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: 1446866
Sex: M
Age: 25
State: IN

Vax Date: 05/28/2021
Onset Date: 05/29/2021
Rec V Date: 07/05/2021
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: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Woke up will chills around 3AM which lasted till about 11AM. Drank a bunch of water and slept on/off till about 6PM due to fatigue. Got out of bed and the the fatigue mostly settled by 11PM. Felt mostly okay the next morning.

Other Meds: Men's multivitamin

Current Illness: N/A

ID: 1446867
Sex: F
Age: 78
State: IA

Vax Date: 06/29/2021
Onset Date: 07/02/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient reports having itchy eyes and eye pain starting a few days after vaccination

Other Meds:

Current Illness:

ID: 1446869
Sex: M
Age: 68
State: PA

Vax Date: 03/30/2021
Onset Date: 04/14/2021
Rec V Date: 07/05/2021
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 that I know

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

Symptoms: I feel dizzy and confuse for few minutes but after I went home I was ok. However two weeks after the first shot I woke up at 2:oo in the morning with the noise in my head. I thought I was going to get a struck and I was no able to sleep after that. I have to wait for the weekend to be over. I make an appointment with the doctor and I get referrals to a cardiologist and a ENT. I got US of my carotid artery both sides with normal results. I had a hearing test and they said I has lost of hearing but in my daily life I have not experience problem with my hearing. The ENT sent me for an MRI of the brain and inner ear but came out normal. Since April 14, 2021 I can not sleep at night because of the ringing in my ear. I spoke with others with this problem after the vaccine and I check on line and learn about others with similar effects and for that reason I am sending this report.

Other Meds: Admylodipine blood pressure medication, Qq10 supplement

Current Illness: sinus congestion

ID: 1446870
Sex: F
Age: 87
State: OH

Vax Date: 06/16/2021
Onset Date: 07/04/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Right arm muscle became tight and painful to move. Patient could not lift arm more than a few inches. Have encouraged gentle stretching and movement. Took one dose of Naproxen. Lingering issue of tightness remains.

Other Meds: Nadolol, Ezetimibe, Valsartan, Synthriod, Esomeprozole, low-dose asprin

Current Illness:

ID: 1446871
Sex: F
Age: 18
State: PA

Vax Date: 05/25/2021
Onset Date: 05/26/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies: Allergies FoodHives/Urticaria, Fever-Watermelon, honeydew, caneloupe and hazelnut AmoxicillinHives/Urticaria Bee VenomAnaphylaxis

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

Symptoms: Moderna Covid-19 vaccine administered 5/25/21 5/26/21: Experienced the following in injection arm: - Large red spot around the injection site - Itchy - Arm very sore and hurts to move - From pain scale of 1-10 (10 being the worst) reported it at a 7 - Upper arm is swollen - Took Tylenol and applied ice to the injection site; Called off of work. 5/28/21: Swelling in left arm started to subside, the itching stopped and patient could move arm around. Spot was still "warm to the touch" and the redness around the injection site has spread. No leg swelling or calf pain. Picture was emailed in via MyChart. 6/22/21: HIVES - Started on left leg 6/12 and progressed since then; now spreading to upper/inner thigh and showing on right leg. Hives red, itchy. Similar to previous allergic reactions. Picture sent via MyChart. LEG SPASMS - Started in the left leg on 6/7 and have continued; now altering legs. Describes as "charlie horses" in calves typically at night. PERIOD - was late but did have it and now bleeding stopped. Patient has also had intermittent tension headaches since getting the vaccine. Takes Tylenol, rests and these resolve. There is no shortness of breath, chest pain. No facial lip or tongue swelling.

Other Meds: Acetaminophen-Caff-Pyrilamine (MIDOL MAX ST MENSTRUAL ORAL) Multiple Vitamin (MULTI-VITAMIN ORAL) predniSONE (DELTASONE) 10 MG tablet TRI-LO-MILI 0.18/0.215/0.25 MG-25 MCG TABS

Current Illness:

ID: 1446872
Sex: F
Age: 83
State: PR

Vax Date: 07/05/2021
Onset Date: 07/05/2021
Rec V Date: 07/05/2021
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: Pt received vaccine from Pfizer on 6/14/21 and came in at 3 weeks for her second dose, but MODERNA was given by mistake. Pt 30 minutes after the vaccine was given she felt fine.

Other Meds:

Current Illness:

ID: 1446873
Sex: F
Age: 46
State: IL

Vax Date: 06/30/2021
Onset Date: 07/04/2021
Rec V Date: 07/05/2021
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: Nons

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I am not sure if this would be considered a side effect or allergic reaction, however I am concerned as I broke out in hives all over my legs and ankles. My left leg also became slightly swollen. This event occurred 4 days after the first dose. Benadryl helps to relieve the symptoms.

Other Meds: Multi-Vitamin Birth Control

Current Illness: Covid-19 positive test on May 7,2021

ID: 1446874
Sex: F
Age: 51
State: KY

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

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

Lab Data:

Allergies: has had delayed anaphylactic reaction to something she had eaten at Taco-Bell, a muffin and a CBD gummy but never a vaccine

Symptom List: Pharyngeal swelling

Symptoms: roughly 20 minutes after receiving the vaccine, patient began to have trouble breathing and her throat started to feel scratchy, we administered a dose of epinepherine then called 911

Other Meds: unknown

Current Illness: none

Date Died: 07/02/2021

ID: 1446875
Sex: M
Age: 83
State: AR

Vax Date: 01/18/2021
Onset Date: 06/13/2021
Rec V Date: 07/05/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient is an 83 year old male admitted with COVID respiratory failure who has end stage COPD. His condition declined throughout hospitalization and expired 7/2/2021.

Other Meds:

Current Illness:

ID: 1446876
Sex: F
Age: 17
State: NY

Vax Date: 07/05/2021
Onset Date: 07/05/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Systemic: Fainting / Unresponsive-Mild, Additional Details: PATIENT WAS GIVEN COVID VACCINE AT 9:13AM. Patient was slightly nervous, covid vaccine was adminstered as normal routine. Patient was tense, slight blood at adminstration site. Left arm was wiped with pad, and given band-aid. After 30 seconds patient passed out on chair with faint response. I IMMEDIATELTY called 911 and ambulance came to observe patient. Ptaient became response, mother assured she had "Anxiety" and she left pharmacy.

Other Meds:

Current Illness:

ID: 1446877
Sex: M
Age: 16
State: FL

Vax Date: 06/30/2021
Onset Date: 07/01/2021
Rec V Date: 07/05/2021
Hospital: Y

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

Lab Data:

Allergies: No allergies

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

Symptoms: Patient started by having fever, chills and vomiting. The next day, he started having chest pain and shortness of breath. Mother took him to Urgent care and then was asked to go to the ER. He was admitted to the ICU for positive cardiac inflammatory markers and diagnosed with Myocarditis.

Other Meds: No OTC med was taken at time of vaccine.

Current Illness: No illnesses was none.

ID: 1446878
Sex: F
Age: 53
State: TN

Vax Date: 07/01/2021
Onset Date: 07/02/2021
Rec V Date: 07/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe, Systemic: Allergic: Rash Generalized-Severe, Systemic: Body Aches Generalized-Mild, Systemic: Chills-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fever-Mild, Systemic: Headache-Mild

Other Meds:

Current Illness:

ID: 1446879
Sex: M
Age: 19
State: WA

Vax Date: 05/29/2021
Onset Date: 05/29/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies: Gentamiacin

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

Symptoms: I fainted while sitting in a chair about 3 minutes after receiving the dose. When I was woken up I was disoriented and had patchy vision as though due to low blood flow to my brain. I laid down on the floor with my feet in the air for several minutes to regain blood flow, then slowly got to my feet.

Other Meds: Apriso, Perrigo Mesalamine

Current Illness:

ID: 1446880
Sex: F
Age: 58
State: FL

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 07/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1446881
Sex: F
Age: 14
State: GA

Vax Date: 07/05/2021
Onset Date: 07/05/2021
Rec V Date: 07/05/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: patient got very dizzy, with an almost "grey" color to skin. She had not eaten anything before vaccine. Given a coke to drink by dad and monitored for 15 minutes. Patient had full color back when she left and felt so much better

Other Meds: unknown

Current Illness: nka

ID: 1446882
Sex: U
Age: 26
State:

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 07/05/2021
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 fainted and seized for approximately 30 seconds and regained consciousness about a minute after. Patient felt dizzy and lightheaded.

Other Meds:

Current Illness:

ID: 1446883
Sex: F
Age: 87
State: IL

Vax Date: 03/17/2021
Onset Date: 05/29/2021
Rec V Date: 07/05/2021
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: Statins

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

Symptoms: Bells Palsy left side of face- paralysis was seen in the ER on 5/31. Was seen on 6/17 by PCP due to left ear pain was ordered steroids and to increase Gabapentin

Other Meds: Clopidogrel; Gabapentin 100 mg bid, Fosrenol after meals; Levemir 6 Units; Torsemide 20 mg daily; Tramadol as needed

Current Illness: None

ID: 1446884
Sex: F
Age: 60
State: NC

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Site: Bruising at Injection Site-Severe, Site: Pain at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: Severe bruising was almost 2 inches below the actual injection site. Bruising covered large area of arm just above elbow--again not near actual site.

Other Meds:

Current Illness:

ID: 1446885
Sex: F
Age: 48
State: MN

Vax Date: 01/01/2021
Onset Date: 06/15/2021
Rec V Date: 07/05/2021
Hospital: Y

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: I just feel it may warrant further in estigation. Viral gastric enteritis presenting as small bowel obstruction. Sbo are usually fibrous adhesions. 3 people I have heard of had had these viral induced. Never heard of it before this year. How about a young man that at 21.got a terrible kidney infection recently. Let's be clear I would still get the vaccine. That was a nephew and my brother died a week after getting vaccination and chemo 2 days apart

Other Meds: Birth control, losarten, simvastatin, zoloft

Current Illness: None

ID: 1446886
Sex: F
Age: 62
State:

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 07/05/2021
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: Patient feel nausea, lightheadleness. EMS was at patient side for 10 min . Water given. After the 30 minute patient stated " I feel ok now". Patient left to go home.

Other Meds:

Current Illness:

ID: 1446887
Sex: M
Age: 62
State: PA

Vax Date: 05/27/2021
Onset Date: 05/01/2021
Rec V Date: 07/05/2021
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: NKMA

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

Symptoms: 63 year old male patient presents to ED 6/25/21 reporting 5 weeks of progressive cough, dyspnea and intolerance to exertion that has become steadily worse despite supportive therapies. He reportedly completed outpatient ABX from PCP within the past 2 weeks and suffers ongoing deterioration of his breathing accompanied by night-sweats, chills and fever. 1st Vaccine on 5/27/21, 2nd 6/17/21. hypoxemia secondary to large left sided pneumonia.large left sided effusion with compressive atelectasis and question of infectious vs malignant origin.acute hypoxemic respiratory failure requiring HFNC. Patient admitted to the ICU on our service for ongoing care.Hospital Course:Mildly elevated BNP and non-diagnostic EKG.Findings consistent with bilateral pneumonia, large left complex parapneumonic effusion versus empyema with compression of left lung and evidence of external impingement on LV. Systolic blood pressures ranging in the 80s to 90s with MAPs ranging from mid 60s to mid 80s with heart rates in the 90s, which may be attributed to diminished LV filling. Transferred 6/26/21.

Other Meds: Aspirin EC* (Aspirin 81*), 81 MG PO DAILY, (Reported) Atorvastatin Calcium * (Atorvastatin Calcium *), 40 MG PO DAILY, (Reported) Clopidogrel (Clopidogrel), 75 MG PO DAILY, (Reported) Dulaglutide (Trulicity), 1.5 MG SQ QWEEK, (Reported) Emp

Current Illness:

ID: 1446888
Sex: F
Age: 48
State: CA

Vax Date: 05/04/2021
Onset Date: 06/01/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies: food, dust and pollen in general

Symptom List: Unevaluable event

Symptoms: From June 1 midnight, got itchy rashes around my waist mostly, a few of them on arm and right thigh, mid to late June, rashes move to both feet and left leg, July 4th, move to right leg. late June, there are 31 rashes on right leg. Some of the rashes become blisters. The rashes/blisters heal themselves in 2 weeks mostly, but it reoccurs at different place of the body till now, and so sign of stopping. Took Zyrtec or Claritin can ease the itches, touching by hands or clothes made them more itchy. My daughter (12 years old) has similar symptom two weeks after her first dose, (June 18 first dose of Pfrizer, July 1st rashes started from feet, then to legs.)

Other Meds: N/A

Current Illness: N/A

ID: 1446889
Sex: M
Age: 42
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 07/05/2021
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: Collapsing or losing conscious; Lightheadedness.

Other Meds:

Current Illness:

ID: 1446890
Sex: M
Age: 30
State: MI

Vax Date: 07/05/2021
Onset Date: 07/05/2021
Rec V Date: 07/05/2021
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: NKDA

Symptom List: Injection site pain, Pain

Symptoms: Patient complained of lightheadedness, slight vision loss, and feeling overheated. This lasted for maybe a few minutes; laying down on his back helped relieve the symptoms.

Other Meds: Unknown

Current Illness: Unknown

ID: 1446891
Sex: F
Age: 34
State: GA

Vax Date: 04/01/2021
Onset Date: 04/15/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies: Guardasil

Symptom List: Injection site pain, Menorrhagia

Symptoms: Heavy menstrual periods. The durant is still 5 days but I could no longer use sanitary pads or tampons. I had to switch to a menstrual cup.

Other Meds: None

Current Illness: None

ID: 1446892
Sex: M
Age: 39
State: MN

Vax Date: 04/10/2021
Onset Date: 05/08/2021
Rec V Date: 07/05/2021
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: None

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

Symptoms: Initial chest pain 1 month after vaccine, pain returned with increased severity June 19th resulting in ER visit. Pulmonary embolisms have caused some permanent lung damage. Patient is currently taking Xarelto. Minor symptoms remain.

Other Meds: None

Current Illness: None

ID: 1446893
Sex: M
Age: 34
State: MN

Vax Date: 07/03/2021
Onset Date: 07/01/2021
Rec V Date: 07/05/2021
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: Expired vaccine was injected into the patient. A vial was punctured on 7/2/21 at 1:35pm Central time and kept in proper refrigeration temperatures. Instead of the vial being thrown out after the six hour viability window per the manufacturer, it was used on 7/3/21 and a single dose was injected into the patient. Janssen was contacted after the error was discovered and they could give no guidance as to a course of action to take. There was no recommendation on if the patient should be revaccinated or not. The patient will be contacted regarding the information gathered. No adverse event has been reported from the patient as of yet.

Other Meds:

Current Illness: none

ID: 1446894
Sex: F
Age: 19
State:

Vax Date: 07/02/2021
Onset Date: 07/02/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: chest tightness/pain within 10 minutes of receiving vaccine; advised to go to ED

Other Meds:

Current Illness:

ID: 1446895
Sex: F
Age: 43
State: UT

Vax Date: 05/06/2021
Onset Date: 07/04/2021
Rec V Date: 07/05/2021
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: Penecillin

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

Symptoms: July 4th, 2021 @1pm Mountain Time - First symptoms. Lost muscle control on right side of the face. July 4th 2021 @ 9:30pm Mountain Time - Entered Emergency Room and ruled out a stroke. Was diagnosed.

Other Meds: citalopram

Current Illness: None

ID: 1446896
Sex: F
Age: 65
State:

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 07/05/2021
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 fainted after 5 minutes of sitting in observation.

Other Meds:

Current Illness:

ID: 1446897
Sex: F
Age: 55
State: CA

Vax Date: 07/05/2021
Onset Date: 07/05/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies: Shellfish

Symptom List: Injection site pain

Symptoms: Patient began experiencing tingling and itching of the tongue and mouth roughly 15 minutes following 2nd Moderna vaccine. No issues with 1st dose aside from fatigue and arm soreness. Reported the tingling began on the tip of her tongue, migrating to the base. No throat involvement, full breath was drawn with no issues. Benadryl 25 mg was given orally and patient waited an additional 20 minutes. Swelling and itching of lips as well as tongue began to subside and pt left with intent for husband to drive her home; instructed to seek emergent medical attention if s/sx worsened or returned.

Other Meds:

Current Illness:

ID: 1446898
Sex: F
Age: 32
State:

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 07/05/2021
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: Developed dizziness and headache immediately post vaccine . Patient without other symptoms . Patient noted to have good oxygenation. Symptoms almost completely resolved after 20 . ER precautions given.

Other Meds:

Current Illness:

ID: 1446899
Sex: F
Age: 82
State:

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 07/05/2021
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: Patient with development of nausea and non bloody emesis x1, Patient observed for 30 min post emesis without return of symptoms . ER precautions given .Patient without symptoms at time of discharge.

Other Meds:

Current Illness:

ID: 1446900
Sex: M
Age: 63
State: IL

Vax Date: 06/14/2021
Onset Date: 06/29/2021
Rec V Date: 07/05/2021
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: nkda

Symptom List: Tremor

Symptoms: cva with left sided weakness, LH and vision changes

Other Meds: none

Current Illness: none

ID: 1446901
Sex: F
Age: 91
State: IN

Vax Date: 03/03/2021
Onset Date: 03/17/2021
Rec V Date: 07/05/2021
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: Allergic to sulfa

Symptom List: Erythema, Pruritus

Symptoms: Significant decrease in ability to function physically and mentally. Increased confusion. Unsteadiness resulting in two falls. Weakness of muscles. Facial numbness which lasted for several hours. These symptoms showed up within a few days of the second dose of the Moderna vaccine. The effects lasted for about one month. Since then, the person is back to normal functioning with no weakness, or confusion. She is doing well now but for one month following the Moderna vaccine was very debilitated and unable to function in normal activities of daily living.

Other Meds: Losartan 100 mg

Current Illness: None

ID: 1446902
Sex: F
Age: 19
State: NJ

Vax Date: 07/02/2021
Onset Date: 07/02/2021
Rec V Date: 07/05/2021
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: soy, wheat

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

Symptoms: chest tightness/pain within 15 minutes of receiving vaccine; went to ED

Other Meds: unknown

Current Illness: unknown

ID: 1446903
Sex: M
Age: 15
State:

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 07/05/2021
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: Vaccine was administered to a patient who did not meet age criteria for EUA

Other Meds:

Current Illness:

ID: 1446904
Sex: F
Age: 55
State: TX

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 07/05/2021
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 known

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient reported to pharmacy on July 5th to report swelling and pain in right side of face and neck. She was on her way to emergency room or clinic seeking steroids to calm the reaction

Other Meds: Metoprolol

Current Illness: none

ID: 1446905
Sex: F
Age: 56
State:

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 07/05/2021
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 describes development of metallic taste and headache after vaccine administration . No other symptoms reported . No dizziness , sob, difficulty ambulating / standing noted . Patient sent home with ER precautions and told to follow-up with PCM.

Other Meds:

Current Illness:

ID: 1446906
Sex: M
Age: 59
State: FL

Vax Date: 03/27/2021
Onset Date: 03/01/2021
Rec V Date: 07/05/2021
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: none

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

Symptoms: Severe pain in left arm at point of shot. Hurt for days after with swelling, pain and redness. Since then, I have had weakness and pain in the arm and will be woken up at night with the same severe pain in the area and swelling.

Other Meds: Atrovastin, Wellbutrin, Testosterone, Cialis, Fibercon, Vitamin B12, Vitamin D3, Tumeric, Milk Thistle, Aleve

Current Illness: none

ID: 1446908
Sex: F
Age: 34
State:

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 07/05/2021
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: Vasovagal reaction. Was observed by EMS and her symptoms resolved. She left under her own ambulation and was symptom free.

Other Meds:

Current Illness:

ID: 1446909
Sex: F
Age: 60
State:

Vax Date: 06/14/2021
Onset Date: 06/26/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Shingles, pain then rash (never had before)

Other Meds: lysine, multivitamin

Current Illness: none

ID: 1446910
Sex: F
Age: 37
State:

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 07/05/2021
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: Lightheadedness and 5/10 chest pain. Hx of HTN and sarcoidosis. Bp was 168/86. HR 64 and 100% spo2 on RA. CP resolved within 5 min of initial vitals. Evaluated by ems and released home in stable condition. Patient advised to follow up with PCM as soon as possible.

Other Meds:

Current Illness:

ID: 1446911
Sex: F
Age: 69
State: KY

Vax Date: 05/07/2021
Onset Date: 05/09/2021
Rec V Date: 07/05/2021
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: NKDA

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

Symptoms: Starting approximately 2 days after vaccination, pt experienced soreness in left arm that has continued until day of report (7/5/21). Pain is intermittent, located in deltoid muscle only, comes and goes. No redness or swelling at site. Pain has been unrelieved with OTC pain relievers.

Other Meds:

Current Illness:

ID: 1446912
Sex: F
Age: 38
State: IN

Vax Date: 06/09/2021
Onset Date: 06/23/2021
Rec V Date: 07/05/2021
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:

Symptom List: Vomiting

Symptoms: Started feeling dizzy and nauseous after a couple weeks of first dose. I continue to feel dizzy and have brain fog after the second dose.

Other Meds: Levothyroxine

Current Illness:

ID: 1446913
Sex: M
Age: 57
State: CA

Vax Date: 06/14/2021
Onset Date: 06/20/2021
Rec V Date: 07/05/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pain and stiffness in left index finger joints - first and second knuckle.

Other Meds:

Current Illness:

ID: 1446915
Sex: F
Age: 69
State:

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 07/05/2021
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:

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

Symptoms: Patient developed itchyness around eyes and tingling sensation around mouth ,arms and legs ( mild). Patient without sob, chest pain ,dizziness or other issue. No evidence of facial dissymetry . Ems called. See ems report for further assessment .

Other Meds:

Current Illness:

ID: 1446916
Sex: F
Age: 55
State:

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 07/05/2021
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: patient suffered a 2-minute long seizure. She has a history of known seizure disorder. Her last seizure was 3 months ago. She also suffers from severe anxiety. patient was alert and oriented times 3 and refused transport to a local hospital by EMS. She left.

Other Meds:

Current Illness:

ID: 1446917
Sex: F
Age: 69
State: NY

Vax Date: 03/12/2021
Onset Date: 05/02/2021
Rec V Date: 07/05/2021
Hospital:

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

Lab Data:

Allergies: codeine, doxycycline, shellfish derived, penicillin

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

Symptoms: Few weeks later developed shortness of breath which improved after a few weeks with steroids but still persists on exertion. Has also new onset vertigo

Other Meds: Cartia XT 180 mg capsule,extended release, Compazine 10 mg tablet, EZETIMIBE TAB 10MG, hydrochlorothiazide 12.5 mg tablet, PANTOPRAZOLE SOD DR 40 MG TAB, rosuvastatin 20 mg tablet, Venofer 200 mg iron/10 mL intravenous solution, avelumab

Current Illness: cancer of renal pelvis

ID: 1446919
Sex: F
Age: 26
State: ME

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

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

Symptoms: Administered vaccine from vial that's BUD was 6-26-21 at 10:15 A.M. Vial was kept in refrigerator entire time prior to administration.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm