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: 1431744
Sex: M
Age: 64
State: OR

Vax Date: 05/21/2021
Onset Date: 06/11/2021
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: PENICILLIN

Symptom List: Dysphagia, Epiglottitis

Symptoms: PT SAID HE EXPERIENCE BAD NEUROPATHY ABOUT A WEEK BEFORE GETTING THE SECOND SHOT. HE CHECKED HIS A1C AND WAS 9.7. HE GOT THE SECOND SHOT AND EXPERIENCED EXRTREME MUSCLE FATIGUE AND EXTREME CRAMPING. HIS SON WAS TOO SCARED TO LEAVE HIM ALONE AT HIS HOUSE AFTER THEIR FISHING TRIP

Other Meds: VICTOZA, FESO4,METFORMIN,LIPIRTOR,LYRICA,CLOPIDOGREL,NORTRIPTYLINE

Current Illness:

ID: 1431745
Sex: F
Age: 57
State: LA

Vax Date: 06/21/2021
Onset Date: 06/22/2021
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: Macrodantin/nitrofurantoin, bactrim, codeine

Symptom List: Anxiety, Dyspnoea

Symptoms: Sharp chest pains, heart palpitations, racing heartbeat.

Other Meds: Armor thyroid, low dose naltrexone, bioidentical hormone replacement therapy

Current Illness: None

ID: 1431746
Sex: M
Age: 53
State: CA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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: 2nd dose Pfizer given too early. 1st dose Pfizer was on 04-07-2021

Other Meds:

Current Illness:

ID: 1431747
Sex: F
Age: 35
State: MO

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

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fetal cerebral ventriculomegaly demonstrated on May 6th for the first time. Both lateral cerebral ventricles dilated: one side is currently mild; the other moderately dilated.

Other Meds: Lexapro, hydroxyzine, prenatal vitamins

Current Illness:

ID: 1431748
Sex: M
Age: 55
State: NJ

Vax Date: 02/24/2021
Onset Date: 02/25/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: After dose 1 on Jan 27, 2021, only soreness in left arm around the site of the shot which abated by the end of the 2nd day. After dose 2 on Feb 24, 2021, soreness in right arm around the site of the shot, headache, neck ache, lower back ache which abated by the 3rd day. HOWEVER, my very mild pre-existing tinnitus became much louder and has not dissipated.

Other Meds: Multi-vitamin and Omega 3 fish oil

Current Illness: None

ID: 1431750
Sex: F
Age: 66
State: NV

Vax Date: 05/26/2021
Onset Date: 05/29/2021
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: Legumes Grains

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

Symptoms: Three days after the second dose of the vaccine I woke up and I could not see. My vision was blurry, and I was seeing double. It lasted for two days all day and than it went away. I went to the ER and I was Tachycardic. I went to the Ophthalmologist and there was no evidence of damage. Two weeks after the vaccine I had symptoms of a Stomach Virus with vomiting and diarrhea.

Other Meds: Metformin, Doxycycline 100mg Ezetimibe 10mg, Citalopram 20mg, Alendronate 70mg Vitamin D3, Calcium with D3 Preservision, Vitamin B12, Folic Acid

Current Illness:

ID: 1431751
Sex: F
Age: 34
State: KS

Vax Date: 05/04/2021
Onset Date: 05/25/2021
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: No

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I Broke out in red bumps all over my body,the bumps are really itchy All the time. It's been three weeks since it started, and it's not going away.

Other Meds: No

Current Illness: No

ID: 1431752
Sex: M
Age: 39
State: MT

Vax Date: 03/16/2021
Onset Date: 06/09/2021
Rec V Date: 06/28/2021
Hospital: Y

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: Pt recieved both Covid vaccines, developed atrial fibrillation secondary to pericarditis. Requiring 1L draining of fluid around heart. Discharged home.

Other Meds: Eliquis, suboxone, antihypertensives

Current Illness: none

ID: 1431753
Sex: F
Age: 32
State: CA

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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Client felt dizzy and lightheaded. Offered food and water. Placed in gravity chair. Monitored for additional 30 min.

Other Meds:

Current Illness:

ID: 1431755
Sex: F
Age: 71
State: CA

Vax Date: 03/13/2021
Onset Date: 05/10/2021
Rec V Date: 06/28/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin; sulfa drugs

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Vomiting and diarrhea the morning after Mother's day. And I thought it was the flu. By June 9th or so, I wasn't eating at all and was vomiting constantly and couldn't hold down any liquids. Called the doctor and they sent me to ER - on (onteh 11th) there I was treated for awhile in outpatient with IVs and was admitted to the hospital the night of the 12th . - Treated for vomiting and diarrhea and I tested positive for COVID - with an Asymptomatic result. I don't have vomiting and diarrhea anymore but slowly starting back up on soft food - eggs, oatmeal; chicken but not other meat (that comes up). I'm having trouble with bowel movements - I have the urge but when I do have one it is difficult to pass and they are small and hard.

Other Meds: Insulin; Lisinopril; Lipitor; Synthroid; Pepcid; Omeprazole

Current Illness: no

ID: 1431756
Sex: F
Age: 60
State: OH

Vax Date: 03/23/2021
Onset Date: 03/30/2021
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: Morphine, Betadine

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

Symptoms: My hearing started to fade. A little bit of vertigo.

Other Meds: Alphagan P

Current Illness: Iritis

ID: 1431757
Sex: F
Age: 53
State: OR

Vax Date: 06/19/2021
Onset Date: 06/23/2021
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: NKA

Symptom List: Rash, Urticaria

Symptoms: ON WEDNESDAY JUNE 23, PT'S ROOF OF MOUTH STARTED FEELING NUMB. ON 06/24/21 BEHIND HER EAR STARTED HURTING.

Other Meds: ZOLOFT, LOSARTAN,CHOLECALCIFEROL

Current Illness: NONE

ID: 1431758
Sex: F
Age: 65
State:

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:

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

Symptoms: Adverse reaction to a J & J vaccine. Reaction was described as an anxiety attack, happened 5 min later after a vaccine. Had chest tightness, felt like throat was closing for ~1 min, took vitals, gave water, left with friend, walking on her own.

Other Meds:

Current Illness:

ID: 1431759
Sex: M
Age: 75
State: FL

Vax Date: 03/03/2021
Onset Date: 06/02/2021
Rec V Date: 06/28/2021
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: Tetracycline and Brylinta

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

Symptoms: Bilateral extensive pulmonary embolism

Other Meds: Too many to list

Current Illness: none

ID: 1431760
Sex: F
Age: 56
State:

Vax Date: 04/26/2021
Onset Date: 04/26/2021
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: guillton

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

Symptoms: Fever , chills , left arm pain that continued until 2nd vaccaine. after 2nd vaccine shortness of breath, sore thoart , hoarse, bone pain muscle pain nausea

Other Meds:

Current Illness: none

ID: 1431761
Sex: F
Age: 14
State: PA

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: 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: After the patient received the shot she stated she was dizzy and then passed out. She was only unconscious for about 2 minutes. After she gained consciousness she started to feel better within 5 minutes. She did not need any medical attention.

Other Meds: N/A

Current Illness: n/a

ID: 1431762
Sex: M
Age: 47
State: CA

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

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

Symptoms: Patient reports feeling dizzy, lightheaded, then lost consciousness for approx. 20 secs., skin color pale then reddish, eyes rolled back. Patient then regained consciousness.

Other Meds: N/A

Current Illness: back injury 6/27/21 Hx of syncopal event Hx of MVA at age 4

ID: 1431764
Sex: M
Age: 41
State: CO

Vax Date: 06/12/2021
Onset Date: 06/12/2021
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: no known allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: No adverse reaction, pt received 2nd dose Moderna. 1st dose given was Pfizer. Patient felt fine, was advised that since both are mRNA shots the vaccine series is considered complete and to report any unusual side effects other than what we counseled him on as normal Side effects of the vaccine administration. To date, no concerns have been brought to pharmacy attention

Other Meds: unknown

Current Illness: unknown

ID: 1431765
Sex: F
Age: 42
State: HI

Vax Date: 03/13/2021
Onset Date: 06/01/2021
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: Erythromyacin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Low grade fever, sore throat

Other Meds: Prescriptions: Ozempic, Metformin, Rosuvastatin, Fenofibrate, Propranolol. Supplements: Multi-vitamin, Vitamin D

Current Illness: n/a

ID: 1431766
Sex: F
Age: 22
State:

Vax Date: 04/27/2021
Onset Date: 04/27/2021
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: no

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

Symptoms: migrains, light sensitivity ,noise sensitivity nausea, throwing up . potassium low and co2 high

Other Meds: no

Current Illness: no

ID: 1431767
Sex: F
Age:
State: TX

Vax Date: 05/24/2021
Onset Date: 05/25/2021
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: Sulfur products

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

Symptoms: Horrible cough, hard time sleeping, wheezing

Other Meds: Losartsn/HCT Levothyroxine Pramipexole Atorvastatin

Current Illness: None

ID: 1431768
Sex: F
Age: 45
State:

Vax Date: 06/26/2021
Onset Date: 06/27/2021
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: Fatigue and body aches

Other Meds:

Current Illness:

ID: 1431769
Sex: M
Age: 14
State: CA

Vax Date: 06/05/2021
Onset Date: 06/05/2021
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: NKDA

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

Symptoms: Reported that he experienced chest pain, irregular heart beat, difficulty breathing and fatigue staring the night he got the 1st dose of the vaccine 6/5/21. Chest pain lasted approx. 7 days (more at night). Palpitations lasted for about 2 weeks (intermittent). Difficulty breathing was only at night when he tried to lay down (lasted about 10 days). When last seen in clinic 6/29/21 reports all symptoms resolved.

Other Meds: None

Current Illness: Had COVID19 approximately 1 month prior to vaccination

Date Died: 05/01/2021

ID: 1431770
Sex: M
Age: 85
State: CA

Vax Date: 02/15/2021
Onset Date: 02/16/2021
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: Shortness of breath, low blood oxygen which gotten increasingly worse the days following first vaccine. Went to ER two days after vaccine as symptoms continued to get worse and was placed on oxygen full time. Had a portable oxygen machine. Was also placed on hospice care March 18, 2021; 3 days after 1st vaccine. He had a stable bill of health on Feb 4,2021. Dizziness, fainting and falling down days after second vaccine on March 8 2021. Was in and out of urgent care, ER and assisted care as symptoms and health rapidly deteriorated. He died May 1, 2021

Other Meds: Eliquis, flormax, klonopin, lasix, isordil, toprol xl, apresoline, zyloprim, ecotrin, proscar

Current Illness: None

ID: 1431771
Sex: F
Age: 29
State: OH

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

Symptom List: Injection site pain, Menorrhagia

Symptoms: Tuesday June 8th around 4 started feeling horrible tired, weak, headache, nose started dripping and all this got worse as the day went one. The next day I couldn't get out of bed and all my symptoms were worse but my face was swollen and my throat felt like it was as well. This went on til that Saturday June 12th. And by Sunday I started feeling better. I tried aspirin, Tylenol and SudafedPE head congestion +pain nothing helped i just slept and rested for all those days.

Other Meds: None

Current Illness: None

ID: 1431772
Sex: F
Age: 17
State: TX

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

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

Lab Data:

Allergies: N/A

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

Symptoms: This was the patient's second dose of the Pfizer COVID19 vaccine. The patient came with her mother. She was slightly nervous before getting the vaccine. The vaccine was given to her; she was pleasantly surprised that it barely hurt and even said "wow that was nothing!". Her mother did mention that the patient got her first dose at a clinic where the pharmacist who gave it to her gave the vaccine very roughly and the patient and her mother were in tears after the FIRST shot at clinic so they were so thankful that it barely hurt for her SECOND dose. Then we started talked about traveling and everyone was engaged in a pleasant conversation for about 5 minutes. Then suddenly the patient almost fell to the side but thankfully the chair that the patient was in had armrests and her mother caught her. We gave the patient a bottle of Sprit soda for her to drink. The patient was still in her chair and resting against her mother and said "I'm fine" but her mother insisted that we call 911. So 911 was called while a pharmacy team member stayed in the room to help keep and eye on the patient. After 911 was called that patient didn't need to rest against her mother anymore but she looked very pale and looked like she wanted to throw up. Shortly after the fire department and EMS came and took over the situation. When EMS came they said it probably sounded like a vasovagal reaction. Afterwards they cleared the situation and the patient and mother were fine afterwards (patient regained color in her face and looked and sounded normal).

Other Meds: N/A

Current Illness: N/A

ID: 1431773
Sex: F
Age: 31
State: CA

Vax Date: 04/14/2021
Onset Date: 05/19/2021
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: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Got pregnant the night of first shot. Ended up being an ectopic pregnancy that ruptured right after my second shot. Had to have emergency surgery for ruptured ectopic pregnancy and ovary removed.

Other Meds:

Current Illness:

ID: 1431977
Sex: F
Age: 92
State: NV

Vax Date: 05/26/2021
Onset Date: 06/13/2021
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: Two weeks after the vaccine I had symptoms of a Stomach Virus with vomiting and diarrhea. My daughter had the same symptoms for two days on the two days before mine. I was given medication and recovered. About four weeks after the second dose I was experiencing constipation. After four days of abdominal pain we went to the ER. I was diagnosed with an impacted bowel. We don't know if was caused by the previous medication for the stomach problems. I was discharged after a few hours and it resolved at home.

Other Meds: Amlodipine; levothyroxine; ibandronate; vitamin D3; vitamin B12; folic acid

Current Illness: Pancreatitis Hospitalization two weeks before the first dose

ID: 1431978
Sex: F
Age: 26
State: CA

Vax Date: 03/25/2021
Onset Date: 03/26/2021
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: Penicillin; cleaning supplies

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

Symptoms: Body aches in arm, back and pelvic area. Fatigue and body weakness after first vaccine for two days. Diarrhea, stomach discomfort, mild fever and body aches after second vaccine. Month following adverse reaction to vaccine, new allergies to food and products, GERD, diarrhea, mild fever, fatigue, dehydration and body ache at vaccine sites on arms. Diarrhea was continuous during the months of April, May and June as a result to certain food. Specific food was eliminated from diet. Such as carrots, broccoli and egg. Diet consisted of fruit smoothies, turkey/ham with crackers and steak tacos. In continuation, body aches/pains and shortness of breath developed as a result to certain food. New diet restrictions were placed in accordance to food allergy test that showed new food allergies. Constipation was treated after using bismuth. Treatment for GERD, body aches/pains, mild fever, allergies, dehydration, UTI: pantoprazole, Tylenol, allergy liquid medication, antibiotic, IV and cranberry D-mannose.

Other Meds: N/A

Current Illness: No illnesses, maybe UTI, but not diagnosed during time of vaccination

ID: 1431979
Sex: F
Age: 67
State: CA

Vax Date: 03/16/2021
Onset Date: 03/27/2021
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: Kiwi

Symptom List: Nausea

Symptoms: In retrospect, hearing about heart inflammation, twice I experienced a fluttering sensation across my upper chest area. I thought it was related to older age/post-menopause. Went away on its own. Lasted only 30-40 seconds.

Other Meds: Prozac, Famotidine, Atorvastatin, Seroquel (Sleep aid), MVI, Calcium plus Vit. D3,

Current Illness: none

ID: 1431980
Sex: F
Age: 47
State: CA

Vax Date: 03/13/2021
Onset Date: 03/15/2021
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: none

Symptom List: Injection site pain

Symptoms: For the first 48 hours after the shot, I felt dizzy and flu like. After those 48 hours, I was left with moderate to severe dizziness that has not subsided. At times, it has seemed almost like vertigo, but mostly it has been just a constant feeling of things being off balance and that things are moving when I shift my eyes from place to place. I have also had a lot of headaches (which was a very rare occurrence for me prior to the vaccine).

Other Meds:

Current Illness:

ID: 1431981
Sex: F
Age: 59
State: OH

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

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

Lab Data:

Allergies: beta blockers, ACEIs, diphenhydramine, cyclobenzaprine, adhesive tape

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

Symptoms: Patient reports that for the past two days (since date of vaccination) she has felt dizzy. She also reports ongoing confusion since her surgery for her cerebral aneurysm. She reports that for the past few days she has been bumping into walls and generally feeling off balance as well as experiencing word-finding difficulties. Patient is being admitted for MRI and neurology evaluation. CT and CTA of the head show no acute abnormalities.

Other Meds: trazodone, pregabalin, potassium chloride, lidocaine ointment, lamotrigine, furosemide, folic acid, eszopiclone, clopidogrel, clonazepam, Breo Ellipta, baclofen, atorvastatin, aspirin, aripiprazole, albuterol inhaler

Current Illness:

ID: 1431982
Sex: M
Age: 52
State: MA

Vax Date: 06/21/2021
Onset Date: 06/25/2021
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: PCN

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

Symptoms: Rt deltoid, area of discreet swelling, tender faint erythema below swelling . Cold therapy, monitoring

Other Meds: folic acid, thiamine, gabapentin, Vimpat, rouvastatin, loratidine, amlodipine, acetaminophen,, chlorthalidone, Vitamin D

Current Illness: none

ID: 1431983
Sex: F
Age: 51
State: AL

Vax Date: 06/18/2021
Onset Date: 06/19/2021
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: Sulfa, penicillin, keflex

Symptom List: Tremor

Symptoms: shingles -outbreak on left side face, in mouth, sinus. Also face and ear pain. Ongoing treatment is antiviral meds and antibiotics. I have been under the care of my General Physician and ophthalmologist.

Other Meds: Levothyroxine, topimax, musinex, Zyrtec, asmanex, vitamin d, vitamin b12, vitamin c, Xopenex

Current Illness: N/A

ID: 1431984
Sex: F
Age: 12
State: AZ

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: The patient returned for her 2nd Pfizer vaccine after 2 weeks (14 days) instead of 3 weeks. This wasn't noticed until after the shot had been administered and her vaccination record card was being filled out. Patient was monitored for 15 minutes after and no adverse event were observed

Other Meds:

Current Illness:

ID: 1431985
Sex: F
Age: 59
State: PA

Vax Date: 03/09/2021
Onset Date: 03/30/2021
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: None

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

Symptoms: Sudden total loss of hearing in left ear beginning March 30, 2021. Initial visit to family physician. Diagnosed as not an infection, not a blockage. Followed instructions to lake a course of decongestant. No change after one week, followed up with physician. Followed instructions to add Flonase to decongestant. No change after an additional week. Family physical prescribed a ?Z Pack? of steroid. After no change, advised to see ENT doctor. Saw ENT doctor initially on April 26, 2021. Hearing test confirmed profound hearing loss in left ear. Was given a blood panel and instructed to get an MRI of my head. Neither revealed any cause for hearing loss. Follow up appointment with ENT was June 3, 2021. I reported slightly improved hearing at this appointment and hearing test confirmed some improvement. Current course of action is since there was improvement the body appears to be healing itself and to let it continue to do so unaided. Second follow up scheduled with ENT in three months. There seems to be no improvement since early June.

Other Meds: Multi-vitamin; calcium supplement (600 mg); CoQ10 (200 mg); Lower Dose aspirin (81 mg); Glucosamine HCI (1500 mg)/Chondroitin Sulfate Sodium (1200 mg)

Current Illness: None

ID: 1431986
Sex: M
Age: 40
State: HI

Vax Date: 06/15/2021
Onset Date: 06/15/2021
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: sulfamethoxazole

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

Symptoms: No adverse event. Duplicate dose. Previously received a dose at another facility on 3/13/21.

Other Meds: divalproex, quetiapine

Current Illness: none reported

ID: 1431988
Sex: M
Age: 47
State: CA

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: Patient reported after fainting that he has a history of fainting with vaccines

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: At 11:30 patient was given Moderna and told to sit for 15 minutes. At around 11:35 patients wife screamed his name and attempted to get his attention by slapping him across the face several time. Patient was unresponsive, pale in color and eyes were open and glazed over. Patient was given an 0.03mg Epipen and was shortly responsive. EMTs promptly arrived 3 minutes later and it was found that he fainted and had a history of fainting with other vaccines. He did not faint with the 1st moderna shot given at our facility.

Other Meds: N/A

Current Illness:

ID: 1431989
Sex: F
Age: 44
State: MA

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: 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: I just received my first dose of the Pfizer covid19 vaccine yesterday morning. I'm reporting this reaction because what I experienced is not listed as a common side effect. Approximately 3-4 hours after receiving my shot at the pharmacy, I started feeling an unusual sense of urgency just before urinating and within less than an hour, it progressed to pain similar to a urinary tract infection that I have had in the past. However, compared to the two UTIs I have experienced in the past, the pain was not felt deep in my urinary tract in my abdomen. Rather, the pain was focused right inside the urethra. There were two types of situations where I would feel the pain. The first type of situation was while I was doing nothing in particular and did not feel the need to urinate (sitting, lying down, anything), and the painful sensation would come on as a throbbing pain and then stop. Then it would start again maybe 5 minutes later. The second type of situation where I felt the pain was when I sat down on the toilet to urinate, just before the urine passed through the urethra. I would feel the throbbing pain as I felt the urine get to my urethra and then right when the urine would start coming out, the pain would stop and what I felt instead was the sensation of swollen vulva and urethra but not pain. In the past, a UTI would take several days to clear up. I would be in pain urinating for at least the first 3 days. This time, however, the pain got very intense and frequent lasting into the night, then within 14 hours of the onset of symptoms, it had stopped altogether. I'm certain it was related to the vaccine as it came about within a couple of hours after my shot and went away after 14 hours. I am not someone who gets UTIs frequently. I have only had 2 in my lifetime, and the last one was 11 years ago.

Other Meds:

Current Illness:

ID: 1431992
Sex: M
Age: 21
State: MI

Vax Date: 05/21/2021
Onset Date: 05/24/2021
Rec V Date: 06/28/2021
Hospital: Y

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: NKDA

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

Symptoms: Discharge Summary Risk of unplanned readmission within next 30 days: N/A (0-12 low risk, 12-21 moderate risk, 22-28 high risk, 29+ extreme risk) Reason for Admission: Present on Admission: ? Acute chest pain Final Diagnosis: Acute chest pain Myopericarditis Hospital Course: Patient is a 21 y.o. Caucasian male who presents with acute onset of fever, headaches, chest/back pain and rapid heart rate after having received second dose of Pfizer Covid vaccine on 5/21/2021. Chest pain with oppressive character (pressure-like, squeezing) that is associated with palpitations, sweating, SOB, not nausea, exertion, dizziness. +cardiac risk factors (smoking, and +FH). Patient evaluated by cardiology. Echocardiogram with normal left ventricular ejection fraction no pericardial effusion. Troponins downtrending. Patient diagnosed with myopericarditis pericarditis as per cardiologist: "discharge him home with plans for a repeat echocardiogram in 1 month and follow-up with a cardiologist. I do not feel strongly that we need to start cardioprotective medications or any anti-inflammatory medications as he is feeling better." Once symptomatically improved and repeat troponin downtrending patient was cleared for discharge by cardiology in stable condition Significant Medication/Changes this Admission: See MAR Follow Up Recommendations: PCP Problems Addressed During this Admission: Acute chest pain Elevated troponin Engages in vaping * No resolved hospital problems. * Consults: Consultants below were obtained for their respective expertise as needed (Please refer to their consult and progress notes for details). Discharge Disposition: Condition at discharge: Stable. Discharged to Home

Other Meds: cetirizine fluticasone

Current Illness: NA

ID: 1431993
Sex: F
Age: 22
State: OR

Vax Date: 06/23/2021
Onset Date: 06/24/2021
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: Narcotics

Symptom List: Pain in extremity

Symptoms: Sleeping dizzy feeling sick not eating much

Other Meds: Buspirone escital latuda mirtazapine vitamin d prenatal vitamin strattera hydroxyzine ibuprofen

Current Illness: None

ID: 1431994
Sex: F
Age: 76
State: IL

Vax Date: 01/06/2021
Onset Date: 01/20/2021
Rec V Date: 06/28/2021
Hospital:

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

Lab Data:

Allergies: sulfa. statins

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

Symptoms: Vaccine admin 0n )1/06/21 Very mild local reaction. 2 weeks later and 6 weeks later injection site became red, swollen, itchy and painful--resolved after 24 hours On 05/10/21 injection site became very red and swollen and painful did not resolve became worse and was diagnosed as shingles on 05/12 diagnosed as shingles cond improving except for pain and itching at injection site 06/28/21

Other Meds: aspirin-carvedilol--ezetimibe--levothyroxine--losartan--omeprazole--

Current Illness: none

ID: 1431996
Sex: F
Age: 51
State: WA

Vax Date: 03/14/2021
Onset Date: 05/11/2021
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: 2 months after 2nd covid vaccine, developed sudden onset atrial fibrillation. unclear what triggered this in otherwise fairly healthy 1 yr old. wanted to report it just in case it was a possible late effect of the covid vaccine.

Other Meds:

Current Illness:

ID: 1431997
Sex: F
Age: 38
State: IN

Vax Date: 06/26/2021
Onset Date: 06/27/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: fever, body aches, chills, gastro discomfort, mild diarrhea.

Other Meds: none

Current Illness: none

ID: 1431998
Sex: F
Age: 16
State: ID

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Vomiting

Symptoms: Pfizer vaccine was not removed from the freezer at the 14 day cutoff when it is supposed to be moved to warmer fridge temperature. This vaccine was kept in the freezer and thawed at the 19 day mark. The vaccine does not have stability data published after 17 days, but was not yet expired or out of freezer at any time other than to thaw.

Other Meds: unknown

Current Illness: none

ID: 1431999
Sex: F
Age: 53
State: NC

Vax Date: 03/24/2021
Onset Date: 03/25/2021
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: Seasonal allergies Sulfa drugs Codeine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient had fever exceeding 104 F for following three days along with severe shoulder/arm pain. Fever dissipated after three to four days. However, severe shoulder/arm pain and stiffness persisted for weeks. After seeing family physician for continued shoulder/arm pain and stiffness, patient was referred to Orthopedic for evaluation on May 28, 2021. An X-Ray was performed at the 5/28/2021 Orthopedic visit. Doctor ordered an MRI on June 13, 2021. At follow up appointment on June 22, 2021 Doctor stated that he recommended surgery to address "frozen shoulder" indicating pain in left shoulder/arm due to COVID vaccine. Surgery is scheduled for July 15, 2021.

Other Meds: Mirtazapine 30 mg Trintellix 10 mg Apiprazole 2 mg Topiramate 50 mg Norethindrone Acetate 0.5 mg / Ethinyl Estradial 2.5 mg Restasis

Current Illness: None

ID: 1432000
Sex: F
Age: 60
State: VT

Vax Date: 04/08/2021
Onset Date: 05/07/2021
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: none

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

Symptoms: One month after my second dose I felt aching in my shoulders and neck area. The symptoms were similar to those I had when I had a minor heart attack in 2015. I went to the emergency room and after many test it was determined I had pericarditis.

Other Meds: amlodapine 10mg lisinopril 20 mg

Current Illness: none

ID: 1432001
Sex: M
Age: 58
State: FL

Vax Date: 12/19/2020
Onset Date: 04/03/2021
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: None known

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I started having a headache on 04/03/2021 that wouldn't go away. I checked my blood pressure on 04/06/2021 and it was elevated at 190/100. It stayed elevated for the next few days. I went to a care center on 04/09/2021 and started on Amlodipine 5mg until I could see my primary Dr. a couple days later. He added Losartan 25mg which I am still taking both. I have never had an elevated blood pressure.

Other Meds: rarely ibuprophen, zinc, vitamin D3

Current Illness: none

ID: 1432002
Sex: F
Age: 65
State: IL

Vax Date: 06/25/2021
Onset Date: 06/27/2021
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: pain meds cause nausea, antibiotics cause yeast infection, eggs cause bumps on face. Dairy constipates

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

Symptoms: Had soreness in all muscles . Throat felt full 6/26/2021. 6/27/21 inside mouth/gums sore and slight fever... 6/28/21 gums still sore on upper left mostly hard to eat. did

Other Meds: ferrous Sulfate

Current Illness: sinus

ID: 1432003
Sex: M
Age: 31
State: TX

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: Pfizer vaccine was not removed from the freezer at the 14 day cutoff when it is supposed to be moved to warmer fridge temperature. THis vaccine was kept in the freezer and thawed at the 19 day mark. THe vaccine does not have stability data published after 17 days but was not yet expired or out of freezer temperature at any time other than to thaw.

Other Meds: unknown

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm