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: 1414206
Sex: M
Age: 60
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/21/2021
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:

Symptom List: Dysphagia, Epiglottitis

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

Other Meds:

Current Illness:

Date Died: 06/13/2021

ID: 1414207
Sex: F
Age: 79
State: MI

Vax Date: 04/27/2021
Onset Date: 06/07/2021
Rec V Date: 06/21/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia. During admission received dexamethasone, convalescent plasma, remdesivir. Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21.

Other Meds: metoprolol, amlodipine, losartan, eliquis, lexapro, anastrozol

Current Illness: COPD

ID: 1414208
Sex: F
Age: 49
State: CT

Vax Date: 05/05/2021
Onset Date: 06/16/2021
Rec V Date: 06/21/2021
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: Compazine

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

Symptoms: Havent menstruated since 09/2020. Have had hot flashes for months/years. Hot flashes ceased within couple of weeks of second vaccine. Started menstruation on 6/16/2021. Flow became very heavy at times with cramping.

Other Meds: Levothyroxine Sertraline

Current Illness:

ID: 1414209
Sex: F
Age: 51
State: KY

Vax Date: 04/16/2021
Onset Date: 05/07/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies: Penicillin and Latex

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 40% percent hearing loss in left ear only coupled with constant ringing. There were no prior issues and the Ear, Nose and Throat Doctor claims to be having several people come in that had no previous hearing issues now exhibiting the same symptoms.

Other Meds: Losartan 20mg. Vitamin D3

Current Illness: None

ID: 1414210
Sex: F
Age: 17
State: OK

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 06/21/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1414211
Sex: M
Age: 76
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/21/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1414212
Sex: F
Age: 46
State: NC

Vax Date: 03/18/2021
Onset Date: 03/26/2021
Rec V Date: 06/21/2021
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: Sulfur, Hydrocodone, Oxycodone, Augmentin, Fruit allergies such as apples, pears etc.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I was diagnosed with Atrial fibrillation after this shot. The first shot was 03-18-2021. A heart monitor for 30 days caught the AFib. Dr referred me to the electrophysiologist in their office for treatment of A-Fib. I have fluttering that feels like butterflies and it flutters in my back shoulder blade. A heart ablation (surgery) is recommended. The event monitored showed over 8, 500 abnormal heartbeats. A fib was caught during the 2nd week of wearing the monitor which was shortly after the 1st Pfizer shot.

Other Meds: Metoprolol, Furosemide, Losartan, Novolog, Levemir, Clonazepam

Current Illness: N/A

ID: 1414213
Sex: F
Age: 31
State: CO

Vax Date: 03/16/2021
Onset Date: 04/30/2021
Rec V Date: 06/21/2021
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 Codeine

Symptom List: Pharyngeal swelling

Symptoms: Early menstrual cycle by one week, prolonged cycle extended to multiple days. Cycle used to start on the 24th of each month, has now started on the 16th or 18th of the month since April. Second cycle since the last dose has now last a week when it used to be 4-5 days.

Other Meds: Stelara B12 Injection

Current Illness:

ID: 1414214
Sex: M
Age: 83
State: NY

Vax Date: 02/12/2021
Onset Date: 05/23/2021
Rec V Date: 06/21/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: For the past several weeks I have been experiencing terrible pain and stiffness in my shoulders and legs. The X-Rays taken show mild arthritis, but I did not feel this discomfort until the past several weeks. Just want to check if the vaccine could have caused it.

Other Meds: Vitamin B and D. high blood pressure medication

Current Illness: None

ID: 1414215
Sex: F
Age: 97
State: MA

Vax Date: 01/26/2021
Onset Date: 06/20/2021
Rec V Date: 06/21/2021
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: Acyclovir Celebrex Flagyl Lisinopril Morphine Motrin Niacin Penicillin Questran

Symptom List: Diarrhoea, Nasal congestion

Symptoms: No adverse events noted Resident was on hospice care

Other Meds: Metoprolol 37.5 MG Aspirin 81 mg Sodium Chloride 1GM Tab Latanoprost 0.005% SOL one drop to both eyes Brimonidine tartrate 0.2% SOL one drop to both eyes Levothyroxine sodium 88 mcg tablet Potassium chloride 10 MEQ CER Hyoscyamine sulf

Current Illness: Age-related physical debility 2019 -nCov acute respiratory disease (last year)/recovered Hypothyroidism Muscle weakness (generalized) Resident was on hospice care

ID: 1414216
Sex: F
Age: 73
State: PA

Vax Date: 03/17/2021
Onset Date: 05/28/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies: Iv Dye [Iodinated Contrast Media]Hives / Urticaria, Swelling TetracyclineIndigestion / GI upset

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

Symptoms: PT TESTED POSITIVE FOR COVID BEFORE BEING DISCHARGED FROM THE HOSPITAL - Admission Discharged 5/3/2021 - 5/28/2021 (25 days) Last attending ? Treatment team Diverticular stricture (CMS/HCC) Principal problem BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: CRNP Primary Care Physician at Discharge: MD Admission Date: 5/3/2021 Discharge Date: 5/28/2021 Hospital Problems POA * (Principal) Diverticular stricture (CMS/HCC) Yes Colonic obstruction (CMS/HCC) MSW Social Worker Plan of Care Addendum Date of Service: 5/28/2021 10:34 AM Addendum Hide copied text for details LTAC able to take pt today and pt is stable for d/c. COVID test ordered. Results not needed prior to d/c. Per at Clinic, pt is able to go after noon today. Working on transportation time. SW updated pt's dtr on plan and she is in agreement. 10:36 AM Pt's COVID test came back positive. Transportation cancelled. Care team notified. 1:57 PM LTAC aware of COVID positive status. They are still able to admit pt. Working on getting transportation back. 2:26 PM Transportation coming back. Confirmed with Dr team that pt is stable for d/c even with COVID positive status. 2:32 PM

Other Meds: albuterol 2.5 mg /3 mL (0.083 %) nebulizer solution amiodarone (PACERONE) 200 mg tablet apixaban (ELIQUIS) 5 mg tablet cefePIME 1,000 mg in sodium chloride 0.9% 100 mL IVPB dronabinoL (MARINOL) 2.5 mg capsule fluconazole in NaCl, iso-osm, (

Current Illness:

ID: 1414217
Sex: U
Age: 48
State:

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 06/21/2021
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:

Symptom List: Rash, Urticaria

Symptoms: 1620 C/O pressure in back of head which progressed to Dizziness and Weakness unable to stand no LOC, Oriented x4. VS BP 138/89,HR 82 reg, Resp 15,Sats 99%. Refused offer of rescue.1622 Placed on stretcher Ekg 12lead done. 1625 BP 121/76, HR 83,Resp 18. Expressed Dizziness improved. 1630off stretcher sitting on chair. Her husband is present. Monitored 15more mins. 1645 expressed Dizziness resolved. 1646Left for home ambulating with her husband. Educated on S/S to call 911

Other Meds:

Current Illness:

ID: 1414218
Sex: F
Age: 40
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/21/2021
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: Pfizer vaccine administered after being stored regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

Date Died: 06/17/2021

ID: 1414219
Sex: F
Age: 59
State: NY

Vax Date: 06/16/2021
Onset Date: 06/01/2021
Rec V Date: 06/21/2021
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 listed

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

Symptoms: The patient was vaccinated on 5/26/21 for dose one and 6/16/21 for dose two with Pfizer COVID-19 vaccine. Patient passed away the day following her second dose on 6/17/21.

Other Meds: Not known

Current Illness: Unknown

ID: 1414220
Sex: F
Age: 50
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1414246
Sex: F
Age: 41
State: TX

Vax Date: 03/18/2021
Onset Date: 05/01/2021
Rec V Date: 06/21/2021
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: Aspirin; Iodine; Latex

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

Symptoms: I noticed I was extremely fatigued since I had both of the vaccines, then I noticed my eyes had turn yellow as if I had Jaundice. I went to an urgent care appointment and they did a full panel, my labs came back abnormal first and my potassium levels were low and they referred me to a liver specialist. They did not prescribed any medications.

Other Meds: Lopresor; Lunesta

Current Illness: None

ID: 1414247
Sex: F
Age: 61
State: MA

Vax Date: 06/16/2021
Onset Date: 06/18/2021
Rec V Date: 06/21/2021
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: adhesive tape

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

Symptoms: "itchy warm slight raised rash radiating out from the site of the injection about 4inches by 2 inches in size towards my elbow." used antihistamine and cortisone

Other Meds: bupropion xl 300mg one daily calcium and vit d celebrex 200mg capsule clobestasol 0.05% rarely fiber capsule hair/skin/nails biotin letrozole 2.5 mg one tablet daily liver-kidney cleanser lyseine MTV omega 3 omeprazole 20mg every other da

Current Illness: none

ID: 1414248
Sex: M
Age: 74
State: NY

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies: iodine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: blood suger spiked day after vax

Other Meds: norvasc 5mg lipitor 20mg metformin 1500mg aloglipton 12.5mg hydrochliorothiazide 12.5mg asprin 80mg cetrine zertec 10mg bcomplex vitamin c 1000mg ubiquinol 100mg multi vitamin

Current Illness:

ID: 1414249
Sex: M
Age: 50
State: MD

Vax Date: 04/13/2021
Onset Date: 04/20/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Sudden sensorineural hearing loss of left ear

Other Meds: Synthroid, atorvastatin

Current Illness: None

ID: 1414250
Sex: F
Age: 17
State: OK

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1414251
Sex: M
Age: 12
State: OK

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1414252
Sex: F
Age: 55
State:

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 06/21/2021
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: Unevaluable event

Symptoms: 1403 Numbness left arm BP 177/93 Hr 56, resp 18, Sats 99% denies Hx of hypertension. Monitored 15 more mins. 12:19 BP 146/83, HR 64 reg, resp 16. Reports numbness improved. AAOx4, strength 5/5 all extremities. Left for home with her husband.

Other Meds:

Current Illness:

ID: 1414253
Sex: M
Age: 31
State: OK

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1414254
Sex: F
Age: 18
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/21/2021
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:

Symptom List: Injection site pain, Pain

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

Other Meds:

Current Illness:

ID: 1414255
Sex: F
Age: 16
State: OK

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/21/2021
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: Pfizer vaccine administered after being stored regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1414256
Sex: F
Age: 14
State: OK

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1414257
Sex: U
Age: 61
State:

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

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt c/o flushed feeling 15 mins after receiving the 2nd dose of the vaccine, had no reaction to the 1st dose. She reported that she has Hx of HTN, DM II, hyperlipidemia, allergy to dust mites and pollen and that she ate Cheetos last night and Saltine crackers this morning. She was assessed and monitored by NP, EMT and paramedic. She denied headache, dizziness, numbness, tingling, weakness, chest pain, SOB and visual changes. BP readings from initial to last: 193/115, 180/110, 191/107, 170/90, 164/88. HR- 108, went down to 98, O2 sat 99%. She noted that she was nervous because her daughter is in the hospital. She kept at site until she felt better and no complaints. She was given the Vaccination information sheet, reinforced instructions on ADRs/ SEs to call 911 and go to the ED, follow up with her PCP, register with V-safe. Also instructed to take her BP med when she gets home and BP parameters to call 911/her PCP, instructed on low salt diet and therapeutic lifestyle changes. She verbalized understanding and willingness to comply. She left site in no acute distress, had no complaints, she was awake, alert, oriented to person, place, time and situation.

Other Meds:

Current Illness:

ID: 1414258
Sex: M
Age: 48
State: TX

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

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

Lab Data:

Allergies: na

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: The patient did not want to wait the 15 minutes and went out to his truck. A customer brought the patient back in as he was complaining of chest pain and SOB. After resting 15 minutes pt stated that he was having a panic attack.

Other Meds: na

Current Illness: na

Date Died: 03/18/2021

ID: 1414259
Sex: M
Age: 87
State: PR

Vax Date: 03/01/2021
Onset Date: 03/18/2021
Rec V Date: 06/21/2021
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: Unknown.

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

Symptoms: Low heart activity and low oxygenation.

Other Meds: Tamsulosima, Prozac, Synthroid, Amaryl, Risperidone, Famotidine, Januvia, Isosorbide, Furosemide, Carvedidol, Atorvastatin.

Current Illness: Unknown.

ID: 1414260
Sex: M
Age: 23
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/21/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1414262
Sex: M
Age: 14
State: MD

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies: Shrimp and walnuts

Symptom List: Injection site pain

Symptoms: The patient is 14 years old and Moderna vaccine was given by mistake. No adverse event! The patient is doing fine so far.

Other Meds: unknown

Current Illness: none

ID: 1414263
Sex: F
Age: 42
State: NY

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Blistering rash , discoloration of feet and ulcers , severe head headache blurred vision started 6 hours after second shot and had progressed over the past several days

Other Meds: None

Current Illness: None

ID: 1414264
Sex: M
Age: 15
State: OK

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1414265
Sex: M
Age: 45
State: MA

Vax Date: 05/21/2021
Onset Date: 06/06/2021
Rec V Date: 06/21/2021
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: NO...

Symptom List: Tremor

Symptoms: 16 days after receiving my first Covid vaccine shot (The 1st of the 2 shots required) Around 7pm on May 5th I started having a hard time breathing & slight chest pains. I decided to lay down & that seemed to make it worse. I've never had any issues like this before so I figured it would eventually go away on its own & continued to try and lay down on my bed but as each hour passed it continued to get harder and harder to breath & each breath I took became increasingly strained & felt as though my lungs weren't letting me take in large breaths, only short gasps. By 2am May 6th, 2021, I knew something was obviously veryyy wrong! I drove myself to the closest ER (that being Hospital approx 5 minutes away) & was admitted. After running several tests, I was presented with the news that I had ACUTE RESPIRATORY FAILURE, PNEUMONIA, HYPOXIA, PLEURAL EFFUSION & ACUTE SYSTOLIC CONGESTIVE HEART FAILURE...

Other Meds: NO...

Current Illness: NO...

ID: 1414266
Sex: M
Age: 44
State:

Vax Date: 06/19/2021
Onset Date: 06/20/2021
Rec V Date: 06/21/2021
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: Erythema, Pruritus

Symptoms: sickness

Other Meds: none

Current Illness: none

ID: 1414267
Sex: M
Age: 11
State: KS

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/21/2021
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: PCN

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

Symptoms: Patient was 11 years old at time first vaccine was given.

Other Meds: Patient is on Concerta and has a prescribed PRN inhaler that he has not used in quite some time according to mom.

Current Illness: History of Asthma that has required no treatment in quite some time.

ID: 1414268
Sex: M
Age: 20
State: NY

Vax Date: 05/20/2021
Onset Date: 05/22/2021
Rec V Date: 06/21/2021
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: Amoxicillin Pollen

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

Symptoms: For 2 days he had arm pain and hot flashes. Day 3 he felt better but had some arm cramping. 84 hours after the vaccine he woke with tremors for several hours overnight; he then continue to experience muscle twitching but the tremor resolved the next morning. That day he noticed he felt very fatigued. The twitching and spasms lasted about 3 or 4 days. The legs will still spasm at nighttime and he still feels fatigued with less exercise tolerance. His baseline was 2-3 miles walking without difficulty prior to the vaccine, lately a mile will wipe him out. He also noticed intermittent midline pain around his breastbone that has improved. He hasn't had any shortness of breath. He had poor circulation to his hands and were cold and white but that resolved. He did not have sensory changes. His symptoms overall have been improving.

Other Meds: Enteral albuterol Pyridostigmine

Current Illness: Flare of underlying undiagnosed neuromuscular disorder 2 weeks prior without clear trigger.

ID: 1414270
Sex: U
Age: 12
State: OK

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/21/2021
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: Pfizer vaccine administered after being stored at regular freezer temps longer than recommended. Dose determined invalid, client contacted and recommended repeat dose.

Other Meds:

Current Illness:

ID: 1414271
Sex: F
Age: 38
State: CT

Vax Date: 06/16/2021
Onset Date: 06/18/2021
Rec V Date: 06/21/2021
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: Bactrim/Sulfa Drugs

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

Symptoms: Severe, debilitating anxiety. An anxiety attack daily from day 1-4 following vaccination

Other Meds: Multi-Vitamin Vitamin C Vitamin D

Current Illness: Covid-19 positive on 3/4/21

ID: 1414272
Sex: M
Age: 13
State: WA

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/21/2021
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: NKDA

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

Symptoms: fever (101.2 at home) and repeated vomiting starting a few hours after 2nd covid vaccination; guardian attempted to give Tylenol at home but patient immediately vomited so brought to ED for evaluation and treatment.

Other Meds: None

Current Illness: None

ID: 1414273
Sex: F
Age: 32
State: OK

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/21/2021
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: Pain in extremity

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

Other Meds:

Current Illness:

ID: 1414274
Sex: F
Age: 38
State: OK

Vax Date: 04/06/2021
Onset Date:
Rec V Date: 06/21/2021
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: Per OSDH: Regarding The VSIR for GSP Health on the following COVID Vaccine Moderna. Please see the following determination; Doses Administered from 4.6.2021 to 5.21.2021:Based on the information you have provided and the lack of temperature data, we are not able to conduct an analysis or guarantee the doses administered between 4/6/2021 and 5/21/2021 provided the necessary protection against a COVID-19 infection. Please continue with the original plan of action on revaccination and completing a VAERS Reports on the all clients you have identified.

Other Meds:

Current Illness:

ID: 1414275
Sex: M
Age: 12
State: PA

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 06/21/2021
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: Cinnamon, ibuprofen, aspirin

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

Symptoms: Lymph node swelling and pain in left armpit and left side. Tender to the touch. This was the side of the injection. Lasted for a week after the vaccine injection.

Other Meds: Concerta 36mg

Current Illness: n/a

ID: 1414276
Sex: F
Age: 23
State: OK

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

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1414277
Sex: F
Age: 54
State: OK

Vax Date: 04/06/2021
Onset Date:
Rec V Date: 06/21/2021
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: The following COVID Vaccine Moderna. Please see the following determination; Doses Administered from 4.6.2021 to 5.21.2021:Based on the information you have provided and the lack of temperature data, we are not able to conduct an analysis or guarantee the doses administered between 4/6/2021 and 5/21/2021 provided the necessary protection against a COVID-19 infection. Please continue with the original plan of action on revaccination and completing a VAERS Reports on the all clients you have identified.

Other Meds:

Current Illness:

ID: 1414279
Sex: M
Age: 0
State: OK

Vax Date: 04/06/2001
Onset Date:
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Per OSDH: Regarding The VSIR for GSP Health on the following COVID Vaccine Moderna. Please see the following determination; Doses Administered from 4.6.2021 to 5.21.2021:Based on the information you have provided and the lack of temperature data, we are not able to conduct an analysis or guarantee the doses administered between 4/6/2021 and 5/21/2021 provided the necessary protection against a COVID-19 infection. Please continue with the original plan of action on revaccination and completing a VAERS Reports on the all clients you have identified.

Other Meds:

Current Illness:

ID: 1414280
Sex: M
Age: 35
State: OK

Vax Date: 04/06/2001
Onset Date:
Rec V Date: 06/21/2021
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: Regarding The VSIR on the following COVID Vaccine Moderna. Please see the following determination; Doses Administered from 4.6.2021 to 5.21.2021:Based on the information you have provided and the lack of temperature data, we are not able to conduct an analysis or guarantee the doses administered between 4/6/2021 and 5/21/2021 provided the necessary protection against a COVID-19 infection. Please continue with the original plan of action on revaccination and completing a VAERS Reports on the all clients you have identified.

Other Meds:

Current Illness:

ID: 1414281
Sex: M
Age: 27
State: OK

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

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

Other Meds:

Current Illness:

ID: 1414282
Sex: F
Age: 41
State: PA

Vax Date: 05/01/2021
Onset Date: 06/16/2021
Rec V Date: 06/21/2021
Hospital:

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

Lab Data:

Allergies: Tramadol Noratripalene

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

Symptoms: Loss of appetite and not being able to drink. I get sick after I eat and was in the ER due to dehydration. I also had to go again due to my heart racing. My normal BP is 110/70 and it was 145/98 and my resting heartrate is 65-75 and it spiked to 149.

Other Meds:

Current Illness:

ID: 1414283
Sex: M
Age: 69
State: OK

Vax Date: 04/06/2021
Onset Date:
Rec V Date: 06/21/2021
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:

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

Symptoms: Regarding Health on the following COVID Vaccine Moderna. Please see the following determination; Doses Administered from 4.6.2021 to 5.21.2021:Based on the information you have provided and the lack of temperature data, we are not able to conduct an analysis or guarantee the doses administered between 4/6/2021 and 5/21/2021 provided the necessary protection against a COVID-19 infection. Please continue with the original plan of action on revaccination and completing a VAERS Reports on the all clients you have identified.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm