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: 1424358
Sex: M
Age: 12
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: PATIENT RECIEVED THE DOSE AFTER MANUFACTURER RECOMMENDED FREEZER STORAGE DURATION.

Other Meds:

Current Illness:

ID: 1424359
Sex: F
Age: 47
State: VA

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/24/2021
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: Severe Vertigo

Other Meds: Concerta

Current Illness: None

ID: 1424360
Sex: F
Age: 32
State: OR

Vax Date: 05/22/2021
Onset Date: 05/24/2021
Rec V Date: 06/24/2021
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: wheat, gluten,

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

Symptoms: heart palpitations and premature ventricular contractions several times day nausea, chills, fatigue everyday - worse on the day after the vaccine

Other Meds: Levothyroxin 50mcg

Current Illness:

ID: 1424361
Sex: M
Age: 64
State: CT

Vax Date: 04/07/2021
Onset Date: 04/27/2021
Rec V Date: 06/24/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Bell's Palsy

Other Meds: Atorvastatin 20 mg

Current Illness: none

ID: 1424362
Sex: F
Age: 40
State: GA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/24/2021
Hospital:

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

Lab Data:

Allergies: SULFA, PCN, ASPIRIN,BENADRYL

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

Symptoms: RASH ALL OVER AND ITCHING AND HEADACHE

Other Meds:

Current Illness:

ID: 1424363
Sex: M
Age: 21
State: CA

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/24/2021
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: AFTER GETTING HIS 1ST DOSE OF MODERNA VACCINE, PATIENT SAT IN THE OBSERVING AREA. AND WITHIN 2 MINUTES OF RECEIVING THE VACCINE, PATIENT HAD A SEIZURE LIKE SYMPTOMS FOR 1-2 SECONDS AND HE FELL OFF THE CHAIR. HIS MOTHER WAS THERE TO CATCH HIM. I CAME RUNNING OUT TO ASSIST. HE REGAINED CONSCIOUSNESS ALMOST IMMEDIATELY AND REMEMBERED EVERYTHING THAT HAPPENED. BUT HE TOLD ME THAT HE FELT VERY DIZZY. I HAD HIM LAY DOWN ON HIS SIDE. HE WAS ALSO SWEATY. HE LAY ON THE FLOOR FOR THE NEXT 10 MINUTES, DURING THAT WHOLE TIME HE WAS ALERT AND AWAKE. ONCE HE FELT BETTER AFTER 10 MINUTES LATER, HIS MOTHER TOOK HIM HOME. WE DIDNOT HAVE TO CALL AN AMBULANCE FOR HIM.

Other Meds:

Current Illness:

ID: 1424365
Sex: F
Age: 15
State: IL

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/24/2021
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: PATIENT RECIEVED THE DOSE AFTER MANUFACTURER RECOMMENDED FREEZER STORAGE DURATION.

Other Meds:

Current Illness:

ID: 1424366
Sex: M
Age: 28
State: OR

Vax Date: 05/06/2021
Onset Date: 06/22/2021
Rec V Date: 06/24/2021
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: Shortness of breath, chest tightness, pain in shoulder, neck, and lower back. Symptoms started on 6/22/2021. Went to ER on 6/24/2021. Diagnosed with pulmonary embolism (multiple clot in left lung). Labs and imagining done, now on medication.

Other Meds: None

Current Illness: None

ID: 1424367
Sex: M
Age: 12
State: IA

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/24/2021
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: Pediatric patient presented to Covid vaccination clinic for scheduled first dose of Pfizer. Inadvertently patient received 0.3ml of Janssen vaccine instead of 0.3 ml of Pfizer vaccine. Patient had headache and tiredness in the days following vaccination was fine on 6/23.

Other Meds:

Current Illness:

ID: 1424368
Sex: F
Age: 22
State:

Vax Date: 06/17/2021
Onset Date: 06/19/2021
Rec V Date: 06/24/2021
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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: change in mensural cycle. early onset of period followed by another period after 14 days characterized by longer length then usual.

Other Meds: none

Current Illness: none

ID: 1424369
Sex: M
Age: 25
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/24/2021
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 reported

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

Symptoms: At 1142, patient reported minimal chest discomfort to nurse Patient reported the chest discomfort started at approximately 1130 and stated "it comes and goes". Patient reported he took deep breathes and walked after it started. Patient reported history of anxiety attacks and similar episodes in March 2021. At 1150, Nurse assessed patient vitals: blood pressure 148/92 mmHg, pulse 78 beats/minute, and SpO2 98%. Patient offered 911. Patient refused 911. Patient reported he was nervous before getting the vaccine and stated "I know it's all mental". At 1205, nurse assessed patient vitals: blood pressure 140/98 mmHg, pulse 82 beats/minute, and SpO2 98%. At 1212, nurse assessed patient vitals: blood pressure 142/90 mmHg, pulse 76 beats/minute, and SpO2 99%. Patient reported he wanted to leave. Nurse educated patient on signs/symptoms of when to seek emergency care, to sign up on V-safe, and to follow up with primary care provider. At approximately 1220, patient left facility with unlabored respirations and steady gait.

Other Meds: None reported

Current Illness: None reported

ID: 1424370
Sex: F
Age: 14
State: TX

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/24/2021
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: Left arm heaviness, palmar erythema and itching, shortness of breath, palpitations, lightheadedness

Other Meds:

Current Illness: None

ID: 1424371
Sex: M
Age: 71
State: SC

Vax Date: 03/04/2021
Onset Date: 03/07/2021
Rec V Date: 06/24/2021
Hospital:

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

Lab Data:

Allergies: Metoprolol

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

Symptoms: Patient stated that he woke up a couple of days later and he could not walk. His vision has doubled. He feels that he is virtually blind. Hearing is also defected. Right hand and leg have no feel like he has had a stoke, Or is making motion on its own.

Other Meds: Prilosec 40mg 2x daily Probiotic lipitor30mg 1x daily Xejanz x r11 Axaor 10/40mg 1x daily Lexapro 5mg 1x daily

Current Illness: n/a

ID: 1424372
Sex: F
Age: 51
State: NV

Vax Date: 03/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/24/2021
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: NO

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

Symptoms: I went to see the doctors because I had trouble breathing. I was coughing up green stuff. I had a fever the day before I went to the doctor but not on the day I went to the doctor. They gave me 6 pills of Zythromyocin - Z-Pac and they gave me an inhaler with a new booster thing to get it all the way in my lungs. Mucinex prescription as well to make it break up. Within 24 hours, I was feeling better.

Other Meds: NO

Current Illness: NO

ID: 1424373
Sex: M
Age: 61
State: HI

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/24/2021
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: triple antibiotic topical

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

Symptoms: 30 minutes after vaccination he did not feel good, has droopy eyes , slurred speech, numbness of left arm. high blood pressure, headach, shortness of breath 2 days after vaccination he feels better but still has mild headache , pressure behind eye, Rt eyelid ptosis, numbness of left upper arm and slight shortness of breath

Other Meds: multivitamin saw palmetto vitamin C biotin fish oil Ecklonia cava

Current Illness:

ID: 1424374
Sex: F
Age: 33
State: MI

Vax Date: 04/26/2021
Onset Date: 04/29/2021
Rec V Date: 06/24/2021
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: Penicilin

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

Symptoms: I woke up in the morning around 6am with excruciating pain in my left shoulder blade and it wrapped around my chest and neck and arm. All on the left side. I meditated in bed and fell asleep again hoping the pain would go away. Got out of bed around 8am to try some yoga. I'm a yoga teacher, I tried to do some gentle movement but it felt so uncomfortable. I paced around and didn't know what to do with myself. I called a couple chiropractors. I got one scheduled for noon. That didn't help relieve any of the pain. So finally around 5pm, my friend suggested I reach out to my doctor. I emailed through MyChart hoping to get a video call and explained to them just as I have here. They called right away. I was put in touch with the Covid Vaccine research team and talked to a Triage nurse. After explaining the chest discomfort and that my dad died of a heart attack, after he spent a long month in the hospital I tried to explain, she urged me to get off the phone and call 911. I ended up driving myself to hospital down the street. After 5 hours in the Emergency Room I was told my EKG / Xray / blood work all looked normal. They suggested it was muscular skeletal. I have mild scoliosis. Relieved, yet I was still experiencing pain. Though not as much as when the day began. I still felt stabbing pains in my chest that came and went. I got home and did some gentle yoga. After a month of still feeling tightness/compression in my chest, doing gentle yoga, talking walks, May 26th, I scheduled Physical Therapy and a video appointment I spoke with Doctor who didn't think it was vaccine related. He reviewed my lab work but didn't have the actual EKG/Xray and was only able to view the notes. He said to continue with my PT treatment and go from there. May 30th I couldn't lay down I felt compression in my chest. I ended up sleeping upright. Every time I tried to lay down it hurt. I took Tylenol and propped myself up on pillows and fell asleep like that. June 3rd I had my second vaccine dose. I just remember having a sore arm and hyperawareness. June 8th at PT I had a panic attack and my heart rate reached 175bpm. I had done an exercise pulling a rope up and down, and didn't understand why my head hurt I felt a sorta strain in the back of my head. So as I tried to meditate I realized I couldn't let go of that sensation and when I looked at my Apple watch I saw my heart rate was up to 140 and after seeing that I panicked and that's why it continued to go up. My PT talked me through it, and I was able to get through it. I've been very anxious and I don't ever recall feeling this much anxiety, especially since I don't know why I'm having these pains. I had Physical Therapist on May 26th - it was my first PT appointment. My PT told me I have costrocondritis. Inflammation in the chest area. So we've been working on more abdominal breathing, strengthening the back, focusing on my posture alignment and other exercises and stretches. I've been going 1-2x a week for the last month now. I feel better although I still have soreness and bruising sensation in my rib cage area in the abdominal area on the left side. My chest still hurts occasionally. I've been practicing yoga every day for 3.5 years, lately my practices have been more gentle. I went from working out 7x a week where I was also strength training and doing cardio, to only doing gentle yoga and working on my posture and alignment. As of recent, my PT has suggested I start trying to do a little more so we've added some more strengthening exercises.

Other Meds: none

Current Illness: none

ID: 1424375
Sex: M
Age: 19
State: OH

Vax Date: 06/08/2021
Onset Date: 06/10/2021
Rec V Date: 06/24/2021
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: No

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

Symptoms: Left sided chest pain, shortness of breath, exertional tachycardia, radiating chest pain to the back x 7 days. Treated with rest, Medrol Dose pack and improved over 3 days. Diagnosis from cardiolgist -myocarditis

Other Meds: Zoloft

Current Illness: No

ID: 1424376
Sex: M
Age: 84
State: MO

Vax Date: 03/18/2021
Onset Date: 03/20/2021
Rec V Date: 06/24/2021
Hospital:

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

Lab Data:

Allergies: Mold; lisinopril; Tikosyn; sulfa

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Bowel issues, kidney function low.

Other Meds: Long list will advise by doctor at patients request.

Current Illness: Bowel issues

ID: 1424377
Sex: F
Age: 15
State: CO

Vax Date: 06/17/2021
Onset Date: 06/18/2021
Rec V Date: 06/24/2021
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: First dose 5/28/21, second dose 06/17/21, "normal" second dose symptoms, fever, chills, headache, stomach pain, after 3 days still feeling pain, worse vommiting, pain above spleen, change in cheek coloring. Mom took patient to ER and they did a CT and blood work, found nothing wrong and ruled out thrombocytopenia. Today she is feeling better still a headache and a bit nauseous. Mom called to make sure this incident was reported,

Other Meds: Unknown

Current Illness: none stated

ID: 1424378
Sex: F
Age: 45
State: CT

Vax Date: 06/19/2021
Onset Date: 06/24/2021
Rec V Date: 06/24/2021
Hospital:

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

Lab Data:

Allergies: NONE

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

Symptoms: ON 6-24-2021 PATIENT NOTICED SWELLING AND WARMTH AT INJECTION SITE ON ARM. CALLED PHARMACY. SINCE IT WAS 5 DAYS POST INJECTION SHE WAS ADVISED TO CONTACT MD . MD WAS CONTACTED AND PATIENT ADVISED TO CONME IN FOR OFFICE VISIT. AFTER EXAM IT WAS DETERMINED TO BE CELLULITIS. AN ANTIBIOTIC WAS PRESCRIBED.

Other Meds: NONE

Current Illness: NONE

ID: 1424379
Sex: M
Age: 16
State: VA

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/24/2021
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: no allergies

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

Symptoms: after 15 minutes patient fainted and collapsed in store then pharmacist came and patient was awake and breathing and very pale pharmacist was assisting him then 911 was called and came and took patient to hospital

Other Meds: none

Current Illness: none

ID: 1424380
Sex: M
Age: 19
State: GA

Vax Date: 06/19/2021
Onset Date: 06/20/2021
Rec V Date: 06/24/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Unevaluable event

Symptoms: Fever the morning following vaccine then development of chest pain. Found to have elevated Trop levels and ST elevation on EKG. Elevated CRP, Sed Rate and Cardiac MRI consistent with Myocarditis.

Other Meds: Lantus Insulin Regular Insulin Zocor

Current Illness:

ID: 1424381
Sex: F
Age: 32
State: IL

Vax Date: 03/20/2021
Onset Date: 05/21/2021
Rec V Date: 06/24/2021
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: I experienced two months after my J&J vaccine- soreness to my left arm with pain that lasted two weeks. I also experienced SVT, supraventricular tachycardia, my heart rate went up to 103 bpm and my heart rate could not go down. I went to ER where they helped my heart rate go down and I am still being monitored for SVT.

Other Meds: Nortriptyline 150mg, Neurontin 2700mg, Hydrocodone 30mg, OTC Tylenol

Current Illness:

ID: 1424382
Sex: M
Age: 17
State: OH

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/24/2021
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: vomiting blood

Other Meds:

Current Illness:

ID: 1424383
Sex: F
Age: 30
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/24/2021
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: PATIENT RECIEVED THE DOSE AFTER MANUFACTURER RECOMMENDED FREEZER STORAGE DURATION.

Other Meds:

Current Illness:

ID: 1424384
Sex: M
Age: 1
State: TN

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/24/2021
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: He was given shots at health department. Three hours later he spiked a 104 fever and started shaking, vomiting and developed a rash on his leg. At the hospital, his heart rate was elevated as well. He is still running fever and has mild rash today.

Other Meds: Not applicable

Current Illness: None

ID: 1424385
Sex: M
Age: 74
State: CO

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/24/2021
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: Pain at injection site, swelling, and erythema

Other Meds: Atorvastatin, Lisinopril - HCTZ, Metoprolol succinate, Omeprazole, Xarelto

Current Illness: None

ID: 1424386
Sex: M
Age: 58
State: OH

Vax Date: 03/18/2021
Onset Date: 06/10/2021
Rec V Date: 06/24/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient did NOT experience any adverse events, but he did receive 2 doses of the Janssen COVID vaccine 12 weeks apart. The first dose failed to report, so the administering provider of the 2nd dose was unaware that the patient had received the first dose. The patient, however, was aware that he had already received the first dose and chose to get a 2nd dose because he had heard people talking about "booster" shots and "figured why not?" (patient's own words). He disclosed this to me when this error was discovered and I called to assess him for any adverse effects. Again, he states that he did not experience any adverse effects from the 2nd dose. Lot of 2nd dose was 1820095, also administered IM in left arm

Other Meds: Albuterol Sulfate (Albuterol Sulfate HFA) 108 (90 Base) MCG/ACT Inhalation Aerosol Solution Aspirin 81 MG Oral Tablet Delayed Release Carvedilol 12.5 MG Oral Tablet Furosemide 40 MG Oral Tablet Lisinopril 5 MG Oral Tablet Mometasone Furoate

Current Illness:

ID: 1424387
Sex: M
Age: 38
State: MT

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 06/24/2021
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: vaccine was administered after the expiration date of 4/28/21. pt reports no adverse events.

Other Meds:

Current Illness:

ID: 1424388
Sex: M
Age: 20
State: CA

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/24/2021
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: AFTER RECEIVING HIS 2ND DOSE MODERNA VACCINE, THE PATIENT SAT IN THE OBSERVATION AREA. 5 MINUTES IN THE OBSERVATION AREA, THE PATIENT CAME TO OUR COUNTER TO ALERT ME THAT HE FELT DIZZY. I IMMEDIATELY ASKED HIM TO SIT BACK DOWN, AND CAME OUT TO HIS SIDE. HE THEN TOLD ME THAT HIS DIZZINESS SYMPTOM INTENSIFIED. HIS BODY SUDDENLY SHOOK A BIT, I HELD ON TO HIM TO KEEP HIM STEADY. THEN I HAD HIM SAT DOWN ON THE FLOOR, THEN HE TOLD ME HE NEED TO LIE DOWN. SO I HELP HIM LAY DOWN. HIS SKIN STARTED TO FEEL VERY DAMP. HE SAID HE FELT EXTREMELY NAUSEOUS. I HAD MY TECHNICIAN CALL 911 FOR HIM, I REMAINED WITH HIM BY HIS SIDE THE WHOLE TIME UNTIL PARAMEDIC GOT TO US IN 8 MINUTES. THEY TOOK HIS VITAL SIGNS. EVERYTHING CHECKED OUT. HE DIDNOT GO TO THE HOSPITAL. PARAMEDICS LEFT. HIS MOM CAME TO PICK HIM UP. HE FELT NAUSEOUS FOR THE NEXT 5 HOURS, THEN HE SLOWLY FEELING BETTER.

Other Meds:

Current Illness:

ID: 1424389
Sex: M
Age: 57
State: IL

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/24/2021
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: Patient stated he felt as if he was going to faint and that this feeling happens often when he receives shots or sees needles. EMS was called and EMS took vitals. BP: 113/62. HR: 60. Patient stated he felt better after several minutes and EMS sent patient home.

Other Meds:

Current Illness:

ID: 1424390
Sex: F
Age: 28
State: IL

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 06/24/2021
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: PATIENT RECIEVED THE DOSE AFTER MANUFACTURER RECOMMENDED FREEZER STORAGE DURATION.

Other Meds:

Current Illness:

ID: 1424391
Sex: F
Age: 25
State: WV

Vax Date: 04/20/2021
Onset Date: 04/25/2021
Rec V Date: 06/24/2021
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: Cephalosporin class antibiotics

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

Symptoms: Due to my IUD, have not had a period in 2 years (PMS symptoms are minimal too). On 4/25, I woke up with horrible cramping and nausea. I was irritable, in pain, and needed to use feminine products for the first time in years. Since this vaccine, I have had spotting and cramping randomly. This did not happen pre-vaccine. No treatment known (other than removal) that is preferable. Slowly this is going back to normal but still having random days of spotting. Filing a report in case there is a reaction found between hormones (birth control) and vaccine ingredients.

Other Meds: Topamax, adderall XR, vitamin D6, Zyrtec, viibryd, Liletta IUD

Current Illness: N/A

ID: 1424392
Sex: M
Age: 14
State: OR

Vax Date: 06/16/2021
Onset Date: 06/17/2021
Rec V Date: 06/24/2021
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: pollen allergy

Symptom List: Tremor

Symptoms: Myocarditis

Other Meds: Vitamin D 600 IU daily

Current Illness: Assault by a stranger 5/19/2021 eczema

ID: 1424393
Sex: F
Age: 48
State: AL

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/24/2021
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: NKDA

Symptom List: Erythema, Pruritus

Symptoms: PATIENT HAD ITCHING AT THE INJECTION SITE FOLLOWING THE FIRST DOSE AND WAS STARTING TO ITCH IMMEDIATELY AFTER ADMINISTRATION OF THE SECOND DOSE (TODAY). NO RASH OBSERVED. OFFERED PATIENT LIQUID BENADRYL AND SHE ACCEPTED. GAVE PATIENT 10ML OF BENADRYL 12.5MG/5ML WHILE SEATED IN THE OBSERVATION CHAIR. PATIENT DRANK WITH NO ISSUES AND DID NOT COMPLAIN OF ITCHING AFTER ADMINISTRATION.

Other Meds: UNKNOWN

Current Illness: COUGH FROM SEASONAL ALLERGIES

ID: 1424394
Sex: M
Age: 86
State:

Vax Date: 01/23/2021
Onset Date: 06/08/2021
Rec V Date: 06/24/2021
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: COVID vax#1 (MODERNA) given on Jan 23, 2021. COVID vax#2 (MODERNA) given on 2/23/2021. Started having waxing and waning L axillary adenopathy after 2nd vax. 6/8/2021 Biopsy is consistent with an aggressive lymphoma.

Other Meds:

Current Illness:

ID: 1424395
Sex: M
Age: 56
State: OH

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/24/2021
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: extremely sore arm for 4 days

Other Meds:

Current Illness:

ID: 1424396
Sex: F
Age: 36
State: PA

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 06/24/2021
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: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: patient was light headed had to sit down. came close to fainting. unable to drive.

Other Meds: unknown

Current Illness: none

ID: 1424397
Sex: M
Age: 12
State: NH

Vax Date: 06/05/2021
Onset Date: 06/07/2021
Rec V Date: 06/24/2021
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: ER 6/7/2021 Chest Pain, irregular heart beat/sinus arrhythmia. Labs showed, High, ALK Phosphatase, Low Creatinine, High CRP. Discharged.

Other Meds: No medication, . Children's multi vitamin.

Current Illness: None

ID: 1424398
Sex: F
Age: 45
State: TX

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/24/2021
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: NKA

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

Symptoms: Patient received 2nd dose of Pfizer instead of Moderna. Vaccinator failed to identify need for Moderna; both vaccination card and consent were indicating need for Moderna. The scribe caught the error after the vaccine had already been given and reported it to the supervisor. Pt was immediately provided counselling and 15 minute observation was tolerated without complications.

Other Meds: N/A

Current Illness: n/a

ID: 1424399
Sex: F
Age: 67
State:

Vax Date: 06/17/2021
Onset Date: 06/01/2021
Rec V Date: 06/24/2021
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: Patient stated that a red itchy spot appeared on injection site after a few days.

Other Meds:

Current Illness:

ID: 1424400
Sex: F
Age: 44
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/24/2021
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: PATIENT RECIEVED THE DOSE AFTER MANUFACTURER RECOMMENDED FREEZER STORAGE DURATION.

Other Meds:

Current Illness:

ID: 1424401
Sex: F
Age: 24
State: CA

Vax Date: 06/21/2021
Onset Date: 06/22/2021
Rec V Date: 06/24/2021
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: Penicllin

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

Symptoms: Pt stated she went to ER the day after the vaccination (on 6/22/21) complaining of headache, fever, rash, and shortness of breath. She went to the ER a second time on 6/24/21 again complaining of shortness of breath. In pharmacy she stated she was concerned about blood clots because she has family history with them. She was prescribed albuterol inhaler and prednisone. She has an appointment to see her primary care physician.

Other Meds: Unknown

Current Illness: Unknown

ID: 1424402
Sex: M
Age: 49
State: IL

Vax Date: 06/08/2021
Onset Date: 06/11/2021
Rec V Date: 06/24/2021
Hospital:

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

Lab Data:

Allergies: None.

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

Symptoms: Day 2- slight red rash on chest. Day 3 - severe vomiting, Day 5 - called 911 taken to the Emergency Room for supraventricular tachycardia, Heart Rate of 158. Day 9 - had an additional SVT, Heart Rate 171. Day 10 - additional SVT, Heart Rate 150. Have not been able to engage in pre-vaccine regular life activities without my heart rate severely rapidly increasing. I had to quit my job. Saw my doctor on Day 9 who examined blood levels from ER visit on Day 5, and ordered an echocardiogram. I have an echocardiogram scheduled in the next 3-4 weeks, which was the soonest I was able to be seen.

Other Meds: Men's Daily Multi Vitamin -- Magnesium (250mg) -- Vitamin D (25mcg - 1000 IU). Atorvastatin 20 mg (for Cholesterol)

Current Illness: None.

ID: 1424403
Sex: F
Age: 38
State: CA

Vax Date: 04/21/2021
Onset Date: 05/20/2021
Rec V Date: 06/24/2021
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: Imatrex and acylclavir

Symptom List: Vomiting

Symptoms: Missed Miscarriage

Other Meds: Zoloft

Current Illness:

ID: 1424404
Sex: F
Age: 56
State: WI

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 06/24/2021
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 reported that she "blacked out", has had headaches, is fatigued, has lesions on her brain, has vasculitis, a small brain bleed, possible stroke, and is being evaluated for multiple sclerosis. Patient had a positive COVID-19 test 10/29/2020. She stated that some of her symptoms started in November when she returned to work. Regarding #5 in the patient information section is an estimated date. Patient is unable to give an onset date.

Other Meds:

Current Illness:

ID: 1424405
Sex: F
Age: 68
State: MI

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/24/2021
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: N/A

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

Symptoms: Pt described feeling clammy, sweaty, having a sore throat, ear pain, and numbness in arm

Other Meds: N/A

Current Illness: N/A

ID: 1424406
Sex: F
Age: 63
State: IL

Vax Date: 03/07/2021
Onset Date: 04/01/2021
Rec V Date: 06/24/2021
Hospital: Y

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: Penicillin, Sulfa

Symptom List: Injection site swelling, Limb discomfort

Symptoms: It started with my left palm exp warm to touch(felt like slight fever around some areas) and itching all over skin.The symptoms will come and go after touching items causes whelps to appear. Around a week ago it was hard to make a fist(both hands) from the continuous itching on my hands. I have went to the doctor was prescribed Cetirizine and prescribed hydroxyzine by the ER. I have appt on 7/12 to see a Dermatologist.

Other Meds: Metoprolol, Amlodipine, Hydrochlorzide

Current Illness: No

ID: 1424407
Sex: F
Age: 48
State: IN

Vax Date: 03/26/2021
Onset Date: 04/04/2021
Rec V Date: 06/24/2021
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: I was a 48 year old woman(at the time of my vaccine) who had not had a mensural cycle in 12 months, rendering me menopausal. Nine days after my first injection, I experienced break through bleeding for roughly 24 hours, requiring a tampon to manage the bleeding. By Monday, April 5 the bleeding had stopped. I have not had any bleeding since that day.

Other Meds: multivitamin

Current Illness: n/a

ID: 1424408
Sex: M
Age: 14
State: IL

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/24/2021
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: PATIENT RECEIVED THE DOSE AFTER MANUFACTURER RECOMMENDED FREEZER STORAGE DURATION.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm