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

Incidents per State

State Total
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 1519006
Sex: F
Age: 68
State: OH

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies: Ampicillin, Septra

Symptom List:

Symptoms: with the first injection I only recall having some soreness, slight swelling & redness at the injection site for a couple days. The 2nd injection was a very different story: 29July-- Received the injection around 11:00-- in the afternoon I felt tired and then mid to late afternoon started a vague sense of just not feeling well-- only desire to eat easy to digest dinner- no blatant nausea-- as the evening progressed just felt more tired-- injection site was sore, but no redness, found arm bones ached & shoulders- may have run a low grade fever, but never checked it-- just laid on the couch watching TV & no energy to do anything. Think I went to bed around 22:00/23:00-- During the night I woke up about every hour-- didn't sleep well at all-- developed frontal headache in addition to just not feeling well, arms/shoulders achey-- 30July-- got up around 07:00-- no real appetite so just ate some toast-- was up for about 2-3 hrs then had to go back to bed-- think I slept around 3 hrs-- still took another hour to get out of bed-- made some oatmeal then down to the couch-- realized my arms didn't ache anymore & my H/A was less-- laid on the couch for another hour or so-- then as the afternoon progressed I realized my H/A was gone-- I was feeling less fatigued-- I still didn't have my appetite back, but ate a sub for dinner-- 31July-- the only symptom now was my arm was still somewhat sore, & now had slight rash around injection site-- but otherwise felt back to normal 1Aug-- still some soreness at injection site--

Other Meds: Cytomel, Synthroid, Centrum MVI, Fish Oil, Vitamin D, Balanced B-100, Magnesium, DHEA DR, Adrenal Rebuilder, Adrenal Support 1, Combigan, Restasis, Refresh eye drops, Progesterone, BIHRT estrogen/testosterone, n-acetyl cysteine , elidel

Current Illness: none

ID: 1519007
Sex: F
Age: 17
State: NE

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Keflex, Varicella vaccine

Symptom List:

Symptoms: patient described shortness of breath, was taken to ER my mother. per mother, she was treated with albuterol Inhaler, steroid and benedryl and released after a few hours. told to follow up with asthma dr on Monday 8/2/21.

Other Meds: unknown

Current Illness: Asthma

ID: 1519008
Sex: F
Age: 17
State: NV

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Patient had trouble breathing, blurred vision within 15 minutes after injection. 911 paramedics came and believed she was having a panic attack. After breathing exercises she started feeling better but was taken to the hospital for further assesment.

Other Meds:

Current Illness:

ID: 1519009
Sex: F
Age: 39
State: TN

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: penicillin

Symptom List:

Symptoms: Patient received 2nd dose at approximately 4:07 pm administered by immunizing technician supervised by pharmacist. At approximately 4:20 patient stated that she felt tightness when breathing. At this time of complaint, the patient said that she felt tightness in her chest when breathing but has asthma. The patient said that her breathing was getting better. Pharmacist administer 10ml of liquid oral benadryl at 4:30 and at 4:36 to equal a total of 50mg. Monitoring of the patient continues, with patient stating that breathing is better. At 4:47pm patient complains that the tip of her tongue feels numb. patient did state that she had no trouble breathing. At 4:55pm, patient complains that she thinks she might have trouble swallowing , at this point pharmacy called 911. Emergency Medical Technicians came and patient stated to the EMT that she does have anxiety and refused to go the hospital because she stated that she was feeling better. At 7:36 pm called and followed up with patient and patient states that her she has no problem breathing but her tongue feels a little numb On 8/1/21, called patient and patient states that she is having aches and body pains and that her tongue was feeling numb still. Pharmacist urged patient to see physician.

Other Meds:

Current Illness: Trigeminal Neuralgia and Fibromyalgia

ID: 1519010
Sex: F
Age: 69
State: FL

Vax Date: 02/06/2021
Onset Date: 02/08/2021
Rec V Date: 08/01/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Site:

Lab Data:

Allergies: NOONE

Symptom List:

Symptoms: AFTER FIRST VACCINE: CONFUSION, MEMORY PROBLEMS, INABILITY TO CARE FOR SELF

Other Meds: SINEMET, AZILECT, LEXAPRO, GOCOVRI, VIT D, SYNHROID,

Current Illness: PARKINONS DISEASE - 18 YEARS

ID: 1519011
Sex: M
Age: 34
State: OR

Vax Date: 05/11/2021
Onset Date: 07/01/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: amoxicillin

Symptom List:

Symptoms: chest symptoms; discomfort and tachycardia

Other Meds: levothyroxine 75mcg

Current Illness: subclinical hypothyroidism

ID: 1519012
Sex: F
Age: 65
State: IA

Vax Date: 04/23/2021
Onset Date: 05/12/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: none

Symptom List:

Symptoms: Got 2nd shot 04/23/2021 knew I'd be fatigued for a few days. Never got any better at one point could barely lift my arms. Started having shortness of breath that continued until I went to ER. (May 18, 2021). They diagnosed me with enlarged heart, water around my heart, and weakened heart muscle, congestive heart failure after going through many tests. As of right now, I am wearing a defibrillator vest 24/7 in case of heart attack! Hopefully get this off at the end of August then I'm not sure. DR put me on Entresto, Furosemide, Metoprolol, Spironolactone and low doe aspirin. Also, after being in the emergency room I developed a BAD cough that lasted approx. 2 and half months

Other Meds: Glimepiride Citalopram Bupropion Trulicity Metformin OSCAL D3 & calcium Ropinirole Low dose aspirin Omeprazole

Current Illness: none

ID: 1519013
Sex: F
Age: 36
State: HI

Vax Date: 07/22/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Vax Route:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Big red rash when shot was administered (around 3in x 5in), itchy

Other Meds:

Current Illness:

ID: 1519014
Sex: M
Age: 48
State: IN

Vax Date: 07/17/2021
Onset Date: 07/24/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: I have stage 3 chronic kidney disease, and my glomerular filtration rate has consistently been 50 the last two years. I had to go to the lab to have bloodwork done for my kidney function a week after getting the vaccine, and my GFR Rate has dropped to 46 after getting the vaccine. I know that 4 points doesn`t look like a significant number, but when you have stage 3 kidney disease, it is significant, The drop in my GFR rate directly correlates to getting the vaccine.

Other Meds: L-Thyroxine 100MG Lisonopril 10 mg Calcitroil 25 MG

Current Illness:

ID: 1519015
Sex: M
Age: 67
State: AZ

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: Bactrim, Siladine cream

Symptom List:

Symptoms: First symptoms were immediate. My left forearm ached for several days. The next day my right calf felt like I was kicked. 20 days after the second shot I had a syncope vasa vagal event when I got up in the middle of the night to urinate. That was preceded by a rapid heart beat that night while laying in bed. I have palpitations so I am accustomed to irregular beats. But this was different from a palpitation.

Other Meds: Losarton, Metoprolol, lovistatin, pantoprozole, amlodipine, ranididine, loratitine, Zinc, magnesium, D3, B-12, B-6, tylenol

Current Illness: none

ID: 1519016
Sex: M
Age: 55
State: FL

Vax Date: 07/28/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: none

Symptom List:

Symptoms: On Friday morning, I was feeling fatigued and my nose started running severely, with post nasal drip. As the day went on, the fatigue got worse, I started getting muscle aches all over and a headache. These continued through Saturday and I started getting chills. These still continued today (Sunday) along with diarrhea.

Other Meds: Fexofenadine 180mg, Famotidine 20mg, One-A-Day Men's Silver Multi-vitamin gel tab, Red Yeast Rice, CoQ10

Current Illness: none

ID: 1519017
Sex: M
Age: 41
State: WI

Vax Date: 05/25/2021
Onset Date: 05/31/2021
Rec V Date: 08/01/2021
Hospital: Y

Vax Type:
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Lot:
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Lab Data:

Allergies: none

Symptom List:

Symptoms: demyelinating illness started 5 days after second vaccine started with numbness and tingling of legs, progressed to lower extremity weakness, developed facial numbness, hand incoordination mri showing enhancing lesions in brain, cervical, thoracic spine lp abnormal, lymphocytosis oligoclonal bands got high dose steroids for 5 days no improvement getting plasmaphersis hospitalized since 7/22 to present

Other Meds: escitalopram

Current Illness: none

ID: 1519018
Sex: M
Age: 47
State: CT

Vax Date: 07/30/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Lab Data:

Allergies: NKDA NKFA

Symptom List:

Symptoms: Joint ache, muscle fatigue, feeling close to fainting, louder tinnitus than usual.

Other Meds: Metoprolol 100mg QD Amlodipine 10mg QD Creator 20mg qd

Current Illness: None

ID: 1519019
Sex: F
Age: 29
State: TX

Vax Date: 03/12/2021
Onset Date: 03/26/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Reglan

Symptom List:

Symptoms: 2 weeks following the vaccination, I started to develop a prominent burning at the tip of my tongue In the first week of April 2021, I started noticing that the taste buds on my tongue were inflamed and I started developing red lesions along the top of my mouth along the soft palate I have not had any reprieve from these symptoms and now my tongue constantly feels like I burned it on a hot drink and the oil glands in my eyes have reduced significantly

Other Meds: Women's 1 a day multivitamin Lo Loestrin Fe

Current Illness: N/A

ID: 1519020
Sex: U
Age: 50
State: CA

Vax Date: 04/02/2021
Onset Date: 04/30/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Nothing

Other Meds:

Current Illness:

ID: 1519021
Sex: F
Age: 55
State: VA

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Bactrian- Sulfur/ Sulfur products- Polysorbate products- Pfizer vaccine

Symptom List:

Symptoms: Tounge and throat swelling, unable to swallow - Anaphylaxis Within 3 minutes of vaccination Given epinephrine injection left arm - ER for 6 hours prescribed Famotidine 40mg, Prednisone 20mg for 4 days

Other Meds: Dicyclomine 20mg, Bupropion, 150mg, Omeprazole DR 40mg, Celecoxib 100mg, Gabapentin 300mg, ProAir 90 inhaler , Dulcolax, Nasacort, Eye drops

Current Illness: None

ID: 1519022
Sex: F
Age: 16
State: SC

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: norco

Symptom List:

Symptoms: Idiopathic vasovagal reaction, lasted about 30 seconds. emergency response activated. Evaluated by EMS after and released with mother.

Other Meds: unknown

Current Illness: no

ID: 1519023
Sex: M
Age: 50
State: IN

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Vax Route:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Minor headache with accompanying fatigue of equal intensity. Very minor muscle soreness in the area directly below the injection site, not the site itself. Headache and fatigue began roughly three hours after injection. These subsided with one over the counter headache pill and an hour nap. They returned a short time later, but we slightly less intense. As of 6 hours after the injection, no other side effects have been noted.

Other Meds:

Current Illness:

ID: 1519024
Sex: F
Age: 12
State:

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Patient became severely disoriented, lost hearing, pale, after vaccine administration. Called 911 but after evaluation, patient did not go to the hospital with 911 team.

Other Meds:

Current Illness:

ID: 1519025
Sex: F
Age: 54
State: NV

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Joint pain all over my body (hand, shoulder, knees)

Other Meds: None

Current Illness: None

ID: 1519026
Sex: F
Age: 23
State: CA

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: She was feeling lightheaded at 6:15PM. The client ambulated and sat in the anti-gravity chair. Vitals obtained at 6:21PM were as follows: HR 55, O2 99%, and automatic BP 108/64. The client was provided water at 6:24 PM and began drinking it. The client denied any other s/s of anaphylaxis. At 6:28PM the client stated the lightheadedness was improving. Client was moved to a reclining position in the anti-gravity chair. Repeat vitals obtained at 6:31PM were as follows: HR 53, O2 99%, automatic BP 110/72. Educated the client and her family on s/s of anaphylaxis, when to seek EMS, and V-safe. Client and her family voiced understanding of this education. Client denied any current medications. No known allergies. Repeat vitals obtained at 6:41 PM were as follows: HR 58, O2 99%, and automatic BP 109/68. The client denied feeling lightheaded at the time. The client left the vaccination site at 6:44PM. The client ambulated unassisted with a steady gait.

Other Meds: None

Current Illness:

ID: 1519027
Sex: M
Age: 25
State: PR

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies: n/a

Symptom List:

Symptoms: Localized allergic reaction on neck and chest.

Other Meds: n/a

Current Illness: n/a

ID: 1519028
Sex: F
Age: 23
State: GA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No known allergies.

Symptom List:

Symptoms: Patient became light headed shortly after receiving the vaccine. She briefly fainted, but quickly became responsive. She was sweating profusely, but had no chest tightness, shortness of breath, or swelling of the throat. She laid down for 20-30 minutes while we called 911. When the ambulance was slow to arrive, she made the decision to have her friend drive her to the emergency room. She was able to walk out of the store with her friend's assistance.

Other Meds:

Current Illness:

ID: 1519029
Sex: F
Age: 53
State: CA

Vax Date: 07/28/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Patient presented with half of her left eye red in color. It appears as though a blood vessel ruptured. She states there is no pain associated with the eye. She had been suffering with a migraine the day prior.

Other Meds: None

Current Illness: Migraines

ID: 1519030
Sex: F
Age: 42
State: FL

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Continuous diarrhea ever since the day of the injection so three months so far. I have never had this issue prior. Tennis elbow in injected arm. Never had condition prior

Other Meds: Losartan 50mg, hctz 12.5mg, valacyclovir 500mg, Allegra, multi vitamin, b complex, d3

Current Illness: None

ID: 1519031
Sex: M
Age: 20
State: KS

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: nka

Symptom List:

Symptoms: Patient passed out immediately after shot given, patient came to within 10 to 15 seconds, pale in color and incoherent at first. Cold compress applied to neck and forehead. patient passed out second time after 1 to 2 minutes and EMS contacted. Patient came to within 10 to 15 seconds and still very incoherent. patient was laid down flat on back with cold compress. EMS arrived , pulse no other vitals taken EMS determined patient was ok to leave after approximately 30 minutes. Patient refused any further treatment.

Other Meds: none known

Current Illness: none listed

ID: 1519032
Sex: F
Age: 38
State: FL

Vax Date: 07/28/2021
Onset Date: 07/29/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

Symptom List:

Symptoms: Shoulder Pain and sever neck pain on left side up the cervical and thoracic spine into head and skull, feels nerve intense plus muscular. Some numbness down left arm.

Other Meds: none

Current Illness: none

ID: 1519033
Sex: F
Age: 26
State: OK

Vax Date: 07/15/2021
Onset Date: 07/15/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Iodine, shellfish

Symptom List:

Symptoms: After being taken back to room the shot was administered. I stood up to wait in the lobby for the required 15 minutes. Immediately upon standing a wave of lightheaded/dizziness hit with nausea and dry heaving. All fingers and toes went numb and excessive sweating started. After 2-3 minutes breathing became labored and pharmacist staff reported that I was turning blue. Both hands and both feet were numb and hands began cramping at first knuckle, unable to straighten fingers without assistance from an object and applied pressure. The pharmacist immediately rushed to get an epipen while manager called EMS, but did not administer as they were afraid of making reaction worse. After approximately 15 minutes the symptoms subsided and breathing returned to normal. EMS did provide on assessment on site, but agreed that medical transport was not needed but would remain under supervision from family to ensure no further reaction. Pain from cramping in hands lasted for approx. 4 days.

Other Meds: Oral Hydrocortisone 35mg per day

Current Illness: N/A

ID: 1519034
Sex: F
Age: 71
State: WA

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies: No known food or drug allergies

Symptom List:

Symptoms: Patient's daughter called and stated that patient was experiencing adverse side effects after receiving the tdap (Boostrix) vaccine yesterday. Symptoms included rapid heart rate, fever of 100.4 degrees Fahrenheit, weakness and fatigue. Patient's daughter stated she called Hospital and the agent she spoke with suggested for her to call us since we gave the vaccine. I suggested to the patient's daughter to take her mother (the patient) to immediate care or the emergency department for further monitoring due to the increase in heart rate. I did let her know that the other symptoms may occur as an immune response to the vaccine but the rapid heart rate should get looked at by a professional healthcare provider. Patient's daughter stated she will take her mother into one of the suggested clinics for further guidance/monitoring.

Other Meds:

Current Illness: none

ID: 1519035
Sex: M
Age: 17
State: PR

Vax Date: 06/30/2021
Onset Date: 07/25/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
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Lot:
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Vax Site:

Lab Data:

Allergies: bakers yeast

Symptom List:

Symptoms: Patient with a history of bakers yeast allergy dignosis as a kid ten years ago (2011) that later stopped in a couple of months of that same year with treatment and diet. In a couple of months (2011) returned to normal diet and without treatment. Not any recurrence of any symptoms in 10 years, until June 25th, 2021 (26 days after the first dose of Covid 19 Vaccine) that the same allergy appeared with the same symptoms as in 2011 consisting of: Sections of irritated red, rised and swollen skin (from less than 1 inch to 5,6 or 7 inch diameter) in head, face, back of ears, arms, torso, pelvis and legs. On and off episodes, still ocurring as this moment (July 30th).

Other Meds: no

Current Illness: no

ID: 1519036
Sex: F
Age: 12
State: NV

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Patient fainted after receiving the vaccination. She started to lean forward in her seat. I caught her before she fell. She recovered in under 20 seconds. The mother refused further medical attention but agreed to be monitored for 20 minutes after. The patient drank some water and felt better afterward. After the observation period no further issues or adverse event was noted and the patient decided to go home.

Other Meds: None

Current Illness: None

ID: 1519037
Sex: M
Age: 24
State: PA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: PENICILLIN

Symptom List:

Symptoms: Patient reported feeling dizzy to his caregiver while seated during observation period and then completely passed out. By this time Pharmacist had requested the technician to call 911. Patient gained consciousness within seconds but reported dizziness and blurry vision. Patient stated being able to breath fine, but pharmacist noticed labored breathing, pharmacist checked pulse and breathing and pulse was 60 bpm. Police officer arrived on sight by 3:10pm, followed by EMT. Vitals were checked BP 104/64. Patient declined medical care and being taken to the hospital, stating feeling normal now. During 911 call, emergency agent informed pharmacy staff to inform patient to remove any tight clothing so patient willfully removed his T-shirt since he was sweating. Patient waited in the sitting area and left around 3:50pm

Other Meds:

Current Illness:

ID: 1519038
Sex: F
Age: 30
State: IL

Vax Date: 06/30/2021
Onset Date: 07/03/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: Augmentin

Symptom List:

Symptoms: Constant pain head, neck, back , limbs, hands and feet go numb, Uncontrolled Body tremor, uncontrollable neck tic, difficulty walking, tripping, loss of grip, loss of muscle, difficulty with speech, memory issues, loss of bladder, stuttering, difficulty making out words

Other Meds: Lisinopril Jardiance Trajenta Lantus Humilog Metoprolol Sertaline Abilify Vitamin D

Current Illness: Diabetes, hypertension, depression, ptsd, anxiety

ID: 1519039
Sex: M
Age: 24
State: FL

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: patient received a vaccine and was informed to wait 15 minutes. While I was administering the vaccine to someone else, we heard a crash, when I jumped up, I see him on the floor. I told a tech to call 911 and the manager. A customer called 911 for me on her cell phone. The patient asked for a bottle of water which we quickly got for him. He was delirious and sweating for a while but after drinking the water appeared to recover. Rescue came but I think the patient was ok by the time they arrived. He had gotten help up from off of the floor and to the chairs. I asked him where he was going because he was supposed to wait 15 minutes and he replied that he was going to get something to drink

Other Meds: NONE

Current Illness: N/A

ID: 1519040
Sex: M
Age: 26
State: CA

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: none

Symptom List:

Symptoms: The patient did not experience any adverse events other than sore arm, but the vaccine was administered a week early.

Other Meds: none

Current Illness: none

ID: 1519041
Sex: F
Age: 48
State: NC

Vax Date: 04/03/2021
Onset Date: 06/01/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: None

Symptom List:

Symptoms: I had heart palpitations(PVC?s) from June 4th until July 15th. I?ve also had daily spotting and a little more than spitting at times from July 2nd until today August 1st. I have reported the heart palpitations and abnormal spotting to my dr.

Other Meds: None

Current Illness: None

ID: 1519042
Sex: M
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies:

Symptom List:

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 1519043
Sex: F
Age: 56
State: AR

Vax Date: 07/20/2021
Onset Date: 07/24/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: No

Symptom List:

Symptoms: Left ear and tongue, throat covered with whitish puss material and ear feels so full and the ringing in ear is about to drive me crazy. Heart palpitations after years of not having any. Burning I'm chest. Dizziness. Horrible taste in mouth

Other Meds: No

Current Illness: No

ID: 1519044
Sex: F
Age: 36
State: CA

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital: Y

Vax Type:
Manufacturer:
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Lab Data:

Allergies: Iodine Reglan Shellfish

Symptom List:

Symptoms: Patient had tingling in the mount and felt like her tongue was swelling about two hours after vaccination. Paramedics were called who took her to the ER

Other Meds: Lyrica Pantoprazole Linzess Gabapentin Topiramate Motegrity Baclofen Enoxeparin Clonidine Cyproheptadine Benadryl Ondansetron

Current Illness: Not known

ID: 1519045
Sex: F
Age: 48
State: MO

Vax Date: 07/24/2021
Onset Date: 07/25/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: Lamactil

Symptom List:

Symptoms: I have experienced Vertigo Since receiving the Vaccination, I have not been able to leave my home or go to work, because my Vertigo is so bad.

Other Meds: Vitamin D, Vitamin K, CBD oil, Multi vitamin

Current Illness: idiopathic intracranial hypertension

ID: 1519046
Sex: F
Age: 19
State: IN

Vax Date: 07/20/2021
Onset Date: 07/21/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: None

Symptom List:

Symptoms: Fever, body aches, congested, sore throat, asthma, migraine, no appetite, weak

Other Meds: None

Current Illness: None

ID: 1519047
Sex: F
Age: 38
State: WI

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: Had adverse reaction to supplement PS 150.

Symptom List:

Symptoms: After I received the shot, I walked out to the store to browse. Within 1-2 minutes I began to feel lightheaded and my heart began to pound rapidly. I went back to vaccination area and sat down with pharmacist. My heart continued to pound rapidly for about another 4-5 minutes. Once my heart slowed down, I continued sitting about another 5min, as I still felt lightheaded. I then left the store to walk outside in fresh air. I had to sit down outside because I felt weak (about 15 min post shot) As I was resting, my heart began to beat rapidly again for about 30sec-1min. It took about 45m for my lightheadedness to fully subside.

Other Meds:

Current Illness:

ID: 1519048
Sex: M
Age: 74
State: FL

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 08/01/2021
Hospital: Y

Vax Type:
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Lab Data:

Allergies: Penicillin - Cipro - Lisinopril-Feathers-Wool- Horse Hair, Pollen-Some detergents.

Symptom List:

Symptoms: Received 1st Vaccination on 2/4/21. Started to get severe back pain on left about a week after 1st injection about 2/11/21. Received 2nd Pfizer Covid-19 injection on 2/25/21. On 3/3/21 was sent to ER by my PCP based upon abnormal Blood Work on 8/26/21. Found to have Staph infection in lower back and Sepsis. Had fver for several days after admission, don' know temperature. Treated with antibiotics and had drain inserted into my back. Release from hospital on 3/11/21. Was treated with injection of Cefazolin 3 times per day for 6 weeks until 4/23/21. Drain was removed on 3/23/21 at hospital.

Other Meds: 81 mg Asprin Daily, a.m.100 mg Losartan, a.m.25 mg Hydrochorot, 10 mg Glyburide Daily, 5 mg a.m., 5 mg p.m.,1,000 mg Metformin ER Daily, 500 mg a.m., 500 mg p.m.,150 mg Metoprolol ER Tab, 75 mg a.m. and 75 mg. p.m.,7 mg. Prednisone, 12 - 1

Current Illness:

ID: 1519049
Sex: M
Age: 62
State: TX

Vax Date: 07/30/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: None

Symptom List:

Symptoms: Within twelve hours I developed a high fever of 100.6 which lasted till the following morning. I was treated at home with ice packs and 600 mg ibuprofen every six hours. At 8:00am the next morning the fever had broken. No other issues were observed.

Other Meds: Gabapentin 600 MG Methylphenidate 10 MG Alprazolam 0.25 MG Fexofenadine HCL 180 MG Testosterone CYP 1ML Trazodone 50 MG Baclofen 10 MG Aspirin 81 MG Isosorbide Mon

Current Illness: None

ID: 1519050
Sex: M
Age: 15
State: CA

Vax Date: 07/28/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
Hospital: Y

Vax Type:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: Peri/myocarditis - chest pain, pending treatment. At this point, just planning on NSAIDs

Other Meds: None

Current Illness: None

ID: 1519051
Sex: F
Age: 50
State: TN

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 08/01/2021
Hospital: Y

Vax Type:
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Allergies:

Symptom List:

Symptoms: 05/03/2021 - Received 2nd dose of Pfizer Covid-19 vaccine. Experienced mild cold-like symptoms that evening. 05/04/2021 - Awoke to excruciating lower back pain. Tried to walk it out, but passed out from pain. Could not sit, stand, or lie down. Only relief was kneeling with shoulders lower than hips. OTC pain meds, ice, and (very old) muscle relaxers did not help. 05/05/2021 - Went to ER. Was given a steroid shot and morphine. CT Scan came back normal. Sent home with a steroid pack and pain medicine. Intention was to schedule epidural steroid injection with spine specialist. Insurance refused to pay for injection. Pain meds didn't last long. Took 2nd steroid pack. Spent 12 more days on knees. 05/18/2021 - Went to ER for 2nd time. MRI showed existing issues at L4/L5 and L5/S1 and a new disc protrusion at L1/L2 with severe impingement of the L1 nerve root. Admitted to hospital for pain control 05/20/2021 - Received epidural steroid injection. 05/21/2021 - Discharged from hospital with 3rd steroid pack, muscle relaxers, and more pain meds. Over the next 5-7 days, slowly regained the ability to sit and stand. Have experienced relapses but usually recover in 1-3 days.

Other Meds: Kurvelo (28) Multi-vitamin, Calcium, Vit D, Vit C

Current Illness:

ID: 1519052
Sex: M
Age: 72
State: CO

Vax Date: 01/25/2021
Onset Date: 02/08/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: On January 25, 2021, My father who was 72 years old at the time, received his first Moderna Covid 19 vaccine at the Clinic. At the time of the vaccine he was a healthy, very active man. He works everyday as a ranch hand and cattle feeder 7 days a week. He does not and never has taken any prescription medications that would give us any suspicions of a reaction with those. He takes vitamin supplements to stay healthy, which is why he does not need or use prescription medications. Upon receiving this Covid-19 vaccine in his left arm, he noticed an immediate muscle soreness, which he thought was to be expected with a shot. This soreness or "achiness" that he describes in his left arm has never went away, even to this very day. He believes that these series of Moderna Covid-19 vaccines has permanently "damaged" the muscle in his arm. His left arm muscle aches every single day, all day long. On February 23, 2021 he received his second Moderna Covid-19 shot again in his left arm. Two weeks after his first Covid-19 vaccine shot, he went to get a haircut. His beautician and also my father noticed that his hair seemed to be getting a little thinner. Around the second week of March, two weeks after his second Moderna Covid-19 vaccine, he began to notice massive amounts of hair falling out. His hair brush was full of hair and he could literally run his hands through his hair and get a handful of hair immediately. This went on for weeks and months until around May 2021 when there was no more hair to fall out. He was completely bald. He looks like a "Chemotherapy patient NOW! He has always been a very excessive hairy man. He always could grow a full beard, mustache and side burns. He has always had massive belly and chest hair where there was no definite line between his chest hair and his beard. Hairy arms and legs, hair in his ears and nostrils. At this point and time (July 29, 2021) as I am filling out this form, My father, has also told me that In the last month he has NOW also lost about 90% of his eye brows and eye lashes. What few eye lashes he does have left, have dried discharge on them (similar to when a person has pink eye). His long, thick chest hair is starting to thin and quite a bit of his arm hair has fallen out also (50 % loss). He has small bald spots on his arms. The hair on his legs fell out probably started falling out about the same time as the hair on his head (95 % loss). He says the skin on his legs are now super smooth and soft just like " babies skin" as he has told me. This condition he has is very similar to "Alopecia" but has not been confirmed by a dermatologist yet. A gentleman who lives in the very same small town as my father, has had the same reaction to the his series of Moderna Covid-19 vaccine, "COMPLETE HAIRLOSS". I would hope that you will ask for photos of my fathers adverse reaction to your vaccine and that these very serious complaints be documented and publicized to the public.

Other Meds: Absolutely None! only dietary supplements: Vitamin E, Vitamin C, Vitamin D-3, Vitamin K-2, Vitamin B Complex, Niacin, Fish Oil, Calcium Magnesium and Zinc

Current Illness: None!!!!

ID: 1519053
Sex: F
Age: 41
State: CA

Vax Date: 07/07/2021
Onset Date: 07/11/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: None

Symptom List:

Symptoms: Client reported that 5 days after receiving the 1st dose COVID vaccine Pfizer she developed a headache which lasted 4 days. The client also stated she developed "trouble breathing and throbbing in her chest" 5 days after the vaccine. The client reports intermittent episodes of trouble breathing since receiving the first dose of COVID vaccine Pfizer. The last episode of shortness of breath was on 07/25/21. The client states the shortness of breath sometimes triggers an anxiety attack where she has to take deep breaths to calm down. The client stated she did seek care at a doctors office where she was prescribed some sort of pain medication that did not provide relief of her symptoms. The client did not know which specific medication she was prescribed. The client returned to the doctors where she was given some sort of medication in an injection which resulted in improvement of her symptoms. The client does not know which type of medication she was given via injection. The client reports that she "feels weird" ever since she received the first dose COVID vaccine Pfizer. The client denies any chronic conditions. She does not take any medications regularly. The client denies any known allergies. The client denies any history of shortness of breath prior to receiving the first dose COVID vaccine Pfizer. Current vitals obtained were as follows: automatic BP 122/90, HR 75 BPM.

Other Meds: None

Current Illness:

ID: 1519054
Sex: M
Age: 16
State: NY

Vax Date: 07/22/2021
Onset Date: 07/24/2021
Rec V Date: 08/01/2021
Hospital: Y

Vax Type:
Manufacturer:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: Had high fever, chest pain, body aches

Other Meds: None

Current Illness:

ID: 1519055
Sex: F
Age: 70
State: CA

Vax Date: 07/06/2021
Onset Date: 07/07/2021
Rec V Date: 08/01/2021
Hospital:

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Lab Data:

Allergies: wheat, gluten (celiac) certain drugs: avelox, antibiotics

Symptom List:

Symptoms: Extreme alertness, inability to sleep at night, for 2 weeks solid, and now intermittently, for another week. Waking in middle of night with extreme anxiety running through my body (never experienced in my life before, i calmed it down myself, 4 nights this week); Extreme fatigue.

Other Meds: dessicated thyroid, tryptophan

Current Illness: COPD for 52 years bronchiectasis or chronic lung inflammation

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm