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: 1410868
Sex: M
Age: 24
State: WA

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

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Syncopal episode without injury. Patient briefly lost consciousness, and was placed on the floor on his back with legs elevated, at which point the patient quickly regained consciousness. Patient was advised to remain on the floor and attempt to stand only under supervision of the pharmacist. After approximately twenty minutes the patient was able to stand and walk with no difficulty and was allowed to leave. No signs of injury or trauma were noted.

Other Meds: Long term tobacco and cannabis user

Current Illness: None

ID: 1410869
Sex: M
Age: 13
State: WA

Vax Date: 06/08/2021
Onset Date: 06/10/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: PT developed a fever of around 102 as expected about a day and a half after his second dose. After four days I called the nurse at his pediatrician and she said kids his age can have fevers longer than adults did, and not to worry if it lasted a week. He ultimately had a fever for nine days, slowly lowering to 99-ish the last few days. He felt relatively fine throughout, only a little tired the first couple of days. I do not consider this a serious reaction (especially as the nurse said not uncommon). He did not see his pediatrician in person. I'm only reporting it bc the VSafe person I talked to said to.

Other Meds: Accutane

Current Illness: None

ID: 1410870
Sex: M
Age: 13
State: OH

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: 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 event/outcomes at this time. Patient received Pfizer vaccine at pharmacy and after dose was administered it was realized that the patient had also received a Gardasil vaccine at their MD office earlier in the same day.

Other Meds:

Current Illness:

ID: 1410871
Sex: F
Age: 40
State: PA

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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt. reported via arabic phone interpreter of having nausea, dizziness and abdominal pain

Other Meds:

Current Illness:

ID: 1410872
Sex: F
Age: 60
State: AK

Vax Date: 01/19/2021
Onset Date: 02/01/2021
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: Hydrochlorothiazide

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

Symptoms: Have ringing in my left ear started either before or after 2nd covid vax. And have dry red eyes right worse than left. Also have fatigue. Still have all three symptoms

Other Meds: Coreg, chlorthalidone, lisinopril, metformin and multi vitamins

Current Illness: Covid 19

ID: 1410873
Sex: F
Age: 34
State: MI

Vax Date: 05/28/2021
Onset Date: 06/02/2021
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: None

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

Symptoms: Started with a rash on my face 5 days post vaccine that continued to spread to arms, stomach, back & thighs blistered in some areas

Other Meds: None

Current Illness: None

ID: 1410874
Sex: M
Age: 67
State: GA

Vax Date: 06/07/2021
Onset Date: 06/11/2021
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: Pyrexia, White blood cell count decreased

Symptoms: RECONSTITUDED WITH BACTERIOSTATIC SODIUM CHLORIDE 0.9% CUSTOMER DID NOT EXPERIENCE ADVERSE EVENTS

Other Meds:

Current Illness:

ID: 1410875
Sex: M
Age: 11
State: CO

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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: No allergies

Symptom List: Pharyngeal swelling

Symptoms: Patient is an 11 year old boy with a birthdate of 12/28/2009 who received the Pfizer vaccine at a school clinic. He is not age appropriate to get the Pfizer vaccine, it is only authorized for children 12 years old and higher. I met his family today at Health Facility and explained that he is not able to get a second dose here as his age disqualifies him. The family will return to Health Dept/Facility after his 12th birthday in December 2021 or will contact provider for a second off label dose if their physician is willing to permit this special situation. Client and family were educated that he does not have full protection by only receiving one dose, continue to wear masks, practice social distancing, and hand wash regularly. The patient had no ill effects after the vaccine was administered at Health facility.

Other Meds: Unknown

Current Illness: No other illnesses reported

ID: 1410876
Sex: F
Age: 22
State: OH

Vax Date: 05/06/2021
Onset Date: 05/12/2021
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: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I had a typical fever/chills and headache but then a couple days later I found a lump in my right breast which lasted about a week before going away

Other Meds: N/A

Current Illness: N/A

ID: 1410877
Sex: M
Age: 70
State: NJ

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: No adverse events. Residnet rec'd pfizer on 1/7 and 1/28 and on 6/2 rec'd J&J

Other Meds:

Current Illness: none

ID: 1410878
Sex: F
Age: 36
State: FL

Vax Date: 05/05/2021
Onset Date: 05/08/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: I had bad headaches for about a day, a rash on my shoulders for a few days. Minor nose bleed after dose 2.

Other Meds: I was taking metformin, procardia,

Current Illness: none

ID: 1410879
Sex: M
Age: 22
State: ME

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

Lab Data:

Allergies: n/a

Symptom List: Rash, Urticaria

Symptoms: Patient started to not feel well about 2 minutes after injection, asked for water. I grabbed co-worker (my pharmacist as I am a student) and she stayed with him while I called 911. He passed out on here, came back to, EMTs arrived and he again passed out on them so they took him to ambulance on stretcher

Other Meds: n/a

Current Illness: n/a

ID: 1410880
Sex: F
Age: 15
State: GA

Vax Date: 06/07/2021
Onset Date: 06/11/2021
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: RECONSTITUDED WITH BACTERIOSTATIC SODIUM CHLORIDE 0.9% CUSTOMER DID NOT EXPERIENCE ADVERSE EVENTS

Other Meds:

Current Illness:

ID: 1410881
Sex: M
Age: 20
State:

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

Lab Data:

Allergies:

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

Symptoms: Fever, chills, weakness, headache, aches and pains

Other Meds:

Current Illness:

ID: 1410882
Sex: M
Age: 22
State: NC

Vax Date: 06/10/2021
Onset Date: 06/13/2021
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: Started experiencing chest pains a couple days after I received my second dose. Ended up being hospitalized for almost 3 days. Now I am taking colchicine twice a day and ibuprofen as needed.

Other Meds:

Current Illness:

ID: 1410883
Sex: F
Age: 73
State: MD

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

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

Symptoms: Pt was admitted to HCF with Carotid artery stenosis on 4/5/21 after getting the second dose of vaccine on 4/1/21

Other Meds:

Current Illness:

ID: 1410884
Sex: F
Age: 69
State: FL

Vax Date: 02/20/2021
Onset Date: 02/21/2021
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: Lactose, I'm allergic to almost all antibiotic and pain medications. I can only take zpack and I have to take it with Benadryl.

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

Symptoms: First I got sick to my stomach and extreme diarrhea before midnight. Then I had tremendous pain in my leg that felt like blood cot. I've had them in the past and I was pretty certain I had one. So I put hospital stockings on. I called the hospital and they wanted me to come in but I didn't think it was safe so. Then I went on CDC site and couldn't find anything about blood cot. The next morning I had a extreme headache. In the past with blood cot I would put heat and stockings on and watched to see if it would go away. The following Monday I went to the Doctor and he said his wife had a similar reaction to the vaccine. I have a history of Phlebitis, blood cots in my legs but I haven't had one for probably 20 years. When it was gone it was gone just as quickly.

Other Meds: I was on thyroid medicine Levothylycine, Melatonin, Primidone, Madalolo, Benadryl.

Current Illness: No.

ID: 1410885
Sex: F
Age: 19
State: MS

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/18/2021
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 became very dizzy a few minutes after receiving vaccine. someone was called to come pick her up she was walked to her ride

Other Meds:

Current Illness:

ID: 1410886
Sex: M
Age: 15
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
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: Patient c/o throat swelling and itching after getting covid vaccine; received epi and benadryl

Other Meds:

Current Illness:

ID: 1410887
Sex: F
Age: 36
State: FL

Vax Date: 03/09/2021
Onset Date: 03/09/2021
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: no

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

Symptoms: I had a real bad headache after this dose for 24 hours.

Other Meds: Metphormin and procardia

Current Illness:

ID: 1410888
Sex: F
Age: 62
State: TX

Vax Date: 06/15/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine Thimerosal

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

Symptoms: Allergic type reaction Itching on face, scalp, arms, legs, torso Started approx. 50 hours after injection Treated with OTC Benadryl, 2 doses thus far Patient continued with milder itching and a tingling sensation, similar to a Niacin "flush" on the skin Continued condition remains after 72 hours after injection

Other Meds: Olmesartan Tirosint Liothyronine Gabapentin Bromalaine supplement

Current Illness:

ID: 1410889
Sex: F
Age: 29
State: NE

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: Latex

Symptom List: Unevaluable event

Symptoms: patient's throat swelled up and couldnt breath quite easily. gave epipen and 10ml of benadryl solution. patient was able to breath more easily within minutes

Other Meds: unknow

Current Illness: none reported by patient

ID: 1410890
Sex: F
Age: 48
State: NY

Vax Date: 06/11/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Unknown

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

Symptoms: Note from NP at clinic 6/11/21: "She (pt.) received the shot and about 5 minutes later started to feel flushed, tachycardic, and said her throat felt "numb." She was laid down on a cot, her vitals were taken (BP 148/90 and pulse 112 apical), she was given 25mg of liquid Benadryl and symptoms resolved after about an hour. She was given instructions to contact her PCP Dr. after leaving the clinic and should symptoms return to go to the ER for further evaluation." Follow-up note from Health Department Medical Director 6/14/21: "She (pt.) told me that within 5 minutes of having the Pfizer she developed numbness of her lips and tongue and a sensation of throat numbness. She was evaluated and her BP was high and she was tachycardic and she was told to lay down. She felt some trouble breathing more with laying down and she had some nausea in addition to some itchiness of her face and neck. She was given Benadryl. She also remembers having almost an instant headache and hot feeling with her symptoms. Once the Benadryl started to take effect, she felt her breathing and tingling and itchiness was better. She did go to see her primary care that same day and her symptoms did return. She was given steroids orally and told to take Benadryl every 4 hours. She noticed that her symptoms of throat tingling and lip tingling and face and neck itchiness and splotchiness would return when she was due for Benadryl. The last time she noticed this was Saturday morning. She is still taking Benadryl every 4 hours and is no longer having any symptoms as of today."

Other Meds: Unknown

Current Illness: Unknown

ID: 1410891
Sex: F
Age: 51
State: OH

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

Symptom List: Injection site pain, Pain

Symptoms: PATIENT REPORTED TEMPERATURE OVER 100 DEGREES CONSISTENTLY STARTING DAY AFTER SECOND DOSE SHOT (6/02/21). DID NOT LOSE TASTE/SMELL. OCCASIONAL HEADACHES. BODY TIRED NEXT DAY AFTER 2ND SHOT. NO SYMPTOMS AT ALL FROM 1ST SHOT. NEVER TESTED POSITIVE FOR COVID.

Other Meds: NONE REPORTED

Current Illness: NONE

ID: 1410892
Sex: F
Age: 56
State: CA

Vax Date: 06/07/2021
Onset Date: 06/07/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: used wrong diluent to dilute medication

Other Meds:

Current Illness:

ID: 1410893
Sex: M
Age: 67
State: TN

Vax Date: 01/20/2021
Onset Date: 02/10/2021
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: Increased coughing. I must clear my throat much more frequently than before due to congestion. I have increased phlegm. It is only just very annoying.

Other Meds: Daily VItamins

Current Illness: No illness

Date Died: 06/07/2021

ID: 1410894
Sex: M
Age: 75
State: MT

Vax Date: 02/18/2021
Onset Date: 03/11/2021
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: LA

Lab Data:

Allergies: streptomycin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient was hospitalized due to COVID-19 from May 19, 2021 to May 22, 2021. Patient was then placed on hospice on 6/5/2021 and expired on 6/7/2021.

Other Meds: allopurinol 300 mg PO DAILY amoxicillin 500 mg PO 2 caps prior to dental appt then 2 caps BID the following day. ; apixaban (Eliquis) 5 mg PO BID aspirin 81 mg PO QHS cholecalciferol (vitamin D3) 2,000 units PO DAILY coenzyme Q10 30 mg PO

Current Illness: diffuse large B cell lymphoma, cardiovascular disease, diabetes mellitus type 2, hypertension.

ID: 1410895
Sex: F
Age: 50
State: TX

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None Known

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pfizer vaccine #2 ~10:10 AM 06/15/2021. ~3:00 PM gums felt inflamed. ~5:00 PM whole mouth inflamed/swollen, sore tongue and top of throat. No trouble breathing. ~4:00 AM 06/16/21 awoke to stomachache and thick sinus congestion; blew nose, tissue full of bright red blood. ~9:00 AM 06/16/2021: tiny blisters on still sore tongue, inside lips slightly swollen but worst subsided. Pain under left arm (injection arm). 6/17/2021 AM: All symptoms subsided except pain in left underarm. 6/18/2021 AM: Stil pain under left armpit. NOTE: Normal reactions: slight elevated temp and headache x 2 days. Took no OTC meds to avoid antibody interference. Stayed hydrated. Oura Ring showed significant sleep interference x 2 days.

Other Meds:

Current Illness: None

ID: 1410896
Sex: F
Age: 45
State: NY

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Generalized arm pain after injection, severe fever, chills, brain fog, swollen lymph nodes, severe fatigue. Symptoms were most severe for 18 hours after shot. Swollen lymph nodes and severe fatigue continued for two weeks post shot.

Other Meds: Allegra, Singulair

Current Illness:

ID: 1410897
Sex: F
Age: 18
State: GA

Vax Date: 06/07/2021
Onset Date: 06/11/2021
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: RECONSTITUDED WITH BACTERIOSTATIC SODIUM CHLORIDE 0.9% CUSTOMER DID NOT EXPERIENCE ADVERSE EVENTS

Other Meds:

Current Illness:

ID: 1410898
Sex: F
Age: 62
State: HI

Vax Date: 03/11/2021
Onset Date: 05/28/2021
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: no

Symptom List: Injection site pain

Symptoms: I had all the symptoms were related to low hemoglobin. So I tests done. Went to ER - The day before my transfusion - I had Low hemoglobin so on May 28t, I had a blood transfusion; and had another blood transfusion - on June 16th. Apparently, I have some kind of bleeding so they have to continue to do more testing.

Other Meds: Simvastatin; Iron; Vyvanse; Treximet - as needed

Current Illness: no

ID: 1410899
Sex: M
Age: 45
State: NV

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Patient came in for second COVID vaccine shot, he previously did get Moderna for first dose and on 06/15/21 he was given Pfizer Vaccine at 2:52 PM. Patient did come in during our regular COVID Vaccine walk-in schedule and was mistaken for Pfizer Vaccine.

Other Meds: Hydroxyzine HCI 25 mg tablet, metoprolol succinate ER 100 mg tablet

Current Illness: No known illnesses

ID: 1410900
Sex: M
Age: 11
State: MA

Vax Date: 06/16/2021
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: RA

Lab Data:

Allergies: amoxicillin and cephalosporins

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

Symptoms: LEFT ARM AT AND BELOW VAC SITE 20 X 15 CM RED RAISED AND WARM INDURATED REACTION-CELLULITIS. PARENTS NOTICED RASH EARLIER TODAY. PATIENT PUT ON: SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSPENSION 200-40 mg/5 mL Suspension 15 mL PO twice daily; for 10 days

Other Meds: Depakote prn, Epi-pen prn

Current Illness:

ID: 1410901
Sex: F
Age: 45
State:

Vax Date: 02/08/2021
Onset Date: 02/08/2021
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: Tremor

Symptoms: I passed out - lost consciousness - followed by projectile vomiting and extreme diahrea.

Other Meds:

Current Illness:

ID: 1410902
Sex: F
Age: 14
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: Erythema, Pruritus

Symptoms: Symptoms: Patient was sweaty, dizzy and nauseated 1 minute after the administration of the vaccine. Treatment: Patient laid down and symptoms improved . Outcome: Patient was discharged to POV/Home once the symptoms were improved.

Other Meds:

Current Illness:

ID: 1410903
Sex: F
Age: 49
State: HI

Vax Date: 03/02/2021
Onset Date: 03/02/2021
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: Gluten sensitive

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

Symptoms: Lymph nodes became swollen within about 4 hours. At hour 8, I noticed sore bumps on my left buttocks. At that point, I went to see my PCP, who then suggested a Midwife/OBGYN. I went in to see one and she thought it was vaginitis and took a sample. I had a lot of candida infection and started taking medication. I also took acyclovir to speed out the herpes outbreak and then it started to ease up. I have been feeling in general more tired and muscle fatigue. Lab work was done because sex was painful. My OBGYN thought to give me progesterone to help with that.

Other Meds: None.

Current Illness: None.

ID: 1410904
Sex: F
Age: 67
State: TX

Vax Date: 05/07/2021
Onset Date: 05/09/2021
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: NKDA

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

Symptoms: Patient started having difficulty breathing 2 days after receiving the second dose of Pfizer vaccine. Patient states she has had a 2-3 week history of tongue swelling, inner cheek swelling, lip swelling with itching. Patient has severe mouth pain and the inner lips are peeling.

Other Meds: Topamax Levoxyl

Current Illness: Uknown

ID: 1410905
Sex: F
Age: 61
State: MD

Vax Date: 03/23/2021
Onset Date: 04/03/2021
Rec V Date: 06/18/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt was admitted to hospital from the ED with complaints of chest pains on 4/3/21, after receiving the first dose of vaccine 3/23/21. Per guidelines, all hospitalizations are reported.

Other Meds:

Current Illness:

ID: 1410906
Sex: M
Age: 26
State: TX

Vax Date: 06/10/2021
Onset Date: 06/10/2021
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: Unknown

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

Symptoms: The patient was given the Janssen vaccine around 12pm. After about 15 minutes he left the pharmacy area to find his siblings in the store. He returned and stated that he felt dizzy and fell. He cut his elbow from the fall. He stated that dizziness is all that he experienced. I advise him to sit in the waiting area for about 30 minutes so that we could continue to monitor him.

Other Meds: Unknown

Current Illness: Unknown

ID: 1410907
Sex: M
Age: 17
State: CA

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

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

Symptoms: used wrong diluent to dilute medication

Other Meds:

Current Illness:

ID: 1410908
Sex: F
Age: 70
State: WA

Vax Date: 01/22/2021
Onset Date: 03/18/2021
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: N/D

Symptom List: Pain in extremity

Symptoms: Experienced an episode of rapid heart rate and chest pain consequently diagnosed as Atrial fibrillation in the emergency room. Was cardioverted and placed on Apixaban and Diltiazem . Returned home

Other Meds: multi vitamins , diclofenac ,atorvastatin

Current Illness: N/D

ID: 1410909
Sex: M
Age: 54
State: GA

Vax Date: 06/07/2021
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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: RECONSTITUDED WITH BACTERIOSTATIC SODIUM CHLORIDE 0.9% CUSTOMER DID NOT EXPERIENCE ADVERSE EVENTS

Other Meds:

Current Illness:

ID: 1410910
Sex: F
Age: 51
State: CA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
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: nka

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

Symptoms: Pt was given Pfizer as second dose, first dose given on 5/17/21 was Moderna. No reaction noted.

Other Meds: Asa, Atorvastatin, Os Cal D, Zyrtec, Vit D, Ibuprofen, Protonix, Prazosin, Seroquel

Current Illness: none

ID: 1410911
Sex: M
Age: 61
State: NY

Vax Date: 04/16/2021
Onset Date: 05/25/2021
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: None

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

Symptoms: DVT right leg posterior tibial vein on ultrasound 5/27/2021

Other Meds: None

Current Illness: None

ID: 1410912
Sex: M
Age: 33
State: VA

Vax Date: 02/25/2021
Onset Date: 02/26/2021
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: none

Symptom List: Vomiting

Symptoms: I woke up the next day with a severe twitch in my right eye and had trouble speaking and getting words out. The eye twitch lasted for 3 months and I am currently still have slight speech impairment. I am basically waiting it out and seeing if it will improve.

Other Meds: none

Current Illness: none

ID: 1410913
Sex: F
Age: 75
State: WI

Vax Date: 02/24/2021
Onset Date: 02/25/2021
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: SEPTRA DS tabs, nufrontan, fosomax, aAllegra D

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Day later, mild ache in left arm which increasingly turned to pain within a week. Using arm became painful when pushing or lifting something, raising arm overhead, turning door know or putting arm out to side or above head when sleeping. Arm did not hurt during day, only when doing tasks as enumerated above.

Other Meds: Symbicort inhaler

Current Illness: None

ID: 1410914
Sex: M
Age: 15
State: CA

Vax Date: 06/09/2021
Onset Date: 06/09/2021
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: used wrong diluent to dilute medication

Other Meds:

Current Illness:

ID: 1410915
Sex: M
Age: 79
State: NE

Vax Date: 03/17/2021
Onset Date: 05/08/2021
Rec V Date: 06/18/2021
Hospital: Y

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: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Moderna COVID 19 Vaccine Patient admitted inpatient for Hyperkalemia, given kayexalate orally and lasix

Other Meds: Lasix, duoneb, Glucosamine chondroitin, flomax, eliquis, metoprolol, amiodorone, tylenol, melatonin, pravastatin, loratadine, multivitamin

Current Illness:

ID: 1410917
Sex: M
Age: 30
State: MA

Vax Date: 05/29/2021
Onset Date: 05/30/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Extremely strong shivering for several hours Loss of coordination after standing up Fainting after standing up

Other Meds: None.

Current Illness: None.

ID: 1410918
Sex: F
Age: 69
State: FL

Vax Date: 01/28/2021
Onset Date: 06/09/2021
Rec V Date: 06/18/2021
Hospital: Y

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

Lab Data:

Allergies: Sulfa, vicodin

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

Symptoms: Idiopathic bilateral systemic pulmonary embolisms and enlarged right heart

Other Meds: Mavenclad, ampyra, fish oil, vitamin d, green tes extract, artichoke extract, evening primrose oil

Current Illness: Secondary Progressive M.S, fatigue

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm