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: 1437988
Sex: M
Age: 14
State: CA

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: unknown (none to peg or polysorbate or vaccine or injections)

Symptom List: Dysphagia, Epiglottitis

Symptoms: patient immediately vomited after vaccine, was monitored for additional 15 min and followed up with mom 1 hour later patient was fine

Other Meds: none

Current Illness: unknown

ID: 1437989
Sex: F
Age: 17
State: SC

Vax Date: 06/28/2021
Onset Date: 06/29/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

Symptom List: Anxiety, Dyspnoea

Symptoms: Lightheadedness, dizziness, and nausea. Redness and swelling at the injection site.

Other Meds: Birth control pills

Current Illness: none

ID: 1437990
Sex: F
Age: 13
State: CA

Vax Date: 06/28/2021
Onset Date: 06/29/2021
Rec V Date: 06/30/2021
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: NONE

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

Symptoms: Shortness of breath, weakness, headache ? Vaccine RXN Orthostatic Hypotension Nausea

Other Meds: Sumatriptan 25mg Amitriptyline 10mg Metoclopramide HCL 5ml Ibuprofen 400mg Setraline HCL 25mg

Current Illness: NONE

ID: 1437991
Sex: F
Age: 56
State:

Vax Date: 04/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/30/2021
Hospital:

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: Pain in arm and shoulder is more severe than patient expected. She went to the Dr and they gave her anti-inflammatories and told her to follow up with the pharmacy.

Other Meds:

Current Illness:

ID: 1437992
Sex: F
Age: 30
State: WA

Vax Date: 05/19/2021
Onset Date: 06/06/2021
Rec V Date: 06/30/2021
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: On sunday June 6, I woke up with a sore throat. I thought I might be coming down with a cold, but for about 10 days I just kept waking up with a sore throat, but later in the day I would feel fine. On wednesday, June 16, my sore throat was worse in the morning and wasn't going away. Plus it had been dragging on for so long, so I was concerned. So I visited for a throat swab. Everything was negative. Later that day, I started to feel feverish, and to get more typical cold symptoms like a stuffy nose and cough. Those symptoms lasted a couple days and then I got better and didn't have the sore throat anymore.

Other Meds:

Current Illness:

ID: 1437993
Sex: F
Age: 62
State: TX

Vax Date: 03/22/2021
Onset Date: 05/16/2021
Rec V Date: 06/30/2021
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: I am allergic to iodine.

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

Symptoms: Around the time in May I experienced chest pains, after that I went to get a covid vaccine because my husband had been exposed. My test came back positive. I was also prescribed steroid medication.

Other Meds: I was taking my normal thyroid medicine.

Current Illness: None.

ID: 1437994
Sex: F
Age: 34
State: CA

Vax Date: 05/15/2021
Onset Date: 06/02/2021
Rec V Date: 06/30/2021
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: Pyrexia, White blood cell count decreased

Symptoms: I learned I was pregnant the day after the first dose of my vaccine. Two and a half weeks after the second dose I experienced bleeding when my pregnancy was at seven weeks. I had spotting for two days. Two weeks after that I had heavier bleeding. I thought my pregnancy was progressing but it was confirmed that the baby stopped growing at seven weeks. I should have been eleven and a half weeks pregnant at that time. Due Date: 01/08/2022 Pregnancy: fourth

Other Meds:

Current Illness:

ID: 1437995
Sex: M
Age: 68
State: VA

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Client presented at the vaccination clinic and reported that he had never received any doses of Covid vaccine. He received a first dose of Pfizer vaccine today without any obvious incident. In checking through our state database this afternoon, it was noted that the client had actually had a dose of Johnson and Johnson vaccine on 3/6/21, about which he had neglected to mention.

Other Meds: none

Current Illness: none

ID: 1437996
Sex: F
Age: 59
State: PA

Vax Date: 04/28/2021
Onset Date: 05/04/2021
Rec V Date: 06/30/2021
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: EXTREME ANXIETY, INABILITY TO WORK AND DO OTHER FUNCTIONS AT HOME

Other Meds: LEVOTHYROXINE CITALOPRAM ZOLPIDEM PREMARIN

Current Illness: NONE

ID: 1437997
Sex: U
Age: 24
State: WA

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 06/30/2021
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: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Around 12 hrs. later I notice there was red swollen circle and the next day it double in size. It was hot to the touch and painful and stiff.

Other Meds: Spintex

Current Illness: No

ID: 1437998
Sex: F
Age: 58
State: PA

Vax Date: 06/29/2021
Onset Date: 06/29/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: Mold - anaphylaxis

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

Symptoms: 1-2 hrs after vaccine, pain and swelling in left arm. 4 hrs after, headache. Next day, shoulder is swollen and red, warm to touch and painful. 24 hrs after vaccination, rash all around the injection site. 30hrs after, rash gone. Shoulder still swollen, red, warm and painful.

Other Meds: Toprol XL, Cozaar, Lipitor, Zetia, Wellbutrin, Cymbalta, Adderal, dulcolax, magnesium, zinc, baby aspirin

Current Illness:

ID: 1437999
Sex: F
Age: 36
State: OR

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 06/30/2021
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: No

Symptom List: Rash, Urticaria

Symptoms: Two minutes after receiving the vaccine, I developed tachycardia, heat sensation in my chest and later throughout my body. It lasted for approximately five minutes. In the first two hours after the vaccine, I experienced several waves of the same symptoms. I addressed my symptoms with a monitoring team, they offered me some snacks and water. The next day I was feeling better and only experienced generalised weakness. I notified my employee health about my experience and was recommended not to get the second dose of the vaccine.

Other Meds: Dietary supplements and herbal remedies

Current Illness: No

ID: 1438000
Sex: F
Age: 41
State: TX

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 06/30/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: 14 hours after injection I had normal reactions of headache, nauseous, fever, body ache, but I also had every joint hurt even my knuckles I couldn't bend my fingers neck was stiff I couldn't turn my head and I had the heart palpitations like a racing heart.

Other Meds: lexapro

Current Illness: none

ID: 1438001
Sex: M
Age: 23
State: CA

Vax Date: 06/21/2021
Onset Date: 06/23/2021
Rec V Date: 06/30/2021
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: NKDA

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

Symptoms: Chest pain; elevated Troponin; suspect Myocarditis; possibly after Moderna vaccine.

Other Meds: Colchicine 0.6mg 1 tab daily for PRN for gout pain Famotidine 1 tab+ 20mg oral daily tablet

Current Illness: None reported

ID: 1438002
Sex: F
Age: 83
State: WA

Vax Date: 03/23/2021
Onset Date: 03/24/2021
Rec V Date: 06/30/2021
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: ibuprofen, NSAIDS, steroids

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

Symptoms: Chills, fever, weakness, exhaustion, nausea, abdominal distress with diarrhea, sore belly, insomnia, back muscle pain, unusual dreams, hallucinations. Symptoms on and off to varying degrees for a month, especially muscle pain. Fatigue was constant.

Other Meds: Tylenol, Pravastatin, Clopidogrel Bisulfate, Latanoprost eye drops, Timolol eye gel

Current Illness: none

ID: 1438003
Sex: M
Age: 63
State: MD

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received Janssen vaccine previously in March per Pharmacy.

Other Meds:

Current Illness:

ID: 1438004
Sex: M
Age: 21
State: MD

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
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: not known

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

Symptoms: pt felt dizzy and light headed, looked pale, sweating, nausea

Other Meds: N/A

Current Illness: none

ID: 1438005
Sex: F
Age: 45
State: NY

Vax Date: 06/28/2021
Onset Date: 06/29/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 45 year old female presents with cc of left axillary pain and swelling since yesterday 6/29/2021 s/p J&J Covid19 Vaccine on 6/28/2021 to left deltoid. Pt reports pain is moderate, nonradiating, constant, minimally relieved despite use of tylenol and ibuprofen. Pt denies trauma to affected region. She denies fever, chills, cough, chest pain, SOB, palpitations, weakness, numbness, tingling, headaches, neck pain, back pain, rash, dizziness. Pt offers no other complaints.

Other Meds:

Current Illness:

ID: 1438006
Sex: M
Age: 18
State: LA

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: NONE KNOWN

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: ADVERSE EVENT IS ONLY RELATED TO A DELAY IN THE INTERVAL OF ADMINISTRATION. PATIENT RECEIVED DOSE #1 ON 5/7/21. PT CANCELLED MULTIPLE TIMES FOR SECOND INJECTION. DOSE #2 GIVEN 6/30/21 ON DAY 54 POST INJECTION OF DOSE #1. SPOKE WITH MODERNA CUSTOMER CARE PRIOR TO ADMINISTRATION AND DISCUSSED LACK OF DATA SUPPORTING EXTENDED INTERVAL DOSING. DISCUSSED WITH PATIENT AND MOTHER PRIOR TO ADMINISTRATION. PATIENT AND MOTHER VERBALIZED UNDERSTANDING OF INFORMATION AND AGREED TO TODAY'S INJECTION.

Other Meds: VYVANSE, ADDERRAL, CLONIDINE, VISTARIL, PROZAC

Current Illness: NONE KNOWN

ID: 1438007
Sex: M
Age: 39
State:

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
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: Swelling /tingling of the tongue. Evaluated by EMS-Cleared

Other Meds:

Current Illness:

ID: 1438008
Sex: F
Age: 68
State: ND

Vax Date: 02/04/2021
Onset Date: 04/15/2021
Rec V Date: 06/30/2021
Hospital: Y

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: ERYTHROMYCIN SULFA DRUGS CODEINE IBUPROFEN

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

Symptoms: Case was hospitalized.

Other Meds: unknown

Current Illness: unknown

ID: 1438009
Sex: F
Age: 20
State: TX

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: Patient experienced rigid fingers, nausea, fever, and stuffy ears about 8 minutes after the vaccine was administered. Patient was given a cold water bottle, an ice pack to place on her forehead, and bucket in case she needed to vomit. EMS was called right away. They arrived and checked her out. She was not transported to the hospital. She waited approximately for 30 more minutes and then felt well and left.

Other Meds: N/A

Current Illness: N/A

ID: 1438010
Sex: F
Age: 31
State: DC

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient stated she previously received the Moderna COVID-19 vaccine and had a severe reaction consisting of tinnitus. She also stated she discussed the side effect with her PCP, and would like to receive the Pfizer COVID-19 vaccine to complete her vaccine series.

Other Meds:

Current Illness:

ID: 1438011
Sex: M
Age: 30
State:

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/30/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Lighted headed, dizzy, cold clammy skin, history of these type symptoms with injections.

Other Meds:

Current Illness:

ID: 1438012
Sex: F
Age: 75
State: WV

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

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

Lab Data:

Allergies: Bad reaction to Epinephrine

Symptom List: Injection site pain, Menorrhagia

Symptoms: I had the second dose on 3/25/2021. I started one new med on 04/27/2021 Toremifene 16 mg and after that the doctor increase my Crestor from 5 mg a day to 20 mg a day on 05/26/2021. Most of it was brain fog and lack of energy and some depression. Both medicines caused the side effects and the doctor said it was too much of the same thing. I also had a fall on the sidewalk on 06/09/2021, the doctor thought it was because I was dizzy. I tripped on the curve and fell face down my glasses made a little cut below my right eye. The bruise its still there. The next day I went to the eye doctor and they said there was no damage and no concussion. After that my primary doctor told me to go off Crestor for 2 weeks and let her know how I was doing, so I did that and I am doing much better. I have more energy. I still have some brain fog but I think the Toremifene is doing that. But every day I feel much better.

Other Meds: Pilocarpine salagen; Myrbetriq; vitamin D; multi vitamin; probiotic; magnesium; Terazosin; Paroxetine; Lorazepam; baby aspirin; Eye drops Restasis one drop in each eye at night and in the morning.

Current Illness: None

ID: 1438013
Sex: F
Age: 45
State: WA

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 06/30/2021
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: unknown

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

Symptoms: Patient received Moderna as a 1st dose on 5/28/21 and a Pfizer Booster doses on 6/25/2021

Other Meds: unknown

Current Illness: unknown

ID: 1438014
Sex: F
Age: 49
State: MO

Vax Date: 06/21/2021
Onset Date: 06/24/2021
Rec V Date: 06/30/2021
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: No allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I had twitching

Other Meds: Yes i was taking prescriptions.

Current Illness: No other illnesses.

ID: 1438015
Sex: F
Age: 74
State: OH

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/30/2021
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: NKDA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Rhabdomylitis, hyponatremia, hypovolemia, Elevated Creatinine Kinase. Patient went to ER for body aches 6/28/21 and was sent back to ER by PCP after telephone visit on 6/29/21. Patient was admitted to Hospital

Other Meds: Ginkgo Biloba, Krill oil, MVI, Vitamin D 2000iu, Tramadol 50mg, Fluticasone

Current Illness:

ID: 1438016
Sex: M
Age: 41
State: WA

Vax Date: 05/02/2021
Onset Date: 06/20/2021
Rec V Date: 06/30/2021
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: Panicillin

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

Symptoms: Cardiac Arrest/Heart Attack/STEMI

Other Meds: None

Current Illness: None

ID: 1438017
Sex: F
Age: 73
State: FL

Vax Date: 06/09/2021
Onset Date: 06/14/2021
Rec V Date: 06/30/2021
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: I got the second vaccination on 06/09/21 at 9:30 AM nothing wrong, the day after arm moderate pain. Then on 6/14/21, I went to PCP for a year's check-up, during the Vital chek up my pulse went up over 150, but my Blood Pressure not too bad. The Dr took EKG show arritmia. He did't prescribe medication. I came home and call my Cardiologist, went the day after, and new medication was prescribed Metoprolol er succinate 100MG and Lisinopril -HCTZ 20/25 mG taking and Lisinopirl 20 mg at night

Other Meds: None. Just prescribed medication Lisinopril 20-25 HCTZ -Januvia 100 mg-Carvedilol 12.50 mg

Current Illness: Anxiety- Taking Lorazepam .025 when need it.

ID: 1438018
Sex: F
Age: 17
State: MT

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Administered Moderna vaccine to a person under the age of 18. No adverse reactions

Other Meds:

Current Illness:

ID: 1438019
Sex: F
Age: 70
State: WI

Vax Date: 03/01/2021
Onset Date: 06/29/2021
Rec V Date: 06/30/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: 11/09/2020 - Tested positive for COVID-19 02/08/2021 & 03/01/2021 - Received Pfizer COVID-19 vaccines 06/29/2021 - Tested positive for COVID-19 at Hospital 06/29/2021 - Admitted to Medical Center / Hospital 06/30/2021 - Tested negative for COVID-19 at Medical Center / Hospital 06/30/2021 - Discharged from Medical Center / Hospital

Other Meds:

Current Illness:

ID: 1438020
Sex: F
Age: 35
State: MO

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: None listed on profile.

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

Symptoms: Patient received a second dose of COVID vaccine that was different from her first dose. She received Moderna for her first dose and Pfizer for her second dose. The manufacturer of the first dose was not known at the time second dose was given.

Other Meds: Unknown, none on profile.

Current Illness:

ID: 1438021
Sex: F
Age: 64
State: CO

Vax Date: 03/08/2021
Onset Date: 05/07/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: On 05/07/2021 I felt foggy, light headed- but not vertigo light headed, just didn't feel on my game. That lasted for about a week, and I was trying to change my diet so I wasn't drinking any alcohol, eating any sugar, and I wasn't taking any ibuprofen or anything. A week later on 05/13/2021 I noticed at night that my heart rate and blood pressure was high, so I tested my BP and it was indeed high 160/90 and I noticed my heart felt funny and it was irregular heart beats-4 strong beats and then a soft mushy beat. I felt light headed during this. I called nurse line and she encouraged me to call doctor and talk to on call doctor and she encouraged me to go to the ER. in the ER they immediately hooked me up to the EKG machine, and within minutes they made declaration I was having the PVC (Premature ventricular contractions). They also did a blood test and found that my potassium level was low and they gave me potassium and monitored me and then sent me home. At home for the next several days I was diligent about taking electrolytes. I was drinking daily electrolyte drinks (powder). The PVC continued but tapered off (05/13/2021-05/20/2021). Then I did a f/u blood test and found that my electrolytes were well balanced and fine. I did at this point decide to opt to use a heart monitor for 2 weeks to see what patterns were detected in my heart but I haven't gotten that data back (survey was from June 14, 2021). I continued to have PVC incidents every other day frequently-I notice them most at night. I am mostly waiting for the heart monitor results but I did have a f/u blood test done a week ago and the numbers are normal for the electrolytes. I still have symptoms of the PVC and I haven't had them before in my life and that's why I'm curious. The main thing is the idea of having had chemotherapy plays apart (Chemotherapy from breast cancer 1994 --drugs taken were Adriamycin and Cytoxan).

Other Meds: None

Current Illness: None

ID: 1438022
Sex: M
Age: 23
State: NY

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
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: Unknown

Symptom List: Erythema, Pruritus

Symptoms: 23 y/o complained of heart palpitations, heart pounding after 1st dose of Pfizer vaccine. Service was rendered to patient by EMT and Nurse Practitioner on site. According to notes on report, after examination, pt was breathing adequately, 3 lead EKG was normal sinus rythim, Pt. feels better and is observed for another 30 minutes. He refused transport to hospital. He was advised to follow up w/PCP.

Other Meds: Unknown

Current Illness: History of Brugada Syndrome per NP's account. Information from the patient and his mother.

ID: 1438023
Sex: M
Age: 50
State: TX

Vax Date: 03/27/2021
Onset Date: 03/31/2021
Rec V Date: 06/30/2021
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: 1) pain in scrotum starting approximately 3-4 days after 2nd dose. Much improved as of 6/30/21, but still mild, occasional pain 2) Ciprofloxacin prescribed resulting in severe reaction with tendon pain and neuropathy. Onset of reaction about 6-7 days (4/10/21) after prescription started, 2 weeks after vaccination. Tendon pain improved but still present as of 6/30/21. Neuropathy still present and unchanged since onset.

Other Meds: Ciprofloxacin started on 4/3/2021, one week after vaccination.

Current Illness:

ID: 1438024
Sex: M
Age: 40
State: MA

Vax Date: 03/25/2021
Onset Date: 04/14/2021
Rec V Date: 06/30/2021
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: Palpitations, PVCS

Other Meds: Hydrochlorothiazide Simvastatin

Current Illness: None

ID: 1438025
Sex: M
Age: 41
State: ID

Vax Date: 05/13/2021
Onset Date: 06/22/2021
Rec V Date: 06/30/2021
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: no

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Upset stomach; heartburn; Gas; diarrhea - for around 48 hours. Fatigue also - maybe longer - about 60 hours. Tried to keep hydrated. Didn't see the doctor.

Other Meds: Wellbutrin

Current Illness: no

ID: 1438026
Sex: F
Age: 46
State:

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/30/2021
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: Hives as well as an itchy and painful rash within 1 hour of injection.

Other Meds:

Current Illness:

ID: 1438027
Sex: M
Age: 51
State: FL

Vax Date: 04/25/2021
Onset Date: 04/29/2021
Rec V Date: 06/30/2021
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: None

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

Symptoms: Aortic dissection, aortic valve partially detached, right coronary artery dissection

Other Meds: Multivitamin, vitamin D3, Niacinmide, Omeprazole

Current Illness: None

ID: 1438028
Sex: F
Age: 14
State: PA

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
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: Patient felt woozy(dizzy) within minutes after vaccine administration. patient sat down in chair and was given water and an icee and placed an ice pack on neck for observation. She was observed for 30 minutes and had no further complications

Other Meds:

Current Illness:

ID: 1438029
Sex: F
Age: 69
State: WA

Vax Date: 03/22/2021
Onset Date: 06/05/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: Codeine Dairy

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

Symptoms: I woke up thinking I had a bad cramp on left side, above the heart. Didn't go away! Called on call Dr, was told I had costochondritis. No reason could be found. Two weeks later, saw my Dr. Again, no reason found. Just happens is the basic thought. For me, I would like to add, when I received the shot, I felt I HAD TO BE IN RAPPORT with everyone...my husband made the appointment for the shot. I felt "out of choice, no self governance " over my body. I had wanted to wait, until I was ready, perhaps another week or two. Being in rapport hurts the connective tissue. I betrayed myself. I cannot blame the vaccine, only myself for not listening and waiting until I felt 100% capable of handling the vaccine within my body. 13 hours after I had the vaccine, I became ill. My bowels also have been slow to regain their true rhythm. Again I blame me for rejecting the vaccine!!!! I am only reporting this, because I believe a study about connective tissue and rapport, along with the willingness of someone to receive the vaccine would be interesting for someone to study. I ache, still, from the costochondritis. I take that ache as a reminder, and my responsibility to be more at peace with my choices. Thank you for listening, feels good to express myself.

Other Meds: Green tea Psyllium Vinegar

Current Illness: No

ID: 1438030
Sex: F
Age: 48
State:

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 06/30/2021
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: Strange feeling in chest when leaning over, then a few days later gradually over 2 weeks more intense pain in chest on left side enough to wake at night several times with rapid heart beat

Other Meds:

Current Illness:

ID: 1438031
Sex: F
Age: 21
State: NJ

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
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 known

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

Symptoms: Rash on hand going up arm, burning feeling 3 hours after vaccine

Other Meds: Albuterol sulfate (PRO AIR) Xyzal Nasacort Junel Fe

Current Illness: No

ID: 1438032
Sex: F
Age: 14
State: NC

Vax Date: 06/11/2021
Onset Date: 06/12/2021
Rec V Date: 06/30/2021
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: amoxicillin

Symptom List: Vomiting

Symptoms: fever, weakness, orthostatic hypotension with syncope, headaches starting 36 hours after vaccines were given

Other Meds: melatonin and magnesium

Current Illness: none

ID: 1438033
Sex: M
Age: 63
State: CA

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Extreme Fatigue Disoriented Imbalanced Memory Loss Inability to perform daily tasks

Other Meds: Medformin Glipizide Atorvastatin

Current Illness: None

ID: 1438034
Sex: F
Age: 34
State: NY

Vax Date: 02/25/2021
Onset Date: 04/16/2021
Rec V Date: 06/30/2021
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: morphine, esmolol, ciprofloxin

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

Symptoms: I developed a C. difficil infection in April 2021. I've had C. diff recurrences for five years of our so and do not think it was related to the Covid-19 vaccine.

Other Meds: sotolol, sildenafil, warfarin, spironolactone, metoclopramide, pantoprazol, mirtazapine levothyroxine, sodium bicarbonate, b-12, baby aspirin, multi-vitamin+ iron, vitamin-D, loperadimide

Current Illness: urinary tract infection

ID: 1438035
Sex: F
Age: 92
State: ND

Vax Date: 01/28/2021
Onset Date: 04/13/2021
Rec V Date: 06/30/2021
Hospital: Y

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: Adhesives, Penicillins, Sulfa Drugs

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Case was hospitalized

Other Meds: unknown

Current Illness: unknown

ID: 1438036
Sex: M
Age: 55
State: TX

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 06/30/2021
Hospital:

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

Lab Data:

Allergies: No Known Allergies

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

Symptoms: Patient completed the COVID-19 Vaccine Screening and Consent Form and reported that he had not previously received a dose of any COVID-19 vaccine. The dose of Janssen vaccine was administered 6/30/21 at 11:46am without incident. At A Health office, we searched the Department of State Health Services data base and found a record that the patient had received a dose of the Pfizer vaccine on 5/25/2021. The patient did not report this previous dose.

Other Meds: Unknown

Current Illness: No known recent illnesses

ID: 1438037
Sex: M
Age: 31
State: CA

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/30/2021
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: Client reports that for his first vaccine he felt dizziness and heaviness in his head. Client reports it lasted 30 minutes and he felt better after eating since he did not eat that day.

Other Meds: none

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm