they acknowledged that he was only 11 years of age and they knew the recommendations for the vaccination were for children 12 years of age and older.

Other Meds: None

Current Illness: None

ID: 1410039
Sex: F
Age: 37
State: OK

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 06/18/2021
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: Codeine, Quinamine

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Bottom lip started welling same day of vaccination and it stop on its own the same day and exactly 2 weeks later my right side of the face began swelling I went to the ER and my whole face was swollen face inside my mouth. they said I wasn't anaphylaxis I .was given steroids and anhistamines and Pepcid. They tested me for autoimmune disease ANA came back positive and endocrinologist did a US thyroid and everything was normal and he changed my medications and vitamin D and I saw an RA specialist. they did x rays on my hands and they did ANA and it came back negative. after 18 days it started disappearing.

Other Meds: Thyroid medication

Current Illness: None

ID: 1410040
Sex: F
Age: 24
State:

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/18/2021
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: Pt was observed post Covid-19 immunization for 30 minutes based on pre-vaccination screening . During the observation period, she experienced an adverse reaction with the following symptoms: dizziness and rapid heart rate. Assessment : Time of assessment . 8:40am- Alert and oriented able to respond to questions but blank stare. Mom accompanying, at her side.She was discharged home on Wednesday from medical center after a 4 day stay for seizure like activity after passing out at home on Saturday. CT at hospital showed chronic sinusitis. Has continued with coughing and nasal congestion since discharge. Actions taken: 8:43am- moved out of pt area and laid on stretcher. B/P 127/83, HR-66. C/O feeling hot. No breakfast or fluids taken in this AM. OJ given and water. 8:45am- Talking and laughing with mom still verbalizes dizziness. 8:49am-B/P 124/72, HR- 67. 9am- Sat on side of stretcher B/P 115/79, HR- 68, O2 sat 100% on room air. Verbalizes she feel some dizziness. 9:05am- Stood up,B/P 123/89, HR- 68 became very dizzy and unsteady on feet, immediately laid back down. Encouraged to drink water. 9:14am- Sat up on stretcher, no dizziness. B/P 118/67, HR-67. 9:17am- Stood up, denies dizziness. B/P-119/67, HR- 68. 9:18am- ambulating without complaints. No dizziness, HA, SOB and alert and oriented x4. 9:20am- Discharged home and will be home with mom all day, she has a post hospital f/u appt with her PCP today. Will relay with information to them. Medications administered: No medication administered.

Other Meds:

Current Illness:

ID: 1410041
Sex: M
Age: 43
State: TX

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 06/18/2021
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: Patient was seen once in my office complaining of persistent shortness of breath and chest tightness of sudden onset that happened few days after receiving second dose of covid vaccine. A CT angiogram ordered showing pulmonary embolism. Diagnosis made more than 10 weeks after vaccination. symptoms appeared in less than one week.

Other Meds:

Current Illness:

ID: 1410042
Sex: M
Age: 11
State: IL

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/18/2021
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: unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Parent lied about age when given first dose COVID-19 vaccination. Staff discovered when entering into system and saw the match.

Other Meds: unknow

Current Illness: unknown

ID: 1410043
Sex: F
Age: 38
State: KS

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/18/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Patient felt faint and dizzy, Her right hand started tightening up and she could not move it and it hurt. EMS was called arrived within a few mins. Her legs were becoming stiff. She was immediately taken to the hospital by EMS for possible blood clot.

Other Meds: unknown

Current Illness: none

ID: 1410044
Sex: M
Age: 43
State: FL

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/18/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: PATIENT WAS GIVEN A VACCINE THAT WAS OUTSIDE OF THE ALLOWABLE TIMEFRAME OF A RECONSTIUTED VACCINES. WHICH MAY HAVE AFFECTED THE EFFICACY. PATIETN WAS INFORMED , INCEDNT REPORTS WERE SUBMITTED. PATIENT VOICED UNDERSTANDING. WILL RETURN ON 6/18/2021 TO REPEATED DOSE 2 VACCINE.

Other Meds: Ergocalciferol 1,250 mcg taken by mouth once daily Vitamin D 2000 to 4000 units daily

Current Illness: none

ID: 1410045
Sex: M
Age: 60
State: CO

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 06/18/2021
Hospital:

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

Lab Data:

Allergies: Have had adverse reaction to fluoroquinolone anti-biotics. Tendon / connective tissue pain.

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

Symptoms: Chest pain in heart region at night progressing to pain radiating down left arm and up left side of neck and slight nausea. Symptoms similar to beginning of heart attack, so went to emergency room for observation. No signs of heart attack were detected and emergency room doctor suggested follow up with heart specialist. Follow up also showed no heart attack occurred. Pericarditis not detected with stethoscope but was suspected. Pain in heart region was not severe, ~level 2, but was persistent. Heart doctor said that was not consistent with heart attack which tends to be severe but episodic. Slight pain noticeable in heart region for weeks afterward and still evident but now very slight. Not acute, but joint pain seems slightly increased after the vaccine.

Other Meds: None

Current Illness: None.

ID: 1410046
Sex: F
Age: 50
State: MD

Vax Date: 03/27/2021
Onset Date: 05/03/2021
Rec V Date: 06/18/2021
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: onions and eggs

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

Symptoms: Got Peripheral Neuropathy in upper left arm, bruising everywhere

Other Meds: Naturethroid 130mg once daily

Current Illness: no

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm