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: 1422355
Sex: M
Age: 37
State: NY

Vax Date: 04/25/2021
Onset Date: 05/06/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: I had my first dose of COVID vaccine on April 25, 2021. On May 6, 2021 evening around 8 PM I had a severe dizziness attack that lasted for 2 hours and intermittent vomiting for 4 times that night and my dizziness resolved spontaneously. The next morning I went to Urgent Care for further evaluation, they gave me Anti-Vertigo medicine. I felt well till next week. On the following week again I had a severe dizziness attack, profuse sweating, and vomiting. On next morning, I lost my hearing in the right ear, couldn't hear anything. And again i went to Urgent care, that time they gave me Antibiotics Amoxy-clavulanate for 10 days, after 2 days of loss of hearing, it recovered and felt well. After that, I took 2nd dose of COVID vaccine on May 19, 2021. Again on June 4, 2021 I had dizziness attack and profuse sweating along with i started feeling uncomfortable in my right ear and next morning my hearing loss again. Ever since my hearing is not recovered yet. I am extensively visiting my ENT/Otolaryngologist ever since and my doctors prescribe me steroid by mouth and injection in the ear. Till date i profoundly loss my hearing. I can't hear anything now.

Other Meds: None

Current Illness: None

ID: 1422356
Sex: F
Age: 26
State: MN

Vax Date: 04/24/2021
Onset Date: 04/25/2021
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: azithromax

Symptom List: Anxiety, Dyspnoea

Symptoms: The day after the second vaccine, I experienced elevated morning heart rate (HR) and lowered heart rate variability (HRV). Initially, this was not unexpected; however, my HR and HRV remained abnormally high and low, respectively, with no clear cause. I am an athlete, so I pay very close to these metrics on a daily basis. My mean morning heart measurements 40 days prior to the second vaccine: HR = 68.5 bpm, HRV= 8.0 . Mean Morning heart measurements 30 days post vaccine: HR = 82.7, HRV = 7.2

Other Meds: Yaz

Current Illness: None

ID: 1422357
Sex: F
Age: 17
State: CA

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: nuts

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

Symptoms: Client received the Pfizer COVID vaccine (lot #EW0187 and expiration date 7/15/21) at approximately 3:30pm. Client came in for first dose Covid-19 vaccine and PHN submitted medical consult regarding concerns from mother due to client having a reaction to a vaccine at the age of 7 where she broke out in a rash and then had to go to the hospital. Mother of client reports she has no allergies and they never figured out what caused the reaction. When she was younger she had asthma and used an inhaler. Per Mother client has not needed an inhaler or had any asthma symptoms for a long time. Client reports she is just getting over a mild cold (runny nose) because her sister is a doctor and said it was not COVID and she's on antibiotics. Client states she "feels fine" today. Per Supervisor, client approved to receive first dose with 15 minute observation. Prior to arriving to the observation area client reports feeling a little nervous due to nearby emergency with another client. PHN walked client over to observation area and client reports "feeling fine." At 3:35PM EMT alerts PHN and PHN client is having reaction. PHN and PHN arrive at 3:38pm. Client reports headache 7/10, nausea and chest pressure. Client denies feeling throat closing, chest pain or shortness of breath. At 3:38 pm, pulse 75 and oxygen sat 95%. PHN calls 911 at 3:38pm. Current medications: ampicilina 500mg, guaifenesina clorfenamina metamizol 250mg. Vitals by EMT at 3:41pm: blood pressure 160/82, pulse 66, oxygen sat 98%. At 3:42pm client reports headache on temples. At 3:44 client reports headache radiating from temples to occipital area and pain level 7/10. Vitals at 3:45pm: blood pressure 140/70, pulse 66, oxygen sat: 98%. Client reports feeling a "pinching feeling in throat". PHN clarified with client if she felt swelling, closing of throat, itchiness or shortness of breath. Client denied all, stated just "pinching feeling". During assessment, mother of client reports client is allergic to nuts. At 3:47pm Fire department arrived and assumed care. Blood pressure done by paramedics at 3:50pm 165/108. Client transported to hospital via ambulance. Client left facility with paramedics at 4:01PM.

Other Meds: ampicilina & guaifenesina clorfenamina metamizol

Current Illness: recently getting over a cold

ID: 1422358
Sex: F
Age: 25
State: MA

Vax Date: 06/20/2021
Onset Date: 06/20/2021
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: Unknown

Other Meds:

Current Illness:

ID: 1422359
Sex: M
Age: 39
State: NY

Vax Date: 05/28/2021
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:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422360
Sex: F
Age: 15
State: NY

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422361
Sex: M
Age: 27
State: NC

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

Lab Data:

Allergies: Lactose Intolerant

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Small rash and swelling about 2-3 inches in diameter

Other Meds: n/a

Current Illness: n/a

ID: 1422362
Sex: F
Age:
State: NY

Vax Date:
Onset Date:
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: Pharyngeal swelling

Symptoms: My daughter pt. has heart palpitations and fast heartbeat at times, her pressure can go from 100 to 40 or below very quickly and she feels nauseous and lightheaded. Dr. did EKG was good but is still experiencing these affects frequently and she doesn?t feel good at all, then she?s fine for a while and it comes back again.

Other Meds:

Current Illness:

ID: 1422363
Sex: M
Age: 15
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422364
Sex: F
Age: 58
State: OR

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Flu-like symptoms, fever, profuse sweating, extremely sore muscles, extreme fatigue, headache first 3 days. Flu-like symptoms, fever, profuse sweating improved on 3rd day. Two weeks post 2nd dose, sore muscles continue, extreme fatigue (cannot work/focus/concentrate), headache. Trouble with cognition, trouble speaking clearly (stumbling on words as if tongue/brain are not in sync). Extreme brain fog.

Other Meds: Prometrium 100 mg; multimineral/multivitamin; fish oil; probiotic; DHEA 15 mg

Current Illness:

ID: 1422365
Sex: U
Age: 30
State: NY

Vax Date: 05/20/2021
Onset Date: 05/20/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422507
Sex: M
Age: 33
State: MA

Vax Date: 06/20/2021
Onset Date: 06/20/2021
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: Unknown

Other Meds:

Current Illness:

ID: 1422508
Sex: F
Age: 29
State:

Vax Date: 04/26/2021
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: Sumatriptan

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

Symptoms: Onset of Hyperthyroidism - positive for Graves disease. Previous normal bloodwork (several years wroth).

Other Meds: Acne cream Naproxen as needed

Current Illness:

ID: 1422509
Sex: U
Age: 48
State: NY

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

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422510
Sex: U
Age: 14
State: NY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422511
Sex: F
Age: 23
State: CA

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: No

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

Symptoms: About three hours after getting the shot I started feeling rumbling in my stomach so I got up to go to the bathroom and almost fell over from being so dizzy and light headed. I continued to throw up and have diarrhea every 15-30 minutes all through the night. I was sweating but had the chills at the same time. I?ve never felt so sick before.

Other Meds: No

Current Illness: No

ID: 1422512
Sex: F
Age: 70
State: NY

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

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: none

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

Symptoms: Patient is a very pleasant 70-year-old female with a past medical history significant for type 2 diabetes, hyperlipidemia, hyperthyroidism, depression and past history of coronary artery disease/inferior wall MI in 2001 resulting in PCI who presented to the emergency room on 6.18 with a chief complaint of recurrent substernal chest pain that has been occurring since it started suddenly on June 12 associated with nausea, two episodes of vomiting and sweating. She reported prior to that she was in her usual state of health. She admits to a chronic issue with going up her 28 stairs in her home but reports that there has been no change in the shortness of breath pattern doing the stairs or in her usual joint pain doing the stairs up until this past Saturday. She denied any recent illness any fever or chills any diarrhea or any abdominal pain. She just had her second Covid vaccine on June 6. She takes an aspirin and atorvastatin and tries to control her blood sugars.She last had an echocardiogram in August 2018 as well as a stress echo which revealed a normal ejection fraction and findings consistent with an RCA/PDA distribution abnormality there was no significant valvular abnormalities or other stress-induced regional wall motion abnormalities. In the emergency room she received nitroglycerin paste, morphine and an aspirin and then was started on a heparin drip at the direction of cardiology. She was admitted with a NSTEMI and unstable angina and transferred to a higher level of care on 6/21 where coronary angiogram, showed severe left main and 2 vessel CAD. She was then referred for emergent CABG and on 6/21 she underwent CORONARY ARTERY BYPASS GRAFTING; LIMA-LAD; ENDOSCOPIC VEIN HARVEST OF THE LEFT GREATER SAPHENOUS VEIN; SVG-MARG; SVG-PDA; ON CARDIOPULMONARY BYPASS . She remains hospitalized as of 6/23/21 on open heart.

Other Meds: aspirin, lipitor , celexa, tapazole, lantus, meloxican

Current Illness: none

ID: 1422513
Sex: F
Age: 34
State: NY

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422514
Sex: F
Age: 49
State: KY

Vax Date: 01/21/2021
Onset Date: 02/06/2021
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: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Originally, I did not think that the skin issue that arose shortly after the vaccine was related because it was not located on the arm that I received the vaccine. All of the news I had read about skin reactions seemed to be at the injection site. I developed a lesion (~ 2"x2") on my right torso that I thought was something similar to ringworm as well as a red patch on my left forearm (~2"x2") that did not resemble ringworm, and another inside my right thigh. None of these lesions were hot, painful or itchy. I had been scheduled for a food allergy test to try and pinpoint a possible cause of my scalp psoriaisis which was due in April so I waited thinking the patch on my forearm might be some sort of food allergy. I treated the lesion on my torso with clotrimazole thinking it was ringworm but it did not help. My food allergy test was negative and I scheduled an appointment with a dermatologist/pathologist to examine my lesions. He collected a punch biopsy from my back rom a 4th lesion which I had not noticed. The findings/cells are suspicious for cutaneous T-Cell lymphoma although he states this cannot be 100% confirmed. I have no family history of cancer/lymphoma and no previous personal history. The dermatologist/specialist has not indicated that the vaccine was the cause of this event but I felt the need to report it. I am currently treating the lesions with topical steroids and I did receive intralesional injections at the office visit. The lesions are little improved but remain painless. Following my second vaccine/injection, I experienced Tmax of 102.3 approximately 24 hrs post vaccine but no other side effects. I did have a COVID antibody test done sometime late in 2020 because I wondered if my scalp issue might be related to having asymptomatic COVID because it started in March 2020. I did not have antibodies.

Other Meds: Pepcid 20mg daily

Current Illness: scalp psoriasis - mild

ID: 1422515
Sex: F
Age: 15
State: NY

Vax Date: 05/20/2021
Onset Date: 05/20/2021
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: 1422516
Sex: F
Age: 45
State: CA

Vax Date: 04/20/2021
Onset Date: 05/01/2021
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: Pelvic pain, menstrual cycle began 2 weeks after 2nd injection and continues to now come every 2 weeks. It should be clarified that I have zero history of irregular cycles. Initially, went to clinic when I could not get in with my Dr. they treated me for BV, YI though I had no symptoms associated with either of those infections. 2 weeks later symptoms again, I got an appointment with my regular Dr who advised the pelvic pain was from the vaccine and to give it 3-4 months to calm down my cycle. In the meantime, the results from the clinic came back with an abnormal pap with HPV. It is my belief that the vaccine triggered HPV. I've been super healthy and never have issues.

Other Meds: None

Current Illness: None

ID: 1422517
Sex: M
Age: 22
State: MA

Vax Date: 06/20/2021
Onset Date: 06/20/2021
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: Unknown

Other Meds:

Current Illness:

ID: 1422518
Sex: U
Age: 14
State: NY

Vax Date: 05/21/2021
Onset Date: 05/21/2021
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: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422519
Sex: M
Age: 42
State: NY

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422520
Sex: U
Age: 17
State: NY

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422521
Sex: F
Age: 18
State: CA

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

Lab Data:

Allergies: none

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

Symptoms: At 1611 client's Mother alerted EMT daughter had headache and nausea. PHN responded. At 1611 client sitting upright in chair, alert and oriented x4. Client reports that she has been feeling headache since she sat down in observation 20 mins ago and did not inform anyone. At arrival to observation room client stated headache pain 5/10. EMT took vitals at 1614: blood pressure 122/78, pulse 90, oxygen sat 97%. Client denies blurred vision, dizziness, shortness of breath, no rash visible or swelling. Client reports medical history of migraines and high cholesterol, no medications and no known allergies. Per client tolerated 1st Pfizer Covid-19 vaccine well. At 1616 client reports headache resolved and nausea is improving. Vitals at 1620: blood pressure 116/84, pulse 83, oxygen sat 100%. Client reports new onset of "feeling head heavy". Client denies headache at this time or nausea. Per client this "heavy" feeling has happened in the past. PHN advises client to follow up with provider and client states she does not have insurance or provider at this time. PHN gave client healthcare resources: list of community clinics and Medi-cal resources. PHN gave ER precautions. Vitals at 1625: blood pressure 110/84, pulse 82, oxygen sat 99%. Client reports all previous symptoms have resolved. Last vitals at 1635: blood pressure 110/78, pulse 82, oxygen sat 99%. Client reports "feeling fine". Client left facility with steady gait at 1640.

Other Meds:

Current Illness:

ID: 1422522
Sex: M
Age: 20
State: NY

Vax Date: 05/30/2021
Onset Date: 05/30/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422523
Sex: M
Age: 23
State: MA

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: UNknown

Other Meds:

Current Illness:

ID: 1422524
Sex: U
Age: 48
State: NY

Vax Date: 05/16/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422525
Sex: F
Age: 49
State: PA

Vax Date: 04/01/2021
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: First shot on March 20, next period following first shot experienced a heavier than usual period lasting 10 days. Second shot received on April 17, very light period lasting 2 weeks. No period in May or June.

Other Meds: Wellbutrin SR 150mg twice a day.

Current Illness:

ID: 1422526
Sex: M
Age: 30
State: NY

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422527
Sex: M
Age: 61
State: CA

Vax Date: 04/12/2021
Onset Date: 04/13/2021
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: Allergic to bees

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

Symptoms: Patient severely fatigued and unable to care for self and get out of bed for approximately 50 days. Low grade fever and flushed or pale pallor. Patient gradually recovered between days 50 and 60 (best estimate) but is still recovering strength and stamina.

Other Meds: TSH hormone replacement therapy (thyroid removed due to cancer) medical Marijuana for sleep

Current Illness: None

ID: 1422528
Sex: M
Age: 16
State: NY

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

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422529
Sex: M
Age: 22
State: MA

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Unknown

Other Meds:

Current Illness:

ID: 1422530
Sex: M
Age: 62
State: CA

Vax Date: 04/01/2021
Onset Date: 04/16/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: dizziness (aka vertigo), nausea, dry heaves, hearing loss headache

Other Meds: Combivent and Serevent

Current Illness:

ID: 1422531
Sex: F
Age: 58
State: MI

Vax Date: 05/03/2021
Onset Date: 05/08/2021
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: Pentasa Morphine Latex Generic Bactrim only

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

Symptoms: I had covid arm with swelling and rash it lasted about 4 weeks. I used hydrocortisone for rash swelling lasted approximately 4 weeks

Other Meds: Cimzia Folic Acid B12 injection Procrit Calcitrol Sodium Bicarb Magnesium

Current Illness: Crohns disease Avascular necrosis Fibromyalgia Chronic Kidney disease Pernicious Anemia Osteoarthritis Arthritis

ID: 1422532
Sex: M
Age: 32
State: NY

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422533
Sex: M
Age: 36
State: NV

Vax Date: 05/24/2021
Onset Date: 05/27/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Myocarditis Triponen levels over 9.0

Other Meds: None

Current Illness: None

ID: 1422534
Sex: F
Age: 17
State: IL

Vax Date: 06/04/2021
Onset Date: 06/05/2021
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: Amoxicillin

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

Symptoms: Patient received her first COVID Vaccine on 6/4/2021 and on 6/5/2021, 6/6/2021, 6/7/2021, and 6/8/2021, she experienced chest pain and shortness of breath. She experienced shortness of breath even when ascending the staircase in our home. She felt chest pain and tightness in her chest for 4 days after receiving her vaccine.

Other Meds: Fluoxetine 20 mg

Current Illness: none

ID: 1422535
Sex: U
Age: 15
State: NY

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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: 1422536
Sex: U
Age: 19
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422537
Sex: F
Age: 34
State: VA

Vax Date: 06/21/2021
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: No

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

Symptoms: Shortness of breath Severe chest pain Strong heart beat Fever Headache Severe stomach pain Unable to sleep

Other Meds: No

Current Illness: No

ID: 1422538
Sex: F
Age: 13
State: NY

Vax Date: 05/20/2021
Onset Date: 05/20/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422539
Sex: F
Age: 58
State: MA

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

Lab Data:

Allergies:

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

Symptoms: Unknown

Other Meds:

Current Illness:

ID: 1422540
Sex: F
Age: 56
State: NY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: biotin, pcn, chromium, tetanus toxoid

Symptom List: Vomiting

Symptoms: 56-year-old very pleasant female with a known history of alcohol dependence and cirrhosis along with tobacco dependence and underlying nonoxygen dependent COPD who presented to the ER on 6/16 with uncontrolled diarrhea that started suddenly 2 weeks after getting her johnson and johnson vaccine on 5/5/21 associated with significant weight loss and persistent nausea and acute renal failure. She initially presented to her PCP on 5/25 complaining of urinary urgency for the past few months. She denied any frequency or dysuria but reported that her urine had an odor and an orange color. During that visit urine was positive for nitrates and leukocyte esterase she also had bilirubin in her urine and was given a 7-day course of Macrobid. There was not enough urine to send to the lab for culture. She then went to the emergency room that evening because her PCP contacted her that her potassium was low and she was sent to the emergency room during that visit she reported developing diarrhea she was given potassium and discharged home. She followed up with her PCP on 6/1 to follow-up on her ER visit and reported that the antibiotic was helping her urinary tract infection she continued to complain of some urinary urgency and it was recommended she have a urine culture done again which showed pansensitive E. coli which despite being sensitive to Macrobid she did not respond so she was prescribed 5 more days of Cipro. She reported that she quit drinking alcohol on 5/19/21 but admitted to drinking a beer now and then. Patient had her Johnson & Johnson COVID-19 vaccination on 5/5 and reports she was tired for a day or 2 afterwards and then felt better but then 2 weeks thereafter she felt terrible with associated development of nausea, weight loss, new diarrhea which has continued to progress to developing significant diarrhea and weight loss and fatigue for which she presented back to the ER on 6/16 with acute renal failure, uncontrolled diarrhea, hyponatremia and hypokalemia and metabolic acidosis. Imaging showed pancolitis, colonoscopy performed show diffuse bowel wall edema. She remains hospitalized as of 6/23/21. Stool pathogens panel and stool C. difficile x2 are both negative but the diarrhea is persistent and severe. Pt reports gi symptoms bagan 2 weeks after receiving her J and J vaccine associated with nausea, abd pain and development of diarrhea. CT of the abdomen pelvis showed a pan colitis and enteritis. colonoscopy was normal other than showing sign mucosal edema. Pathology negative for malignancy but the terminal ileum shows prominent peyers patches which are the immune sensors of the intestine.. stool o and P neg. Lactoferrin/fecal leukocytes is neg. fecal fat pending. stool ob neg. esr and crp markedly elevated.- budesonide 9mg was started, Added imodium q6h and acidophilous qid. rheumatoid factor neg, antinuclear and antimitochondrial antibodies neg, antineutrophilic cytoplasmic antibodies neg, anti-Saccharomyces cerevisiae antibodies neg and antithyroid peroxidase antibodies neg ,celiac ds panel neg. stool ob neg.. renal failure is felt due to acute tubular necrosis from severe diarrhea and poor po intake. She remains hospitalized in serious condition as of 6/23/21.

Other Meds: potassium, magnesium, albuterol prn, folic acid

Current Illness: saw pcp on 5/25 for urinary urgency- prescribed 7 days of macrobid - cx was not sent as not enough urine was collected. saw pcp again 6/1 for continued urinary urgency and prescribed cipro for 5 days, cx was pansensitive e coli

ID: 1422541
Sex: U
Age: 19
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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422542
Sex: M
Age: 29
State: NY

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422543
Sex: U
Age: 54
State: NY

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

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422544
Sex: M
Age: 78
State: MA

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:

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

Symptoms: Unknown

Other Meds:

Current Illness:

ID: 1422545
Sex: U
Age: 87
State: NY

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm