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: 1427835
Sex: F
Age: 63
State: AZ

Vax Date: 03/23/2021
Onset Date: 03/01/2021
Rec V Date: 06/25/2021
Hospital:

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

Lab Data:

Allergies: adhesives on some bandages (hives)

Symptom List: Dysphagia, Epiglottitis

Symptoms: A few days after receiving the first Moderna Covid-19 vaccine, the low level of tinnitus I normally have ramped up to pretty high levels. It is now June 25, three months later, and the ringing in my ears is still intense. Before my second dose, I researched online if anyone else had experienced tinnitus, or increased tinnitus, and saw that many people had. I called my doctor's office to discuss and we agreed that it would not be wise to take the second injection until the tinnitus resolved back to the low level that I normally have. I still have not taken the second Moderna shot. The doctor's nurse practitioner said the level of protection from Covid would still be effective with only one Moderna shot (in the 80% range), which is comparable to the J & J vaccine which is one dose, so that is what I chose to do. It is still bothering me quite a bit, so I am reporting it since it has not gone away even after 3 months.

Other Meds: Prescriptions: estradiol, progesterone, testosterone (topical), liothyronine, meloxicam (as needed) Supplements: fish oil; kelp; vitamins B2, B12, C, D3, and K2; multivitamin; turmeric and black pepper; calcium; magnesium; zinc; S-adenosyl

Current Illness: none

ID: 1427836
Sex: F
Age: 52
State: NY

Vax Date: 04/18/2021
Onset Date: 04/19/2021
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: Am a long hauler - symptoms were almost like a recurrurance of Covid- fever, chills, diarrhea, headaches immediately that subsided after a couple of days but shortness of breath and tightness of chest continues, as does painful joints and blurry vision

Other Meds: None

Current Illness: None

ID: 1427837
Sex: M
Age: 69
State: IL

Vax Date: 02/26/2021
Onset Date: 04/23/2021
Rec V Date: 06/25/2021
Hospital: Y

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: no allergies

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

Symptoms: Pt began having SOB and lethargy around 03/2021. Increasing SOB in April until May. 6/11/2021 patient had emergent SOB and decreased LOC. Wife called EMS. Pt transported to ED for eval. Bilateral PE shown on CTA.

Other Meds: wife could not list

Current Illness: no

ID: 1427838
Sex: F
Age: 46
State: TX

Vax Date: 03/10/2021
Onset Date: 03/20/2021
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: penicillin, latex

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: After two weeks of the vaccination i had swollen lymph nodes and my neck was in pain a lot. I had to go to the doctors and check it out. I had to do further testing and the lymph nodes were increased and that's when they scheduled the ent check up. It went away after two weeks.

Other Meds: thyroid hormone medicine, gabatine

Current Illness: none

ID: 1427839
Sex: F
Age: 28
State: AZ

Vax Date: 05/28/2021
Onset Date: 05/28/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Pt reported that approx 12 hrs following vaccine, her lips and nails turned "blue". She reports "intense" body aches, chills and difficulty breathing. She also reports headache. She denied and swelling of lips or throat. She did not seek treatment. She took OTC excedrin migraine and states symptoms lasted 3 days

Other Meds: none

Current Illness: none

ID: 1427840
Sex: M
Age: 41
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/25/2021
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 received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427841
Sex: M
Age: 38
State: OK

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: LA

Lab Data:

Allergies: Gluten allergy

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: syncope occurred about 10 minutes after dose. Patient recovered over about 5 minutes and was ok after about 15. No further issues.

Other Meds: n/a

Current Illness: n/a

ID: 1427842
Sex: F
Age: 33
State:

Vax Date: 06/18/2021
Onset Date: 06/19/2021
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: None

Symptom List: Pharyngeal swelling

Symptoms: Cycle stopped completely.

Other Meds: None

Current Illness: None

ID: 1427843
Sex: F
Age: 30
State: CO

Vax Date: 06/20/2021
Onset Date: 06/23/2021
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: No allergies reported

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient has raised bumps rash on both arms. Started approximately 3 days after getting vaccine per conversation with patient. Spoke with her about follow up with and what treatment she was getting. She mentioned she is getting Prednisone from

Other Meds: Unknown

Current Illness: Unknown

ID: 1427844
Sex: F
Age: 73
State: IN

Vax Date: 06/07/2021
Onset Date: 06/07/2021
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: Mellon, Latex, Eye Drops

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 6:00pm- 8:00 pm Stiff neck, swollen glands in neck, headache 10:00pm face became numb in the evening 2 days lump under left arm [glands removed right side Contacted Dr. via Portal she advised second shot on 28 June 2021

Other Meds: Synthroid 100, Diovan 88, 2000 Vit D, 2500 B12, Pepcid Complet

Current Illness: Cold virus

Date Died: 05/24/2021

ID: 1427845
Sex: M
Age: 70
State: MN

Vax Date: 03/30/2021
Onset Date: 05/24/2021
Rec V Date: 06/25/2021
Hospital: Y

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: Hospice patient was hospitalized and died within 60 days of receiving a COVID vaccine series

Other Meds:

Current Illness:

ID: 1427846
Sex: F
Age: 64
State: OH

Vax Date: 04/07/2021
Onset Date: 04/19/2021
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: NKA

Symptom List: Rash, Urticaria

Symptoms: 12 days after 1st shot- Blisters on heels , then blisters , swelling, severe pain of both feet 12 days after 2nd shot- ash on both hands and arms. biopies showed IGA varicosis. 5 weeks of steroids and I can fnally but shoes on. the sores were so bad that the doctor says I will have scars. I have pictures that I would love to send you

Other Meds: levothyroxine, lipator, prilosec, osteo bi-flex

Current Illness: NONE

ID: 1427847
Sex: F
Age: 71
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

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

Other Meds:

Current Illness:

Date Died: 04/25/2021

ID: 1427848
Sex: M
Age: 78
State: NM

Vax Date: 02/19/2021
Onset Date: 04/12/2021
Rec V Date: 06/25/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Symptom onset 4/12, hospital admission date 4/19, died 4/25. Primary cause of death COVID-19, underlying causes sepsis secondary to COVID-19, hepatic encephalopathy, liver cirrhosis

Other Meds:

Current Illness: Liver disease

ID: 1427849
Sex: M
Age: 56
State: AZ

Vax Date: 04/06/2021
Onset Date: 04/08/2021
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: None

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

Symptoms: 5 x 1 inch bruise on inside of right forearm that lasted for 2 weeks.

Other Meds: Pravastatin, aspirin, multi-vitamin, CoQ10, vitamin D, Flax seed oil

Current Illness: None

ID: 1427850
Sex: M
Age: 18
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
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: 1427851
Sex: M
Age: 23
State: IN

Vax Date: 06/25/2021
Onset Date: 06/25/2021
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: none

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

Symptoms: within a minute of the shot (2nd of the series) patient reported graying/reddening of vision and weakness/fainting - sat on ground - drank water - ate cookies - over 10 minutes patient felt better - EMT came in and checked him out - bp at that time 108/60 pulse 60 - blood sugar 66 - after 10 minutes tried to stand - felt weak and dizzy again - vision disturbed again - bp 110/70 - EMT suggested hospital - patient went to hospital

Other Meds: none

Current Illness: none

ID: 1427852
Sex: M
Age: 46
State: MI

Vax Date: 06/22/2021
Onset Date: 06/24/2021
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: NO

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Started breaking out in rash on the torso approx 48 hours after admin that then moved to arms and legs during the day on 6/24/21 and then to face on 6/25/21. Treatment recommended: Benadryl, cortisone, and to check with primary care doctor if rash gets worse or if no improvement in 3-4 days

Other Meds: GABAPENTIN, BUPRENORPHINE/NALOXONE

Current Illness: NO

ID: 1427853
Sex: M
Age: 17
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

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

Other Meds:

Current Illness:

ID: 1427854
Sex: M
Age: 64
State: MO

Vax Date: 06/25/2021
Onset Date: 06/25/2021
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: unknown

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

Symptoms: There was an error when the Pfizer vial was diluted and less than 1.8mL of diluent was added to the vial so a higher than recommended dose was administered. Unknown exact amount of diluent added, but four 0.3mL doses were taken out of vial. Patient notified of error and side effects to monitor for.

Other Meds: unknown

Current Illness: unknown

Date Died: 05/30/2021

ID: 1427855
Sex: M
Age: 26
State: VA

Vax Date: 05/24/2021
Onset Date: 05/30/2021
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: UNKNOWN

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

Symptoms: PATIENT'S MOTHER REPORTED TO PHARMACY THAT PATIENT DIED 6 DAYS AFTER RECEIVING THE JANSSEN COVID 19 VACCINE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1427856
Sex: F
Age: 60
State: VA

Vax Date: 01/29/2021
Onset Date: 02/01/2021
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: Contrast Dye

Symptom List: Unevaluable event

Symptoms: Headache, fatigue, nausea, heavy legs, whooshing in the head, temperature, exhaustion, joint pain, knee pain, sore leg muscles , sore arm joints, sore lower back

Other Meds: Zoloft, Multi Vitamin

Current Illness: none

ID: 1427857
Sex: F
Age: 32
State: NC

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:

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

Symptoms: patient was given shot in immunization room, then was in waiting room to wait the required 15 minutes.. she then began to have panic like symptoms and stated her throat felt funny and was having trouble breathing, the technician came and got myself, pharmacist,, she was already laying on the floor.. I assessed her and she stated the same, that she feels like she is having a panic attack and throat feels funny. I placed a tote under her feet to elevate her legs while she is in the supine position. I explained to her that I need to give her an Epi pen and she then said no, and stated this often happens when she receives shots or sees blood and that she is just having a panic attack. She then stated her breathing is fine and that her throat is fine too. She wanted to leave and I insisted she stay 30 minutes to continue to evaluate her. She agreed too. She did not receive the EpiPen because she was completely recovered and it was a panic attack not anaphylaxis. After 30 minutes she was completely fine, I gave patient my cell # to call me once she was home. She called me once home and was completely fine.

Other Meds:

Current Illness:

Date Died: 05/14/2021

ID: 1427858
Sex: M
Age: 65
State: NM

Vax Date: 04/06/2021
Onset Date: 04/23/2021
Rec V Date: 06/25/2021
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: COVID-19 symptom onset 4/23, hospital admission date 4/30, died 5/14. Primary cause of death COVID-19 viral pneumonia

Other Meds:

Current Illness: Diabetes mellitus

ID: 1427859
Sex: M
Age: 13
State: IL

Vax Date: 06/05/2021
Onset Date: 06/24/2021
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: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: myocarditis requiring care in pediatric ICU

Other Meds: none

Current Illness: none

ID: 1427860
Sex: M
Age: 16
State: IL

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

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1427861
Sex: M
Age: 63
State: FL

Vax Date: 03/23/2021
Onset Date: 03/23/2021
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: LA

Lab Data:

Allergies: TRIPTIN drug gives me flu like symptoms

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I started feeling cold and shaking and very bad headache and discomfort all over. I was bedridden for a couple of days, then it got a little bit better and then it got worse again. Then it got hard to breath. So I lost over 30 pounds in the matter of a month and that is unlike me, I have always been overweight and a food addict and so I called the DR and they told me to get a covid test because the symptoms were similar. I got the test and it was negative. I went to the ER and they said I got pneumonia, which I do not know is related or not but it did happen after the shot and seemed pretty odd. I tend to be the person to just tough things out. At the ER they told me pneumonia in my right light and gave me antibiotics. I called my pulmonologist when home because it was getting worse and he prescribed more antibiotics. I went to see him and he took another x-ray of my lungs. I still had stuff in my lungs so he gave even more antibiotics. He took another x-ray and CT scan recently that I do not have the results of yet. I have vertigo which just started about two weeks ago as well, I read about exercises to do for that and it helped a bit but it came back and now cannot get rid of it. It still is kind of hard to breath as well. I have no appetite which is weird for me and I am cold which is also very strange. I usually could go in a cold place of like 35 degrees and be fine and now I am just always cold. Even when I know I'm hot and know it's hot, I am cold and using a blanket. I shiver and shake so much from being so cold but my bed is soaking wet from sweating, it just doesn't make sense. I have a hard time going to sleep because I am cold and uncomfortable. Even today I am still very tired and now with the vertigo it is hard to do anything today, just talking a lot like right now I am out of breath.

Other Meds: fenofibrate for cholesterol, vitamin c, vitamin e, probiotics, magnesium, amino acids, vitamin D3, supplement cellgevity

Current Illness: n/a

ID: 1427862
Sex: F
Age: 67
State: NC

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I got really tired after the second shot. A lot of fatigue everyday. Joint pain all over the body.

Other Meds: Thyroid medication

Current Illness: No

ID: 1427863
Sex: F
Age: 84
State:

Vax Date: 04/02/2021
Onset Date: 05/03/2021
Rec V Date: 06/25/2021
Hospital: Y

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: Patient hospitalized for TAVR procedure within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1427864
Sex: M
Age: 57
State:

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

Symptom List: Nausea

Symptoms: Erectile dysfunction

Other Meds: Pravastatin, CoQ10, multi-vitamin, flax seed oil, vitamin D

Current Illness: None

ID: 1427865
Sex: F
Age: 22
State: PA

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: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: patient was administered a dose of moderna covid 19 vaccine as her second dose in series. first dose was the pfizer vaccine. given 31 days apart.

Other Meds:

Current Illness:

ID: 1427866
Sex: F
Age: 41
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

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

Other Meds:

Current Illness:

ID: 1427867
Sex: F
Age: 47
State: NC

Vax Date: 06/02/2021
Onset Date: 06/02/2021
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: unknown

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

Symptoms: Patient describes flushing and face, neck and upper chest, dizziness and lightheadedness that started 45 minutes after the vaccine was administered. She had already left the clinic at this time. She did not take any medications or seek any medical attention. The symptoms resolved 45 minutes after they started. She subsequently consulted with her primary care provider, who advised her not to get her second vaccine dose and referred her to an allergist for further evaluation and advice.

Other Meds: unknown

Current Illness: unknown

ID: 1427868
Sex: M
Age: 19
State: MO

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: There was an error when the Pfizer vial was diluted and less than 1.8mL of diluent was added to the vial so a higher than recommended dose was administered. Unknown exact amount of diluent added, but four 0.3mL doses were taken out of vial. Patient notified of error and side effects to monitor for.

Other Meds:

Current Illness:

ID: 1427869
Sex: F
Age: 43
State: MA

Vax Date: 05/06/2021
Onset Date: 05/21/2021
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: Shellfish

Symptom List: Erythema, Pruritus

Symptoms: In my first 2 menstrual cycles following the 2nd dose of my COVID-19 vaccine (approximately 2 weeks later), menstruation phase was significantly heavier and longer than my normal menstruation phase. Normal (currently on an Mirena IUD) currently is 5-6 days of hormonal changes and very light. brown or dark colored spotting, with very little red blood, that peaks on day 2 or 3. After the vaccine, menstruation for the next two cycles lasted 8 full days of bright red discharge which was daily heavier than normal conditions and consistent across the days (did not get more or less for 8 days). However, it was never so heavy to be dangerous (e.g. still rarely used a tampon). The concerning or noticeable change was both the color and the length of time. Have only had 2 menstrual cycles so far.

Other Meds: Fluoxetine Claritin Mirena IUD Magnesium Vitamin B Multi-vitamin Ranitidine (occasionally)

Current Illness: None

Date Died: 05/18/2021

ID: 1427870
Sex: F
Age: 69
State: NM

Vax Date: 03/19/2021
Onset Date: 05/03/2021
Rec V Date: 06/25/2021
Hospital: Y

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-19 symptom onset 5/3, hospital admission 5/11, and death on 5/18/2021. Primary cause of death acute hypoxic respiratory failure, underlying cause COVID-19 viral pneumonia

Other Meds:

Current Illness: Diabetes mellitus, rheumatoid arthritis, chronic immunosuppression

ID: 1427871
Sex: F
Age: 28
State: TX

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: N/A

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

Symptoms: My period was supposed to start the day I received my first shot. It has not started since I received the first shot (and I have since gotten the second shot as well). I have had intense cramping but my period has not come back since getting the vaccine. I don't think this is life-threatening, but I am concerned that nobody seems to know what is going on. I have confirmed that I am not pregnant.

Other Meds: Vitamin D

Current Illness: N/A

ID: 1427872
Sex: F
Age: 40
State: ND

Vax Date: 04/15/2021
Onset Date: 04/22/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient hospitalized for supervision of labor and delivery within 6 weeks of receiving COVID vaccination. She had an uncomplicated postpartum course.

Other Meds:

Current Illness:

ID: 1427873
Sex: M
Age: 14
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
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: Patient received dosage after the manufacturer recommended freezer storage time.

Other Meds:

Current Illness:

ID: 1427874
Sex: F
Age: 63
State: NY

Vax Date: 06/18/2021
Onset Date: 06/21/2021
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: Penicillin and all its derivatives

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

Symptoms: Woke up Monday, June 21 feeling fine, just a sore arm, and decided to do some mild exercise. After bending at the waist for the fourth time, my heart started racing and I felt like I would faint. The palpitations began at 10:40 AM and continued for 12 hours into the evening. My normal approaches to bring them under control - bearing down, rest, homeopathic remedies and metoprolol - did nothing. Heart rate was as high as 200+ and slowing dropped to 190 for several hours, 180 for several hours, 174 for awhile and after taking the homeopathic remedy thyroidinum it finally dropped to 94 and has gone back to normal. Basically, I spent Monday day lying on my left side waiting for it to stop, trying to belly breathe slowly. I had no appetite, felt faint each time I sat up. Once the palpitations stopped, I have experienced shortness of breath whenever I go upstairs each day this week. However, as I get further away from the vaccination day, the breathlessness is lessening.

Other Meds: None

Current Illness: Being treated for anemia due to low iron in blood, which results in shortness of breath at times and palpitations.

ID: 1427875
Sex: F
Age: 62
State:

Vax Date: 03/31/2021
Onset Date: 05/13/2021
Rec V Date: 06/25/2021
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:

Symptom List: Pain in extremity

Symptoms: Date of symptom onset: 05/13/21

Other Meds:

Current Illness:

ID: 1427876
Sex: F
Age: 12
State: MO

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: There was an error when the Pfizer vial was diluted and less than 1.8mL of diluent was added to the vial so a higher than recommended dose was administered. Unknown exact amount of diluent added, but four 0.3mL doses were taken out of vial.

Other Meds:

Current Illness:

ID: 1427877
Sex: F
Age: 17
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
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:

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

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

Other Meds:

Current Illness:

ID: 1427878
Sex: F
Age: 39
State: FL

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

Lab Data:

Allergies: Sulfa drugs

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

Symptoms: At about 2am, the patient reported feeling itchy all over and had face swelling. At this point, her tongue started to swell. She was brought to the ER where she received steroids and recovered.

Other Meds: None

Current Illness: None

ID: 1427879
Sex: F
Age: 35
State: MN

Vax Date: 05/10/2021
Onset Date: 06/04/2021
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: Penicillin; sulfa; Ketek

Symptom List: Vomiting

Symptoms: New worsening symptoms started on 06-04-2021, I woke up with my ear itching, were painful, felt like my ears were on fire. My ears were swollen also developed redness, rash on my chest. I ordered Benadryl through delivery for what looked like hives to me. On 06-14-2021 I also developed new allergies that I did not have. My face swelled up and went numb, had tingling sensation to my hands. I went to see my PCP who referred me to an allergist doctor. I also had an allergic reaction to a skin care product that I use. I went to HCF to see a doctor who performed a physical exam. The doctor at the HCF felt my breasts which are so tender to touch, the doctor also could feel the swelling of my lymph nodes in my breasts and also my menstrual cycle is 6 days early this month. To this day the swelling in my lymph nodes are still present and painful. I still continue with fatigue, nausea as before but now I feel its more constant. I do not have my lot# to provide.

Other Meds:

Current Illness:

Date Died: 06/07/2021

ID: 1427880
Sex: M
Age: 69
State: MN

Vax Date: 05/13/2021
Onset Date: 06/06/2021
Rec V Date: 06/25/2021
Hospital: Y

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 was hospitalized and died within 60 days of receiving a COVID vaccine series

Other Meds:

Current Illness:

ID: 1427881
Sex: M
Age: 24
State: TN

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: RA

Lab Data:

Allergies: N/A

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

Symptoms: Approximately 5 minutes after vaccine was administered pt. fell out of chair and lost consciousness for approximately 5-10 seconds. Pt. was turned on his side until consciousness was regained. 911 was called, EMS arrived and evaluated pt. because pt. struck his head when he fell out of the chair. Vital signs were stable and pt. refused any further medical treatment. Pt. remained with nursing staff until 30 minutes after event. No further signs/symptoms of any adverse effects noted. Advised pt. call 911 immediately if shortness of breath, dizziness, difficulty breathing, swelling of the face, lips, or throat develop, chest pain, or any additional emergency arise. Pt. verbalized understanding. From beginning of the event to pt. regaining full consciousness with no symptoms or complications was approximately 5 minutes.

Other Meds: N/A

Current Illness: Congestion, sinus pressure, cough approximately 3 weeks ago.

ID: 1427882
Sex: F
Age: 40
State: NJ

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

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Received 3 Moderna Vaccines. 1st received on 3/31/21. Then she received her second and third vaccine on 5/3/21 and 6/1/21. I spoke to find out if this was an error or if she did receive 3 vaccines. She expressed she did receive 3 doses. She stated she did not return on the proper date after getting her first vaccine so she thought she had to start the series again. She denied telling that she received her first dose. I asked her If I could have a nurse call her back to fill out the VEARS with her and she agreed. Multiple attempts were made to contact this patient to get additional information to fill out forms. She has not called back after several voice messages were left. I am completing this form with only the information from my initial contact with her.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1427883
Sex: F
Age: 45
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
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: 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: 1427884
Sex: F
Age: 92
State: MI

Vax Date: 03/26/2021
Onset Date: 06/02/2021
Rec V Date: 06/25/2021
Hospital: Y

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

Lab Data:

Allergies: Niacin preparations, actos

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

Symptoms: Patient fully vaccinated, admitted to hospital on 05/28/2021 for COVID pneumonia, after being diagnosed per PCR on 05/28/2021. Patient discharged home on 06/02/2021 and then readmitted 06/08/21 to 06/10/21 for failure to thrive. Discharge home with homecare on 06/10/21.

Other Meds: PRN Tylenol, Ventolin inhaler, Dulcolax PRN, multivitamin, miralax

Current Illness: No acute conditions noted.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm