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: 1427731
Sex: F
Age: 48
State: FL

Vax Date: 06/21/2021
Onset Date: 06/22/2021
Rec V Date: 06/25/2021
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: Multiple ulcers/canker sores on mouth, tongue and throat, soreness at injection site, painful swollen lymph node in left armpit.

Other Meds: Nuva Ring

Current Illness: none

ID: 1427732
Sex: M
Age: 4
State: NC

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/25/2021
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: 3" x 3.35" redness and swelling medial to Dtap injection, slight warmness, tenderness

Other Meds: Zyrtec

Current Illness: Allergic Rhinitis

ID: 1427733
Sex: F
Age: 21
State: NC

Vax Date: 05/27/2021
Onset Date: 05/28/2021
Rec V Date: 06/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: The first day after I received my shot I was running a fever of 102. My side effects passed by May 29th, 2021. On May 21st I went to the hospital due to vaginal bleeding. While at medical center I was told I had a miscarriage. I was showing at 4 weeks when I was supposed to be 7 weeks. I found out I was pregnant on April 30th. I got my first dose on May 5th. My first shot I just had soreness, but I?ve had a previous successful pregnancy but lost this one between my first and second dose.

Other Meds: Vitamin D Ceterizine

Current Illness: None

ID: 1427734
Sex: F
Age: 47
State: OH

Vax Date: 04/07/2021
Onset Date: 04/14/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies: cipro and flagyl

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I had no reaction immediately after the injection. It started about a week later, I developed a rash on the back side of my left knee and some random spots on my arms and legs. I assumed it was just an eczema flare and didn't even think that it might be related to the vaccine because I felt fine after both injections. The rash behind the knee got worse. I was given a steroid shot by my physician when I went in to see him and a Medrol dose pack with some Clobetsol cream. As soon as I finished the steroid, the rash came back and spread to different spots. I was then given Prednisone and the same thing happened and continues to happen as soon as I stop the steroid. I went to the dermatologist and they biopsied it and it came back at an allergic reaction but no one will test or can test to see if it's to the vaccine I am told because it's so new. I went to the allergist and they didn't test. The rash had caused a malar flush and for a minute they thought I had developed Lupus and nothing to do with the vaccine. I have now had blood work that has ruled out lupus but I will be finishing the 5 round of steroids soon and still have no answer. I do not know if it's related to the vaccine but that is the only new thing I have been exposed to. I am afraid that this is related to the vaccine and no one will tell me how long it will or can last since it's so new and nothing is known. I don't want to keep taking steroids but as soon as I stop, it comes back. I am not even sure that filing this out is the right thing to do.

Other Meds: Midi birth control, vitamin d, multivitamin and melatonin

Current Illness: n/a

ID: 1427735
Sex: F
Age: 47
State:

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/25/2021
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: Vaccine administered after the expiration date of 04/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1427736
Sex: M
Age: 80
State: IL

Vax Date: 02/26/2021
Onset Date: 04/29/2021
Rec V Date: 06/25/2021
Hospital: Y

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: Allergen Reactions ? Ace Inhibitors Angioedema ? Losartan Angioedema Angioedema to ACEi. ? Morphine ? Statins Myalgia ? Tricor [Fenofibrate]

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

Symptoms: 4/29/21 hpi admission to inpatient: 80 y.o. male with a past medical history notable for Diabetes, history of CVA, arthritis, reflux, BPH, hyperlipidemia, hypertension. The patient presents for evaluation of Worsening issues of weakness and hyperglycemia in addition to being worsening itchiness. Patient states he has had some issues with worsening reflux. Patient has not any emesis. Patient's wife thinks he may be slightly jaundiced. Upon further evaluation patient was found to have pancreatitis. Patient was placed in-patient will hold patient NPO and provide IV fluids. Patient has had pancreatitis previously. Patient's itchiness is probably due to elevated transaminases. Patient's past medical history, past surgical history, social history, family history, medications allergies were reviewed. Transferred to hospital 5/1 HPI: 80 y.o. man with a history of type II DM, hypertension, and remote h/o CVA who presented to hospital following transfer from another hospital for acute pancreatitis. Patient was initially admitted to their facility on 4/29, treated for pancreatitis with IVF, pain medication, and antiemetics. He LFTs failed to improve. RUQ US with no evidence of gallstones. Transferred here for MRCP/ERCP. He currently denies any abdominal pain. No chest pain. Breathing stable. No fever or chills. He states he has been having some belching and acid reflux for the last 1-2 weeks, worsening after a trip 1 week ago. 5/17/21 radiology: Malignant neoplasm of pancreas Admitted 5/20 - 5/24: Open biopsy of liver/Pancreas, ECRP 6/14 Office Vist : oncology, pancreatic carcinoma metastatic to liver

Other Meds: Current Outpatient Medications on File Prior to Encounter Medication Sig Dispense Refill ? acetaminophen (TYLENOL) 500 MG tablet Take 500 mg by mouth every 6 hours as needed for Pain ? bisoprolol-hydrochlorothiazide (ZIAC) 10-6.25 MG pe

Current Illness:

ID: 1427737
Sex: M
Age: 60
State: NC

Vax Date: 06/24/2021
Onset Date: 06/25/2021
Rec V Date: 06/25/2021
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: Morphine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fever over100. Mental fog

Other Meds: Flomax, Testosterone replacement, omega3, multi vitamin

Current Illness: N/A

ID: 1427738
Sex: F
Age: 79
State:

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/25/2021
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: Vaccine administered after the expiration date of 04/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1427739
Sex: M
Age: 34
State: MI

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies: PCN. Garlic, Silver

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: First one couple days later gave edema in feet and ankles Second caused Edema and Neuropathy. Following immediately that evening and worsening each day and still going on.

Other Meds: Novolog, Lantus, Tadalfil

Current Illness: Diabetes Mellitus Type 1

ID: 1427740
Sex: F
Age: 62
State: MO

Vax Date: 04/28/2021
Onset Date: 05/01/2021
Rec V Date: 06/25/2021
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: penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Woke with extreme pressure on left side, painful. Lasted five after first shot. Activity , stress, and laying increased pain. Never any heart issues or lung issues before. Run 15 miles a week for 30 years and never any issues until now.

Other Meds: fiber vitamins probiotic and digestive support

Current Illness: none

ID: 1427741
Sex: M
Age: 30
State:

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/25/2021
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: Vaccine administered after the expiration date of 04/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1427742
Sex: M
Age: 63
State: OR

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 06/25/2021
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: When I got the shot, nothing happened. My blood pressure was normal. The next day when I woke up, my heart problems had worsened and my blood pressure was high. Through out the day my blood pressure stayed high. Days later I spoke with a doctor and decided to go to urgent care. They triaged me there. They did vital signs and got me into a clinic examination room. They noticed my heart rate was fluctuating from 93 to 49 BPM. My heart rate had been dipping into the 40s. I didn't take the medicine I was given because of my already low heart rate. I was concerned that the medicine was going to make my heart rate drop even more. When I spoke to my cardiologist he said it may of been the vaccine that caused inflammation and problems with my heart rate. June 14th I went to the ER because my heart beats were severe. At the ER they agreed that it could've been the vaccine that caused the problems. The doctor said it may be inflammation that would resolve in time. It was an unusual heart beat pattern. The ER doctor told me to request an echocardiogram. The echocardiogram said I had atrial premature complex and left ventricular hypertrophy. After the 1st dose my high blood pressure went up but intensified after the 2nd dose.

Other Meds: Multivitamins

Current Illness:

ID: 1427743
Sex: F
Age: 63
State:

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaccine administered after the expiration date of 04/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1427744
Sex: M
Age: 51
State: SC

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/25/2021
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: none known

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

Symptoms: Around 6 pm a headache developed. By 9:00 pm there was a stiff neck, facial swelling, and some swelling of the throat. Went to the emergency room; after waiting for 3 hours the symptoms were subsiding but still present. Oral prednisone was given and went home.

Other Meds: Men's multivitamin, Levothyroxine, ubiquinol, low dose aspirin, lisinopril, rosuvastatin, metropolol

Current Illness: none

ID: 1427745
Sex: M
Age: 63
State:

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 06/25/2021
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: Vaccine administered after the expiration date of 04/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1427746
Sex: F
Age: 15
State: IL

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427747
Sex: M
Age: 20
State: SC

Vax Date: 05/12/2021
Onset Date: 06/22/2021
Rec V Date: 06/25/2021
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: PT TESTED POSITIVE FOR COVID 19 AFTER BEING FULLY VACCINATED.

Other Meds:

Current Illness:

ID: 1427748
Sex: F
Age: 71
State: VA

Vax Date: 03/12/2021
Onset Date: 04/01/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies: codeine, bactrim, penicillin, dogs, cats, trees, grasses

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 1. Diagnosed with petechiae 04/01/2021 - no treatment, lesions began to form on lower left and right legs 2. Diagnosed with vasculitis and edema 04/23/2021, treated with antibiotics large lesions mainly on lower left leg, some on lower right, lower legs very swollen, lab results indicated staf infection 3. Diagnosed with high amount of protein in urine and swelling inlayer legs 05/28/2021, treated with furosemide for edema 4. 06/03/2021 - kidney biopsy to check for kidney disease 5. 06/11/2021 - Mild chronic (long term) kidney disease

Other Meds: Gabapentin 300 mg, 3 caps 3 x/day; Aleve as needed; amlodipine 5 mg, 1/day; enalapril 20 mg, 1/day, ferrous sulfate 325 mg, 1/day; fexofenadine 180 mg, 1/day; hydrochlorothiazide 25 mg, 1/day; levebunolol, 1 drop in right eye, 2x/day; metfo

Current Illness: anemia; lumbar radiculopathy (chronic), murmur ( chronic) type 2 diabetes mellitus with microalbuminuris (HCC) (chronic), glaucoma, restless leg syndrome, essential hypertension, mixed hyperlipidemia, elevated LFT's, fatty liver (chronic), microalbuminuria due to type 2 diabetes mellitus (HCC) (chronic)

ID: 1427749
Sex: M
Age: 34
State: TX

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 06/25/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pain in his whole mainly in his mouth and toes. Staring to get a lot of mild sores that wont heal, always coughing, lost 20lbs. Having extreme pain in throat and mouth.

Other Meds: N/A

Current Illness: N/A

ID: 1427750
Sex: F
Age: 38
State:

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 06/25/2021
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: Vaccine administered after the expiration date of 04/28/21. Patient reports no adverse events.

Other Meds:

Current Illness:

ID: 1427751
Sex: F
Age: 23
State: IL

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/25/2021
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: Patient received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427752
Sex: M
Age: 44
State: LA

Vax Date: 03/20/2021
Onset Date: 04/03/2021
Rec V Date: 06/25/2021
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: Two weeks to the day after having second injection of Pfizer Vaccine a lump began to grow behind my right nipple inside my chest/breast. The lump is very painful when pressed on and is shaped like a Cylinder closely resembling a small tootsie roll. The length is approximately 2 inches long and the diameter is maybe 1/4 an inch.

Other Meds: Hydrocodone 5mg, 1 pill 4 times a day Gabapentin 300mg, 2 pill 3 times a day Venlafaxine 75mg, 1 pill per day

Current Illness: None

ID: 1427753
Sex: M
Age: 65
State: CA

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 06/25/2021
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: N/A

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

Symptoms: Client stated that he received his first dose at back in May and does not recall if it was Housing for Health or the Fire Department. He only knows that he was told to come back for second dose at this location. Client information was checked both inand there was no record of him. Notified nurse manager,, and was directed to administer moderna. Client was notified of situation and client consented of moderna. Client had no reaction after 15 min of monitoring post vaccination.

Other Meds: N/A

Current Illness: N/A

ID: 1427755
Sex: F
Age: 21
State: PA

Vax Date: 04/28/2021
Onset Date: 05/12/2021
Rec V Date: 06/25/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Beginning May 12, congestion, sore throat, irritated eyes, headache and feeling overly warm (no fever registered). By the end of May, congestion and sore throat had faded but headaches (several days each week), fatigue (most days each week), and some mental fogginess persist. Treatment of headaches included Tylenol and Advil; Claritin and Allegra were attempted in late May and early June, but symptoms persisted.

Other Meds: None

Current Illness: None

ID: 1427756
Sex: F
Age: 58
State: IA

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies: sulfur

Symptom List: Injection site pain, Menorrhagia

Symptoms: high fever, chills, fatigue, cough

Other Meds:

Current Illness:

ID: 1427757
Sex: M
Age: 43
State: FL

Vax Date: 05/06/2021
Onset Date: 05/19/2021
Rec V Date: 06/25/2021
Hospital: Y

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 developed a DVT in left calf that resulted in multiple pulmonary embolisms; patient complained of shortness of breath x 2 weeks and presented with a swollen and discolored lower leg. X-rays and scans confirmed DVT and PE's. Patient underwent thrombectomy and was on Heparin drip followed by Eliquis at home. Patient discharged from ICU after 3 days.

Other Meds: VYVANSE 70MG ALPRAZOLAM 1MG

Current Illness: NONE

ID: 1427758
Sex: M
Age: 35
State: IL

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/25/2021
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: Patient received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427759
Sex: F
Age: 14
State: UT

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient received vaccine. As she walked out of the consult room she felt dizzy and described that she thought she blacked out. She fell into a plastic room divider and went to the ground. Her dad was right there and hoisted her upright. Offered to call ambulance but patient's dad declined and reported that she had history of being squeamish and had passed out from needles before. Patient was breathing and quickly began responding verbally. Her dad picked her up and she sat upright in a chair. Took patient's blood pressure, provided water, and had patient sit. First blood pressure reading was low (90s over 40s). Offered to call ambulance again. Patient's dad declined. Patient drank water and juice. Retested blood pressure about 15-20 minutes later and it was 116/65 and patient reported that dizziness had subsided. Patient's dad had left message with doctor's office to report what had happened and to see if they wanted her to come in to be seen today. Encouraged him to do that and seek medical attention if anything worsened.

Other Meds:

Current Illness:

ID: 1427760
Sex: F
Age: 52
State: NC

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/25/2021
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: NKA

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

Symptoms: Immediately after receiving vaccine, patient felt dizzy but waited 15 minutes and felt ok to drive home. Upon arriving home, she felt sensation of weakness on her left side. She stated that her vision was somewhat impaired and that she felt weak, although able to move her arms and legs. This lasted for around one hour. She also started to have symptoms of fatigue, stiffness of neck and shoulders(bilaterally), chills, tightness of the upper back and chest but no shortness of breath noted. These symptoms continue. She went to an urgent care office on 6/11/21 and was diagnosed with a sinus infection. No lab work or medical tests were performed. She was prescribed Augmentin and finished full regimen of medication. The symptoms of fatigue, stiffness of neck and shoulders(bilaterally), chills, tightness of the upper back and chest continue today.

Other Meds: None

Current Illness: No

ID: 1427762
Sex: F
Age: 64
State: KY

Vax Date: 06/19/2021
Onset Date: 06/21/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies: shell fish

Symptom List: Nausea

Symptoms: chest pains, didn't dertermine cause

Other Meds: metoprol succ er 50mg, losartan potassium 50mg, atorvastatin 20mg

Current Illness:

ID: 1427763
Sex: F
Age: 20
State: IL

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/25/2021
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 received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427764
Sex: F
Age: 25
State:

Vax Date: 06/21/2021
Onset Date: 06/22/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: I had the Moderna vaccine at 6:35 PM on June 21st, 2021. Pins and needles/tingling on the left side of my face began the following morning at 10 AM on June 22nd, 2021. The tingling goes from in front of my left ear, along my cheek and jaw into my bottom lip. The pins and needles on the left side of my face has been constant since it began, and has NOT resolved as of 06/25/21. Occasionally tingling is felt on right side of face and down into both of my arms/hands. I had aching/tenderness down the left side of my neck/throat, down into my left shoulder blade on 06/24/21, but no injection site pain. I had a doctors appointment on 06/23/21 and they were unable to diagnose me, but told me to follow up if the problem persists which it has. I had no pre-existing health conditions and am an active healthy woman.

Other Meds: None

Current Illness: None

ID: 1427765
Sex: M
Age: 15
State:

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 06/25/2021
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: N/A

Other Meds:

Current Illness:

ID: 1427766
Sex: F
Age: 29
State: MA

Vax Date: 03/01/2021
Onset Date: 04/04/2021
Rec V Date: 06/25/2021
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: Reglan, doxycycline , bees

Symptom List: Tremor

Symptoms: Healthy pregnancy 3rd pregnancy past two were full term. 20 weeks ultrasound looked good. reported decrease movement to doctor after first dosage at 31 weeks. After second dosage repeat decrease movement which continued to become less. Ultrasound done at 34 weeks diagnosed with IUGR at 35 weeks IUGR and oligohydramnios. All preeclampsia testing negative. Baby delivered via c section 4lbs 11oz on 4/4/2021. Required supplemental oxygen support, low glucose, high billi. With delayed feeding. Infant spent 19 days in scn.

Other Meds: Albuterol and symbicort

Current Illness:

ID: 1427767
Sex: M
Age: 86
State: WA

Vax Date: 01/19/2021
Onset Date: 01/23/2021
Rec V Date: 06/25/2021
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: Erythema, Pruritus

Symptoms: Dizziness, swelling of testicles.

Other Meds: Atorvastatin, Lisinopril.

Current Illness:

ID: 1427768
Sex: F
Age: 54
State: ME

Vax Date: 03/23/2021
Onset Date: 03/30/2021
Rec V Date: 06/25/2021
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: Latex, soy, sulfur, fish, penicillin

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

Symptoms: So the first adverse event was shingles, and that was maybe a week or two after the second vaccine, I just don't know because I did not keep track of it all. The second thing was pain in the right shoulder and like terrible nerve pain going up my neck and down underneath my right armpit and also tingling up the right and back of my head - just burning, aching and made it hard to breath at times. I saw the DR at ER on 6/19/2021 and saw a sports medicine DR on 6/22/2021.

Other Meds: Acidophilus herbal supplement

Current Illness: N/A

ID: 1427769
Sex: M
Age: 21
State: IL

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/25/2021
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: Patient received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427771
Sex: F
Age: 16
State: OH

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 06/25/2021
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: hx: Anaphylaxis to peanuts

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient was fine when receiving vaccine,(350 pm) patient and parents were instructed to wait 30 and to stay close in case there was a reaction. after a few minutes parent and patient started to walk to a nearby park bench and when she was sitting she "Looked like something was wrong" per parents, they (Parents walked her back over to mobile unit and the Nurse immediately called 911 at 3:56pm. Patient was talking at this time, she stated she lost hearing, appeared pale and Diaphoretic, patient was sat down and given water, her color started to return to her lips and face, patient stated after a few minutes she started to feel better. the emergency squad arrived at roughly 4:05 pm. Patent walked to squad car and they took her vitals. Patient and family refused to go the hospital. After squad left patient stated that "She only had coffee all day"

Other Meds: unknown

Current Illness: unknown

ID: 1427772
Sex: M
Age: 39
State: CO

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/25/2021
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: After receiving the first Pfizer vaccine, the patient started to suspect that he was going to experience an epileptic event related to the vaccination administration. The patient screamed, and upon assessment the patient's eyes were pointing up and I could see the whites of his eyes, and felt like he was going to vomit. The patient appeared to be oriented. The patient's blood pressure and HR were taken, found to be within BP 133/90 HR at 124. The patient appeared anxious and said that he was "seeing red", and continued to appear restless. The patient stated "I am going to have an event" and "I think I'm having blurry vision". EMS called while this RN comforted the patient during this time and appeared to become calm. Prior to EMS arrived, the patient stated "My body is moving and I'm not doing anything". The patient was encouraged to lay down on the floor as he stated that he felt weak, stated he was having chest pain, and continued to experience intermittent blurry vision. EMS arrived at 1213 and he was assessed. EMS suggested that walking over to the emergency department,and the patient agreed. The patient and son were escorted to the ED triage desk by this RN via wheelchair. On arrival to ED Pt left stating "I feel better and I'm gong to eat some food and come back" Did not return

Other Meds:

Current Illness:

ID: 1427773
Sex: F
Age: 62
State: CA

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 06/25/2021
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: Iodine, penicillin, macrolides, statins, NSAIDS

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

Symptoms: Per pt's agent, Pt had arm pain going down her Right arm (vaccine given in Right deltoid) within 15 minutes of receiving vaccine. Pt left after 15 minutes (pt did not notify us of anything wrong, and went straight to her PCP). Pt's agent said within 1 hour of the vaccine, pt was experiencing arm pain that radiated to neck, shaking, headache, heavy feeling of chest accompanied by shortness of breath, general muscle pain, and worsening of her carpal tunnel. pt agent said PCP gave pt benadryl shot, and prescribed pt hydroxyzine and diazepam (which were promptly picked up by pt agent to be delivered to the pt). Pt relayed all the above information to us as she was on the phone with the pt during this whole conversation. We will follow up with pt today.

Other Meds: Pancreaze, Brand name Singulair, Halobetasol 0.05% cream, Metformin, Methocarbamol, eszopiclone, levothyroxine, Levalbuterol, losartan, buspirone, sertraline, theophylline, potassium chloride, Advair Diskus, Omeprazole, famotidine

Current Illness: Asthma, Heart Disease, pulmonary disease, neuromuscular disease, neurologic disorder

ID: 1427774
Sex: F
Age: 33
State: MA

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 06/25/2021
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: Severe pain in arm/shoulder at vaccination site. Pain has worsened over the month since vaccine was administered and I have had multiple instances of being unable to lift anything with my left arm.

Other Meds: Adderall (generic) instant release 30 mg 2x per day

Current Illness:

ID: 1427775
Sex: F
Age: 16
State: IL

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/25/2021
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 received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427776
Sex: M
Age: 68
State:

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 06/25/2021
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: benadryl,

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

Symptoms: high fever, severe chills, teeth chattering, pounding headache lasting 30 hours

Other Meds: carbamazepine, primidone, Vitamin C, Vitamin D, B6, Magnesium, Naproxen

Current Illness:

ID: 1427777
Sex: M
Age: 21
State: IL

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/25/2021
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: Patient received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427778
Sex: F
Age: 21
State: GA

Vax Date: 05/20/2021
Onset Date: 06/22/2021
Rec V Date: 06/25/2021
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: PT TESTED POSITIVE FOR COVID 19 AFTER BEING FULLY VACCINATED.

Other Meds:

Current Illness:

ID: 1427779
Sex: F
Age: 71
State: IN

Vax Date: 04/22/2021
Onset Date: 05/01/2021
Rec V Date: 06/25/2021
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: penicllan

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: mental fogginess; headache; dizziness; to a lessor extent: nausea. Symptoms started around the first of May and have continued to present. Fogginess has become much more regular. No treatment received

Other Meds:

Current Illness: none

ID: 1427780
Sex: F
Age: 27
State: CA

Vax Date: 05/21/2021
Onset Date: 05/23/2021
Rec V Date: 06/25/2021
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: No known

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

Symptoms: Developed 2 pink maculopapular nonpruritic rashes on right breast and right buttock. She still has them today and they appear to be pityriasis rosea. This initial rash appeared 2 days after her second vaccine. 2 weeks after, she developed what she describes as hives that were not pruritic and were not visible to the eye but can be felt on her skin. They resolved on their own and are not present today. She occasionally will get the pink maculopapular rashes appearing on her trunk still. No treatment.

Other Meds: Adderall, levetiracetam

Current Illness: None

ID: 1427781
Sex: F
Age: 38
State: CA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 06/25/2021
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: Sulphur

Symptom List: Injection site swelling, Limb discomfort

Symptoms: My asthma has been flaring more then it should be (have to use my rescue inhaler depending upon the activity for the day) since I took the 2nd dosage of the Moderna vaccine. My doctor asked me to take the vaccine because I had it and it would be worst if I had COVID again since I had it last year in May. I didn't go to the hospital because I didn't want to be put on a respirator just because I have asthma. Since taking the vaccine I went to urgent care to make sure that I'm fine since I've had COVID.

Other Meds: No

Current Illness: Asthma

ID: 1427782
Sex: M
Age: 57
State: IL

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/25/2021
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: Patient received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427783
Sex: F
Age: 22
State: MD

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Patient had Pfizer COVID-19 vaccine for Dose # 1, and Moderna COVID-19 vaccine was adm as Dose # 2 today. Patient did not have vaccine card with her and told nurse she had received Moderna for dose #1. Verification in system showed patient had in fact received Pfizer for dose # 1 at another clinic but nurse had already adm the Moderna

Other Meds: Unknown

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm