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

Date Died: 01/17/2021

ID: 1420466
Sex: F
Age: 85
State: TX

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 06/23/2021
Hospital: Y

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: soreness, irritability, diarrhea, mental fog, loss of cognition, death occurred ~10 days after vaccine administered

Other Meds:

Current Illness:

ID: 1420467
Sex: M
Age: 90
State: RI

Vax Date: 01/11/2021
Onset Date: 01/14/2021
Rec V Date: 06/23/2021
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: Sulfur

Symptom List: Anxiety, Dyspnoea

Symptoms: fatigue

Other Meds: Lunesta, Vitamins

Current Illness:

ID: 1420468
Sex: F
Age: 19
State: PA

Vax Date: 03/11/2021
Onset Date: 03/28/2021
Rec V Date: 06/23/2021
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: Pollen

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

Symptoms: My period, which has been regular on the dot since I was 14, has been thrown off. I missed it for the first time ever in March and didn't have it again until the end of April. I then missed may and did not start my next period until today. It was 6 weeks late the first time, 7 weeks late this time.

Other Meds: Zoloft

Current Illness: None

ID: 1420469
Sex: F
Age: 20
State:

Vax Date: 06/22/2021
Onset Date: 06/23/2021
Rec V Date: 06/23/2021
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: Severe chills and shivering that quickly exhausted me. A headache that wrapped around my entire head and did not respond to ibuprofen. both of these happened around 10 hours after the vaccine.

Other Meds: Celexa

Current Illness:

ID: 1420471
Sex: F
Age: 51
State: LA

Vax Date: 06/13/2021
Onset Date: 06/14/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: Phenobarbital

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

Symptoms: Extreme bruising, swelling, heat on day 1. Swelling, numbness, itching, bruising continued for days. Day 11 arms is red, itchy, swollen.

Other Meds: Estradiol, progesterone, Zoloft, Tramadol, Robaxin, Xanax

Current Illness: NA

ID: 1420472
Sex: M
Age: 19
State: TX

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/23/2021
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: Tree nuts

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

Symptoms: High temp fever (102.5), body aches, headache, possible loss of consciousness (momentarily- unverified - I wasn't there) temp responded to acetaminophen/cold compresses but lasted thru night. In AM temp down to <=101 for another 12 hours, slept all day After 18 hours, temp resolved (still achy for another 12 hours) NO chills, NO nausea, only mild injection site swelling Note - the pharmacy suggested I create this report because of the possible loss of consciousness (was non-responsive to sibling when arrived home)

Other Meds:

Current Illness:

ID: 1420473
Sex: M
Age: 51
State: OH

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 06/23/2021
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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Runny nose and eyes, itch deep in left palm, stroke and loss of use in left hand

Other Meds: Lisinopril, Aspirin, Simvastatin, Carvedilol

Current Illness: None

ID: 1420474
Sex: F
Age: 46
State: TX

Vax Date: 06/21/2021
Onset Date: 06/22/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: Vaccine Vial was opened on 6/18/2021 and was not discarded at end of day. Same vial was used on Monday 6/21/2021. to vaccinate patient with.

Other Meds: Unkwown

Current Illness: None

ID: 1420475
Sex: M
Age: 74
State: AZ

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: After getting vaccine I had an increase in blood pressure that has been hard to control.

Other Meds: Yes, Flecainide 100mg twice a day, 50mcg lethalthyroxine

Current Illness: No

ID: 1420476
Sex: F
Age: 18
State: IL

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 06/23/2021
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: NKDA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: On 6/21/21, patient came into clinic for a nurse only appointment to receiver her Men B vaccine. Her father is a physician in the clinic and he approached his nurse about her coming in. The nurse thought she heard him say, she was coming in for her Covid vaccine too in addition to the Men B vaccine. The nurse prepared both the Men B and Pfizer Covid vaccines and administered. Patient was inadvertently given a 3rd Covid vaccine. She has already received 2 Moderna Covid vaccines on 01/16/2021 and 02/14/2021. On 06/21/21 she developed chills and body aches, on 06/22/21 the chills and body aches continued, on 06/23/2021 the chills and body aches resolved but she has a small localized reddened area at injection site with mild pain.

Other Meds: Fluoxetine HCI 20mg daily

Current Illness: None

ID: 1420477
Sex: F
Age: 50
State: PA

Vax Date: 06/12/2021
Onset Date: 06/18/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: Fluorquinolone antibiotics

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

Symptoms: Heavy menstrual period started 6 days after receiving 2nd Covid vaccination that was 15 days from previous start day of last menstrual cycle. First COVID vaccination was received on 15May2021. Bilateral breast soreness was also felt for approximately two weeks prior to start of heavy menstrual period.

Other Meds: Metoprolol 25 mg SID

Current Illness:

ID: 1420478
Sex: M
Age: 68
State: FL

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 06/23/2021
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: Took the shot, after waiting the allotted time my left eye began to feel abnormal and then I began seeing black wavy lines, the situation continued about 10 minutes, then my eye seemed alright but as my vision adjusted everything was blurry and distorted. The following morning I realized I also had a floater in my eyesight. Over the next several days I realized my central vision was distorted and was having a hard time reading. I made an appt. with the Eye Glass Doctor thinking new glasses were needed, after seeing him he made an appt with the Opthamologist. I saw him and he explained I had cataracts and that I needed to see a retina specialist, which I did, he thought my eye under the macula was swollen and sent me to a surgeon, after several test from these doctors they have all agreed there is a hole in my macula that was not there prior to the shot.

Other Meds: Atorvastatin, Metoprolol, Pantoprazole, Furosemide, Lisinopril, Diltiazem, and one baby aspirin

Current Illness: none

ID: 1420479
Sex: F
Age: 49
State: OR

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 06/23/2021
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: The morning after I got the vaccine, I woke up and felt fine. Around noon I started to feel bad. By 2 o clock I was in bed. I stayed in bed the whole day. I felt really crappy for 5 days. The next week I felt like I had a cold with a running nose, headache, sinuses, and sore throat. I had a headache ever since I got the shot. I still can't get the headache to go away. I went to the doctor because of my headache and they told me to take Tylenol and Advil, but it still doesn't help the headaches. I had a covid test that was negative and my bloodwork was fine. My doctor wants me to get a MRI of my head for my headaches.

Other Meds: Multi Vitamin Zoloft 25mg, 1xday

Current Illness:

ID: 1420480
Sex: F
Age: 50
State: OH

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 06/23/2021
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: seasonal allergies

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

Symptoms: Same day as the vaccination, 02/25/2021 in the evening I started to feel woozy. After the shot I had mini COVID on the checklist: diarrhea , fatigue, nausea migraine, I was pretty sick, lasted for 3 or 4 days. But the fatigue, and the diarrhea , and migraine continue as of today (the migraine stopped 2 months ago) Right now I am on short term disability. My pancreas has stopped work and I am now taking Creon 3600 units. I now have high blood pressure , I take Lisinopril 20 mg at bedtime. I wasn't taking this medication before the Moderna Dose 2. In addition, I am on Bentyl 10 mg , helps stomach pain, mesalamine 1.2 grams, 2 tablets every morning for inflammation. Bephenoxylate-atrop12.5-0.025 for diarrhea. Budesonide 3 mg steroid, prednisone for possible Crohn's. PRN Zyprexa for Sleep, which I never had a problem sleeping.

Other Meds: prazosin 1 mg 1 x night beletoxib 200 mg 1 capsule 1 x night singulair 10 mg 1 capsule x night inhaler Symbicort 160/4.5

Current Illness: Covid19 in November uncomplicated asthma tested positive for, but dormant Ankylosing Spondylitis iritis

ID: 1420483
Sex: F
Age: 26
State: WI

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: 2 hours after receiving the vaccine, patient experienced a very sore arm and was in and out of sleep all night. Pt was also nauseous throughout the night.

Other Meds: NA

Current Illness: NA

ID: 1420484
Sex: F
Age: 13
State: NV

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/23/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Pt. came into the pharmacy to get a 2nd dose of Covid-19 vaccine. 1st dose was on 6/1/21, with a hx of an adverse reaction of dizziness/pale Asked pt & her dad if she was fine after that incident-Pt. states she was totally fine when she got home so wanted to get 2nd dose. Shot was given ~4:15pm, and when I checked pt. if she's ok, she started to pale and told me she was dizzy. Called paramedic ~4:25pm and around 4:55pm paramedic teams walked pt. out, pt. seemed fine, and confirmed she was fine

Other Meds:

Current Illness:

ID: 1420485
Sex: F
Age: 26
State: TX

Vax Date: 06/21/2021
Onset Date: 06/22/2021
Rec V Date: 06/23/2021
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: Unknown

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

Symptoms: Vaccine Vial was opened on 6/18/2021 and was not discarded at end of day. Same vial was used on Monday 6/21/2021. to vaccinate pt with.

Other Meds: unknown

Current Illness: unknown

ID: 1420486
Sex: F
Age: 62
State: CA

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Ear pain, Hypoaesthesia

Symptoms: At the time of shot patient is report that around the injection site is red swollen and inching... symptoms got worse as she got home.. itching starting 06/22

Other Meds: no

Current Illness: no

ID: 1420487
Sex: M
Age: 57
State: NY

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/23/2021
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: Top teeth on roof of mouth feel numb" like when you get novacaine at dentist" also salivating . Starting 20 minutes after getting shot. These symptoms still exit

Other Meds:

Current Illness:

ID: 1420488
Sex: M
Age: 31
State: NY

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: NKDA/NKA

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

Symptoms: NO ADVERSE AFFECT EXPERIENCED BY PATIENT. TD ADMINISTERED TO PATIENT ON THE 23JUN21. EXPIRED ON THE 06JUN21. ADVISED BY PHARMACY OFFICER THAT VACCINE IS NOT VALID AND MEMBER WILL HAVE TO RECIEVE A NON EXPIRED DOSE.

Other Meds: PRE WORKOUT, DAILY VITAMIN, ACYCLOVIR

Current Illness: NONE

ID: 1420489
Sex: F
Age: 68
State: TX

Vax Date: 06/21/2021
Onset Date: 06/22/2021
Rec V Date: 06/23/2021
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: Sulfa

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

Symptoms: Vaccine Vial was opened on 6/18/2021 and was not discarded at end of day. Same vial was used on Monday 6/21/2021. to vaccinate pt with.

Other Meds: unknown

Current Illness: unknown

ID: 1420490
Sex: F
Age: 32
State: GA

Vax Date: 06/18/2021
Onset Date: 06/22/2021
Rec V Date: 06/23/2021
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: Body aches, chills, fatigue

Other Meds: Lexapro, amlodipine, taytulla

Current Illness:

ID: 1420491
Sex: F
Age: 38
State: NY

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 06/23/2021
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: pineapple

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

Symptoms: chest pain still since the vaccine, asthma increase as well

Other Meds: Ventolin HFA 90 mcg/inh 2 puff(s) inhaled 4 times a day 30 days Qvar Redihaler 80 mcg/inh 1 puff(s) inhaled 2 times a day 30 day(s) predniSONE 20 mg 1 tab(s) orally once a day 7 day(s)

Current Illness: none

Date Died: 06/18/2021

ID: 1420492
Sex: F
Age: 86
State: GA

Vax Date: 03/01/2021
Onset Date: 06/16/2021
Rec V Date: 06/23/2021
Hospital: Y

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: Patient hospitalized after testing positive for COVID-19. Patient died. Patient was fully vaccinated.

Other Meds:

Current Illness:

ID: 1420493
Sex: F
Age: 46
State: NM

Vax Date: 01/20/2021
Onset Date: 01/23/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Memory loss x4 days. "Foggy" thinking for several days after that. Extreme pruritis on body but long lasting on bilateral lower extremities. Continues today. Legs are scarred from scratching. Itch feels "deep." Have tried anti-itch sprays, benadryl, eczema lotions, oatmeal baths. Limited success.

Other Meds: Gabapentin, Mirtazapine, Sertraline, Lorazepam

Current Illness: None

ID: 1420494
Sex: F
Age: 69
State: OH

Vax Date: 03/11/2021
Onset Date: 03/22/2021
Rec V Date: 06/23/2021
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: RETROMICINE

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

Symptoms: soreness, upset stomach, temp

Other Meds: SUPPLIMENTS

Current Illness: HEART PALPATATIONS

ID: 1420495
Sex: M
Age: 96
State: NY

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Musculoskeletal discomfort; pain started in chest, moves to sides and back. Painful to cough, and painful to bend over, and twist; getting in and out of a chair difficult. Peripheral edema; swelling in ankles and feet. Coughing up phlegm/muscus All tests came back normal; regiment of ibuprofen and acetaminophen recommended for the pain. All symptoms persisted.

Other Meds: None

Current Illness: None

ID: 1420496
Sex: M
Age: 70
State: ND

Vax Date: 03/31/2021
Onset Date: 04/12/2021
Rec V Date: 06/23/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient hospitalized for aortic valve replacement within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1420497
Sex: F
Age: 66
State: PA

Vax Date: 03/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/23/2021
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: Penicillin; Sulfa: Erythromycin; Walnuts; Pecans; Lobster; Stinging insects

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

Symptoms: I have developed a facial spasm/tremor/twitch on the left side of my face, on my cheek. Wearing a mask or CPAP makes it worse, but it persists even when I haven't been wearing a mask. Dr. advised taking 500 mg Naproxen twice a day and avoiding Fexofenadine ( as well as Topamax, which I was no longer taking). He has referred me to a neurologist at medical center who I will be able to see on 07/26/2021, possibly for a Botox injection. The spasms are uncomfortable and annoying and sometimes leave my cheek feeling sore.

Other Meds: Lipitor, 40 mg; Fexofenadine, 180 mg; Biotin Forte, 5 mg; Naproxen 500 mg; Metformin HCL 1000 mg x2; Flovent Diskus 100; Caltrate 600-D

Current Illness: N/A

ID: 1420498
Sex: F
Age: 64
State:

Vax Date: 02/24/2021
Onset Date: 04/01/2021
Rec V Date: 06/23/2021
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: Patient with a history of Graves disease, well controlled on methimazole 2.5 mg every other day. She developed symptoms of Graves in April 2021 (approximately 2 weeks after second dose). In May she was found to be floridly hyperthyroid and methimazole was increased.

Other Meds:

Current Illness:

ID: 1420499
Sex: F
Age: 57
State: NC

Vax Date: 04/05/2021
Onset Date: 05/19/2021
Rec V Date: 06/23/2021
Hospital: Y

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

Lab Data:

Allergies: codiene - allergic

Symptom List: Injection site pain

Symptoms: Stroke, dizziness, speech, and walking inhibitions

Other Meds: None

Current Illness: None

ID: 1420500
Sex: M
Age: 34
State: FL

Vax Date: 05/18/2021
Onset Date: 05/28/2021
Rec V Date: 06/23/2021
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: Started feeling chest pains approximately one week after second vaccination. Nothing noticeable after the first vac. Pain comes and goes, no connection to activity from what I can tell. Can feel sharp but is dulled. Lessens with mid-day rest. Symptoms come and go, and are either beginning to fade or I?m just getting used to it. Started taking aspirin just in case. Have not seen healthcare provider yet but have considered emergency and urgent treatment.

Other Meds: B-complex, ashwaghanda, L-theanine, zinc, vitamin c, nattokinase

Current Illness: None

ID: 1420501
Sex: F
Age: 65
State: MA

Vax Date: 02/27/2021
Onset Date: 03/03/2021
Rec V Date: 06/23/2021
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: Epinephrine Sulfa Mold Extracts Amoxicillin Doxycycline Montloska Prednisone

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

Symptoms: I had an inflammatory response with in a week of getting the vaccine, I was stiff and has muscle spasms. I had acute pain in the back, shoulders and neck. I felt off balance. I had impaired vision, which I had trouble driving. I had brain fog as well. I had impaired range of motion. I also felt shaky, and stiffness. It was hard for me to do my morning activities due to this. I stopped driving and I stopped my normal yoga classes. I increased my physical therapy. I was not able to do any strength training. I started to have involuntary movements, my head was shaking and my arm were shaking. I had shortness of breath and heart palpitations. My doctor listened to my lungs and they were cleared. They also did bloodwork. They also checked my thyroid, which came back clear. I saw PA because my doctor was out. I started to have trouble remembering things and brain fog got really bad. My iron level in the bloodwork was a little low, but they were not too concerned about it and contributed it to not feeling well. No the pain is not too bad and I began to get my range of motion back slowly. I did also have insomnia as well. They think it could be related to having Prolia (my osteoporosis medication) 3 days before the vaccine.

Other Meds: Lipitor 20mg 1xday Nasal Spray Vetcozine 10mg Prebiotic and Probiotic Chokuten Vitamin D3 1000umg Calcium Carbonate 600mg 2xday B12 1000mcg Levothyroxine 80mcg Herbal teas

Current Illness:

ID: 1420502
Sex: F
Age: 47
State: VA

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 06/23/2021
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: 10 min Strong Metallic taste in mouth- faded after 3 hrs and resolved over 5 day period. 10 min sharp tingling sensation tongue lips throat resolved within 1 hour 20 min sharp pain in right side 30 min numbness right side, mostly tight leg ; some neck, right arm, lasted approx 24 hours 3 hrs heart rate 220 bpm - ranged 154-225 bpm for approx 4 hours; intermittent heart racing 170-190bpm for brief (10 min) periods over next week Day 2 Headache and numbness R side Sleep cycle opposite of normal 3 weeks wake at 3 am sleepy 3pm (unusual unknown if related) Next 2 Menstrual cycle Unusually heavy / clotting and shortened.

Other Meds: no

Current Illness: no

ID: 1420503
Sex: F
Age: 25
State: AL

Vax Date: 05/28/2021
Onset Date: 06/12/2021
Rec V Date: 06/23/2021
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: None

Symptom List: Erythema, Pruritus

Symptoms: Patient presented to hospital with headache 6/21/21. CT head with contrast showed 1. Sinus thrombosis suspected in the patient's sigmoid and transverse right sinus. 2. No venous infarction or other acute finding identified. MRA neck showed thrombosis of right jugular vein and right sigmoid sinus. Patient started on heparin drip. Transitioned to Eliquis by neurologist and hospitalist. Remains hospitalized at this time.

Other Meds: Creatine pre work supplement Camrese birth control

Current Illness: None- but did have Covid in January 2021

ID: 1420504
Sex: M
Age: 67
State: PA

Vax Date: 01/30/2021
Onset Date: 02/01/2021
Rec V Date: 06/23/2021
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: Did have transient allergy to statin drugs, but it has since gone away

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

Symptoms: After the first dose, about 36 hours later I had severe vomiting followed by intense chest pains. About three months later it was determined by cardiologists that I had suffered an SMI at that time and hadn't realized it. It was also determined that I was 80 - 90% blocked in the main artery which likely was the culprit and two stents were implanted. I have no idea (nor do the doctors) if the vaccination was in any way related to the cardiac event, but I felt completed to report it due to the closeness in timing. I am currently on different medications and cardiac rehab therapy.

Other Meds: Losartan, Allopurinol, Vascepa

Current Illness: None

ID: 1420505
Sex: F
Age: 65
State: ND

Vax Date: 03/11/2021
Onset Date: 04/22/2021
Rec V Date: 06/23/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Patient presented to the ED and was subsequently hospitalized for pulmonary embolism within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1420506
Sex: F
Age: 54
State: WI

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/23/2021
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: Sensitive to Rice Sensitive to many household products - uses mainly natural products for cleaning

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Nausea after 10 minutes of receiving vaccine. Fatigue, fever, chills (my body felt like it was pulsing-like I was receiving electric shock therapy). Abdominal cramping (felt like I was having labor contractions), loose stool from 6/16/2021 night through morning of 6/21/2021.

Other Meds: Fish Oil 1200 mg PRN Hair-Skin and Nails PRN Ibuprofen PRN Tylenol PRN Acyclovir 200 mg PRN

Current Illness: None

ID: 1420507
Sex: F
Age: 37
State: NJ

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/23/2021
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: Pork and corn

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

Symptoms: Bilaterally swollen lower legs that were noticed after work while taking a shower and discomfort/pain due to the pressure of the edema. I never had swollen legs in the past. Swelling came completely 2 days after and some discomfort was still felt id standing too long. On 4th day I went to run (I am a runner) and I initially something had bit me on my lower leg then the pain started to get worse such as if I had shin splints all over my lower legs. I could not run any longer and this is something I did not have before. I felt the legs off but after stopping the run I was fine so I took my regular salsa dancing class a few hours later and they pain started again but worst, it felt as if I had bruises all over and just

Other Meds: Symbicort, albuterol, birth control.

Current Illness:

ID: 1420508
Sex: M
Age: 46
State: TX

Vax Date: 06/21/2021
Onset Date: 06/22/2021
Rec V Date: 06/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Symptoms: chills, upset stomach, body aches, injection site sore. symptoms lasted 2 days.

Other Meds: none

Current Illness:

ID: 1420509
Sex: M
Age: 61
State: NC

Vax Date: 03/18/2021
Onset Date: 03/01/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Pain in extremity

Symptoms: Hearing loss in both ears and ringing tinnitus in left ear

Other Meds: Simvastatin 20mg daily vitamin Vitamin d cetirizine

Current Illness: No

ID: 1420510
Sex: M
Age: 67
State: MI

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/23/2021
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: Pt received Moderna COVID vaccine for 1st dose on 2/4/2021. On 6/22/21 he returned for 2nd dose but indicated on registration form he had not previously had a COVID-19 Vaccination and wanted Pfizer Vaccine on 6/22/21. No adverse event.

Other Meds:

Current Illness:

ID: 1420511
Sex: M
Age: 56
State: CO

Vax Date: 04/16/2021
Onset Date: 04/19/2021
Rec V Date: 06/23/2021
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: None

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

Symptoms: Two days after the shot I was very ill with nausea, bad headache and was very lethargic. Four day later I went to an urgent care for treatment for nausea and the headache. Two days later I was in the emergency room in the Medical Center for treatment of the same symptoms. Eventually the headache got better so I could function but I was very lethargic and had a constant cough for the next 6-7 weeks.

Other Meds: Amlodipine 5MG once a day, multi-vitamin

Current Illness: None

ID: 1420512
Sex: F
Age: 21
State: PA

Vax Date: 06/01/2021
Onset Date: 06/02/2021
Rec V Date: 06/23/2021
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: i had the shakes and a fever, my joints were locked, and i started getting my period every other week

Other Meds:

Current Illness:

ID: 1420513
Sex: F
Age: 56
State: VA

Vax Date: 03/18/2021
Onset Date: 05/12/2021
Rec V Date: 06/23/2021
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: cats; pollen

Symptom List: Vomiting

Symptoms: I had a sinus infection at some point - within the last couple of months - treated with antibiotic (1 course). About six weeks ago my blood pressure was a little elevated and I had chest discomfort. I took the medication OTC - Prevised - 14 day regiment - which I was told to do for when my blood pressure acts up and it seems to have helped. I am feeling a little better so I'm hoping it was just my Reflux that was acting up.

Other Meds: No, with my Humira - went off that for a month in order to take the vaccine - two weeks prior to vaccine and two weeks after the vaccine when I didn't take;

Current Illness: no

Date Died: 06/10/2021

ID: 1420514
Sex: M
Age: 77
State: KY

Vax Date: 04/07/2021
Onset Date: 06/10/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Symptom onset was 12/26/2020, with nausea, fever, chills, rigors, fatigue, cough, & myalgia.

Other Meds: Unknown

Current Illness: Unknown

ID: 1420515
Sex: F
Age:
State: NC

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/23/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: No known adverse health events associated with this vaccine administration. VAERS report is being filed in order to follow CDC Interim Clinical Considerations for Use of COVID-19 Vaccines, which states that this administration error (unauthorized age group) should be reported

Other Meds: unknown

Current Illness: unknown

ID: 1420516
Sex: F
Age: 32
State: FL

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Severe right arm pain 4-6 hours after injection. In ability to lift arm for at least 12 hrs. Fever chills lasting 36 hours. Extreme fatigue, mental fogginess for 2-4 weeks after injection.

Other Meds: None

Current Illness: None

Date Died: 06/06/2021

ID: 1420517
Sex: M
Age: 65
State: CT

Vax Date: 05/27/2021
Onset Date: 05/29/2021
Rec V Date: 06/23/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin

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

Symptoms: 1 week history of shortness of breath and nonproductive cough beginning shortly after receipt of second dose. Patient became hypoxic and had diffuse consolidation through left lung with wedge-shapes consolidation involving the right upper and midlateral lungs. Leukocytosis and bandemia noted and acute renal failure. Developed atrial fibrillation and rapid ventricular response. Multilobal pneumonia, septic shock, non-q-wave myocardial infarction, acute renal failure. Patient expired.

Other Meds:

Current Illness:

ID: 1420518
Sex: F
Age: 79
State: MA

Vax Date: 03/13/2021
Onset Date: 05/18/2021
Rec V Date: 06/23/2021
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: None

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

Symptoms: Swollen Lympth Nodes

Other Meds: Atorvastatin Amlodipine

Current Illness: High blood pressure High Cloresteral

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm