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: 1424863
Sex: F
Age: 67
State: TX

Vax Date: 04/01/2021
Onset Date: 04/26/2021
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: None known

Symptom List: Dysphagia, Epiglottitis

Symptoms: Crushing headache, general malaise, disturbing heart palpitations and skipping of heartbeat, neck pain, Chest pressure

Other Meds: Fosteum, Vitamin s - D, C, B-Complex, Glucosamine, Biotin, DHEA, ZMA

Current Illness: None

ID: 1424864
Sex: F
Age: 29
State: MT

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

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1424865
Sex: F
Age: 83
State: IA

Vax Date: 03/04/2021
Onset Date: 03/08/2021
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: penicillin g, actos, glyburide, januvia, lipitor, lisinpopril, metformin, statins, welchol, jardiance, metoprolol

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

Symptoms: Shortness of breath (very) and heart palpitations (many)... diagnosis of congestive heart failure from a cardiologist

Other Meds: acetaminophen 500mg, asa 81mg, basglar kwikpen nightly, fish oil 1g, flaxseed oil, gabapentin 100mg TID, magnesium 400mg qd, preservision AREDs, multivitamin with minerals, docusate 250mg bid, vitamin B-12, vitamin C, vitamin D3, isosorbide

Current Illness:

ID: 1424866
Sex: F
Age: 33
State: IN

Vax Date: 05/20/2021
Onset Date: 05/21/2021
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fatigue the next day - began when waking up around 8 am in the morning. Continued to approximately 6 pm the same day.

Other Meds: Claritin, tri-sprintec

Current Illness:

ID: 1424867
Sex: M
Age: 63
State: FL

Vax Date: 05/29/2021
Onset Date: 05/30/2021
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: None

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

Symptoms: 18 hours after vaccine experienced chills, joint pain, fatigue followed by sweats and low grade fever . Flu like symptoms subsided 36 hours later. Next about 3 days later FLASHING LIGHTS IN LEFT EYE WHICH SUBSIDED AFTER THREE OR 4 DAYS AND ,PERSISTENT DAILY CHRONIC HEADACHE AND INTRACRANIALPRESSURE WHICH HAS NOT SUBSIDED AT TIME OF THIS REPORT 26 DAYS IN DURATION AND STILL PRESENT.NO PREVIOUS HX OF HEADACHES.

Other Meds: Brilinta 60mg 2xDaily Metoprolol 12.5mg 2xDaily ASA 81mg 1xDaily Crestor 20mg 1x Daily Centrum Silver Multivitamin 1xDaily

Current Illness: None

ID: 1424868
Sex: M
Age: 19
State: NC

Vax Date: 06/21/2021
Onset Date: 06/21/2021
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: patient fell down but was unaware of doing so, he almost immediately was conscious again and went and sat down, he was sweating all over for about 15 minutes as well; he was given a bottle of water and was observed until the EMS arrived: after they arrived and checked him out he left without the EMS

Other Meds:

Current Illness:

ID: 1424869
Sex: M
Age: 17
State: AZ

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

Lab Data:

Allergies: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: none initially - second day had fever, body aches and some chest tightness

Other Meds: Fluticasone, cetirizine, melatonin, ibuprofen

Current Illness: Asthma

ID: 1424870
Sex: M
Age: 27
State: CA

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: N/A

Symptom List: Pharyngeal swelling

Symptoms: Brief fainting episode after the shot (I always pass out after shots)

Other Meds: N/A

Current Illness: N/A

ID: 1424871
Sex: F
Age: 77
State: MO

Vax Date: 03/25/2021
Onset Date: 06/19/2021
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: Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Deep vein thrombosis

Other Meds: Gabepintin, pravastatin, clonaphen

Current Illness: None

ID: 1424872
Sex: F
Age: 17
State:

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Upon walking to recovery area patient went pale and fainted. Witnessed fall, fell and hit head on the floor. Vital signs taken: BP:110/60 HR:70 SpO2: 98% in RA. Pt initially did not recall receiving vaccine but when asked orientation questions, she answered all appropriately (A&Ox4). Within five minutes EMS on scene to assess pt. Pt could not recall last meal, BG checked and was 91. Upon sitting up pt was nauseated and dizzy. Pt transferred to ED for follow up care.

Other Meds:

Current Illness:

ID: 1424873
Sex: M
Age: 16
State:

Vax Date: 05/17/2021
Onset Date: 05/18/2021
Rec V Date: 06/24/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: supraclavicular lymphadenopathy on left side and vaccine on left arm

Other Meds: none

Current Illness:

ID: 1424874
Sex: F
Age: 33
State: IN

Vax Date: 06/10/2021
Onset Date: 06/11/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Fatigue and pain at injection site starting the morning after. Fatigue resolved by the end of the day.

Other Meds: Claritin, tri-sprintec

Current Illness:

ID: 1424875
Sex: M
Age: 29
State: MO

Vax Date: 12/24/2020
Onset Date: 02/17/2021
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: None

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

Symptoms: I am an internal medicine resident at a hospital. By the end of one my call days I started having substernal chest pain, non radiating that was worsened with breathing. I initially thought it was heartburn so I took tumms followed by PPI without any improvement. The pain continued to worsen so I did a quick bedside echocardiogram on myself (poor quality probe), however did not appreciate any effusion, wall motion abnormalities or change in EF. I continued my shift and went home in poor shape unable to speak due to pain on deep breathing. When I laid on my bed the pain worsened significantly and improved when sitting up, so I suspected pericarditis and started NSAIDs. Symptoms improved significantly the following morning and resolved in 36-48 hours with the NSAID course. I never did an EKG to confirm the diagnosis and was never started on anything other than the NSAID course due to uncertain diagnosis. After hearing concerns with myocarditis with pfizer I thought I would report my case knowing it is nearly 2 months after vaccination and there is no definitive diagnosis.

Other Meds: None

Current Illness: None

ID: 1424876
Sex: F
Age: 40
State: OR

Vax Date: 03/30/2021
Onset Date: 04/03/2021
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: Egg allergy

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

Symptoms: I think I experienced Myocarditis. I had weird heart flutters that started a few days after first shot and got worse after second but cleared up about a month after second dose. I?ve never had anything like that before and I?m in very good physical shape.

Other Meds: B vit complex, D3, hyaloronic acid, MSM, magnesium, probiotics

Current Illness: None

ID: 1424877
Sex: F
Age: 73
State: MI

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: 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: Pain at injection site, immediate dizziness, lightheadedness, feeling like head heavy and like someone slamming it, forgetfulness. Extremities felt heavy, like I'd been drugged. Pharmacy people took turns staying with me in the waiting area for an hour until I could walk out of the store and drive the five-minute drive home. Slept all afternoon. Felt nausea in evening, which persisted the next day along with dizziness and need to sleep. This is second day and feeling better by evening, but not fully recovered from lightheadedness. Called my doctor and reported adverse effects.

Other Meds: no

Current Illness: none

ID: 1424878
Sex: F
Age: 37
State: IL

Vax Date: 05/18/2021
Onset Date: 05/18/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Muscle spasms/twitching in right arm evening of first dose. Muscle twitching/spasm in left arm evening of second dose. Narcolepsy symptom of daytime sleepiness exasperated since vaccination ?worse since receiving second dose, but somewhat worse after first dose. Has persisted and is worse than prior to receiving vaccine.

Other Meds: Provigil 200mg

Current Illness: None

ID: 1424879
Sex: F
Age: 14
State:

Vax Date: 06/24/2021
Onset Date: 06/24/2021
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:

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

Symptoms: 16:06, patient went into syncope x3. 911 was called. Blood sugar: 116, RR-14, O2SAT-98%, heart was 45 bpm. When patient awoke heart rate would stay above 80 bpm but would drop back down to mid 40's, then she would become unconscious. Patient's speech was sluggish. Skin was pale and warm to the touch. Constant communication was given to try to keep patient awake. Airway remained. Patient showed no signs of inflammation. 16:10, patient was awake. Alert and oriented to person, place and time. O2SAT-98%, heart rate 82, RR-20. 16:22, patient was taken by ambulance.

Other Meds:

Current Illness:

ID: 1424880
Sex: F
Age: 78
State: NC

Vax Date: 02/01/2021
Onset Date: 02/19/2021
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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: sleep for 36 hours, then nauseas, headache, After that four 4 months no taste or smell Terrible taste in mouth

Other Meds: metforim,lovasatatin,lisinopril,metoprplol,omeprazol,furosemide,duluxetine,baclofe,trazone,potassium,magnesium.vitamins C

Current Illness: none

ID: 1425005
Sex: F
Age: 30
State: MS

Vax Date: 01/01/2021
Onset Date: 02/01/2021
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: Avocado, doxycycline, bananas, tree nuts, soy

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Cycle disturbances. Bleeding every 2 weeks since 1 month after 2nd shot.

Other Meds: Synthroid, metformin

Current Illness: None

ID: 1425006
Sex: M
Age: 47
State: NC

Vax Date: 04/27/2021
Onset Date: 05/15/2021
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: No

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

Symptoms: Can't not see from the left eye anymore

Other Meds: No

Current Illness: No

ID: 1425007
Sex: M
Age: 19
State: MD

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

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA Events: Severe chills, body aches, headache, tension headache, palpations, fever, lightheadedness.

Other Meds: One-A-Day Men's Multivitamin Suppliment

Current Illness:

ID: 1425008
Sex: M
Age: 49
State: CO

Vax Date: 06/11/2021
Onset Date: 06/13/2021
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: none

Symptom List: Unevaluable event

Symptoms: Extreme chills and shaking for 90 minutes

Other Meds: none

Current Illness: none

ID: 1425009
Sex: M
Age: 61
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: LA

Lab Data:

Allergies:

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

Symptoms: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425010
Sex: M
Age: 83
State:

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/24/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient with advanced parkinson's, dysphagia, on G-tube feed received J&J vaccine on 6/9 per wife, developed fatigue/general weakness, developed fever, admitted to hospital for aspiration pneumonia/sepsis/acute respiratory failure.

Other Meds:

Current Illness:

ID: 1425011
Sex: F
Age: 31
State: OH

Vax Date: 03/14/2021
Onset Date: 03/28/2021
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: Amoxicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: At the time of my first vaccine injection on 3/14/21 I was approximately 6 weeks pregnant. I suffered a missed miscarriage somewhere between then and 4/9/21, my first prenatal checkup and ultrasound.

Other Meds: Prenatal supplement

Current Illness: None

ID: 1425012
Sex: M
Age: 18
State: NC

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: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Patient fainted 5 minutes after the administration of the vaccine, he could still talk and told me that he was having difficulty breathing so while 911 was on the way I injected one dose of Epinephrine 0.3 mg. He was also pale and sweating. I was making sure he had a pulse, when 911 arrived they assess him and his blood pressure was a little high. After maybe 15 minutes he was feeling better and he told us that he was afraid of needles. Honestly we do not know if he was very anxious or if he had a reaction to the injection since he mentioned his throat was closing.

Other Meds: None

Current Illness: None

ID: 1425013
Sex: M
Age: 56
State: MT

Vax Date: 05/12/2021
Onset Date: 05/12/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425014
Sex: F
Age: 54
State: KY

Vax Date: 03/04/2021
Onset Date: 03/05/2021
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: penicillins, azithromycin, cephalexin,, bananas, cucumbers

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: unresolving sinus infection

Other Meds: vitamin D, 81 mg ASA, zoloft 200 mg, QD, abilify 5 mg QD,, losartan 50 mg QD, amlodipine 2.5 mg QD, ibuprofen prn OTC, acetaminophen OTC prn, hydrocodone 7.5 mg/APAP 325 TID, estradiol 1 mg QD, medroxyprogesterone 2.5 mg QD, flonase QD o

Current Illness: HTN, depression, anxiety, post menopausal, seasonal allergies, DJD, prior cervical fracture with chronic pain, scoliosis, spondylolisthesis, arthritis

ID: 1425015
Sex: F
Age: 55
State: CO

Vax Date: 05/21/2021
Onset Date: 05/27/2021
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: none

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

Symptoms: The 2 wks following the 2nd Moderna vaccine, I experienced frequent myocarditis incidents: days 3, 6, 7, 10, 14 (twice). This is five times more frequent than any point previously. On 6/9/2021, at 9:05 a.m. I fainted for the first time ever. At 2 p.m. I experienced a hemorrhage in my right eye from a torn retina.

Other Meds: Stelara, Vyvanse (both taken for over ten years)

Current Illness: none

ID: 1425016
Sex: M
Age: 28
State: AZ

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: No allergies

Symptom List: Nausea

Symptoms: Vaccination was administered to the patient, the patient was a little nervous at time of administration. After 5 to 10 minutes of waiting in the pharmacy the patient was lightheaded and dizziness. The patient passed out and fell over, hitting his head on the wall of the pharmacy. The patient was briefly shaking/convulsing per the mother for a few seconds until the patient woke up. The pharmacy staff rushed out to the patient's aid. The patient was confused when he woke up . We had him lay on the floor for a few minutes then helped him up to a chair to sit when he felt better. The patient explained how this has happened to him before when receiving vaccinations, he gets lightheaded and dizzy when receiving vaccinations. The patient explained how he did not take any medications or has any health conditions. The patient refused medical attention and said he felt ok as we waited with him for 5 minutes. We recommended the patient to see a doctor if he as any symptoms. The patient waited for an extra 30 minutes and said he felt fine. The patient's mother and the patient left with the mother driving him home.

Other Meds: None

Current Illness: No illnesses or health conditions

ID: 1425017
Sex: F
Age: 54
State: MT

Vax Date: 05/12/2021
Onset Date: 05/12/2021
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: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425018
Sex: M
Age: 50
State: DC

Vax Date: 04/14/2021
Onset Date: 04/16/2021
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: Penicillin

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

Symptoms: None stated.

Other Meds: No

Current Illness: No

ID: 1425019
Sex: M
Age: 23
State: CA

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: Client's companion alerted EMT client was not feeling well. EMT informed PHN. Upon arrival at 1736 client sitting in chair, pale and diaphoretic. Client alert and oriented x4. EMT performed vitals at 1736: blood pressure 140/90, pulse 59, oxygen sat 100%. PHN began assessment. Client reported blurry vision, shortness of breath and feeling "very hot all over body". Client denies throat closing, no flushing noted, no swelling noted. Client diaphoretic, shirt soaked, arms and legs. Client pale and lips pale. Client reported has history of fainting with blood draws, no current medications and no known allergies. At 1740 client reports feeling "I can't take a full breath", pulse 43. PHN calls 911 at 1740. PHN and PHN observed client using upper muscles to take breaths. PHN auscultated clear lung sounds. 1743 weak pulse, 54. Client diaphoretic, alert and oriented x4. Client reports new onset of headache at. Vitals at 1744: blood pressure 130/80, pulse 56, oxygen sat 99%. At 1747 manual pulse 58. Fire Department arrived at 1748 and assumed care. Client signed AMA and walked out of facility at 1754 immediately after Fire Dept leaves.

Other Meds:

Current Illness:

ID: 1425020
Sex: M
Age: 28
State: MT

Vax Date: 05/15/2021
Onset Date: 05/15/2021
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:

Symptom List: Tremor

Symptoms: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425021
Sex: F
Age: 42
State: TN

Vax Date: 06/11/2021
Onset Date: 06/20/2021
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: SULFA CLARITHROMYCIN, CODIENE, OPIOIDS

Symptom List: Erythema, Pruritus

Symptoms: COVID ARM- PATIENT DEVELOPED A RED, SWOLLEN, ITCHY LUMP AT INJECTION SITE WEEKS AFTER VACCINATION

Other Meds: PROPRANOLOL ER 80 MG, PANTOPRAZOLE DR 40MG, ATORVASTATIN 20 MG

Current Illness:

ID: 1425022
Sex: F
Age: 17
State:

Vax Date: 06/16/2021
Onset Date: 06/16/2021
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: 17yF w/chest pain, SOB, elevated troponins following pfizer vaccination

Other Meds:

Current Illness:

ID: 1425023
Sex: F
Age: 36
State: MT

Vax Date: 05/15/2021
Onset Date: 05/15/2021
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: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425024
Sex: M
Age: 52
State: AL

Vax Date: 04/12/2021
Onset Date: 04/25/2021
Rec V Date: 06/24/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient was immobile, not able to move when he was found and once transported to hospital they concluded patient had a stroke. He has been hospitalized since 4-25-21.

Other Meds:

Current Illness:

ID: 1425025
Sex: F
Age: 60
State: MT

Vax Date: 05/12/2021
Onset Date: 05/12/2021
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:

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

Symptoms: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425026
Sex: F
Age: 12
State: FL

Vax Date: 06/01/2021
Onset Date: 06/10/2021
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: None

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

Symptoms: Right sided intermittent eye pain, ongoing on a daily basis since June 10, 2021. Treated with warm compresses, ibuprofen and acetaminophen. Unresolved as of this report.

Other Meds: Multivitamins, probiotic, sodium docusate

Current Illness: None

ID: 1425027
Sex: F
Age: 41
State: WA

Vax Date: 03/17/2021
Onset Date: 04/25/2021
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: N/A

Symptom List: Pain in extremity

Symptoms: Bilateral pulmonary embolisms Water retention Heart failure

Other Meds: Humira Methotrexate Folic acid One a day multi vitamin

Current Illness: N/A

ID: 1425028
Sex: F
Age: 21
State: CA

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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: none

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

Symptoms: RN vaccinated client approximately 1505 and immediately noticed client turn pale and client stated "I feel dizzy". RN signaled RN to bring anti-gravity chair. PHN joined at 1506. Client was able to transfer herself into anti-gravity chair. PHN took vitals at 1506: blood pressure 122/82, pulse 94, oxygen sat 99%. RN brought client water. Client stated dizziness was improving at 1508. Client's Mother present and stated client had not ate or drank water all day. Client reported being nervous, but did not share information with RN. Client reported no relevant medical history, no medications and no allergies. RN gave client snack and water. Vitals at 1511: blood pressure 120/86, pulse 95, oxygen sat 99%. Vitals at 1516: blood pressure 110/80, pulse 93, oxygen sat 100%. Vitals at 1521: blood pressure 114/84, pulse 89, oxygen sat 99%. Last vitals at 1533: blood pressure 120/80, pulse 88, oxygen sat 100%. Per client dizziness has resolved. PHN advised client to follow up with provider and gave ER precautions. PHN asked client to stand from chair and take a few steps to assess for gait and dizziness. Client stated "feeling fine". Mother would drive client home. Client left facility with steady gait at 1535.

Other Meds: none

Current Illness:

ID: 1425029
Sex: M
Age: 29
State: MT

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

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

Symptoms: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425030
Sex: F
Age: 44
State: OH

Vax Date: 06/13/2021
Onset Date: 06/21/2021
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: Penicillin

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

Symptoms: Itchy, painful, burning red rash all over body. Swollen, stiff joints

Other Meds: Ibuprofen

Current Illness: N/A

ID: 1425031
Sex: M
Age: 57
State: MT

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 06/24/2021
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: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425032
Sex: F
Age: 40
State: CA

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

Lab Data:

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: PATIENT DEVELOPED SHORTNESS OF BREATH, HEADACHE AND PAIN AT INJECTION SITE WITHIN AN HOUR OF RECEIVING VACCINE

Other Meds: patient states she took 0800 Omeprazol 20 mg Vitamin B,C, Zinc

Current Illness: DIIFICULTY SWALLOWING

ID: 1425033
Sex: M
Age: 85
State: MT

Vax Date: 05/12/2021
Onset Date: 05/12/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425034
Sex: M
Age: 66
State: MT

Vax Date: 05/12/2021
Onset Date: 05/12/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vaccine was administered after the expiration date of 4/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1425035
Sex: M
Age: 14
State: WI

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

Lab Data:

Allergies: none

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

Symptoms: Patient was given vaccine with no initial side effects and was asked to wait for 15 minutes before leaving facility. During that wait time patient started to develop blurred vision, and the pharmacist was alerted that the patient fell on the way to the bathroom. Patient was then guided into the immunization room when he briefly lost consciousness. While patient was seated, pharmacist assessed for anaphylaxis reaction and contacted emergency services. Blood pressure was taken and noted to be elevated, other symptoms included blurred vision and sweating. Patient denied itching, swelling, or trouble breathing. Patient did not receive epi-pen and was assessed by emergency services. Patient recovered shortly after emergency services arrived, no further services were needed

Other Meds: none

Current Illness: none

ID: 1425036
Sex: M
Age: 60
State:

Vax Date: 05/02/2021
Onset Date: 05/29/2021
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: Penicillin

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

Symptoms: Blood clots

Other Meds: Vardenafil Ambienn

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm