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: 1410245
Sex: F
Age: 36
State: OH

Vax Date: 03/13/2021
Onset Date: 03/28/2021
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: NONE

Symptom List: Dysphagia, Epiglottitis

Symptoms: LOSS OF BALANCE, LOSS OF COORDINATION WORSE WHILE EYES WERE CLOSED, OR IN THE DARK SAW PRIMARY CARE AND NEUROLOGIST. GOT BETTER DAY BY DAY. THEN SAW VISBIBULAR PT DR. NYSTAGNUS WAS THE DIAGNOSIS. COGNOTIVE SYMPTOMS PAUSES IN MID SENTENCE, TROUBLE WITH EXECUTIVE FUNTIONING TROUBLE MULTI TASKING MEMORY, FILTERING TASK BRAING FOG. INCREASE NEED OF SLEEP

Other Meds: NONE

Current Illness: NONE

ID: 1410246
Sex: F
Age: 68
State: CO

Vax Date: 04/29/2021
Onset Date: 04/30/2021
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: atorvastatin cephalosporins penicillins pravastatin sulfa drugs tramadol avocado dairy

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient reports nausea and vomiting on 4/30/21. On 5/1/21 patient had a syncopal episode. Patient has since reported lasting diffuse muscle and joint pain

Other Meds: cyclobenzaprine hydrocodone levothyroxine lisinopril melatonin

Current Illness: No

ID: 1410247
Sex: M
Age: 17
State:

Vax Date: 04/20/2021
Onset Date: 05/07/2021
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:

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

Symptoms: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.

Other Meds:

Current Illness:

ID: 1410248
Sex: F
Age: 49
State: MO

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: Cillin family NSAids

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt developed scratch in throat approx 5 minutes after administration. Pt began to have difficulty speaking. Additional staff called into room. Client given 1 dose of epi into right deltoid. EMS called. Pt began vomiting bile. 2 minutes after administration of epi, pt began breathing normally again and able to speak. She stated she was overwhelmed with being hot, couldn't catch her breath, wanted to speak but couldn't, and stated there was a sharp pain in her back that cut across. EMS arrived approx 10 minutes after call made to them. Pt was evaluated and no further treatment was required.

Other Meds:

Current Illness:

ID: 1410249
Sex: M
Age: 27
State:

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient presented to pharmacy requesting dose of Janssen vaccine without disclosing previous administration of a dose of Pfizer vaccine. Error was discovered upon reporting to IIS. Upon follow up, the patient did admit to receiving a dose of Pfizer. He originally made an appointment for the Janssen vaccine at and was not made aware of the vaccine product change until he was reviewing his paperwork at home. He also reported having no side effects from either injection, not even a sore arm.

Other Meds:

Current Illness:

ID: 1410250
Sex: F
Age: 47
State: NC

Vax Date: 02/17/2021
Onset Date: 02/22/2021
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: No

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

Symptoms: I started having muscle twitches and spasms my legs. They then started expanding to my legs arm back neck, abdomen, everywhere. I had some numbness in my hands and feet. For a month they continued at a lesser level. Currently, those symptoms persist at a lower level. I had multiple tests and imaging done. I am currently attending physical therapy. It has not really helped with my symptoms.

Other Meds: Yes

Current Illness: No

ID: 1410251
Sex: M
Age: 45
State: IN

Vax Date: 05/01/2021
Onset Date: 05/15/2021
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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Vertigo with head motion lasting 10 seconds but has persisted for at least 30 days.

Other Meds: Hydrochlorathiazide 25 mg daily

Current Illness: None

ID: 1410252
Sex: M
Age: 40
State:

Vax Date: 04/23/2021
Onset Date: 05/09/2021
Rec V Date: 06/18/2021
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:

Symptom List: Pharyngeal swelling

Symptoms: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.

Other Meds:

Current Illness:

ID: 1410253
Sex: F
Age: 52
State: FL

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

Lab Data:

Allergies: Denies

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 52 y/o with past medical history of Allergic Sinusitis who presents with palpitations post vaccination. Patient states that this is the 1st dose in the two-dose Pfizer series. Patient states that vaccination was received in the left arm. Patient denies reaction to vaccinations in the past. NP and Paramedics at patient side. Patient initial vitals with noted hypertension (147/88 BP) all other vitals within normal limits (98 HR, 97% RA, 14 Resp). Patient states that palpitations come and go but denies chest pain or difficulty breathing. EKG obtained with NSR. Due to persistent palpitations, NP asked police to call fire rescue. Fire rescue arrived on site and elevated patient, patient noted to be tachycardic (123 HR) and crying. Patient refused transport for further medical evaluation. Patient states that her mother recently died of Covid 15 days ago and she believes her symptoms are related to that. Patient provided and signed the Against Medical Advice form. Staff aware. Patient escorted to the main door by paramedics.

Other Meds: Loratadine Nasal Spray for Allergies

Current Illness: Denies

ID: 1410254
Sex: F
Age: 30
State: CA

Vax Date: 06/15/2021
Onset Date: 06/16/2021
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: Ibuprofen, Keflex

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient woke up in the morning after vaccination with body aches and fever, chills, head was pounding, reports 102 fever measured by oral thermometer, fatigue that lasted throughout the day, when she got up to use restroom felt light headed and this lasted throughout the day. The next day woke up with headache, a little worse but no fever, noted sweating all day, body aches. Now feels congested.

Other Meds: NA

Current Illness:

ID: 1410255
Sex: F
Age: 52
State: MA

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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Influenza vaccine, indocin, meperidine, erythromycin

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

Symptoms: Anaphylactic reaction requiring IM epinephrine following dose #2 of Pfizer vaccine. Patient experienced nausea ~30 minutes after administration and went on to experience throat tightness and SOB. During this reaction, the patient reported she had an anaphylactic reaction to an influenza vaccine in the past with an onset of ~2 hours s/p administration. This was not in her chart nor reported on intake. Epi-Pen 0.3 mg was administered and a Code Blue was called. Code team transported the patient to the ED.

Other Meds: Montelukast 10 mg PO daily, buspirone 7.5 mg PO BID, dexmethylphenidate ER 20 mg PO daily, albuterol MDI PRN cough/wheeze, lorazepam 1 mg PO TID PRN panic attack, Flovent 220 mcg MDI, Lamotrigine 100 mg PO BID, Metformin 500 mg PO BID, pra

Current Illness: None stated

ID: 1410256
Sex: F
Age: 17
State: WA

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Gave patient whom is 17 second dose of moderna to finish series

Other Meds: unknown

Current Illness: unknown

ID: 1410257
Sex: F
Age: 52
State: WI

Vax Date: 06/02/2021
Onset Date: 06/03/2021
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: LA

Lab Data:

Allergies: None

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

Symptoms: Headache, body aches, muscle aches, fever, fatigue, starting 24 hour after injection of the mRNA and lasting 2-3 days. Diarrhea on day 3. However, the headache, fatigue and muscle aches lasted 6-7 days. At that point, she began to develop pitting edema in both ankles and legs, this was worst on day 8-9 and is slightly improved, but still noticeable 2 weeks later. Also, left arm soreness for 3 days at the site.

Other Meds: Levothyroxine 175 mcg daily Vit D 2000 IU daily

Current Illness: None

ID: 1410258
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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: no

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

Symptoms: Same day as the shot she was having chest pains, hard time sleeping

Other Meds: Ecitalopran 10mg once a day, Vitamin D

Current Illness: no

ID: 1410259
Sex: F
Age: 71
State:

Vax Date: 03/24/2021
Onset Date: 04/11/2021
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:

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

Symptoms: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.

Other Meds:

Current Illness:

ID: 1410260
Sex: M
Age: 45
State: CA

Vax Date: 04/17/2021
Onset Date: 06/04/2021
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: Non

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

Symptoms: - Chest pain after 1.5 months from the second shot - Left arm numbness - Shortness of breadth - Hard to stay asleep - Lack of energy

Other Meds: None

Current Illness: None

ID: 1410261
Sex: F
Age: 70
State:

Vax Date: 04/29/2021
Onset Date: 05/07/2021
Rec V Date: 06/18/2021
Hospital: Y

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.

Other Meds:

Current Illness:

ID: 1410263
Sex: M
Age: 60
State: AR

Vax Date: 06/11/2021
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: Aspirin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient is a 60-year-old gentleman with a history of tonsillar and skin cancer with mets to the lymph nodes status post chemotherapy and radiation, BPH, hypertension, hyperlipidemia, and CKD stage 4. Patient presented to the emergency department for complaint of dizziness x4-5 days with diarrhea x3 days and syncope today , pt noted hypotensive in ER but per ER physician not orthostatic, Dr spoke with pt oncologist and seems his Blood cell count close to his baseline, but his baseline creat 2.1 so does have acute on CKD and dehydration. pt noted COVID 19 positive and cxr suggestive covid pneumonia, his cxr was better couple of days ago when pt wasin ER as well. pt did recived his covid vacine 1st dose on Saturday. He finished his chemo on May 13th.

Other Meds: Tamsulosin 0.4mg PO QD Amlodipine 5mg PO QD Fenofibric acid 135mg cap DR PO QD Rosuvastatin 10mg PO QHS Ondansetron 4mg PO Q8HP Prednisone 20mg PO QD Allopurinol 100mg PO QD

Current Illness: history of tonsillar and skin cancer with mets to the lymph nodes status post chemotherapy and radiation

ID: 1410264
Sex: M
Age: 54
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
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: MYALGIA ARTHRALGIA INJECTION SITE PAIN BACK PAIN MUSCULOSKELETAL STIFFNESS MUSCULAR WEAKNESS

Other Meds:

Current Illness: diabetes

ID: 1410265
Sex: M
Age: 22
State: NC

Vax Date: 06/18/2021
Onset Date: 06/18/2021
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: None

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

Symptoms: Patient was given the vaccine at 10:08 AM and was told to remain in close proximity to the pharmacy incase of an event. Shortly after the patient was slumped over to the right and slightly forward. Pharmacist on duty instructed near by associates to get cold water and candy bar as the patient said he had not eaten before coming to the vaccine appointment. 911 was called and paramedics arrived at the store to provide further care for the patient. No other information is known at this time.

Other Meds: None

Current Illness: None

ID: 1410266
Sex: F
Age: 17
State: KY

Vax Date: 05/21/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Moderna administered to patient 17 years of age. No adverse reaction. Patient did receive both doses. Family aware.

Other Meds: none

Current Illness: none

ID: 1410267
Sex: M
Age: 51
State: KY

Vax Date: 04/27/2021
Onset Date: 04/28/2021
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: No known allergies.

Symptom List: Unevaluable event

Symptoms: Onset 1-2 days after second vaccine (on 4/27/2021), has felt ill, has difficulty breathing, cough - deep and strangling, N/V, no fever, but is sweating, out-of-breath with little exertion. No history of heart or lung problems. Has not seen a doctor. Referred to the ER today (6/18/2021).

Other Meds: None noted in record.

Current Illness: Wife says he is "never sick."

ID: 1410268
Sex: M
Age: 52
State: IL

Vax Date: 05/18/2021
Onset Date: 05/29/2021
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: None

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

Symptoms: Day 11 post-vaccine - intense, itchy rash on bilateral palms. Temporarily relieved by diphenhydramine + prednisone. Rash periodically recurred on skin folds (elbows, knees), always bilateral, always intensely itchy, relieved by diphenhydramine + prednisone for total duration of 5 days. Skin sensitivity on areas of rash persisted for about 7 days after rash. Day 18 post-vaccine - few small bruises in areas unlikely to be associated with trauma, resolved spontaneously (possibly unrelated) Day 19 post-vaccine - leg stiffness/soreness/weakness (possibly unrelated)

Other Meds: None

Current Illness: None

ID: 1410269
Sex: F
Age: 55
State: VA

Vax Date: 01/18/2021
Onset Date: 01/25/2021
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: bee stings

Symptom List: Injection site pain, Pain

Symptoms: About a week after my injection , I woke up with a red swelling on my left arm on Thursday I telemed with my doctor she prescribed a strong antibiotic, On Saturday I spoke to a 2nd telemed because it wasn't getting better, who added a second antibiotic. On Monday it was definitely larger, about 4 inches by 10 inches, red, swollen, and hot to the touch but not itchy and I contacted Dr., she prescribed the Zyrtec in addition to the antibiotics. It started going down, but it took 2 weeks to go away.

Other Meds: tamoxifen 20 mg 1 x day,

Current Illness: no

ID: 1410270
Sex: F
Age: 79
State: NY

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 06/18/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Injection site pain, Menorrhagia

Symptoms: CYCLONE OF DIAREAH, ER VISITS AND BEING ADMITTED FOR 3 DAYS HISTAMENE ISSUES, HISTEMENE INTOLLERANCE

Other Meds: THYROXIN

Current Illness: IBS

ID: 1410271
Sex: F
Age: 39
State: AZ

Vax Date: 06/16/2021
Onset Date: 06/17/2021
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: Ceclore, codiene

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

Symptoms: Fever of 104, migraine, chills, body aches, sore throat, dizziness, weakness, fast heartbeat

Other Meds: None

Current Illness: None

ID: 1410272
Sex: F
Age: 51
State: MS

Vax Date: 05/14/2021
Onset Date: 05/15/2021
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: no

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: first shot was fine second shot next day pt. began having a red swollen tongue ,multiple blisters small to medium size, skin irritation in mouth.

Other Meds: blood pressure and depression medicine. benadryl

Current Illness: no

ID: 1410273
Sex: M
Age: 62
State: MI

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: AT ONE OF OUR OFF SITE VACCINATION CLINICS, HE STATED THIS WAS HIS FIRST COVID VACCINATION. HE WAS GIVEN PFIZER AND RELEASED TO HOME. WHEN IT WAS BEING ENTERED INTO THE STATES DATABASE, MCIR WE LEARNED ON DECEMBER 28, 2020 HE RECEIVED MODERNA FROM PHARMACY, LOT NUMBE3R 025J20A.

Other Meds:

Current Illness:

ID: 1410274
Sex: F
Age: 83
State: MD

Vax Date: 03/30/2021
Onset Date: 04/08/2021
Rec V Date: 06/18/2021
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:

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

Symptoms: Pt was admitted to facility from ED for COVID-19 infection on 4/8/2021 after receiving the first dose of vaccine on 3/30/2021. Per guidelines, all hospitalizations are reported.

Other Meds:

Current Illness:

ID: 1410275
Sex: M
Age: 15
State: MA

Vax Date: 06/11/2021
Onset Date: 06/13/2021
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: NONE

Symptom List: Nausea

Symptoms: COVID-19 Signs and Symptoms cough same; fever same (100-101); shortness of breath same (at night); headache same; sore throat same Contacts and Exposure No known exposure. Pt received 2nd COVID vaccine on Friday 6/11/21 Quality: dry cough Severity: moderate Duration: symptoms lasting 4 days Onset/Timing: date of symptoms onset: (Sunday 6/13/2021) Context: No history of asthma or pneumonia Associated Symptoms: no wheezing; no vomiting; no diarrhea; fatigue; runny nose ROS Patient reports loss of appetite, fever (101 here today), and diminished activity. He reports congestion and sore throat but reports no ear pain. He reports cough and difficulty breathing but reports no wheezing. He reports headache but reports no dizziness. He reports no nausea, no vomiting, and no diarrhea. He reports no sneezing and no runny nose. Fever with cough, mild SOB, fatigue and pharyngitis, likely viral illness. Ibuprofen 400 mg given here now. Negative COVID test here today, will send for chest x-ray, lab work CBC (H/H, RBC, indices, WBC, plt) C-reactive protein comprehensive metabolic panel lyme disease Ab w/refl to blot (IgG, IgM), troponin I, sed rate by modified westergren. EKG done, Continue to monitor for increased WOB or any worsening of symptoms. Consult with Cardiology, Echo recommended and pt. scheduled for one.

Other Meds: NONE

Current Illness: NONE

ID: 1410306
Sex: F
Age: 11
State: WI

Vax Date: 06/03/2021
Onset Date: 06/03/2021
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: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Too young to receive dose. Age 11

Other Meds:

Current Illness:

ID: 1410307
Sex: F
Age: 22
State: NM

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

Symptoms: Pt received 2nd Moderna vaccine 8 days eariy

Other Meds:

Current Illness:

ID: 1410308
Sex: M
Age: 60
State: AZ

Vax Date: 04/08/2021
Onset Date: 04/25/2021
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: RA

Lab Data:

Allergies: Statins

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

Symptoms: I developed AFib with no previous issues. Lasted over 30 days before treatment.

Other Meds: Metoprolol Plavix aspirin81 Hydrocodone Repatha

Current Illness: None

ID: 1410309
Sex: F
Age: 48
State: CA

Vax Date: 02/06/2021
Onset Date: 02/06/2021
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: None

Symptom List: Tremor

Symptoms: I went to the doctor and they told me to take Ibuprofen and that they were going to referred me to an ear nose doctor because of my throat hurting but I never got referred. They did not do any medical tests but they kept treating me like it was a sore throat. I was in out of the country when I got the vaccine.

Other Meds: Valsartan

Current Illness: Head ache and sore throat

ID: 1410310
Sex: M
Age: 4
State: OH

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

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: Erythema, Pruritus

Symptoms: seizure

Other Meds: None

Current Illness: None

ID: 1410311
Sex: M
Age: 11
State: WI

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

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

Symptoms: Too young to receive dose, 11 year old.

Other Meds:

Current Illness:

ID: 1410312
Sex: F
Age: 69
State: GA

Vax Date: 04/28/2021
Onset Date: 05/17/2021
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: None

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

Symptoms: 5/17/21: Left groin lymph node extremely tender and painful on touch. Symptoms lasted about 5 days Skin/bumps eruption between buttocks, sore & itchy. I applied OTC Cortisone. Symptoms lasted 7 days. Ear ache, itchy, clogged, moist. Applied previously prescribed drops:Fluocinolone Acetonide oil Fatigue (only lasted one day) * Irregular heartbeat. Heart muscle gradually tightening then a thump followed by heart skipping a beat and then light palpitations. Lasted 5 days. On and off throughout the day and night. No pain. Tingling left side of neck w/ muscle soreness; traveled down to shoulder and up to behind right ear. Symptoms continuing to present day.

Other Meds: Vitamins: D, Calcium, Multi-Vitamin, Turmeric

Current Illness: None

ID: 1410313
Sex: F
Age: 12
State: GA

Vax Date: 06/04/2021
Onset Date: 06/11/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: RECONSTITUTED WITH BACTERIOSTATIC SODIUM CHLORIDE 0.9% CUSTOMER DID NOT EXPERIENCE ADVERSE EVENT

Other Meds:

Current Illness:

ID: 1410314
Sex: M
Age: 55
State: IL

Vax Date: 06/16/2021
Onset Date: 06/17/2021
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: None that I am aware.

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

Symptoms: Rash all over torso.

Other Meds: Vitamin D3 50mcg 1 daily, Zyrtec 24hr 1 daily

Current Illness: None

ID: 1410315
Sex: M
Age: 18
State: MD

Vax Date: 06/16/2021
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: Headache, fever, back pain, chest pain

Other Meds: None

Current Illness: None

ID: 1410316
Sex: F
Age: 49
State: PA

Vax Date: 02/24/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

Symptom List: Pain in extremity

Symptoms: Heavy post-menopausal bleeding

Other Meds: Armour Thyroid, Labetalol, Escitolopram, Amlodopine

Current Illness: No

ID: 1410317
Sex: F
Age: 55
State: TX

Vax Date: 02/13/2021
Onset Date: 02/14/2021
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: Penicillin, Sulpha, Macrobid, Ibuprofen, Iodine & Preps, Diflucan, Predinisone, Reglan, Terazol 3 Creme, Cipro, Vancomycin, Phenergan, Prozac, Wellbutrin, Propulsid, Paxil, Statin Cholesterol Drugs, Augmentin, Amitriptyline, Neurontin(Gabapentin), Mucinex, Keflex

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

Symptoms: @ 2:00 am 2/14/2021 woke up with temp 100.4, shaking, chills, shivering, aches & pains throughout body rash on right arm where shot given & swollen, Nausea, Vomiting, cough w Phelgm, took 2 Tylenol (1000 mg) & 4 mg of Zofran for nausea / vomiting. Fever broke @ 8-9 am 2/14/2021but rest of symptoms kept on till 2/17/2021. Rash on arm where shot given was still there & pain at injection site. Also, heart racing at times throughout all of this and chest hurting. Blood sugars were not good during this time period either. Found out 5/19/2021 from arteriogram done that heart is now only pumping at 35% & I have Non Sustained Ventricular Tachycardia w Congestive Heart failure. Also had place on right inner heel that was swollen when I got up on 3/9/2021. Thought it was cellulitis, but negative on that. Was sent to foot dr & biopsy done, thinks it?s due to vascular/ neuropathy

Other Meds: Humalog Insulin, Levoxyl, Estradiol, Escitalopram, Lorazepam, Lantanoprost Eye Drops, Xiidra Eye Drops, Thera tears, Ondansetron, Praulent 150 mg Injection, Miralax, Vitamin C Tablet, Vitamin D, Multivitamin, Tylenol,

Current Illness: None

ID: 1410318
Sex: M
Age: 22
State: WA

Vax Date: 05/13/2021
Onset Date: 05/19/2021
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:

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

Symptoms: Previously healthy 22 yr old male with 6 days of chest pain, nl toponin, ECHO, CRP and ESR and mild abnormal ECG, patient given clinical diagnosis of pericarditis which seems correct.

Other Meds:

Current Illness:

ID: 1410319
Sex: F
Age: 18
State: NY

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

Lab Data:

Allergies: Amoxicillin

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

Symptoms: Patient developed Hives (raised, red, itchy) on Left side of body

Other Meds: Isibloom 0.15 MG- 0.3MG Tablets, Iron Suppliment

Current Illness: Stomach pains

ID: 1410320
Sex: F
Age: 60
State: OH

Vax Date: 02/02/2021
Onset Date: 02/05/2021
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: peppers, adhesive, dyes,

Symptom List: Vomiting

Symptoms: Starting on the day of the vaccine 1st dose, just a sore arm. 3 days after the vaccine, I got dizzy, tachycardia and my blood pressure was very high around and starting racing. I was put on blood pressure medication metoprolol. I took the medication for a week and I now take it if needed. I have also noticed an adverse reaction after the vaccine everytime I drink or consume alcohol, I get elevated blood pressure, palpitation and sweats. I also had the same adverse reaction with the 2nd dose vaccine ( lot # 006M20A IM Right Arm).

Other Meds: none

Current Illness: none

ID: 1410321
Sex: F
Age: 57
State: TX

Vax Date: 02/27/2021
Onset Date: 05/17/2021
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: amoxicillin (stomach upset), Ace Inhibitors

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: severe Hives at random, over entire body, one episode severe with enlarged lips, went to urgent care and treated with IV steroids. slighter random episodes have continued, another rather severe episode on 06/17/21 with large whelps/hives over back and lower extremities, relieved over time after 50mg benadryl taken PO. have eliminated environmental suspects, ie: laundry soap, bath soap, , have no known food allergies.

Other Meds: metaprolol, atorvistatin, amlodipine, levothyroxine, farxiga, humalog, truciba, hydrochlorothiazide (prn)

Current Illness: none

ID: 1410322
Sex: F
Age: 43
State: CA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
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:

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

Symptoms: Patient felt immediate pain/tingling upon injection. Has been sore the entire month and is difficult for her to use her arm.

Other Meds:

Current Illness:

ID: 1410323
Sex: M
Age: 35
State: CO

Vax Date: 04/07/2021
Onset Date: 04/09/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I went to the clinic and they diagnosed me with a possible stroke which was caused by the vaccine. I will be needing to receive a MRI next week. Also for the last 24 hours I have not been able to control the motion of my left eye.

Other Meds:

Current Illness:

ID: 1410324
Sex: F
Age: 37
State: VA

Vax Date: 05/28/2021
Onset Date: 05/31/2021
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: No allergies history noted on the consent for immunization form.

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

Symptoms: 3 DAYS AFTER FIRST PFIZER SHOT, MILD-HEAVY SPOTTING FOR 2 WEEKS THAT IS ONGOING --- 6/18/21

Other Meds: Patient did not state any over-the-counter medications use to treat possible adverse event from vaccine.

Current Illness: Patient did not state any illness at the time of vaccination (per consent for immunization form)

ID: 1410325
Sex: F
Age: 39
State: TX

Vax Date: 06/15/2021
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: IM
Vax Site: RA

Lab Data:

Allergies: NKDA

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

Symptoms: Patient states the next day after vaccination felt tired and a little sore throat. Second day after vaccination patient entire body feels itchy, scratches skin turns red.

Other Meds: n/a

Current Illness: no

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm