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: 1433331
Sex: F
Age: 64
State: TX

Vax Date: 06/04/2021
Onset Date: 06/05/2021
Rec V Date: 06/29/2021
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: Patient came in on 06/28/21 to speak to me (pharmacist), she told me she has been trying to contact someone about reporting her adverse event because she did not know how to do it and she called the place she received her vaccination and they were not helpful at all. Patient received her second dose of Moderna on 06/04, about 6 hrs later she could feel the left side of her face numbing. It looks like she has Bell's Palsy. She can't close her eyes, it feels tight, and visually is droopy. She has to manually close her eyes, she has been using eye drops, she can't blink, and uses an eye mask at night to help prevent dryness. I told her she needs to see her PCP, urgent care, or hospital however she doesn't have insurance so she doesn't want to go.

Other Meds:

Current Illness:

ID: 1433332
Sex: F
Age: 66
State: NC

Vax Date: 02/27/2021
Onset Date: 04/01/2021
Rec V Date: 06/29/2021
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: Barley, wheat and rye

Symptom List: Anxiety, Dyspnoea

Symptoms: For weeks, I had trouble breathing and my heart would race whenever I exercised, even as little as walking from the car to a store. This continued for 4 weeks after the second vaccine. Then i developed extreme vertigo. Even the epley maneuver did not help. I couldn't walk and was vomiting. This lasted for about a week, gradually getting better. Finally, I started itching all over my body, but mostly at the joints. This lasted a couple days.

Other Meds: Po;micort, Mpmaluska, Certizine, Vitamins A, C, D3, E, Zina, Probiotics,

Current Illness: ,

ID: 1433333
Sex: M
Age: 37
State: IL

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 06/29/2021
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 the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433334
Sex: M
Age: 21
State: PA

Vax Date: 06/14/2021
Onset Date: 06/18/2021
Rec V Date: 06/29/2021
Hospital: Y

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

Lab Data:

Allergies: No known allergies

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The patient received his second shot of Moderna vaccine on 6/14/21. That night he felt ill with headaches, fever and nausea. On Friday morning (6/18/21), the patient developed a 15-minute episode of chest discomfort. He described it as a moderate midsternal chest soreness radiating to his left arm at rest and worse with a deep breath, not positional. That same evening, the patient had an even worse episode of the same chest discomfort prompting his trip to the emergency department. The patient was admitted to the hospital with an elevated troponin level. He was started on colchicine and ibuprofen.

Other Meds: Flonase nasal spray

Current Illness:

ID: 1433335
Sex: F
Age: 11
State: MT

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaccine was administered at 11 years of age. 2nd dose will be delayed until patient is 12 years old.

Other Meds:

Current Illness:

ID: 1433336
Sex: M
Age: 65
State: ID

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 06/29/2021
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: none

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

Symptoms: headaches, chills and fever. I had really achy joint and couldn't even pick a glass. I had a taste of metal. It lasted about 24 hours.

Other Meds: vitamins, liptore, asprin

Current Illness: none

ID: 1433337
Sex: M
Age: 57
State: CA

Vax Date: 04/23/2021
Onset Date: 05/02/2021
Rec V Date: 06/29/2021
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: None known of

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: My heart went into v-fib flurry and the AICD I have went off 5 times in 3 days. I had a bio-polar v-tach ablation in 2018 that was successful and had no V-fib since May 2019. The symptoms cause my heart rate to elevate 300 bpm in a fraction of a second and passed out each time. I was hospitalized and had to have amiodarone added to my system to get it to stop. Since I have had no v-fib and the only change in my life was the vaccine I received just 1 week prior.

Other Meds: sotolal Lisinopril Epleronone Xarelto Carvedilol Rosuvastatin Vitamin B12 Ferrous iron Magnesium Xanax as needed Hydrocodone as needed

Current Illness: Non-Ischemic Cardiomyopathy

ID: 1433338
Sex: F
Age: 46
State: IL

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 06/29/2021
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: Patient received the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433339
Sex: M
Age: 55
State: AR

Vax Date: 06/03/2021
Onset Date: 06/17/2021
Rec V Date: 06/29/2021
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: Ace Inhibitor

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: On June 17 I went to the ER. Based on the symptoms I had a CT scan. I had a Bi-lateral Pulmonary Embolism with a Saddle Embolism. I was put on Heprin. Based on my Troponin numbers there was damage done to the right side of heart. I spend 4 days in the Hospital. I was released on the 21st of June. I have many doctor appointments scheduled including: cardiologist, phlebotomist, and Primary Physician. I have been sent home with Eliquis and will be on it for the foreseeable future. Days in Hospital: 4

Other Meds: losartin,nifedipine,b12,vitamin,effexor,bisoporalLogactin

Current Illness: None

ID: 1433340
Sex: F
Age: 58
State: NC

Vax Date: 06/18/2021
Onset Date: 06/19/2021
Rec V Date: 06/29/2021
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: Affexor, Albuterol-hives

Symptom List: Diarrhoea, Nasal congestion

Symptoms: One day 1, after vaccine, patient had flu-like symptoms with low grade fever, nausea, headache, body aches x 4 days. Around day 3, symptoms of severe headache with stiff neck and dry cough started along with tingling and numbness of shoulders, arms, hands, lips, legs bilaterally. These symptoms continue today.

Other Meds: None

Current Illness: None

ID: 1433341
Sex: M
Age: 30
State: NE

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 06/29/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Patient stated that he had COVID-19 a few months ago and recently had flu like sxs about 1 week ago. Shortly after receiving the first injection of Pfizer, he began to feel lightheadedness. VSS: 152/100 81 pulse and 98% pulse oximeter. Offered water and snack, and after 30 minutes, resolution of lightheadedness. Blood pressure decreased and patient was discharged to home.

Other Meds: None

Current Illness: sick with flu like sxs 1 week ago

ID: 1433342
Sex: F
Age: 76
State: MO

Vax Date: 02/25/2021
Onset Date: 03/25/2021
Rec V Date: 06/29/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Pain in left leg

Other Meds: Triamt,Glimetiride,Tioglitagone,Omeprazol,atorvastatin,Losartan,Diltiazam,Metformin

Current Illness: Diabetes

ID: 1433343
Sex: M
Age: 84
State: IL

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433344
Sex: F
Age: 65
State: AL

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/29/2021
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: Penicillin

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

Symptoms: Cramping and numbness in legs and feet, tightness in chest

Other Meds: none

Current Illness: none

Date Died: 05/13/2021

ID: 1433345
Sex: F
Age: 93
State: WA

Vax Date: 01/19/2021
Onset Date: 05/13/2021
Rec V Date: 06/29/2021
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: Unknown

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

Symptoms: Died of COVID-19 Illness on 05/13/2021

Other Meds: Unknown

Current Illness: Unknown

ID: 1433346
Sex: F
Age: 54
State: NJ

Vax Date: 02/12/2021
Onset Date: 02/14/2021
Rec V Date: 06/29/2021
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: No known medication or food allergies

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

Symptoms: On day 2 post my second dose, I noticed a change in my heart rate, feeling like my heart was skipping beats. This was noted in the evening hours often at bedtime. Last date I recorded noted the missed beats was February 24, 2021.

Other Meds: Chlorthaidone 12.5mg once daily Fosamax 70 mg once weekly Vitamin D 1000mg once daily Multi-vitamin daily Elderberry Vitamin C and Zinc 3-4 days a week

Current Illness: None

ID: 1433347
Sex: M
Age: 51
State: MI

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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 had a previous dose of Janssen SARS-COV 2 vaccine on 03/12/2021. Patient tolerated Moderna vaccination well. No adverse reaction or health concern.

Other Meds:

Current Illness:

ID: 1433348
Sex: M
Age: 60
State: IL

Vax Date: 06/26/2021
Onset Date: 06/27/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Diarrhea started about 8 hours after injection - has been persistent for several days but calming down now

Other Meds: Minoxidil - 10 mg / twice per day

Current Illness: none

ID: 1433349
Sex: M
Age: 22
State: TN

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Fevers (102 degrees), tachycardia, body aches

Other Meds: none

Current Illness: none

ID: 1433350
Sex: F
Age: 48
State: VA

Vax Date: 06/05/2021
Onset Date: 06/06/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Left hearing loss

Other Meds:

Current Illness: congestion

ID: 1433351
Sex: F
Age: 29
State: IL

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient received the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433352
Sex: M
Age: 60
State: WA

Vax Date: 04/12/2021
Onset Date: 06/24/2021
Rec V Date: 06/29/2021
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: NKA

Symptom List: Unevaluable event

Symptoms: Patient had a Non-STEMI MI on 6/24/21 with new onset A-Fib also. Pt arrived to ER from clinic with c/o chest and Left shoulder pain for 2weeks. Arrived to ER with HR in 150s that converted with IV Diltiazem. Pt showed s/s of MI with elevated Troponin. IV Heparin drip and IV Heparin bolus was given. Pt was transported by helicopter to hospital for further treatment and studies.

Other Meds: None

Current Illness: None

ID: 1433353
Sex: F
Age: 13
State: MD

Vax Date: 06/29/2021
Onset Date: 06/29/2021
Rec V Date: 06/29/2021
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: Peaches,

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

Symptoms: Patient Reports that immediately after patient received vaccine in right arm that she started exhibiting pain running up and down her arm. Patient reports that pain is 10/10. Describe the pain as " Feels like when cold water hits a sensitive tooth". Blood pressure was taken (119/78) with a heart rate of 93. Ice pack was given. Monitored the patient for 30 min.

Other Meds: Multivitamins, Elderberry

Current Illness:

ID: 1433354
Sex: F
Age: 55
State: CT

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/29/2021
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: penecillin, amoxcicillian

Symptom List: Injection site pain, Pain

Symptoms: flu-like symptoms for approximately 8 hours, inflamation and joint pain ever since shot.

Other Meds: Ursodiol

Current Illness:

ID: 1433355
Sex: M
Age: 18
State: PA

Vax Date: 06/29/2021
Onset Date: 06/29/2021
Rec V Date: 06/29/2021
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: Near syncope event after vaccine. Was sitting and turned pale and felt nauseated. Was able to lie down and was then feeling better. Was able to eat and drink and was discharged from the vaccination area in stable condition.

Other Meds: None

Current Illness: None

ID: 1433356
Sex: M
Age: 89
State: IL

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433357
Sex: F
Age: 49
State: FL

Vax Date: 06/16/2021
Onset Date: 06/25/2021
Rec V Date: 06/29/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: My husband and I both got our first shot and a week later he got Covid then I got it a few days later. We barely leave our home as we work from home so we have no idea where we would've gotten it from. The research says this is not common yet I know if another person who got it a week after the first shot too.

Other Meds: None

Current Illness: None

ID: 1433358
Sex: M
Age: 65
State:

Vax Date: 02/18/2021
Onset Date: 02/21/2021
Rec V Date: 06/29/2021
Hospital: Y

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: Patient presented to the ED on 2/21/2021 and was subsequently hospitalized for atypical chest pain and shortness of breath. Patient presented to the ED on 04/12/2021 with Hypotension due to hypovolemia and was subsequently hospitalized. Both visits are within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1433359
Sex: M
Age: 62
State: GA

Vax Date: 04/14/2021
Onset Date: 06/29/2021
Rec V Date: 06/29/2021
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: Autoimmune - confirmed Celiac sprue.

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

Symptoms: Blood pressure spike above normal. Took multiple reads via an automated BP cuff/machine: 137/73 and 133/75 and 2 or 3 similar readings over ~ 2 hours. Friday, 6/26 I checked BP and readings returned to normal range : 114/67, 117/75, 107/61. Heart rate normal ~ 57 bpm.

Other Meds: Statin, multi-vitamin, Calcium + Vitamin D.

Current Illness: none

ID: 1433360
Sex: M
Age: 32
State: IL

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
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: Patient received the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433361
Sex: F
Age: 54
State: PA

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

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

Lab Data:

Allergies: outdoor allergies Wellbutrin

Symptom List: Injection site pain

Symptoms: Extreme fatigue and excruciating headache

Other Meds: Adderall, prozac, probiotic

Current Illness: none

ID: 1433363
Sex: F
Age: 20
State: IL

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
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 the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433364
Sex: F
Age: 68
State: IL

Vax Date: 06/28/2021
Onset Date: 06/29/2021
Rec V Date: 06/29/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: headache, muscle aches

Other Meds: co-q10 vitamin D statin

Current Illness:

ID: 1433365
Sex: M
Age: 52
State: CA

Vax Date: 06/23/2021
Onset Date: 06/24/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Feverish symptoms (feeling cold), body ache, and fatigue

Other Meds: Amlodopine, Atorvastatin, Vitamin D, Baby Aspirin

Current Illness:

ID: 1433366
Sex: M
Age: 76
State: AZ

Vax Date: 06/27/2021
Onset Date: 06/27/2021
Rec V Date: 06/29/2021
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: KNA

Symptom List: Erythema, Pruritus

Symptoms: According to Patient's son: Patient fell down after reaching home after getting this vaccine. Patient was admitted to ER same evening. According to ER doctor, patient has blood clot in his brain and is in vegetative state.

Other Meds: NOT AWARE

Current Illness: Hypertension Atrial Fibrillation

ID: 1433367
Sex: M
Age: 16
State: IL

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
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: Patient received the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433368
Sex: M
Age: 15
State: MI

Vax Date: 06/12/2021
Onset Date: 06/14/2021
Rec V Date: 06/29/2021
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: none

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

Symptoms: myopericarditis, chest pain, myalgias, chills

Other Meds: none

Current Illness: none

ID: 1433369
Sex: F
Age: 63
State: TX

Vax Date: 01/09/2021
Onset Date: 01/12/2021
Rec V Date: 06/29/2021
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: I am now allergic to pantoprazole.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On January 12, 2021 I started to have headaches and not feeling good so I started to check my blood pressure and I realized my blood pressure was up high and I never really had a history of having high blood pressure. That's when I called the doctor but I don't remember the specific date and I told them I am having high blood pressure and I never had any issues so I thin it's the vaccine and my doctor said no, no. I went to the doctor and I don't remember the specific dates , and she prescribe me Lisinopril 2.5mg and I had to take once a day.

Other Meds: I was taking Vitamin C 1000mg, Pantoprazole 40mg, Vitamin D3 3000IU 3x a day, Omega 3 900mg, Citadel , Imatinib Mesylate 400mg once a day.

Current Illness: I have Barrett's Esophagus and Ger Gastroesophageal Reflux.

ID: 1433370
Sex: F
Age: 19
State: IL

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433371
Sex: F
Age: 33
State: IL

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
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:

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

Symptoms: Patient received the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433372
Sex: M
Age: 62
State:

Vax Date: 05/14/2021
Onset Date: 06/12/2021
Rec V Date: 06/29/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient presented to the ED and was subsequently hospitalized for Atrial flutter with rapid ventricular response within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1433373
Sex: M
Age: 63
State:

Vax Date: 05/12/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
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: I21.4 - Non-ST elevation (NSTEMI) myocardial infarction

Other Meds:

Current Illness:

Date Died: 05/17/2021

ID: 1433374
Sex: M
Age: 69
State: WA

Vax Date: 01/20/2021
Onset Date: 05/17/2021
Rec V Date: 06/29/2021
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: Unknown

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

Symptoms: Died of COVID-19 illness on 05/17/2021

Other Meds: Unknown

Current Illness: Unknown

ID: 1433375
Sex: F
Age: 38
State: IL

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
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 the dose after the manufacturer recommended freezer storage duration.

Other Meds:

Current Illness:

ID: 1433376
Sex: F
Age: 18
State: GA

Vax Date: 04/28/2021
Onset Date: 05/07/2021
Rec V Date: 06/29/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Had meat loaf and gallbladder was irritated.

Symptom List: Vomiting

Symptoms: She has sensory motor failure.. on hands and feet

Other Meds: Glucose tablet

Current Illness: Gallbladder was irritated

ID: 1433377
Sex: M
Age: 24
State: CA

Vax Date: 05/15/2021
Onset Date: 05/18/2021
Rec V Date: 06/29/2021
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: Rapid heart rate, chest pressure/tightness on left side of chest. Night sweats.

Other Meds: n/a

Current Illness: n/a

ID: 1433378
Sex: M
Age: 74
State: IL

Vax Date: 03/10/2021
Onset Date: 04/15/2021
Rec V Date: 06/29/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: On 04/15/2021, I experienced an extreme amount of joint pain all over my body, my feet ankle, knees, wrist, shoulders. I was gradually having the pain from the time I received the vaccination on 03/10/2021 to 04/15/2021. I initially saw my PCP, who sent me to the rheumatologist. The Rheumatologist diagnosed me with rheumatoid arthritis. I was put on prednisone a day, and methotrexate a week.

Other Meds: Insulin Humalog by injection; Insulin Toujeo by injection; Metoprolol; Diltiazem; hctz; Pravastatin; Aspirin; Vitamin focus select

Current Illness: No

ID: 1433379
Sex: F
Age: 48
State: MN

Vax Date: 05/08/2021
Onset Date: 05/17/2021
Rec V Date: 06/29/2021
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: dizziness, nausea, loss of balance

Other Meds: Zertec

Current Illness:

ID: 1433380
Sex: M
Age: 36
State: NY

Vax Date: 05/10/2021
Onset Date: 05/29/2021
Rec V Date: 06/29/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: I have developed what was described as superficial blood clots on my left legs. The treatment is to continue to wear compression stocks (I always wear them because of my varicose veins) and a tropical cream to be applied (1% Voltarin). I don't know if this is attributed to the vaccine or not but it was suggested that I report this based on phone call I received today from a person working with control I believe.

Other Meds: Multi vitamin, joint care, fish oild

Current Illness: None

ID: 1433381
Sex: F
Age: 63
State:

Vax Date: 04/01/2021
Onset Date: 06/18/2021
Rec V Date: 06/29/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: J18.9 - Pneumonia, unspecified organism N17.9 - Acute kidney failure, unspecified I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC)

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm