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: 1430269
Sex: M
Age: 44
State: IL

Vax Date: 03/28/2021
Onset Date: 05/23/2021
Rec V Date: 06/27/2021
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: Unknown - N/A Will get tested for allergies soon

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fainted twice after receiving the vaccine. First time 5 days after receding the vaccine, the second time about 6 weeks later. First time I was dehydrated, and fainted at the gym while exercising. The second time I fainted while walking the dog. Both times I broke out in hives, the second time more severely (all over my body). Both times I fell, hit head head and had to get stitches or staples.

Other Meds: Allopurinol 300mg/daily

Current Illness: I fainted on 04/02/21 about five days after the J&J vaccine. Fainted in the gym while exercising, was dehydrated. I never fainted before in my life. Fainted again on 05/23/21 while walking the dog (i.e. not doing strenuous activity). Broke out in full body hives, then fainted on the sidewalk. Needed stitches in my head both times from fainting.

ID: 1430270
Sex: M
Age: 13
State: MI

Vax Date: 06/01/2021
Onset Date: 06/27/2021
Rec V Date: 06/27/2021
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: No

Symptom List: Anxiety, Dyspnoea

Symptoms: My son received his second shot on June 26 10 AM, 8:45 AM the next morning fainted in his bedroom. Pediatrician recommended hospital visit. He was fine but dehydrated. Almost fainted a second time at the hospital. After IV fluids he was much better. Monitoring things now.

Other Meds: Adhd meds - Guanfacine 3 mg & concerta 45 mg

Current Illness: None

ID: 1430271
Sex: F
Age: 45
State: IL

Vax Date: 06/01/2021
Onset Date: 06/12/2021
Rec V Date: 06/27/2021
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: Sulfa, bee stings, mangoes, bananas, morphine

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

Symptoms: Developed hives

Other Meds: Metformin vitamins

Current Illness: None

ID: 1430272
Sex: F
Age: 57
State: PA

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 06/27/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs (rash), versed/fentanyl (vomiting), cantaloupe (itchy throat)

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I woke up the morning after the vaccine so dizzy that I was vomiting. I had brain fog, ringing in my ears and my eyes weren?t right. For almost 2 days I was totally incapacitated. A person in vaccine research heard about me and suggested Benadryl. Within an hour of taking it, I felt a shift in my brain and could think clearer. By the next morning, I could get up and take a shower. I had issues with dizziness until the end of May. The ringing in my ears and the issues with my eyes lasted into June. At times, I also felt pressure behind my right eye, left ear and in my forehead. On May 5, I went to my eye dr because of the pressure behind my right eye, she was shocked to discover my vision had changed and I now had a bad astigmatism only in my right eye. She reported to VEARS. I returned for a check on 6/21/2021 and my vision had almost returned to normal. On 6/2/2021, I had a telemedicine visit with Dr to see why this happen to me and to see what to to in the future about vaccines.

Other Meds: Multivitamin, D3, C, Collagen

Current Illness: None

ID: 1430273
Sex: F
Age: 46
State: MO

Vax Date: 06/26/2021
Onset Date: 06/26/2021
Rec V Date: 06/27/2021
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: Fever, chills, muscle aches, extreme fatigue. I took some Tylenol and went to bed.

Other Meds: Zyrtec, citalopram

Current Illness: None

ID: 1430274
Sex: M
Age: 43
State: OR

Vax Date: 06/14/2021
Onset Date: 06/24/2021
Rec V Date: 06/27/2021
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: Allergic to Penicillin.

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

Symptoms: More prone to bruising, but instead of healing in 4-5days, healing now takes 2-3 days. Cuts and abrasions also take half the time to heal than normal. Wondering if platelet clotting has been affected.

Other Meds: Vitamin/Mineral supplement. EFA. Algae Superfood supplement. D3 Supplement.

Current Illness: none

ID: 1430275
Sex: F
Age: 38
State: MI

Vax Date: 06/27/2021
Onset Date: 06/27/2021
Rec V Date: 06/27/2021
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: PATIENT EXPERIENCED DIZZINESS AND A LITTLE BIT OF NAUSEA

Other Meds: NONE

Current Illness: NEUROLOGIC PAIN

ID: 1430276
Sex: F
Age: 62
State: MI

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 06/27/2021
Hospital:

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

Lab Data:

Allergies: tetracyclines, sulfa and penicillin

Symptom List: Pharyngeal swelling

Symptoms: per tp had dizziness within an hour and nausea and vomiting, also report muscle rigidity in vaccination site. Pt was too fatigued to work or get out of bed for 5 days .

Other Meds: none

Current Illness: none

ID: 1430277
Sex: F
Age: 49
State: AL

Vax Date: 06/22/2021
Onset Date: 06/23/2021
Rec V Date: 06/27/2021
Hospital:

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

Lab Data:

Allergies: Latex

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Besides the soreness on the site and body aches, developed lymph nodes ( a large one on my left armpit and another in my neck- front). Taking Tylenol, iboprofen and using heating pad on it but not getting smaller yet. Went to urgent care saw the doctor this morning ).

Other Meds: Tylenol and Ibuprofen

Current Illness:

ID: 1430278
Sex: F
Age: 44
State:

Vax Date: 06/06/2021
Onset Date: 06/11/2021
Rec V Date: 06/27/2021
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: Menstrual bleeding outside of my normal cycle. It started as minor spotting and has gotten heavier every day. This has continued for over 2 weeks now. Up until this point I have always had regular, clockwork cycles. I will not be getting the second dose until this stops due to the risk of anemia now.

Other Meds:

Current Illness:

ID: 1430279
Sex: F
Age: 61
State: CA

Vax Date: 04/08/2021
Onset Date: 04/23/2021
Rec V Date: 06/27/2021
Hospital:

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

Lab Data:

Allergies: Iodine (IV allergy only), Erythromycin, Penicillin, Ampicillin

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

Symptoms: 04-23-21 - Woke up super dizzy & was unable to get out of bed for about 30 mins after that I had to VERY carefully move around slowly for weeks after that (until mid June) I also had ringing in my ears for most of that time pretty severe at first & still present but better that when I was dizzy. I had not had this before & it is quite unnerving. I have been doing PT for the dizziness & it has pretty much subsided. I have also had pain (no rash or lymph discomfort or swelling) just muscular pain in my upper right arm. This started about a month after the vaccination. It is in the arm muscle NOT the bursa. It happens when I have not moved the arm for awhile & I reach for something, etc.. the pain is not severe but obvious (0 to 10 it is about a 4) & goes down to about a 1 after I move the arm around for 30 seconds or so. I have also had pain & a bit of weakness in my legs & a sharp pain in my left beast (not my chest - the upper left quadrant about 1" below my armpit & 3 inches in the breast tissue. It is a single sharp pain (0 to 10 = 7) and only stays for a few minutes.

Other Meds: Medications & Suppliments (05-02-21) Acyclovir 800mg 400mg am/pm Herpes Estradiol 0.75mg 0.75mg pm HRT Methylphenidate 5mg to 10mg 5mg am AD/HD I take one in the morning so I don't get lost in the house & vape to compensate during the d

Current Illness: None

ID: 1430280
Sex: F
Age: 29
State: PA

Vax Date: 06/26/2021
Onset Date: 06/26/2021
Rec V Date: 06/27/2021
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: Patient describes wide spread tingling and warm sensation in upper body stretching to the face as well as both arms. She reports no fever but is unable to tell if any erythema as she is African American. She said it started late last night and has not changed since that time. She said it felt like she had been out in the sun all day but also the skin was tingling. Since she described tingling skin and warm sensation I had advised her to be checked for possible allergic reaction. Pt was going to go to urgent care to get checked out. Pt did report also suffering from anxiety during telephone call and was not sure it it could have contributed to the situation.

Other Meds:

Current Illness:

ID: 1430281
Sex: M
Age: 35
State: TX

Vax Date: 06/11/2021
Onset Date: 06/12/2021
Rec V Date: 06/27/2021
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: Day of: fatigue 2 hours after Day 2: fatigue, headache, chest pain/burning in left side Day 3: fatigue, continued chest pain Day 7: chest pain subsides

Other Meds:

Current Illness:

ID: 1430282
Sex: M
Age: 59
State: TX

Vax Date: 04/01/2021
Onset Date: 04/04/2021
Rec V Date: 06/27/2021
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

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

Symptoms: Tightness in chest, it went away in 4-5 weeks,

Other Meds: Atorvostatin, Flowmax

Current Illness: None

ID: 1430283
Sex: F
Age: 63
State: OR

Vax Date: 04/05/2021
Onset Date: 04/10/2021
Rec V Date: 06/27/2021
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: Tinnitus in left ear

Other Meds: Vitamin D and melatonin

Current Illness: None

ID: 1430284
Sex: F
Age: 68
State: IL

Vax Date: 06/21/2021
Onset Date: 06/23/2021
Rec V Date: 06/27/2021
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: n/a

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

Symptoms: Pt reported arm soreness and pain as well as hardness around injection site

Other Meds: Pravastatin ,Allopurinol, losartan, insulin

Current Illness: n/a

ID: 1430285
Sex: F
Age: 34
State: CA

Vax Date: 05/25/2021
Onset Date: 05/26/2021
Rec V Date: 06/27/2021
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: Doxycycline

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

Symptoms: Bilateral lower extremity ascending numbness to buttocks

Other Meds: None

Current Illness: None

ID: 1430286
Sex: M
Age: 48
State: CO

Vax Date: 04/30/2021
Onset Date: 05/14/2021
Rec V Date: 06/27/2021
Hospital: Y

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: Pericarditis: Onset on May 14th

Other Meds: Atorvastatin

Current Illness: Mild ear infection, treated with amoxicillin beginning of April

ID: 1430287
Sex: F
Age: 24
State: NC

Vax Date: 05/11/2021
Onset Date: 05/12/2021
Rec V Date: 06/27/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient experienced pain and swelling of left arm for about a week after receiving her first dose.

Other Meds: Claritin

Current Illness: N/A

ID: 1430288
Sex: F
Age: 69
State: CA

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/27/2021
Hospital:

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

Lab Data:

Allergies: all stimulants, morphine, epinephrine, sulfur, aspirin, codeine

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

Symptoms: fever, severe headache, flu like symptoms, body aches, dizziness, severe vertigo, numbness in fingers, foggy head, extreme fatigue occurred within 12 hours of injection. Tylenol did not help. Symptoms increased every day. I could not do anything for over a week. Now day 12...symptoms are decreasing. Started taking 1.5 mg of Naltrexone on Day 8. Will increase dosage to 2 pills each night, if symptoms do not go away.

Other Meds: Progesterone cream 200 mg, estradiol patch .0375 mg, Amlodipine 5 mg

Current Illness: none

ID: 1430289
Sex: F
Age: 25
State: CO

Vax Date: 04/23/2021
Onset Date: 05/04/2021
Rec V Date: 06/27/2021
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: N/A

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

Symptoms: Moderate chest tightness/discomfort in left pectoral area (also soreness/aching), trouble getting a full breath - symptoms got better over the course of a week

Other Meds: IUD (Kyleena)

Current Illness: N/A

ID: 1430290
Sex: F
Age: 63
State: KY

Vax Date: 06/21/2021
Onset Date: 06/22/2021
Rec V Date: 06/27/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Unevaluable event

Symptoms: 6/21: mild arm soreness, afebrile, asymptomatic. 6/22 PM: softball-sized inflammation, warm/hard to the touch, painful, afebrile. 6/25: swelling had gone down, but a bruise and some numbness was developing at injection site. about a golf-ball sized area inflamed, red and warm to the touch; much less pain than before, not getting any worse.

Other Meds: No known medications on profile

Current Illness: None

Date Died: 05/11/2021

ID: 1430291
Sex: F
Age: 43
State: NC

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 06/27/2021
Hospital: Y

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: NKDA

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

Symptoms: Started with body aches, joint pain and weakness, followed by SOB that was aggravated over time- especially after the 2nd dose- Then, she started having increase heart palpitations and chest pressure. Eventually noted ischemic changes with purplish discoloration face, hands and feet. At this time it became great effort to walk due to lack of air- SOB was severe. She was taken to ER at hospital where she was admitted with possible PE, MI or heart failure. After few days no improvement was achieved and patient trans ported to another Hospital to receive more advance care but she was pronounced death in the morning of 5-11-21. The death certificate heart failure as immediate cause of death, preceded by PE and pulmonary hypertension.

Other Meds: Omeprazole before vaccine Albuterol after 1st vaccine

Current Illness: Gastritis

ID: 1430292
Sex: M
Age: 22
State: IL

Vax Date: 06/27/2021
Onset Date: 06/27/2021
Rec V Date: 06/27/2021
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: n/a

Symptom List: Injection site pain, Pain

Symptoms: Patient fainted for about 30 seconds. Recovered fine no issues. Per patient normally happens after receiving vaccinations

Other Meds: none

Current Illness: n/a

ID: 1430293
Sex: F
Age: 50
State: TN

Vax Date: 03/31/2021
Onset Date: 06/01/2021
Rec V Date: 06/27/2021
Hospital:

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

Lab Data:

Allergies: No e

Symptom List: Injection site pain, Menorrhagia

Symptoms: Sore arm for 1 day

Other Meds: Multivitamins, fish oil, aspirin, vitamin d, zinc

Current Illness: None

ID: 1430294
Sex: M
Age: 53
State: MO

Vax Date: 06/27/2021
Onset Date: 06/27/2021
Rec V Date: 06/27/2021
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 was given vaccine and immediately after was bleeding about 2 cottonballs worth. Bleeding stopped after about 1 minute then a small bump under the injection site developed. After 20 minutes the swelling at injection site went down and patient was asked to monitor and report to pharmacy/PCP if it doesn't go away. Patient denied any other reaction. Also denied taking any blood thinners.

Other Meds:

Current Illness:

ID: 1430295
Sex: F
Age: 35
State: CO

Vax Date: 06/24/2021
Onset Date: 06/27/2021
Rec V Date: 06/27/2021
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 symptoms: no strength, hard to breathe, notices blood clots a few inches from injection site

Other Meds:

Current Illness:

ID: 1430296
Sex: M
Age: 30
State:

Vax Date: 06/25/2021
Onset Date: 06/27/2021
Rec V Date: 06/27/2021
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: Approximately 5 minutes after patient received vaccination, the patient passed out. He was standing outside the pharmacy and fell down. Family member cried for help. 911 called. Once I got to patient, he was responsive. Had patient sit up till paramedics arrived. Patient did not go to ER. Tried to call patient 2 days later to see how he was, but no answer. Did not leave message.

Other Meds: no information available, patient did not give info

Current Illness: none

ID: 1430297
Sex: F
Age: 49
State: MI

Vax Date: 04/19/2021
Onset Date: 04/23/2021
Rec V Date: 06/27/2021
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

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

Symptoms: Daily and nightly headache for 2 mo. Severe debilitating insomnia for 2 1/2 weeks. Intermittent burning sensation in my chest for approximately 6-7 weeks , improving.

Other Meds: vit D 2000 IU /daily

Current Illness: no

ID: 1430298
Sex: F
Age: 23
State:

Vax Date: 06/05/2021
Onset Date: 06/24/2021
Rec V Date: 06/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Missed period that is over 4 days late.

Other Meds:

Current Illness:

ID: 1430299
Sex: F
Age: 0
State: NJ

Vax Date: 06/25/2021
Onset Date: 06/26/2021
Rec V Date: 06/27/2021
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: Injection site pain

Symptoms: Second dose was received 4:00 PM friday, June 25. Symptoms started next morning, June 26 at 8:00am. Experienced migraine, nausea, diarrhea, chills, fatigue, stomach cramps and lasted about 14 hours. Followed by fatigue the next day.

Other Meds:

Current Illness: none

ID: 1430300
Sex: F
Age: 16
State: NE

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 06/27/2021
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: 16 and therefore, because Moderna has not been approved for under 18 year olds, she should have not been given that vaccine. This mistake has now been caught and when I took her to the same location to get the second shot, they would not administer the shot due to her age.

Other Meds: None

Current Illness: None

ID: 1430301
Sex: F
Age: 15
State: SC

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/27/2021
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: AFTER vaccination and patient attempted to stand and fell backwards in seat. Patient was incoherent, hot, sweaty, loss color to face and lips and unresponsive. Blood pressure was check 100/46 65 heart rate and temp less the 85degrees. Patient was unresponsive for about 10 minutes. EMS was summoned and the patient was given water and juice to drink. Patient slowly returned to a normal state after about 30 minutes but was still slow to respond.

Other Meds: NONE

Current Illness: NONE

ID: 1430302
Sex: M
Age: 73
State: RI

Vax Date: 02/26/2021
Onset Date: 02/28/2021
Rec V Date: 06/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: Blood pressure began a steady rise over the next several days, up to approximately 160/100. It was a steady rise from approximately 130/85. I had not seen a steady rise like this in the past. It began after the 1st COVID shot (2/26). I did not connect the increase in blood pressure to the vaccine. because it was not listed as a side affect. The trend is evident on a plot of daily blood pressure over. I contacted my PCP when the BP was not returning to normal. PCP added 2.5mg Amlodipine Besylate to medications (5/12). This did not have an affect. My Nephrologist increased my Ramipril dosage from 15mg to 20mg (5/20). My BP began to return to normal (beginning of June). No special tests or hospitalization.

Other Meds: Ramipril 15mg Atorvastatin 10mg Hydrochlorothiazide 12.5mg Centrum Silver Vitamin

Current Illness: None

ID: 1430303
Sex: F
Age: 34
State: NV

Vax Date: 03/30/2021
Onset Date: 04/09/2021
Rec V Date: 06/27/2021
Hospital: Y

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

Lab Data:

Allergies: Lactose intolerance, Morphine , tramadol Topamax

Symptom List: Erythema, Pruritus

Symptoms: Severe cough since April up to now, shortness of breath, Pleural effusion, Bilateral pulmonary embolism. 3 times hospital admissions. April 26th after the first dose, May 25th after the second dose, and June 16th after confirming the pulmonary embolism. I have not been able to work since April 25 to date.

Other Meds: None

Current Illness: None

ID: 1430304
Sex: F
Age: 86
State: TX

Vax Date: 02/08/2021
Onset Date: 05/18/2021
Rec V Date: 06/27/2021
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: none known

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

Symptoms: Myocardial infarction - hospitalization from 5/18/21 until 5/28/21.

Other Meds: Iron -140mg m/w/f Donepezil - 10 mg qd (der to 5mg 2/3) Levothyroxine - 50mcg qd Melatonin - 3mg qhs Metoprolol succinate - 25mg qd Armour thyroid - 30mg qd Sertraline - 50mg qd Vit B12 - 1000mcg qd Vitamin D3 - 5000 units qd Atrovastatin 1

Current Illness: Dementia

ID: 1430305
Sex: M
Age: 34
State: GA

Vax Date: 06/25/2021
Onset Date: 06/26/2021
Rec V Date: 06/27/2021
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 had lips that were swelling one day after event.

Other Meds: Xanax 2 mg

Current Illness:

ID: 1430306
Sex: F
Age: 66
State: OR

Vax Date: 04/08/2021
Onset Date: 04/15/2021
Rec V Date: 06/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: rash diagnosed as pityriasis, which spread . torso, neck arms hands thighs. Then extreme fatigue, general weakness, brain fog. arthr in jointsitic symptoms this went on for six weeks, finally began to improve two weeks ago, rash almost gone except for fingers, which are still slightly swollen. I thought it might be autoimmune flare up.

Other Meds: Thyroid replacement medication

Current Illness: none

ID: 1430307
Sex: M
Age: 34
State: CO

Vax Date: 06/27/2021
Onset Date: 06/27/2021
Rec V Date: 06/27/2021
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: unknown

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

Symptoms: the patient was afraid of needles and blood, the patient was given the shot and asked to remain sited in front of the pharmacy, but in few minutes he got up, got dizzy and fall down, he had never lost consciousness

Other Meds: unknown

Current Illness: unknown

ID: 1430308
Sex: M
Age: 64
State: IL

Vax Date: 04/30/2021
Onset Date: 05/28/2021
Rec V Date: 06/27/2021
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: My right ear has a swooshing sound, almost like a swimmer's ear that has water in it.

Other Meds: Atorvastin,, 40 mg daily. Hydrochlorothiazide, 12.5 mg/daily.

Current Illness: None

ID: 1430309
Sex: F
Age: 38
State: TX

Vax Date: 06/20/2021
Onset Date: 06/01/2021
Rec V Date: 06/27/2021
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: Dose given two days after expiration date

Other Meds:

Current Illness:

ID: 1430310
Sex: F
Age: 64
State: IL

Vax Date: 03/15/2021
Onset Date: 03/25/2021
Rec V Date: 06/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulpha drugs, Augmentin, Bactrim

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

Symptoms: No adverse effects after first Moderna shot, February 15. 4 hours after second Moderna shot, March 15, pre existing tinnitus that I have had for 5 years, volume increased from normal level of 1-2, to volume level of 7-8. This increase in volume lasted only 3 hours, then tinnitus returned to normal 1-2 volume out of 10. On March 25, louder tinnitus returned, back to the volume of 7-8 out of 10. As of this date, June 27, 2021, there has been a little bit of fluctuating to a level of 5-6, but most days its volume of 7-8 is all day long, 24/7. On April 5, 2021, I was prescribed 50 mg of Prednisone for 5 days, no changes in the volume of the tinnitus during or after the 5 days of Prednisone.

Other Meds: Enbrel 50 Mg, Gabapentin 300 mg, Levothyroxine 100 mcg, Lisinopril 10 mg, Fexofenadine, Amitriptyline 25 mg, Vitamin D 2,000 IU, Folic acid 800 mcg, Zinc 25 mg

Current Illness:

ID: 1430311
Sex: F
Age: 46
State: MI

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 06/27/2021
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: Received the vaccine and about 2 hours later I felt an odd sensation in my stomach, this traveled to my head, everything felt like it was moving and this lasted for about 2-3 minutes. After that everything felt fine until later in the evening when I got up to use the bathroom in the middle of the night I walked in to the wall 3x on the way to the bathroom. When I got up the next morning I could not move without feeling extremely sick to my stomach and everything feeling as if it was in motion. I was diagnosed that day at the Dr with vertigo. I followed up with my Dr the following week and sent to PT as I was not feel better. The Physical Therapist determined that I did not have vertigo and could not pin point what was wrong except that I did have balance and motion issues. It has been about 7 weeks since the shot and I continue to have "vertigo" symptoms. I get dizzy and off balance with no explanation. I took several weeks of PT without resolve. I have been to the Neurologist without answers and can only trace it back to starting the day of the Covid shot.

Other Meds: Atorvastatin 10mg. Victoza 1.8 mg. Metformin 500 mg. Sitagtiltin 25 mg. Topiramate 100 mg. Zyrtex 10 mg. Depo-Provera. One a day Multivitamin.

Current Illness:

ID: 1430312
Sex: M
Age: 32
State: KY

Vax Date: 06/27/2021
Onset Date: 06/27/2021
Rec V Date: 06/27/2021
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: 4:10 PM: patient reported feeling "cold". Patient was clammy and upper extremities were cool to touch. Denies lightheaded, dizzy, nausea, other symptoms at this time. Brought back into exam room. Vital signs: BP 106/62, Pulse 62 bpm, Temp 97.1 F, O2 98%. 4:13 PM patient states that he is beginning to feel lightheaded. Lay patient flat on the exam table and propped up lower extremities. Pt lay for about 10 minutes and felt like sitting up, states he is having some improvement in symptoms. Gave him some water to drink and informed him to lay back for a bit longer so we can monitor him and not to get up too quickly because symptoms can return. After resting a bit longer, repeat vital signs at 4:30 PM: BP 120/78, Pulse 74, O2 99%, Temp 97.3 F. Pt reports full recovery from symptoms at 4:30 PM. Leaves the clinic without any distress, steady gait, and improved symptoms amd vital signs. Informed pt will report this and gave him instructions on what to do during next vaccination to prevent this from happening again. Pt verbalizes understanding. Go to ER if any symptoms return or if in any distress.

Other Meds:

Current Illness:

ID: 1430313
Sex: F
Age: 18
State: AZ

Vax Date: 05/29/2021
Onset Date: 06/20/2021
Rec V Date: 06/27/2021
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: none

Symptom List: Vomiting

Symptoms: Unilateral right side facial paralysis-Bell's Palsy

Other Meds: Oral contraceptives, prozac

Current Illness: none

ID: 1430314
Sex: M
Age: 60
State: WA

Vax Date: 06/24/2021
Onset Date: 06/25/2021
Rec V Date: 06/27/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Approximately 20 hours after the injection I was sick with much fatigue and body aches. At about 30 hours had fever, 102 temp with face and injection sites hot to touch. Fatigue and aches lasted the next 24 hours. I also developed about 4 cankers sores in my mouth within about 30 to 48 hours and they continue today 6/27 at 1400 hours. Also have fatigue and aches but less severe than the 24-48 hours following the vaccine.

Other Meds: Angiotensin

Current Illness: Miserable reaction to first dose otherwise, none

ID: 1430315
Sex: F
Age: 30
State:

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 06/27/2021
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: Peanuts

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

Symptoms: 30 year old Female received her first dose of Pfizer Vaccine approximately @ 1211 (Lot #: ER8732 exp 03/24/2021 @ 1045). Patient sat in EMT observation area for 25 minutes, then she reported having a tingling tongue and throat at 1236. EMT sat patient down in zero-gravity chair and started to assess patient, RN recorded incident and assisted with assessment. No sign of swelling in tongue and throat upon EMT assessment. Patient was given water and assessed her medical history, Patient stated that she has an allergy to peanuts and has Asthma, for which she carries an Epi-pen and inhaler on her person. First set of vitals at 1239 (RR 20, HR 96, O2 Sat 98%, unable to assess BP (Large cuff broke- used EMT?s BP Cuff for following BPs). At 1245, patient stated she continues to have tingling on her tongue and throat. Pt offered Benadryl and agreed. At 1250, RN administered 50mg PO Benadryl. Patient was educated of potential side effect of drowsiness with medication. Patient stated she would call her mom or roommate to pick her up. At 1255, vitals reported: (RR 14, HR 96, O2 Sat 97%, Left forearm BP 140/70). Patient stated blood pressure is in her normal range (Patient stated her previous reading was 137/79 last month). At 1257, patient stated she is feeling better and was singing along to the songs playing on the radio. At 1305, assessed vitals: (RR 16, HR 95, O2 Sat 97%, Left forearm BP 144/66). Patient stated she has no more tingling on her tongue or throat. At 1307, patient stood up and sat on a chair near the exit to wait for her roommate. At 1320, roommate picked up patient. Patient left site in stable condition and was alert and oriented x4 with a steady gait.

Other Meds:

Current Illness:

ID: 1430316
Sex: F
Age: 45
State: TX

Vax Date: 06/20/2021
Onset Date: 06/01/2021
Rec V Date: 06/27/2021
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 given past expiration

Other Meds:

Current Illness:

ID: 1430317
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 06/27/2021
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: Extreme aches, chills, fatigue the day after the 2nd vaccine. The 2nd morning after the 2nd vaccine, I broke out in hive on my arms. This continued for a few days, even though I was taking antihistamines night and day. The hives got worse and spread over the rest of my body. After a few weeks, the doctor at work prescribed me a 3-day dose of prednisone(Mar 25), including increasing my antihistamines to 4 times a day (2 morning/2night). The hives went away for about 2 weeks, then returned. Again starting on the arms, then spreading. This time more rapidly and worse than the first outbreak. I made an appointment with my primary care physician, but before the appointment the hives became so severe, my lips, tongue and throat were swelling resulting in an emergency trip to urgent care (28 April), where I was given predisone to get the outbreak under control. A follow up with my primary care physician the next day(29 April) resulted in a 10 day treatment of prednisone with much higher does than the first round plus an increased dosage of antihistamines multiple times a day. This time the hives went away for about 5 weeks after treatment before returning again. Again, the outbreak started on the arms and spread, including to my throat after only a few of days. This time, my doctor prescribed a round of prednilsone(14 June) and changed my antihistamines to 8 doses a day. The hives this time started again only 3 days after the last does of the steroids. (June 23). It is unknown if this condition will ever go away. My doctor indicated it appears the vaccine has created some time of autoimmune response, where it is likely there are proteins created by the vaccine attacking my mast cells resulting in the hives. I wish I had never had the vaccine. I have missed countless hours/days at work. It is so depressing to be constantly in agony. Let alone the over $1000 in doctors bills so far.

Other Meds:

Current Illness:

ID: 1430318
Sex: F
Age: 95
State: NY

Vax Date: 06/27/2021
Onset Date: 06/27/2021
Rec V Date: 06/27/2021
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: N/A

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

Symptoms: Female feeling light headed after receiving shot. Denies any C/P, SOB, DIB. Requested to stay with her daughter seated in a chair. refused to lay down. Vitals obtained. Refused further care or evaluation.

Other Meds: N/A

Current Illness: N/A

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm