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: 1415729
Sex: F
Age: 16
State: IA

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: administered to person under age 18

Other Meds:

Current Illness:

ID: 1415730
Sex: F
Age: 38
State: TN

Vax Date: 04/29/2021
Onset Date: 06/01/2021
Rec V Date: 06/21/2021
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: No e

Symptom List: Anxiety, Dyspnoea

Symptoms: Cough, runny nose, that was getting worse after 7-10 days. went to dr and was diagnosed with bronchitis. Given cocktail shot and 5 day zpack. Didnt help so now I?m 10 day course of cefdinir

Other Meds: Birth control pill, Breo inhaler, amitriptyline, montelukast, Allertec-Flo, Allertec.

Current Illness: None

ID: 1415731
Sex: M
Age: 71
State:

Vax Date: 02/01/2021
Onset Date: 06/12/2021
Rec V Date: 06/21/2021
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: Septra/Sulfa Drugs

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

Symptoms: Acute Interstitial Nephritis Acute Renal Failure

Other Meds:

Current Illness: None

ID: 1415732
Sex: F
Age: 52
State: WA

Vax Date: 04/16/2021
Onset Date: 04/17/2021
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: Naturethroid Gluten sensitivity

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Constant vertigo, fevers on and off, flu-like symptoms, ear aches, tinnitus on and off, metal taste in mouth, brain fog, cognitive impairment.

Other Meds: Levothyroxine, Citalopram, Progesterone capsules, Progesterone cream, BiEst cream, Vitamin C, Bio-Adreno, My Community, fish oil, , UBQH

Current Illness: None

Date Died: 06/14/2021

ID: 1415733
Sex: M
Age: 53
State: CA

Vax Date: 06/13/2021
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: No allergies

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

Symptoms: The pt received his 2nd Moderna covid vaccine on 6/13/21 at 10:45 am (approximately). Starting at 5pm he c/o pain, redness and tenderness in the injection site, chills, and lethargy . The next day he did not go to work b/o he felt tired and he stayed home with his 7 y/o daughter while his wife went to work. His wife spoke with him in the am and he reports he was making breakfast for their daughter and he was going to lie down and sleep afterward. He made lunch for daughter about 1 pm and he went to lie down in his chair. His brother called his wife at about 4:30 pm stating he was blue. 911 was called and they were unable to revive him.

Other Meds: None

Current Illness: None

ID: 1415734
Sex: F
Age: 41
State: GA

Vax Date: 03/22/2021
Onset Date: 05/01/2021
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: Asprin, Ibuprofen, Z-pak antibiotic

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

Symptoms: A few weeks after my second dose on April 19, I started my period and it just didn't really stop. I wasn't bleeding heavily, just spotty, but it was definitely odd. Since I'm on the pill, I usually bleed for 5-7 days and then I'm done until the next one. I also started getting migraines every day, which usually happens due to extreme fluctuations in hormones. I just dealt with the bleeding and took some migraine meds.

Other Meds: Lialda, Zyrtec, Elmiron, Nexium, Montelukast, Symbicort, Volnea, Zoloft

Current Illness: none

ID: 1415736
Sex: F
Age: 51
State: OH

Vax Date: 05/25/2021
Onset Date: 05/31/2021
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: Allergy to Tylenol w/codeine (rash)

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I was experiencing chest pain and shortness of breath. I initially noticed shortness of breath about 3 days after receiving the vaccine-this was during everyday normal, routine activities although especially when climbing stairs, it was worse at night when I tried laying back to sleep. I've never experienced any of these symptoms before this. By Monday, 5/31 my breathing was very labored and I could feel a heaviness like a clutch in my chest which was more pronounced on the left side. I had to sit all the way up in bed and was unable to lie down without a great deal of discomfort-That was when I checked in at the emergency room.

Other Meds: Estradiol patch .5mg. Women's multivitamin

Current Illness: None

ID: 1415737
Sex: M
Age: 28
State: TX

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Fever, body aches, muscle pain, headache, fatigue, diarrhea

Other Meds:

Current Illness:

ID: 1415738
Sex: M
Age: 27
State: PA

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: PT FELT IMMEDIATE SYNCOPE, FAINT, DIZZINES, WAS SWEATING PROFUSELY

Other Meds: NA

Current Illness: NA

ID: 1415739
Sex: M
Age: 61
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: PCN, Lisinopril

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Acute myeloid leukemia

Other Meds:

Current Illness:

ID: 1415740
Sex: F
Age: 33
State:

Vax Date: 03/16/2021
Onset Date: 03/17/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Extreme fatigue leading to only a few hours per day of functionality (for working, doing household chores, exercising, etc.- anything but resting). I had fatigue for a week and a half after the first shot and then so far for 3 months since the second shot (it?s been approximately 3 months since I had the second shot). This is really really bad. I can now only work for around 4 hours per day.

Other Meds:

Current Illness:

ID: 1415942
Sex: F
Age: 73
State: OH

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

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Patient received a third dose of covid vaccine by mistake. no immediate reaction and observed for 30 minutes. patient reported to be fine and not experiencing any signs or symptoms. educated patient that the following day will most likely feel like they did after receiving the second dose.

Other Meds: none

Current Illness: none

ID: 1415943
Sex: F
Age: 53
State: OR

Vax Date: 02/20/2021
Onset Date: 02/25/2021
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: penicillin

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

Symptoms: multiple joints swelling and pain

Other Meds: fish oil; vitamin D

Current Illness: n/a

ID: 1415944
Sex: F
Age: 17
State: CA

Vax Date: 05/17/2021
Onset Date: 06/21/2021
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

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

Symptoms: Patient was 17 years old at the time of the first COVID-19 vaccination. Facility has a signed parental consent form on file. At patient's second dose appointment, patient and mother were made aware that Moderna COVID-19 vaccines have not been FDA approved for anyone under 18 years old. Per continuity of care and physician clearance with mother's consent , the patient received the second dose of Moderna vaccine. Patient informed the Vaccine Coordinator that she only experienced a sore left arm and redness at the injection site after her first dose of Moderna Covid-19 vaccine. The Vaccine Coordinator recognized the patient was a minor at appointment check-in time for her second dose, as her first dose was administered a month ago without realizing her age. Vaccine coordinator spoke with the Medical Director regarding the situation and was given approval to have phamacist administer the second dose.

Other Meds: None

Current Illness: None

ID: 1415945
Sex: F
Age: 31
State: KY

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: 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: dizziness and hot flash x 20 minutes on 6/20/21. fatigue on 6/21/21. no treatment other than fluids and rest.

Other Meds:

Current Illness:

ID: 1415946
Sex: M
Age: 22
State:

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

Lab Data:

Allergies:

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

Symptoms: Patient was given the vaccination and asked to remain in the consultation area for 15 mins. The pharmacy student that administered the vaccination walked turned to walk away when he heard bumping on the wall of the room. He turned to see the patient with his head back and eyes wide open. He returned to the room and called the patient's name with no response. The patient at this point had his eyes shut and seemed to slump in the chair. His breathing was labored and then seemed to stop. His pulse was still felt. The patient was unconscious and seemed to be seizing. An Epipen administered in the right thigh. The patient seemed to twitch and immediately regained consciousness. At this point the EMT arrived and took over. The patient seemed unaware of the events and was fully recovered.

Other Meds:

Current Illness:

ID: 1415947
Sex: F
Age: 31
State: TX

Vax Date: 06/20/2021
Onset Date: 06/21/2021
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: n/a

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

Symptoms: pt called the pharmacy to let us know that the day after receiving second covid 19 dose, she has a rash from head to toe

Other Meds: n/a

Current Illness: n/a

ID: 1415948
Sex: M
Age: 42
State: NV

Vax Date: 03/12/2021
Onset Date: 05/31/2021
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: Azithromycin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Current ongoing symptoms in order of severity include: lethargy/brain fog (daily since), thick mucus buildup (nose and back of throat throughout the day), regular headaches, depression, loose stool, eye redness, and tonsil stones (couched up daily). Events/symptoms after vaccine: tonic-clonic seizure (twice admitted to Hospital last event on 5/31/2021), petite-mal seizure (not admitted to hospital but noted by others in household), severe pounding headache (on and off in middle and back of cranium)

Other Meds: One-A-Day Men's Daily multivitamin and metformin (500 MG BID)

Current Illness: Seasonal allergies about two weeks prior

ID: 1415949
Sex: F
Age: 18
State: GA

Vax Date: 05/22/2021
Onset Date: 06/21/2021
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: Amoxicillin Loratab Codeine Percocet

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 1st shot: headache, nausea, fever, chills, fatigue, chest pain, racing heart, increased anxiety (may 22nd 2021) may 23rd 2021 - june 19th 2021: continued heart racing, irregular heart rate, chest pain, hyperventilating, hard time catching breath. heart rate between 98-150bpm 2nd shot: headache, chills, body aches, eyes swelling, face swelling, chest pains, irregular heart rate, nausea, fatigue. (june19th 2021) june 20th 2021 - now: sharp chest pains, heart racing, hard time catching breath.

Other Meds: N/A

Current Illness: N/A

ID: 1415950
Sex: F
Age: 50
State: CA

Vax Date: 03/29/2021
Onset Date: 04/05/2021
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: none

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

Symptoms: parasthesia in both thighs and legs (tingling sensation)

Other Meds: zoloft/sertraline, ativan as needed (very infrequent)

Current Illness: none

ID: 1415951
Sex: M
Age: 41
State:

Vax Date: 01/29/2021
Onset Date: 02/19/2021
Rec V Date: 06/21/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

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

Symptoms: Saddle Pulmonary Embolism

Other Meds:

Current Illness:

ID: 1415952
Sex: F
Age: 40
State: NY

Vax Date: 05/14/2021
Onset Date: 06/15/2021
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: Penicillin

Symptom List: Unevaluable event

Symptoms: Lymph node swollen near neck area, pain radiates to injection site. With 2nd vaccine lymph node swollen with pain that radiates to injection site. Felt chills and night sweats that night. Fever reached 103.4 for over 24 hours then went to 101. 4 with the use of ibuprofen. Finally got it to come down to 99.2 that Friday. Was seen by doctor through virtual. Felt fatigued muscle aches through our body. Pounding headache. Had Sob and wheezing heard when I went in person to doctor on Friday. Was prescribed steroids and albuteral. Seen primary doctor on Monday she went over my chest X-ray and noticed infiltration on lungs was dx with pneumonia. Prescribed antibiotics with steroids! Have to go for another chest X-ray in 2wks. Also referred to have a Pulmonary capacity test done.

Other Meds: Multi vitamin, omega (fish oil) took Tylenol at first till my Dr. told me to take Ibuprofen because my fever was not going down with the Tylenol! My fever was 103. 4 weds morning!

Current Illness: None

ID: 1415953
Sex: M
Age: 31
State: CA

Vax Date: 04/28/2021
Onset Date: 05/01/2021
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: Azithromycin

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

Symptoms: Fever, sore arm, lethargy, heart palpitations that lasted two weeks, and just had blood work done and my blood pressure, platelets and MCH and MCV were higher than normal.

Other Meds: Biktarvy 50-200-25mg, collagen powder, fish oil

Current Illness:

ID: 1415954
Sex: M
Age: 47
State:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: At 19:24 client received dose 1 of the COVID19 Pfizer vaccine (Lot #EW0187 Exp 08/31/21). Client?s adult daughter was accompanying him. After receiving the vaccine, client and his daughter walked to the observation room and sat down. At 19:57 client communicated to EMT1 that 2 of the fingers on his right hand (pointer & middle fingers) were tingling and felt a little numb. EMT1 radioed Lead RN for notification purposes. Lead RN arrived in the observation room at 19:59. Client informed Lead RN that he was not experiencing shortness of breath, chest pain, or trouble breathing, but his fingers were numb, and he felt a little dizzy. AT 20:02, EMT2 took client?s vitals (BP: 148/102, HR: 88, RR: 14 SPO2 Sat: 99%) and confirmed that he was alert and oriented to person, place, time, and self. Client stated to Lead RN that he has no known allergies, and his underlying conditions consist of diabetes and high blood pressure. He also stated that he takes Metformin and another medication for his diabetes that he could not remember the name of. Client could not provide the name of the high blood pressure medication he has previously taken. Client also stated that since the COVID19 pandemic started, he hasn?t taken much of his blood pressure medication because he has not been able to see his doctor. Client implied that if he still has high blood pressure, it is not being managed. Client stated he was starting to gain feeling back and his fingers and that maybe his hand fell asleep because of the way he was sitting. Lead RN asked client when he had last eaten and/or drank something. Client stated he had not consumed anything since 12:00. EMT1 gave client a granola bar and a bottle of water. After eating the granola bar and drinking the water, client stated he was starting to feel better and was feeling very little, if any, dizziness. At 20:18, EMT2 took client?s vitals (BP: 140/102, HR: 83, RR: 14, SPO2 Sat: 98%). Client stated he felt totally fine and was ready to go. At 20:20 Lead RN educated client on high blood pressure signs and symptoms, the importance of blood pressure management, and recommended client contact his medical provider for follow-up. Lead RN also educated client on the side effects and adverse effects of the COVID19 Pfizer vaccine. Lead RN instructed client to go to urgent care if he started to experience extreme side effects and/or dizziness again and to call 911 if he started to experience any difficulties breathing, shortness of breath, or chest pain. Client stated he understood. Client left with his daughter at 20:23 walking with a steady gait.

Other Meds:

Current Illness:

ID: 1415955
Sex: F
Age: 64
State: SC

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: DUE TO MISCOMMUNICATION, PATIENT WAS ACCIDENTLY VACCINATED WITH A 3RD DOSE OF PFIZER VACCINE (ONE IN APRIL, ONE IN MAY, AND ONE IN JUNE)

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1415956
Sex: F
Age: 56
State: OR

Vax Date: 04/29/2021
Onset Date: 04/29/2021
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: Acetaminophen, Vicodin

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

Symptoms: On 4/29/2021, I received my second vaccination. Within 5 minutes, I had a strong metallic, sour taste in my mouth. It lasted for a couple of days. I had experienced the same taste when I got my first COVID vaccination on 4/8/2021, but this time it was stronger and longer-lasting than the first time. The first time, the flavor lasted for about a day, and it didn't kick in until about 30 minutes after the injection. Both times, I also had sore injection sites and fatigue. It basically felt like I had been punched in the arm. The sore arms and fatigue lasted for only a couple of days, and they didn't impede my ability to function. In 2016, I had a craniotomy, in which the upper and lower vestibular and cochlear nerves were removed. The only nerve now left is the facial nerve. This may have played a role in the formation of the strange taste, but I'm not sure. As of now, I have a sour taste in my mouth, but the metallic taste is gone. The neuroma has swollen as a result of the gamma knife radiation I received in February, so maybe it plays a role in the presence of the sour taste, but I don't know.

Other Meds: Align probiotic, vitamin D3, zinc, magnesium citrate, B12, baby aspirin

Current Illness: Acoustic neuroma. I received gamma knife radio surgery in February 2021.

ID: 1415957
Sex: F
Age: 71
State: WA

Vax Date: 06/21/2021
Onset Date: 06/21/2021
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: No known allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient denoted that she had not yet had the COVID vaccine. Vaccination itself went without issue. Upon attempting to bill for the administration, a third party rejection indicated she got the J&J vaccine already. I confirmed this using the immunization registry that she received this on 3/13/21. Patient has been notified she is not to receive another dose.

Other Meds: Unknown

Current Illness: Unknown

ID: 1415958
Sex: M
Age: 24
State: IN

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: RA

Lab Data:

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Neusea, almost collaspe

Other Meds: N/A

Current Illness: N/A

ID: 1415959
Sex: F
Age: 37
State: NV

Vax Date: 01/30/2021
Onset Date: 02/03/2021
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: Allergic to penicillin, Allegra, pertussis many environmental allergies. I was tested and it came back and I was allergic to 99 of them.

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

Symptoms: So, Photo Phobia an eye pain. I was feeling myself for 5 days and I wore sunglasses because of the light. I was able to work but not really functional. It wasn't a margaine. Just a really bad headache. I was also confused for a day or so. That's not like me. I was having problems remembering things but it went away the following.

Other Meds: I take methylfolate, methyl B-12, lysine, vitamin D, fish oil, multivitamin and vitamin C.

Current Illness: No

ID: 1415961
Sex: M
Age: 26
State: MI

Vax Date: 06/13/2021
Onset Date: 06/13/2021
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: unknown

Symptom List: Nausea

Symptoms: Patient scheduled a Johnson & Johnson vaccination on our online scheduling system. He came to the pharmacy and said he was here for his Johnson & Johnson vaccination. He said he did not have his insurance card with him. He marked on our questionnaire that he had NOT had a previous dose of COVID-19 vaccine. He was asked to confirm prior to injection what shot he was here for today, he confirmed the Johnson & Johnson. I asked him, "The one dose Johnson & Johnson?" and he confirmed. Three days later we were working on billing for our administration fee. His insurance rejected our claim saying that we must use the same manufacturer for the second dose as was used for the first dose. I then checked on the immunization database and discovered that he had a Moderna vaccination on 5/30/2021 at a drug store. The patient failed to mention this detail at any time during our interactions. I have left multiple voicemails for the patient to contact me or any pharmacist at our store. He has not returned our calls.

Other Meds: unknown

Current Illness: unknown

ID: 1415962
Sex: M
Age: 74
State: WA

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: Unknown

Symptom List: Injection site pain

Symptoms: Patient denoted that he had not yet had the COVID vaccine. Vaccination itself went without issue. Upon attempting to bill for the administration, a third party rejection indicated he got the J&J vaccine already. I confirmed this using the immunization registry that she received this on 3/13/21. Patient has been notified she is not to receive another dose.

Other Meds: Unknown

Current Illness: Unknown

ID: 1415963
Sex: M
Age: 73
State: PA

Vax Date: 03/10/2021
Onset Date: 03/11/2021
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: DICLOFENAC

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

Symptoms: BILATERAL HAND/WRIST PAIN AND SWELLING, POLYARTHRALGIAS REPORTED HE EXPERIENCED AFTER RECEIVING 2ND DOSE OF THE VACCINE

Other Meds: ALLOPURINOL, ASPIRIN, ATORVASTATIN, HCTZ, LEVOTHYROXINE, MULTIVITAMIN, KRILL OIL, LOSARTAN

Current Illness:

ID: 1415964
Sex: F
Age: 24
State: PA

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

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

Symptoms: Fever ranging from 100 to 103?f for 12 hours Severe Nausea for 12-15hrs Lack of appetite for 5 days Migraine 2 days

Other Meds: Sertraline

Current Illness:

ID: 1415965
Sex: F
Age: 15
State: MA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NO

Symptom List: Tremor

Symptoms: when patient got the vaccine she had instant drop of blood pressure, felt so dizzy but not had any breathing issue. no treatment was given to the patient. After few minutes patient was about to talk and felt fine. Her blood pressure come up to 106/69 and was able to go home.

Other Meds: NO

Current Illness: NO

ID: 1415966
Sex: F
Age: 50
State: OR

Vax Date: 04/05/2021
Onset Date: 04/08/2021
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: no

Symptom List: Erythema, Pruritus

Symptoms: swollen lymph nodes in neck, and general swelling in neck. this lasted for two weeks. At points during that time my lower jaw was numb. Extreme headaches and stiff neck. Headaches would wake me in the middle of the night. Extreme exhaustion. Also I started having extreme digestive problems. Upper abdomen would spasm and go rigid. When this happened my heart would race and my blood pressure would go up. Had two weeks of zero appetite, and had trouble tolerating food for a month.

Other Meds: wellbutrin

Current Illness:

ID: 1415967
Sex: F
Age: 45
State: TX

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

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

Symptoms: mild headache for 1.5 days. I took tylenol 500mg 1 after the vaccine and one before bed.

Other Meds: none

Current Illness: none

ID: 1415968
Sex: F
Age: 57
State: WI

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

Lab Data:

Allergies: No known

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

Symptoms: Upon administering 1st dose of Pfizer vaccine for patient once the needle was in the patient's arm and I started to push on the plunger the vaccine squirted out of where the needle screws on to the syringe body. In my opinion most of the vaccine sprayed on her arm and very little if any of the vaccine was actually administered into her arm. I cleaned up the liquid on her arm and re-vaccinated with another syringe to ensure she received the proper 0.3ml dose of the vaccine. I administered the vaccine in the same arm.

Other Meds: Unknown

Current Illness: Unknown

ID: 1415969
Sex: F
Age: 35
State:

Vax Date: 06/01/2021
Onset Date: 06/01/2021
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: COVID arm, redness, itching swelling and pain. Started menstrual cycle June 14 and it was severely heavy and painful which is not a normal cycle for me. I don?t have heavy cycles. Treatment for covid arm was benedryl for 3 days until the rash disappeared.

Other Meds:

Current Illness:

ID: 1415970
Sex: M
Age: 38
State: IN

Vax Date: 06/19/2021
Onset Date: 06/19/2021
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: None

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

Symptoms: Full body itching

Other Meds:

Current Illness: None

ID: 1415971
Sex: F
Age: 54
State: CA

Vax Date: 03/07/2021
Onset Date: 06/21/2021
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: 0

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

Symptoms: Next day I had breathing problems followed by lots of inflammation all over my body. All my joints swelled and burned.. following the second vaccine I have excruciating painful joints throughout my body that has not gone away. I have zero history of this. I still have it today. 6-21-2021

Other Meds: 0

Current Illness: 0

ID: 1415972
Sex: F
Age: 80
State: IL

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: fresh mango, fresh pineapple

Symptom List: Pain in extremity

Symptoms: The vaccinated arm had a large, red rash which was very itchy and hot to the touch. The rash lasted for 5 days.

Other Meds: Lovostatin, Quinapril, Metaprolol, Thyroxine, Vitamin C,

Current Illness: none

ID: 1415973
Sex: M
Age: 49
State: VA

Vax Date: 05/03/2021
Onset Date: 05/13/2021
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: No Known Drug Allergies. No food allergies. No other allergies.

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

Symptoms: I am a medical doctor and have shown to a colleague in my office, but no formal office visit. Have had skin rash since the first COVID-19 vaccine (May 3rd). Symptoms started approximately 7-10 days after the first injection. Started on my chest. I have had dry erythematous scaly and flaky areas (8) measuring approximately 3 mm, 4mm, 6mm, 10mm , 20 cm, 8cm, 4cm, 18cm. Located on abdomen, left upper extremity near , both lower extremities approximately lateral and superior to the greater trochanter. Lateral thorax just posterior and inferior to the axilla. Each side of the chest. Symptoms worsened after the 2nd Injection (May 21st). Approximately 5 days after 2nd injection symptoms worsened to the areas listed above.

Other Meds: None

Current Illness: None

ID: 1415974
Sex: M
Age: 12
State: TX

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known Drug Allergy

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

Symptoms: Pt fainted a minute after pfizer vaccination witnessed by his mom, his twin, and two waiters in the vaccination room. He didn't fall, just fainted for a second and spilled some water on the floor. His mom requested no EMS. He is a fainter according to his mom. Whenever he witness any medical procedure done he became anxious and fainted per pt's mom. We gave him some water and remain him in the vaccination room for additional 30-45 minutes for observation. Pt left pharmacy in stable condition.

Other Meds: N/a

Current Illness: N/A

ID: 1415975
Sex: F
Age: 36
State:

Vax Date: 06/15/2021
Onset Date: 06/16/2021
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: 24 weeks pregnant at time of 2nd dose, estimated due date 10/02/2021 Woke up to joint pain and aches 20 hours after injection. Constant pain in upper left abdomen under left rib cage, near spleen/diaphragm. Acute, localized pain when I tried to take a deep breath, yawn or fill lungs. Had to take short, shallow breaths as pain was too intense. On 2nd day of symptoms, developed referred pain in left shoulder/collar bone area that was associated with the same inability to take a deep breath due to pain. Symptoms lasted for 4 full days and started to wane on the 5th day.

Other Meds:

Current Illness:

ID: 1415976
Sex: F
Age: 62
State: NV

Vax Date: 03/17/2021
Onset Date: 03/21/2021
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: PENICILLIN

Symptom List: Vomiting

Symptoms: FOUR DAYS AFTER RECEIVING THE FIRST DOSE I NOTICED I WAS FEELING WARM. AS TIME HAS PROGRESSED I BEEN GETTING SEVERE NIGHT SWEATS AND HOT FLASHES. THE NIGHT SWEATS AND HOT FLASHES HAD BEEN UNDER CONTROL AND NON-EXISTENT FOR THE PAST YEAR BY THE USE OF THE HORMONE REPLACEMENT MEDICATION PREMPRO.

Other Meds: NEXIUM, GLIMEPIRIDE, CLONAZEPAM, TRANDOLAPRIL, MIRTAZAPINE, PREMPRO

Current Illness:

ID: 1415977
Sex: M
Age: 17
State:

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

Lab Data:

Allergies: No allergies.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received his first dose of Pfizer vaccine via IM in left arm. Patient was waiting in the waiting area post Covid vaccine accompanied by his father when his vision started to become blurry. As patient was raising his hand for assistance, he lost consciousness for a couple seconds and hit his head on the wall behind him while remaining in his chair. RN stat was called. Vital signs were taken with blood pressure low. Patient visibly diaphoretic. 911 called at 518. Patient transferred from wheelchair onto stretcher via patients father. Patient has no history of allergies or on medications at this time. When paramedics arrived, patient stated feeling better. Ortho static vital signs taken. Blood sugar checked via paramedics and was 98. Patient stating vision is back to normal. IV fluids started for patient via paramedics. Patient was then transferred via ambulance out of clinic at 1745.

Other Meds: No medications.

Current Illness:

Date Died: 06/16/2021

ID: 1415978
Sex: F
Age: 79
State: CA

Vax Date: 03/26/2021
Onset Date: 04/01/2021
Rec V Date: 06/21/2021
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: tetanus, arithamacian, morphine,

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

Symptoms: Brain bleed, broken leg, death

Other Meds: depakote, quetipaine, lithium, buprenorphine, atorvastatin, methotrexate

Current Illness:

ID: 1415979
Sex: F
Age: 27
State: NY

Vax Date: 04/07/2021
Onset Date: 04/27/2021
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: amoxycillan

Symptom List: Injection site swelling, Limb discomfort

Symptoms: During my first period after receiving the vaccine, I experienced markedly worse menstrual cramps than usual throughout the day. I took Midol extra strength to combat the pain. I couldn't sleep until approximately 2:30 am, and I woke up at 4:00am due to the pain. I noticed that my vagina itself was swollen on the inside and essentially numb - even as my abdomen was cramping painfully. After sitting in the bathroom for a while, I tried to stand. At that point, I briefly passed out and collapsed into the bathtub. This has never happened before in my life.

Other Meds: none

Current Illness: none

ID: 1415980
Sex: M
Age: 26
State: NV

Vax Date: 06/11/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: I woke up feeling a slight pain on my left side of my chest near my heart. When I breathed in too heavily, I experienced that pain. Throughout the day, it continued and slowly got worse. As of now, I can feel that there is a slight discomfort at rest and I am unable to inhale too deeply or laugh without having that pain return. I don't think it could be a result from anything else, as I wasn't sick recently and do not have any conditions or take any medications. I'm waiting to see if it continues through the night into tomorrow to schedule a doctor's appointment.

Other Meds: None

Current Illness: None

ID: 1415981
Sex: F
Age: 46
State: CA

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

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

Lab Data:

Allergies: N/A

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

Symptoms: Day 1- craving for food, sleepy Day 2-3 body aches, fatigued Day 4 - now , pins and needles sensations, too fatigued to do many everyday activities, lighthearted, Day 13-14, chest pain, shortness of breath, fainting, sent to ER twice and hospitalized

Other Meds: Birth control pills Seroquel Multi vitamin

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm