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: 1431164
Sex: F
Age: 21
State: TX

Vax Date: 06/22/2021
Onset Date: 06/01/2021
Rec V Date: 06/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Vaccine given past expiration

Other Meds:

Current Illness:

ID: 1431165
Sex: M
Age: 57
State: CA

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: unknown

Other Meds:

Current Illness:

ID: 1431166
Sex: U
Age: 12
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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:

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

Symptoms: Patient received vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

Date Died: 06/19/2021

ID: 1431167
Sex: F
Age: 81
State:

Vax Date: 02/17/2021
Onset Date: 05/17/2021
Rec V Date: 06/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Death J18.9 - Pneumonia of both lower lobes due to infectious organism

Other Meds:

Current Illness:

ID: 1431168
Sex: F
Age: 77
State: CA

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/28/2021
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: unknown

Other Meds:

Current Illness:

ID: 1431169
Sex: M
Age: 60
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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 vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

ID: 1431170
Sex: M
Age: 59
State: MI

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/28/2021
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: Left side acute abdominal pain, severe constipation, acute pain in left collarbone, painful swollen mass in left armpit, swollen mass in left collarbone.

Other Meds: None

Current Illness: None

ID: 1431171
Sex: U
Age: 23
State: TX

Vax Date: 06/28/2021
Onset Date: 06/01/2021
Rec V Date: 06/28/2021
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 given past expiration

Other Meds:

Current Illness:

ID: 1431172
Sex: M
Age: 39
State: IL

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/28/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Two minutes after injection, patient stated he felt light headed. He started breathing heavily and turning red in the face while clenching his fists. Patient's eyes were open but he was unresponsive for 30-45 seconds. Patient then became responsive and started breathing normally and returned to normal facial color. He was then alert and feeling normal. Patient was given water and observed for 30 minutes. He walked out on his own with no problems. Was given our contact information and told to call with any issues.

Other Meds: Unknown

Current Illness: None/unknown

ID: 1431173
Sex: M
Age: 13
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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: Patient received vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

ID: 1431174
Sex: F
Age: 60
State: IL

Vax Date: 01/07/2021
Onset Date: 05/17/2021
Rec V Date: 06/28/2021
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: NKA

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

Symptoms: Right after injections no issues at all 4 months later May 17th had right thalamus stroke etiology unknown was on vacation. No pre-symptoms normal blood pressure, no headaches, no cough, no fever. Got up in the morning. picked up shoes and had extreme dizziness and double vision, slight drift of left arm. No other symptoms

Other Meds: Metoprolol ER 50 MG daily Olmestartan-HCTZ 40/12.5 daily Crestor 10 mg daily

Current Illness: none

ID: 1431175
Sex: M
Age: 42
State:

Vax Date: 06/24/2021
Onset Date: 06/26/2021
Rec V Date: 06/28/2021
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: Jab site swelling, bruising and soreness. Fatigue and irritability.

Other Meds:

Current Illness:

ID: 1431176
Sex: M
Age: 49
State: CA

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/28/2021
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: unknown

Other Meds:

Current Illness:

ID: 1431177
Sex: F
Age: 30
State:

Vax Date: 06/26/2021
Onset Date: 06/26/2021
Rec V Date: 06/28/2021
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:

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

Symptoms: Reaction: Pt received vaccine in L arm. Pt had immediate vagal response post vaccine administration. Friend supporting pt until staff assisted pt to floor. Pt placed supine, legs elevated, pulses present, airway patent/breathing and able to communicate with staff. Pt reported being confused. Vital signs at 1401: HR 69, Spo2 97% on RA. 1402 Pt placed on 6L 02 for comfort. 1405 HR 61 BP 135/75 RR 16 Spo2 94%. Overall vagal response lasting 20 seconds. 911 called at 1400. Prior to EMS arrival patient A&Ox4, able to move herself to chair position with stand by assist. Patient tolerated a couple bites of granola and a few sips of water and juice. Patient than lied upon chairs with staff supervision until EMS arrived around 1420. Patient ambulated out of clinic with EMS. No record available if patient seen anywhere after episode

Other Meds:

Current Illness:

Date Died: 06/17/2021

ID: 1431178
Sex: F
Age: 84
State:

Vax Date: 03/09/2021
Onset Date: 06/12/2021
Rec V Date: 06/28/2021
Hospital: Y

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: Death SAH (subarachnoid hemorrhage) Observed seizure-like activity Hypo-osmolality and hyponatremia Acute kidney failure, unspecified Thrombocytopenia, unspecified

Other Meds:

Current Illness:

ID: 1431179
Sex: F
Age: 17
State: OR

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 06/28/2021
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: Both Moderna doses were given at age 17. Per Alert, first Moderna dose was given on 1/22/21 and second Moderna dose was given on 2/24/21 and states "Not Valid" for both.

Other Meds:

Current Illness:

ID: 1431180
Sex: F
Age: 28
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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: Patient received vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

ID: 1431181
Sex: F
Age: 69
State: OH

Vax Date: 05/25/2021
Onset Date: 06/14/2021
Rec V Date: 06/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: hard time breathing , shortness of breath

Other Meds: metoprolol 25 mg Ramipril 10mg hydrochlorothiazide 12.5mg rosuvastatin 5mg aspirin 81mg Caltrate 600 mg prednisone 5mg zytiga 250 mg

Current Illness:

ID: 1431182
Sex: M
Age: 48
State: MD

Vax Date: 06/02/2021
Onset Date: 06/07/2021
Rec V Date: 06/28/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Since about 5 days after the second vaccine shot I have had heart inflammation. Treating with ibuprofen. At this point I have had it for 2 weeks. When the ibuprofen wears off I can feel my heart pounding and I start to have chest pains.

Other Meds: Avorostatin Vitmin d3 Claratin Multivitamins

Current Illness: none

ID: 1431183
Sex: F
Age: 70
State: CA

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 06/28/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: I was sore in the right arm. But I had a horrendous ringing and loss of hearing in my left ear. I have seen a doctor for it regularly since then. I had a surgery to let pressure out of the ear.

Other Meds: Losartan; Banaril; three different types of diabetic medication; a cholesterol med; one for high blood pressure

Current Illness: None

ID: 1431184
Sex: F
Age: 43
State: CA

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 06/28/2021
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: Gluten intolerance; lactose intolerant

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

Symptoms: The day of the vaccine, I had a sore arm and kind of a sore wrist on the right side. The next morning, I felt fine and put some laundry away and I immediately had to take a nap. Tired and took a lot of naps. I didn't have a high fever, my husband said I was a bit warm but no full on fever. I slept a lot on that Tuesday. After that, in the following days, I did notice I had a hard time concentrating and that lasted in all the following weeks. I felt like my energy was back but I couldn't concentrate and I felt really foggy and mind was unfocused. That is still occurring but less so. I mentioned this to my doctor. It's similar symptoms to when I'm having an auto-immune flair. I hadn't changed my diet or stopped taking my medicine but it felt like a flair-up. My doctor said I could come in to check my thyroid if I wanted to. Haven't yet but have just been diligent at taking my vitamins and meds really well so I'm trying to see if that works. I have a family friend who is a naturopath, that recommended how to get my inflammation down. She had me increase VIT D and drink more water and not eat anything that causes inflammation, no bread, pasta, nuts and dairy and she has me taking a microbiome probiotic.

Other Meds: Levothyroxine; VIT D; iron Supplements (for low iron)

Current Illness: No I had been having a cough for quite some time doctor said my lungs were clear Had a COVID antibodies test and that was negative and doctor said it was asthma

ID: 1431185
Sex: F
Age: 15
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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: Unevaluable event

Symptoms: Patient received vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

ID: 1431187
Sex: M
Age: 30
State: CA

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/28/2021
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: NKA

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

Symptoms: I am immediately feeling nauseous and my symptoms are already beginning to mimic the height of my Covid symptoms. I had Covid twice which was not bad either time, and the vaccine is already becoming noticeably worse. I want to make sure I?m tracking as well as possible all negative side effects because I was not able to work without getting the vaccine and I am horribly concerned already because I?ve never got a shot that made me feel this bad.

Other Meds: None

Current Illness: None

ID: 1431188
Sex: M
Age: 69
State: GA

Vax Date: 03/22/2021
Onset Date: 04/22/2021
Rec V Date: 06/28/2021
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: About 1 month after the 2nd dose vaccine, I had swollen right ankle, my right shoulder also felt tense, my right jaw has slight pain when I am opening and closing my mouth. I also feel the area of my heart, a slight sharp pain that comes and goes. I also have buckling of both my knees. I went to see my doctor, They did a X-ray, CT scan, and Venous duplex- everything came back normal and did not find anything, The doctor suggested I decrease salt intake. As of now, I am still having intermitten swollen ankles and buckling of my legs, jaw pain and heart symptoms. I am using a air compression massager to increase the blood flow to the legs.

Other Meds: Verapamil, Xarelto

Current Illness: none

ID: 1431189
Sex: F
Age: 42
State: CA

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 06/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: unknown

Other Meds:

Current Illness:

ID: 1431190
Sex: M
Age: 15
State: SD

Vax Date: 05/16/2021
Onset Date: 05/31/2021
Rec V Date: 06/28/2021
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: Minocycline

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

Symptoms: right before his second vaccine dose, he started have very prominent palpitations, could not lie down at night while sleeping, had to sleep elevated or it was difficult to get his breath, had to lean forward to breath during episodes. During the second week of symptoms, he started having pain in his left shoulder and arm Symptoms were intermittent and worse in the evenings

Other Meds: none

Current Illness: none

ID: 1431191
Sex: M
Age: 38
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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 vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

ID: 1431192
Sex: F
Age: 39
State: CA

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: unknown

Other Meds:

Current Illness:

Date Died: 06/19/2021

ID: 1431193
Sex: F
Age: 71
State:

Vax Date: 02/27/2021
Onset Date: 06/08/2021
Rec V Date: 06/28/2021
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: Death J18.9 - Pneumonia, unspecified organism

Other Meds:

Current Illness:

ID: 1431194
Sex: M
Age: 50
State: CA

Vax Date: 04/23/2021
Onset Date: 05/16/2021
Rec V Date: 06/28/2021
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: Intense itching followed by rash that looks like either fungal infection (jock itch) or pityriasis rosea (on back, trunk, under arms, on top of hand), a little over a month, still ongoing.

Other Meds: Carbamazepine

Current Illness: Trigeminal neuralgia

ID: 1431195
Sex: F
Age: 72
State:

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/28/2021
Hospital:

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

Lab Data:

Allergies: latex

Symptom List: Injection site pain

Symptoms: numbness left side of face and neck

Other Meds: none

Current Illness:

ID: 1431196
Sex: F
Age: 48
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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 vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

ID: 1431197
Sex: F
Age: 36
State: VA

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/28/2021
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: NO ALLERGIES

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

Symptoms: PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.

Other Meds: NO PRESCRIPTIONS OR OTC MEDICINES. PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.

Current Illness: NO ILLNESS

Date Died: 06/06/2021

ID: 1431198
Sex: M
Age: 95
State:

Vax Date: 03/06/2021
Onset Date: 03/28/2021
Rec V Date: 06/28/2021
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: Tremor

Symptoms: death E87.1 - Hypo-osmolality and hyponatremia N17.9 - Acute kidney failure, unspecified

Other Meds:

Current Illness:

ID: 1431199
Sex: M
Age: 68
State: MN

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/28/2021
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: Patient felt as if he was having an SVT, heart felt racing. Patient was seen by a Physician an ekg was obtained and patient's ekg was normal and patient was released to go home.

Other Meds: Prilosec 20mg, Multi Vitamin, Glucosamine 1000mg

Current Illness:

ID: 1431200
Sex: F
Age: 63
State: CA

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: unknown

Other Meds:

Current Illness:

ID: 1431201
Sex: F
Age: 35
State: IL

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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 vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

ID: 1431202
Sex: M
Age: 23
State: FL

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/28/2021
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 REPORTED BY THE PATIENT

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PATIENT FAINTED AND FELL DOWN ON THE FLOOR INFRONT OF PHARMACY AT THE END OF HIS 15MINUTE WAITING PERIOD AFTER THE 1 DOSE OF MODERNA COVID-19 VACCINE. IMMEDIATELY ONE OF THE PHARMACY STAFF CALLED 911 AND THE PHARMACIST WENT OUT TO THE PATIENT TO GIVE MEDICAL HELP AND PATIENT REGAINED HIS CONSCIOUS IN A MINUTE AND SLOWLY HE STARTED TALKING. WHEN ASKED HOW HE IS FEELING,HE SAID THAT EVERYTHING BLACKED OUT AND HE IS FEELING LITTLE WEAK AND SWEATING. IN THE MEAN TIME EMS CAME AND TOOK HIS VITALS AND HE PASSED OUT AGAIN, EMS GAVE HIM MEDICAL ATTENTION AND THEY IMMEDIATELY TOOK HIM TO ORANGE PARK MEDICAL CENTER.

Other Meds: NONE REPORTED BY THE PATIENT

Current Illness: NONE REPORTED BY THE PATEINT.

ID: 1431203
Sex: M
Age: 24
State: LA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 06/28/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No Known Allergies

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

Symptoms: Patient is a 24 y.o. male with no significant past medical history who presented on 6/25/21 with intermittent headaches. Patient states he was in his normal state of health but after receiving the COVID-19 vaccination on May 1, he developed a headache shortly after and since then has been having worsening headaches with associated sinus congestion. CT head was done at that time which showed some sinusitis. His headache worsened since then prompting evaluation at an outlying facility. Further evaluation at that facility revealed venous sinus thrombosis on CT head and patient was subsequently started on full dose Lovenox and transferred to ED. MRI brain here also revealed thrombosis of dural venous sinuses. Patient was admitted to the ICU for close neurologic monitoring. He was evaluated by neurology. In the ICU patient remained medically stable. He was deemed stable for non-ICU level of care and transferred to the hospitalist to continue care. Heme-onc was consulted. Patient was evaluated by heme-onc and recommended transitioning to Eliquis and discontinue Lovenox to avoid the possibility of having a HIT type of reaction. Hypercoagulable work-up was initiated hematology recommended Eliquis for 3 months and to follow-up with a local hematologist for discharge follow-up. Patient was cleared for discharge from neurology and hematology standpoint. Patient symptom was controlled on tramadol and Zofran. It was felt patient received maximum benefit of hospitalization and deemed medically stable for discharge. Patient was seen contact his primary care physician who states he will enter the referral to hematologist. Return precautions was discussed with patient and his wife.

Other Meds: Unknown

Current Illness: none

ID: 1431204
Sex: F
Age: 40
State: VT

Vax Date: 04/07/2021
Onset Date: 04/28/2021
Rec V Date: 06/28/2021
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: Mild reactions to penicillin

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

Symptoms: Just acute arm pain after first vaccine After the second vaccine, I experienced horrible menstrual cramps and heavy bleeding (very unusual). I've had 3 periods since my second vaccine, and I am still experiencing menstrual changes- very painful cramping prior to actually getting my period. This is uncommon. I usually have slight cramps after bleeding for a short period of time, but the last 3 periods I've gotten really painful cramping before. The cramps start about 3 days before, and have continued for at least 2 days once I've started my period.

Other Meds: Quetiapine fumarate Astragalus Vitamin D

Current Illness:

ID: 1431205
Sex: F
Age: 58
State: CA

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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: unknown

Other Meds:

Current Illness:

Date Died: 06/23/2021

ID: 1431206
Sex: M
Age: 85
State:

Vax Date: 03/03/2021
Onset Date: 05/10/2021
Rec V Date: 06/28/2021
Hospital: Y

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: Death J18.9 - Pneumonia, unspecified organism N17.9 - Acute kidney failure, unspecified

Other Meds:

Current Illness:

ID: 1431207
Sex: U
Age: 49
State: TX

Vax Date: 06/22/2021
Onset Date: 06/01/2021
Rec V Date: 06/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaccine given past expiration

Other Meds:

Current Illness:

ID: 1431208
Sex: M
Age: 38
State: IL

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 06/28/2021
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 vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

ID: 1431209
Sex: F
Age: 17
State: TN

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 06/28/2021
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: Latex and Amoxicillin

Symptom List: Vomiting

Symptoms: On 06/25/21 at approximately 1500 patient received MMR and Menactra vaccines. Immediately after receiving the vaccines, patient became very anxious and stated her left arm hurt at the site of the Menactra vaccine. This nurse advised Mom and patient that it was normal to have some pain at the injection site. Patient waited 15 minutes in the exam room and was going to be in the clinic for another 15 minutes getting her form and checking out, While at the front desk waiting on the form, patient laid her head down onto the counter and said she felt faint. Skin was pale and clammy. Attempted to take BP x 2 with automatic VS machine and an error message was displayed both times. RN retrieved a manual BP cuff and stethoscope. RN checked patient's BP, which was WNL, as well as her pulse. Complained of numbness and tingling of left arm down to her fingertips. A cold pack was placed on patient's left arm and damp paper towels were provided for her face/neck. Transferred back to clinic room via wheelchair and assisted onto exam table with feet elevated. BP and pulse continued to be normal (averaging 115/60 and 80). After approximately 30 minutes of monitoring VS and elevating lower extremities, patient's skin was pink, warm and dry. She was also smiling and laughing with Mom and this nurse. Denied any numbness or tingling to her left arm, just soreness at the Menactra injection site. Pt was offered transport to the vehicle via wheelchair - she declined. Patient ambulated with Mom to her car in the parking lot without difficulty. The patient never lost consciousness and was awake, alert and oriented during the entire episode.

Other Meds: None

Current Illness: None

ID: 1431210
Sex: F
Age: 31
State: CO

Vax Date: 06/27/2021
Onset Date: 06/27/2021
Rec V Date: 06/28/2021
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: n/a

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fainted, small convulsions, urinated

Other Meds: n/a

Current Illness: n/a

Date Died: 04/10/2021

ID: 1431211
Sex: M
Age: 67
State: KS

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 06/28/2021
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: Penicillamine Penicillins Sulfa (Sulfonamide Antibiotics) Pollen

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

Symptoms: Sudden Death

Other Meds: cefTRIAXone (ROCEPHIN) 2,000mg 1 dose by intraveous injection every 24 hours vancomycin (VANCOCIN) 1,250mg 1 dose by intraveous injection every 12 hours Victoza 0.6mg subcutaneous injection daily HYDROcodone-acetaminophen 5-325mg as needed

Current Illness: Infection in foot Diabetes

ID: 1431212
Sex: M
Age: 68
State: CA

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/28/2021
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: unknown

Other Meds:

Current Illness:

ID: 1431213
Sex: F
Age: 43
State: IL

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 06/28/2021
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 vaccine after the manufacturer recommended freezer time.

Other Meds:

Current Illness:

ID: 1431214
Sex: F
Age: 42
State: TX

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 06/28/2021
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: NKDA

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

Symptoms: This is my 3rd time filing this form because their is an error. Hopefully it takes this time Severe SOB, numbness and tingling of hands, legs, and feet. Cramping of thumbs where they are claw like and cannot move. This lasted for 4hours Severe dizziness/vertigo with intractable nausea and vomiting Took 2 meclizine and zofran at home ER gave 1L NS, zofran, toradol, and valium

Other Meds: HCTZ MVI Omega-3

Current Illness: N/A

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm