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: 1420803
Sex: F
Age: 52
State: MN

Vax Date: 03/25/2021
Onset Date: 04/07/2021
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: LA

Lab Data:

Allergies: Allergic to sulfa based antibiotics (Bactrim)

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient states she was diagnosed with a pulmonary embolism on 4-23-21. She states 2 weeks after her vaccination (4-7-21) she noticed shortness of breath, fatigue, brain fog, and "burning lungs" . She says she has a stressful job and her lungs would feel like they are on fire. She was seen by Dr in urgent care on 4-23-21. She says she was seen by Dr (in the absence of her regular provider) on 5-21-21. She was started on Eliquis 5mg BID on 5-21-21. She also was seen by Dr of Hematology Oncology to evaluate her after the vaccination also. Referred to Pulmonary Dr. seeing on 7-8-21

Other Meds: Citalopram 20 mg daily, Chirothin drops 5 drops a day, folic acid 800 mg one daily, vitamin D3 500 mg daily, vitafusion multivitamin

Current Illness: None.

ID: 1420807
Sex: M
Age: 97
State: MI

Vax Date: 02/12/2021
Onset Date: 05/03/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: 5/3/21 this gentleman reported several days of Left lower leg pain. Ultrasound completed positive for left lower leg DVT. Pt was on chronic Coumadin therapy at that time with therapeutic PT/INR 2.7. Symptoms progressed and ongoing despite initiation of Eliquis. On 6/8/21 he underwent placement of IVC filter to protect from further clotting injury.

Other Meds: Doxazocin, Pravastatin, Coumadin, Vitamin D

Current Illness: none

ID: 1421013
Sex: M
Age: 61
State: MO

Vax Date: 04/01/2021
Onset Date: 04/02/2021
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: none

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

Symptoms: The day after the vaccine he started to get an headache, brain fog, and dizziness. He also lost his sense of smell and taste. Went to see his doctor stated they increased his Effexor. They tried giving him Atarax but it didn't work also gave him supplements L-theanine 200 ml, Ashwagandha 200ml and Magnesium Glycinate 300ml said it helped a little.

Other Meds: Effexor, Lipitor, Zig duo, Vitamin D 50,000 units, and Zyrtec

Current Illness: none

ID: 1421014
Sex: F
Age: 15
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Too young to receive Moderna

Other Meds:

Current Illness:

ID: 1421015
Sex: M
Age: 35
State: FL

Vax Date: 05/14/2021
Onset Date: 05/14/2021
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: Mango

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

Symptoms: Swelling of the lymph nodes in the left armpit. The lymph nodes are still swollen about 6 weeks later

Other Meds: Pepcid AC

Current Illness: none

ID: 1421016
Sex: F
Age: 22
State:

Vax Date: 06/23/2021
Onset Date: 06/23/2021
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:

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

Symptoms: patient c/o lip tingling/itching.

Other Meds:

Current Illness:

ID: 1421017
Sex: M
Age: 64
State: GA

Vax Date: 04/29/2021
Onset Date: 04/29/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: After taking the shot, I could barely walk up and down the stairs. I couldn't bend my knees. I was having difficulty walking because I was in so much pain. I was having a lot of joint related issues. I received cortisone shots in my knees from my doctor. Within a week, things started to get a little better. I still have some difficulty walking, but I could currently stand without help.

Other Meds: Lipitor

Current Illness:

ID: 1421018
Sex: F
Age: 40
State: MO

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Vaccine administered after time allotted for temperature range it was maintained at.

Other Meds: unknown

Current Illness: none

ID: 1421019
Sex: M
Age: 20
State: WI

Vax Date: 01/22/2021
Onset Date: 02/19/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient reported chest pain and difficulty breathing and presented to the ED. He was given Benedryl and morphine and was fine four hours later. He did follow up with his PCP.

Other Meds:

Current Illness:

ID: 1421021
Sex: F
Age: 70
State: OR

Vax Date: 03/09/2021
Onset Date: 03/10/2021
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: mangoes; iodine; shellfish; codeine (makes me really, really sick)

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Cold chills - so bad that my whole entire body shakes. At same time, covers piled on top of me. Still having the cold chills now. It just happened yesterday and it doesn't stop for hours and when it happens, the following day that I'm worthless - just tired. On the third day after the chills occur, I feel better. And then with fever: 97.2 is normal but then it goes up to 101.6 - 5 times - that has happened about every three weeks. (five times since March with the fever). I went to the doctor 5/25/2021 and she said she didn't have a clue as to what caused it. All looked normal with bloodwork.

Other Meds: blood pressure medicine; thyroid medicine; Vitamin B; Vit D and Hair, skin and nail supplement

Current Illness: no

ID: 1421022
Sex: F
Age: 57
State: IL

Vax Date: 05/25/2021
Onset Date: 06/21/2021
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: pcn

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

Symptoms: ER: PT STATES SHE THINKS SHE MAY BE HAVING SEIZURES. PT STATES 2 DAYS AGO SHE HAD AN EPISODE WHERE HER FEET GET HOT THEN GETS NUMB, THEN TRAVELS UP THE REST OF HER BODY. HER LEG GOES STRAIGHT OUT AND THEN HER ARM WRAPS AROUND HER HEAD AND SHE STARTS SHAKING. PT STATES HAD 4 EPISODES 2 DAYS AGO AND 2 EPISODES TODAY.

Other Meds:

Current Illness:

ID: 1421023
Sex: U
Age: 42
State: NY

Vax Date: 05/25/2021
Onset Date: 05/25/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421024
Sex: F
Age: 52
State: TX

Vax Date: 03/13/2021
Onset Date: 03/14/2021
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: None

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

Symptoms: 24hours after First vaccine I experienced high heart rate, shortness of breath and dizziness. Even at night/sleeping I had a heart rate over 105. It continued for a week. I was out of town so I did not seek medical attention. The following week I started to check my blood pressure which was elevated along with my heart rate. My first Dr. visit in regards to this event was 3/25/21. After an abnormal ecg I was referred to Cardiology.

Other Meds: None

Current Illness: None

ID: 1421025
Sex: F
Age: 31
State: IN

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

Lab Data:

Allergies: Penicillin, bees

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

Symptoms: 17 minutes after injection my tongue felt heavy and weird. Then my head felt heavy. Shortly after I passed out. The staff said my BP was in 180s. My normal BP is 100-110. Heart rate stayed around 115. Ice packs used and remained laying down for 30 minutes until heaviness passed. Oxygen remained normal although it felt hard to breathe. Just a heaviness on my chest.

Other Meds:

Current Illness:

ID: 1421026
Sex: M
Age: 29
State: MA

Vax Date: 03/25/2021
Onset Date: 05/26/2021
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: After returning from traveling, I noticed while running, I would be short of breathe. However while running when in traveling, I could run 2 miles without stopping however now before the 1 mile mark, I would begin to get winded and become short of breathe.

Other Meds: None

Current Illness: None

ID: 1421027
Sex: F
Age: 50
State: VA

Vax Date: 03/16/2021
Onset Date: 03/16/2021
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: Aspirin; salsa

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

Symptoms: At 4:30 the afternoon of the second dose, I had what felt like a knife stabbing in my arm at the injection site. It ran all the way down to my fingers. I then had a fever of 102, severe chills, nausea, and vomiting. I went to the ER and was given IV fluids, Valium, and nausea meds. Experienced chills and fever for about four days. I was diagnosed with Alopecia. I went to a dermatologist and received injections. Four weeks after, I had problems with my left shoulder.

Other Meds: Levothyroxine; Singular; QVAR inhaler

Current Illness: None

ID: 1421028
Sex: U
Age: 53
State: NY

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

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421029
Sex: F
Age: 34
State:

Vax Date: 05/29/2021
Onset Date: 06/07/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I had a very normal, healthy pregnancy and delivery.This is my second pregnancy that went into a miscarriage. The fetus stopped growth at 6w5days right around the time of my second dose of vaccine. I was initially detected with subchorionic hemorrhages, the fetal growth stopped around 6w5days. There was initial heart beat on the first ultrasound on 7th June but the later ultrasound on 18th June had a deceased fetus of 6w5days. It was a miscarriage and had to undergo D&C on June 22

Other Meds: Pre-natals

Current Illness:

ID: 1421030
Sex: F
Age: 49
State: CA

Vax Date: 05/18/2021
Onset Date: 05/22/2021
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: Red scaly rash on back lateral side four days after receiving vaccine.

Other Meds:

Current Illness:

ID: 1421031
Sex: F
Age: 15
State: NY

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

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421032
Sex: M
Age: 25
State: MN

Vax Date: 06/20/2021
Onset Date: 06/20/2021
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: None

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

Symptoms: Fever Chills Aches/Joint Pain Headache Tiredness/Lack of Energy Nausea Diarrhea Injection Site Pain Arm Pain

Other Meds: Albuterol Inhaler for Asthma

Current Illness: None

ID: 1421033
Sex: M
Age: 58
State: MO

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

Lab Data:

Allergies: none listed

Symptom List: Unevaluable event

Symptoms: Vaccine administered outside of time allotted for temperature vaccine was maintained at.

Other Meds: none listed

Current Illness: none

ID: 1421034
Sex: M
Age: 0
State: FL

Vax Date: 06/23/2021
Onset Date: 06/23/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: dizzy; gave apple juice and cold pack; checked bp 1)93/62 2)100/34 3)110/74 ; pt improved after 20 minutes

Other Meds: na

Current Illness: na

ID: 1421035
Sex: M
Age: 66
State:

Vax Date: 03/05/2021
Onset Date: 04/29/2021
Rec V Date: 06/23/2021
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: Disruption of stable INR. Patient previously stable on warfarin 3.5mg daily. INR began to run low on 4-29-21 necessitating a dose increase on 5-14-21 to 4mg daily. Patient had an episode of slurred speech during this time he was low. No other cause of low INR could be identified after much investigation.

Other Meds: warfarin 3.5mg daily

Current Illness:

ID: 1421036
Sex: M
Age: 17
State: NY

Vax Date: 05/26/2021
Onset Date: 05/26/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421037
Sex: F
Age: 50
State: VA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
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: Aspirin and salsa.

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

Symptoms: 45 minutes after the shot, my lips started tingling. They went numb and it stayed for about ten days. I also had numbness in the soles of my feet that lasted for about two weeks. The day after the shot, I had the normal reaction. Fatigue, lowgrade fever for about 24 hours. I spoke to my doctor about it, but did not go see anyone.

Other Meds: Don't want to list

Current Illness: None

ID: 1421038
Sex: F
Age: 23
State: NC

Vax Date: 04/09/2021
Onset Date: 05/16/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Heavy bleeding and clotting during menstrual cycles

Other Meds: Prozac 40mg

Current Illness:

ID: 1421039
Sex: F
Age: 18
State: VT

Vax Date: 06/23/2021
Onset Date: 06/23/2021
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: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Client received Pfizer as a dose 2 and Moderna as dose 1 (5/5/2021)

Other Meds:

Current Illness:

ID: 1421041
Sex: F
Age: 40
State: CA

Vax Date: 06/01/2021
Onset Date: 06/21/2021
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: Latex, copper, cyndomyacin antibiotic

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

Symptoms: Beginning 20 days post 2nd vaccine dose: fever, chills, headache, low grade fever, sore throat, throat slightly swollen, shooting pain in left breast (around implant) with hot and red skin. Continuing for 3 days as of reporting today. Immediately Post 2nd vaccine dose: low grade fever; chills; fatigue; low appetite; pain in leg, groin, and back lymph nodes lasting less than 48 hours.

Other Meds: Benadryl, multi vitamin, Quercetin, NAC

Current Illness: Sore throat occasionally

ID: 1421042
Sex: F
Age: 14
State: CA

Vax Date: 06/08/2021
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: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: Pleuritic chest pain, emesis, shortness of breath, palpitations, epigastric pain - albuterol with improved shortness of breath f/u 6/23 all symptoms resolved except epigastric pain

Other Meds: Zyrtec, albuterol prn

Current Illness: none

ID: 1421043
Sex: F
Age: 52
State: FL

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

Symptom List: Injection site pain

Symptoms: It started at 5:30pm that evening after the vaccine. I started to feel achy and my arm started to hurt. That evening I started to have a low grade fever and I had a rash. The next day the rash began to become bigger and I was still running a low grade temperature. The symptoms lasted for about 4 days then they went away.

Other Meds:

Current Illness:

ID: 1421044
Sex: U
Age: 28
State: NY

Vax Date: 05/24/2021
Onset Date: 05/24/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421045
Sex: M
Age: 15
State: FL

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: RA

Lab Data:

Allergies: None known

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

Symptoms: The patient developed diffuse body itching and diffuse body (trunk and extremities) red rash throughout that was not clearly urticarial. This began about an hour after vaccine administration. He denied any symptom of allergy. Symptoms began to improve within 28 hours without intervention but did not resolve. He was advised to trial benadryl and monitor closely.

Other Meds: Protein milk supplement once daily

Current Illness: Insect bites to left leg

ID: 1421046
Sex: F
Age: 51
State: TX

Vax Date: 05/01/2021
Onset Date: 06/01/2021
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:

Symptom List: Tremor

Symptoms: After the shot got extremely shortness of breathe and sick but still got the second shot and breathing got worse. It is slowly getting better but is not all the way back to normal just yet.

Other Meds:

Current Illness:

ID: 1421047
Sex: F
Age: 67
State: NY

Vax Date: 04/01/2021
Onset Date: 05/06/2021
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: Latex

Symptom List: Erythema, Pruritus

Symptoms: Chronic contact Dermatitis/ Excema

Other Meds: Multivitamin Effexor 75 mg Xanax as needed

Current Illness: None

ID: 1421048
Sex: M
Age: 22
State: NY

Vax Date: 05/24/2021
Onset Date: 05/24/2021
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:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421049
Sex: F
Age: 74
State: NC

Vax Date: 06/15/2021
Onset Date: 06/16/2021
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: no

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

Symptoms: Every muscle in body prevented from moving, fatigue, no energy , sweats and chills, severe headache, both shoulders very painful

Other Meds: calcium , supplements

Current Illness: no

ID: 1421050
Sex: F
Age: 15
State: IN

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On my left arm it has hurt a lot I had to put ice and now that pain has reached my shoulder.

Other Meds:

Current Illness:

ID: 1421051
Sex: F
Age: 46
State: CA

Vax Date: 05/17/2021
Onset Date: 05/27/2021
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: None

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

Symptoms: I had vaginal bleeding (like a period) 10 days afterward

Other Meds: Sertraline

Current Illness: None

ID: 1421052
Sex: F
Age: 47
State: NY

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

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421053
Sex: F
Age: 72
State: MA

Vax Date: 05/02/2021
Onset Date: 05/06/2021
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: Severe allergies

Symptom List: Pain in extremity

Symptoms: Itching on injection sight and body, swollen face, severe headaches, nausea, vomiting, dizziness, head spinning

Other Meds: Losartan Potassium 50 mg daily Atorvastatin Calcium 20mg daily Multivitamins Zyrtec

Current Illness: none

ID: 1421054
Sex: M
Age: 20
State: GA

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 got lightheaded and dizzy 30 to 60 seconds after getting immunization. Blurred vision, pale, nausea. Had stay seated leaning back and gave OJ and water, observed for about 30 minutes. Pt walked away after rest and fluids.

Other Meds:

Current Illness:

ID: 1421055
Sex: M
Age: 43
State: OR

Vax Date: 06/17/2021
Onset Date: 06/18/2021
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:

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

Symptoms: Developed mild pain in the chest the day following the first vaccine dose, painful muscle cramps at arm/injection site, muscle cramps in feet, and very painful colon inflammation which made it difficult to move around. Also felt feverish for two nights after the injection but did not take temperature to confirm. All other symptoms and body inflammation appeared to have resolved with the exception of painful inflammation in the knees which appeared after all other inflammation symptoms at various other body sites dimminished.

Other Meds:

Current Illness: Unknown/Undiagnosed auto-immune condition

ID: 1421056
Sex: M
Age: 44
State: AZ

Vax Date: 01/07/2021
Onset Date: 01/12/2021
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: Environmental allergies (cats, bermuda grass) Carbatrol.

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

Symptoms: Altered sense of taste and smell. Things tasted different. I had a very dry mouth as well. I also smelled things that were not there. I lost my sense of smell 10 years ago due to sinusitis. I experienced lethargy about 5 days after the shot up to 4 weeks after. I had some tightness in my chest, my albuterol inhaler helped with that. The tingling in my hand and feet happened on a few occasions. I had numbness that lasted about an hour. I had frequent night sweats that woke me. I had muscle tightness in my leg and abdomen. I also had soreness in my arm, which made it hard to grasp a pen. I did test my reflexes which were normal.

Other Meds: Cymbalta , Asmanex , Accolate , Fish oil, vitamin C, vitamin B complex Flonase

Current Illness: No

ID: 1421057
Sex: M
Age: 53
State: NY

Vax Date: 05/30/2021
Onset Date: 05/30/2021
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:

Symptom List: Vomiting

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421058
Sex: M
Age: 55
State:

Vax Date: 05/25/2021
Onset Date: 05/25/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received Moderna COVID Vaccine Lot 028A21A Exp 04/28/2021, no adverse event reported, this was given past expiration listed on manufacture website.

Other Meds:

Current Illness:

ID: 1421059
Sex: F
Age: 40
State: NH

Vax Date: 01/14/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Employee symptomatic with loss smell and taste 6/22/21. Tested Covid positive on 6/22/21.

Other Meds:

Current Illness:

ID: 1421060
Sex: F
Age: 53
State: FL

Vax Date: 06/18/2021
Onset Date: 06/21/2021
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: SULFA DRUGS

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient reported having fever and generalized reaction in the two days immediately following the injection. However, a localized redness and swelling were persistent afterwards. She contacted us again on the fifth day after injection complaining of the area still being red and swollen and was advised to contact her physician for evaluation and follow up.

Other Meds:

Current Illness:

ID: 1421061
Sex: M
Age: 44
State: FL

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

Lab Data:

Allergies: N/A

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

Symptoms: Pt states heart fluttering, rush, feeling terrible run down. Still continuing, feels as though heart skips a beat ever so often, refuses medical care.

Other Meds: N/A

Current Illness: N/A

ID: 1421062
Sex: M
Age: 27
State: MO

Vax Date: 05/07/2021
Onset Date: 05/07/2021
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: Unknown

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

Symptoms: On 6/23/21, patient reported to pharmacist that a few hours after receiving his 1st Moderna vaccine on 5/7/21, he began to experience numbness and tingling in left arm, on left side of face, and did not have full range of motion in both the left and right arms. This experience lasted "a few hours" according to patient.

Other Meds: Unknown

Current Illness: Unknown

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm