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: 1464614
Sex: F
Age: 91
State: FL

Vax Date: 03/25/2021
Onset Date: 07/09/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt admitted to the hospital for COVID 19 post vaccination

Other Meds:

Current Illness:

ID: 1464615
Sex: F
Age: 61
State: IL

Vax Date: 04/21/2021
Onset Date: 05/03/2021
Rec V Date: 07/12/2021
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: Pain in left arm (injection side). Increased difficulty with shoulder movement. Ringing in ears. Ongoing malaise.

Other Meds:

Current Illness:

ID: 1464617
Sex: M
Age: 64
State: IN

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 07/12/2021
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: Penicillin

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

Symptoms: Began having sore left shoulder. Moved to right shoulder,hips, and knee. Pain so bad couldn't lift arms. Trouble walking. Some days had to use a walker to get around. Began steriod treatment for inflammation. Seeing Rheumatologist. Diagnosis unclear but thinking Polymyalgia rheumatica.

Other Meds: None being taken

Current Illness: None

ID: 1464618
Sex: M
Age: 41
State: CA

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies: NKDA, NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Within minutes of receiving vaccination, pt stated he was hot and thirsty, became unrepsonsive to verbal stimuli. Pt proceeded to have tonic-clonic seizure lasting 25 seconds. Pt lowered to the ground by staff, monitored VS. No incontinence, no biting of tongue. pt regained consciousness, and oriented x3. VSS. pt reported he felt light-headed. When attempted to place in chair, symptoms returned, and pt was placed back in supine position. EMS arrived, and after VS established, EKG indicated sinus rhythm, placed in chair. Pt stated he did not feel good, and similar symptoms began with eyes rolling back and contractures. Pt taken to hospital.

Other Meds: none

Current Illness: None

ID: 1464619
Sex: M
Age: 66
State:

Vax Date: 01/07/2021
Onset Date: 06/28/2021
Rec V Date: 07/12/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: U07.1 - COVID-19 J12.82 - Pneumonia due to coronavirus disease 2019 N17.9 - Acute kidney failure, unspecified

Other Meds:

Current Illness:

ID: 1464620
Sex: F
Age: 63
State: OH

Vax Date: 03/09/2021
Onset Date: 04/03/2021
Rec V Date: 07/12/2021
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: Rushed to emergency room with severe, severe pain left shoulder, arm, hand, underarm breast, upper back and midback (left side). Given morphine and nausea and sent home. Still in pain. Rushed back to emergency room exactly a week later with same symptoms plus blisters and rash (still left side). Treated for symptoms of shingles, but no "classic" signs of shingles. Saw primary care doctor on 06/02/2021. Continued the treatment for shingles. Extremely limited function in left hand (holding, etc.) Future doctor visits schedule for August.

Other Meds: Lysinapril 5ml, Omeprazol

Current Illness: None

ID: 1464621
Sex: F
Age: 56
State: AZ

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 07/12/2021
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: Yes - significant allergies to food, pollen, sulfites, and other common allergens

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Wednesday 4/8 In addition to the expected sore arm, I experienced unusual tightness in my lungs while exercising and had trouble with deep breathing, but those symptoms lessened within 24 hours. Thursday 4/8 sore arm worsened. Took Zyrtec, an allergy medicine. Tightness in chest was less than Wed but still present. Friday 4/9 Terrible stomach pain, diarrhea, and extreme pain in my gall bladder area. Nearly went to ER but nurseline discouraged in absence of a headache, as well. Acute pain gradually resolved with Benadryl over next few days. Anaphylactic reaction was acute but subsided after a week. However, residual pain in left side of chest , around heart area, intermittently since July 1 when treated with powerful anti-inflammatories. Waiting for chest scan, which my doctor prescribed. I do not know at this point whether I had heart inflammation or not. Will know soon hopefully.

Other Meds: None

Current Illness: none

ID: 1464622
Sex: U
Age: 56
State: CA

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies: allergic to Ibuprofen

Symptom List: Pharyngeal swelling

Symptoms: Patient received Covid vaccine and after 5 minutes developed throat discomfort. She was given 25 mg of Benadryl po. Tolerated well. She was kept for 45 min in observation and symptoms subsided. Patient was discharged in no apparent discomfort. Family member drove her home.

Other Meds: patient taking immunosuppressive medication.

Current Illness: thyroid cancer

ID: 1464623
Sex: F
Age: 75
State: FL

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/12/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Health Department was contacted, who asked staff to come to facility to vaccinate bedbound patient. Once staff returned with signed consent after administering the 1st dose of the Moderna series, it was inputted into Shots. Upon inputting the information into shots we realized that the patient has already been fully vaccinated with Pfizer within the facility. Nurse advised, and she stated she didn't realized that patient had already been fully vaccinated.

Other Meds: Unknown-Residing in long term living facility.

Current Illness: Unknown

ID: 1464624
Sex: F
Age: 63
State: NC

Vax Date: 04/12/2021
Onset Date: 04/14/2021
Rec V Date: 07/12/2021
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: Codeine, Flonase

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Started with shoulder ache and malaise on afternoon on second day after vaccination. Then severe headache that lasted 2 1/2 days, extreme fatigue, loss of appetite, shooting pains in head and ears, sore eye sockets, difficulty walking. Felt better on 4/19 and went for a Covid test that was negative. Then started to feel bad again, and on 4/23 tried to get a doctor appointment for the pain in my ears. Told to go to urgent care where they did remove ear wax but were unable to diagnose the issue and kept asking why I was walking (more like shuffling) that way. They sent me to the ER. Got an EKG, CT scan of head, removal of ear wax missed by urgent care, and bloodwork. Was told that some people who previously had Covid have very robust responses after the second Covid shot. Re: previously having Covid, I was on a business trip on Feb 13-15, 2020. On the Tuesday after getting home, I got very sick. Loss of smell, taste, and appetite. Extreme fatigue. Felt like a severe head cold. Weight loss of 10 pounds that I've not gained back. This happened before there were Covid tests. I asked my PCP about getting an antibody test but was told they weren't available. So while I was never officially diagnosed with Covid, I'm 99% sure that's what I had in February 2020. It took me weeks to recover from the side effect episode in April.

Other Meds: Amoxicillin, rosuvastatin, Vitamin B12, Vitamin D

Current Illness: Tooth abscess (reason I was taking amoxicillin - started it on 4/13)

ID: 1464625
Sex: M
Age: 69
State: MT

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Hands were swollen and hands puffy .. soreness

Other Meds: Furosenide; allopuridol; Amlodipine; Metoprolol; Clonidine; Atorvastatin

Current Illness: no

ID: 1464627
Sex: F
Age: 63
State: RI

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 07/12/2021
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: Iodine Dye; Ampicillin.

Symptom List: Rash, Urticaria

Symptoms: I was itchy and developed redness in my face and chest the night that I got the first dose of the vaccine. I did not go to the doctor and they went away in a day or so. I developed a fever and chills. I also had a headache. Those symptoms lasted for a night. The next day I was so fatigued, I could not even get up. I developed nauseous and vomiting the next day.

Other Meds: Turmeric; Multivitamin for vision; Baby Aspirin.

Current Illness: None.

Date Died: 06/21/2021

ID: 1464628
Sex: F
Age: 85
State: MA

Vax Date: 06/03/2021
Onset Date: 06/20/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: ? June 20 ? struggling to breathe; morphine administered ? June 21 ? passed away

Other Meds: - some medications to address Dementia and conditions resulting from stroke in 2002, also on conditions diagnosed with Lung Cancer on May 10, 2021

Current Illness: see Item 9

ID: 1464629
Sex: F
Age: 62
State: IA

Vax Date: 04/08/2021
Onset Date: 05/02/2021
Rec V Date: 07/12/2021
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: Z-pack antibiotic, Percocet, hay fever in the spring

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

Symptoms: I experienced on or about 05-02-2021; started to smell ammonia and it continued for awhile, it was a constant smell all the time then it would kind go and comes. I got concerned about my kidneys. I had some discomfort very slight in my abdomen area and I also had some headaches. I did not call the doctor right away, waited about two weeks. I did go see my doctor on 05-13-2021. I had full physical exam, blood panel, ordered at CT scan of head, have history of lymphoma, non-Hodskin type, that was in the tonsils and asked that I see a ENT specialists to rule out any problems with my sinuses on 06-08-2021. I saw an ENT, also did a sniff test, and there was no problems, no evidence of growth. I also pretty much aced the sniff test. Then my doctor ordered on 06-24-20201 an U/S of my kidney and bladder and another lab work up. The GFR was 53 in May 2021 then on 06-24-2021 my GFR was 55. I still have the ammonia smell but it is less frequent. I have scheduled a colonoscopy and will see what that turns out and will monitor with my doctor and then if my numbers do not improve then the next step of treatment is to see a nephrologist. I do not know that if what I experience is related to the vaccine. I have never had any trouble with my kidneys in the past.

Other Meds:

Current Illness:

ID: 1464630
Sex: M
Age: 52
State: SC

Vax Date: 05/06/2021
Onset Date: 06/18/2021
Rec V Date: 07/12/2021
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: None

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

Symptoms: I have all the symptoms of Guillain-Barre Syndrome from the Johnson & Johnson shot. The symptoms started on June 18th with massive muscle pain in my left side upper back, left shoulder, and left arm. Very painful nerve pain down my arm that has persisted for over 3 weeks. Partial loss of feeling in my arm and loss of strength in my left arm. My arm is substantially weaker and I cannot use my arm in the manner I use too. As if today's date of 7/12/2021 I have muscle weakness, nerve pain from my upper back and all the way down my right arm.

Other Meds: None

Current Illness: None

ID: 1464631
Sex: F
Age: 79
State: TX

Vax Date: 06/11/2021
Onset Date: 06/12/2021
Rec V Date: 07/12/2021
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: The next morning the patient experience jaw and mouth swelling

Other Meds:

Current Illness:

ID: 1464632
Sex: F
Age: 66
State: WI

Vax Date: 02/22/2021
Onset Date: 07/05/2021
Rec V Date: 07/12/2021
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: Angiotensin Receptor Blockers, Losartan, lanolin

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

Symptoms: Pt initially tested positive back on 12/16/2020. She was subsequently vaccinated with the Pfizer vaccine on 2/1/2021 and 2/22/2021. She tested negative on 6/1/2021 and 6/20/2021. As part of SNF admission requirement, she was tested upon discharge from hospital on 7/5/2021 and it resulted positive. Pt was here for non covid reasons and was admitted on 6/20/2021, negative on admit. CT value was over 30 and therefore the viral replication is insignificant for sequencing . She had subsequent negative COVID tests on 7/6/2021 and 7/7/2021. Remained asymptomatic for covid.

Other Meds: amlodipine, aspirin, atorvastatin, cyanocobalamin, ferrous sulfate, insulin aspart, insulin glargine, levothyroxine, metoprolol, omeprazole, venlafaxine, vitamin D3

Current Illness:

ID: 1464633
Sex: M
Age: 56
State: VA

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies: Lorazepam, Ragweed

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Approximately 15 minutes after patient received a Pfizer Covid-19 and Shingrix vaccine, he lost consciousness, but was visibly breathing. I called 911, then patient stopped breathing . He regained consciousness before I could begin CPR. While waiting for EMS, we took 2 BP readings (142/128 & 96/68) and I questioned patient's wife about medical history... she said that he had passed out 3-4 times in the past year. (Pt had not disclosed this on his vaccination Questionnaire)

Other Meds: Unknown

Current Illness: Unknown

ID: 1464634
Sex: F
Age: 46
State:

Vax Date: 06/02/2021
Onset Date: 06/08/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: U07.1 - COVID-19

Other Meds:

Current Illness:

ID: 1464635
Sex: F
Age: 51
State: PA

Vax Date: 03/14/2021
Onset Date: 03/25/2021
Rec V Date: 07/12/2021
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: Bad Headaches at the top of my head started on March 25th. March 30th went to ER with Bells Palsy, tingling in arms, hands felt dumb and felt strange (almost as though I had frost burn) when I would run them under water. Also experience excruciating pain the shoulders and hamstrings. Has a Lyme's test, EKG and CT Scan. All negative. Put me on predisone. Had to get a 2nd prescription because was still experiencing a lot of pain. Went for an MRI and had another Lyme's test. Everything negative.

Other Meds:

Current Illness:

ID: 1464637
Sex: F
Age: 55
State: WA

Vax Date: 04/05/2021
Onset Date: 06/28/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies: Fluconazole

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

Symptoms: First, about 8 hours after the vaccine I had flu symptoms; mostly just a gnarly fever and that ran 24 hours. Seven days of liquid diarrhea; I went to Care Physician. They didn't have an answer as to why it happened, but it did correct itself. No treatment.

Other Meds: Vitamin B; Vit C; Iron

Current Illness: No

ID: 1464638
Sex: F
Age: 58
State: WA

Vax Date: 06/21/2021
Onset Date: 06/29/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Unevaluable event

Symptoms: Soreness of left arm/neck for 4 days. Then had a seizure 1 week after vaccination. No prior history of seizures.

Other Meds: Wellbutrin; Prozac; Metformin; Hydroxyzine

Current Illness: None

ID: 1464639
Sex: F
Age: 62
State: AZ

Vax Date: 04/03/2021
Onset Date: 04/04/2021
Rec V Date: 07/12/2021
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: Nsaids, catsup, eggs, latex, glue on band aids and tape, essential oils, evergreen trees, aspirin, viocodin, tramadol, atenolol,, biaxcin,

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

Symptoms: Immediately following the second dose, I had a lot of trouble with insomnia and nightmares that continued for almost 3 weeks. The nightmares stopped and even tho I am 9 years POST menopausal, I began bleeding again on April 28. Basically, it has only stopped for 3-4 days at a time in between. And I have been bleeding almost constantly ever since except for 10 days. I have had a uterine biopsy at Hospital. And Ultrasounds and there are no issues other than my uterine tissue is thicker than it should be. My joints are painful and enlarged too. That began at the beginning of May. I have had xrays and have been treated with steroids to get the tissue under control. I also am now experiencing Night Sweats and Hot flashes. Mayo doctors believe I need a hysterectomy or D&C to stop the bleeding issue.

Other Meds: Valtrex, folic acid, hctz, fiber, probiotic, ,citrical, d3, progesterone, cranberry, potassium, stool softeners, multi vitamins, valerian complex,

Current Illness: None

ID: 1464640
Sex: F
Age: 12
State: AK

Vax Date: 07/11/2021
Onset Date: 07/11/2021
Rec V Date: 07/12/2021
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: Horses, Cats, Nuts

Symptom List: Injection site pain, Pain

Symptoms: Tongue swelling

Other Meds: 5mg Melatonin PRN at bedtime

Current Illness: None

ID: 1464641
Sex: F
Age: 44
State: TX

Vax Date: 03/04/2021
Onset Date: 06/01/2021
Rec V Date: 07/12/2021
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: Na

Symptom List: Injection site pain, Menorrhagia

Symptoms: Guillain-Barr? Syndrome, IVIG treatment, numbness, tingly, sharp needle feeling, could not walk.

Other Meds: Loestrin

Current Illness: Na

ID: 1464642
Sex: F
Age: 43
State: VA

Vax Date: 05/29/2021
Onset Date: 05/30/2021
Rec V Date: 07/12/2021
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: Dilladuid, Loratab, NSAIDS

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

Symptoms: Horrible migraine 5/30-6/4 went to PCP to get a migraine shot because my migraine breakthrough medicines would not work.Strep throat on 6/11/21 and then my back went out -I was in ER 7/2/21 i couldnt walk or move without crying out in pain.I could not move my legs. Released from theER when I could stand up even though I was still in excruciating pain. I was given a cocktail of muscle relaxer, anti-inflammatory, nausea& 4mg of morphine. I could still feel the pain.Finished the prednisone 7/6 went to a dr at my PC office prescribed me tizanidine 4mg 3x a day, but it isnt helping. Can barely walk, cant drive,I cant turn in bed to roll to my other side. Once I get in one spot I have to stay to stay there.

Other Meds: Levothyroxine, Valacyclovir,pregabalin, norethridrone ,armoda

Current Illness:

ID: 1464643
Sex: F
Age: 36
State: TX

Vax Date: 04/08/2021
Onset Date: 06/12/2021
Rec V Date: 07/12/2021
Hospital: Y

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

Lab Data:

Allergies: Reglan allergy

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Chest pain, leg pain, blood clots, pulmonary embolism, thrombectomy, hypotension shock, life saving measures. Heparin and Eliquis are the medications needed to thin my blood.

Other Meds: Nuvaring birth control

Current Illness: NONE

ID: 1464644
Sex: F
Age: 47
State: MN

Vax Date: 02/02/2021
Onset Date: 07/12/2021
Rec V Date: 07/12/2021
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: Patient tested positive for COVID 7/12/21. She is fully vaccinated. Asymptomatic.

Other Meds:

Current Illness:

ID: 1464645
Sex: F
Age: 51
State: IL

Vax Date: 04/07/2021
Onset Date: 06/27/2021
Rec V Date: 07/12/2021
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: penicillin, codeine, paxil, zofran

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

Symptoms: I am unsure if this is from the vaccine or not but the lady that called me from V-Safe asked me to fill out this form. Pancreatitis , treated with fluids and various medications, hospitalized for six days. Discharged home to follow up with primary doctor later this week.

Other Meds: lasix, spironolactone, zyrtec, omeprazole, montakulast, norco, ibuprofen, fenofibrate, spiriva, symbicort

Current Illness: none

ID: 1464646
Sex: M
Age: 1
State: TN

Vax Date: 07/09/2021
Onset Date: 07/10/2021
Rec V Date: 07/12/2021
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: Mild fever (99.6), rash all over body, itch treated with Benadryl

Other Meds: None

Current Illness: Diagnosed with Hand Foot Mouth the following Monday

ID: 1464647
Sex: M
Age: 73
State: SC

Vax Date: 02/06/2021
Onset Date: 02/09/2021
Rec V Date: 07/12/2021
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: pain shooting down my arm/side cant sleep weak arm

Other Meds:

Current Illness:

ID: 1464648
Sex: M
Age: 63
State: WA

Vax Date: 04/08/2021
Onset Date: 05/21/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

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

Symptoms: I woke that Friday and the bottom half of my right eye was full of netting, within a week entire eye was like that, so about 50% of those optical nerves are permanently dead. Saw Dr. on 05/26/2021. Doctor said My blood supply to eye was restricted, right eye, to the point most of my optical nerves died. I also feel pressure in my head behind my eye. Turns out I also developed a sty. This head pressure on right side of head is killing me. My back and neck are also very sore.

Other Meds: Atorvastatin Allopurinol Am lodapine Aspirin Vitamin D

Current Illness: None

ID: 1464649
Sex: M
Age: 69
State: CA

Vax Date: 04/06/2021
Onset Date: 04/13/2021
Rec V Date: 07/12/2021
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: penicillin

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

Symptoms: Chronic Inflammatory Demyelinating relapse after 25 years of no issues. This is the first vaccine I've received since I was diagnosed with CIDP 25 years ago. Symptoms returned about 1 week after 2nd vaccine. Lost feeling in both feet and had shooting sensations up the outside of both legs. Began high dose 70 MG prednisone immediately which seemed to stop disease progression. Working with neurologist on Prednisone dosing and reduction. Loss of balance but no muscle weakness.

Other Meds: Quinapril 20 MG, Allopurinol 300 MG, Lumigan

Current Illness: None

ID: 1464650
Sex: M
Age: 16
State: TX

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/12/2021
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: nka

Symptom List: Tremor

Symptoms: rash all over body

Other Meds: Diphenhydramine hcl tab

Current Illness: none

Date Died: 06/05/2021

ID: 1464651
Sex: M
Age: 28
State: TX

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Erythema, Pruritus

Symptoms: This was a J&J vaccine but I didn't see that as a choice in the drop down. My son passed away on June 5 2021. He had severe nausea

Other Meds: antibiotics

Current Illness: dry socket from tooth removal

ID: 1464652
Sex: M
Age: 65
State: CA

Vax Date: 02/14/2021
Onset Date: 02/16/2021
Rec V Date: 07/12/2021
Hospital: Y

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: None

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

Symptoms: I experienced a stroke in my right frontal lobe and was hospitalized for two days.

Other Meds: Thorazine 25 mg to rid chronic cough

Current Illness: Cough

ID: 1464653
Sex: F
Age: 52
State: AL

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 07/12/2021
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: Have dust and polen allergies

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

Symptoms: Started having tightness in chest, shortness of breathing, fast heartbeat, body was shaking. Went to Emergency room. Took chest X-ray, blood work. All the heart and lungs related tests were normal. Doctor gave Prednisone 20mg, Benadryl shot, and Albuterol inhaler. Same symptoms repeated after couple of weeks. I could able to manage with Alegra, Nasacort, and Albuterol. Visited Cardiologist for heart evaluation in May. Cardiologist confirmed that heart is healthy.

Other Meds: None

Current Illness: None

ID: 1464655
Sex: M
Age: 18
State: NY

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 07/12/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Dizziness, profuse sweating, felt hot,shortness of breath, felt like passing out, vision disturbance (saw black spots) , weakness. This occurred immediately after shot was given. Medical personnel moved him to area to monitor his vitals, gave him ice packs, checked blood pressure, heart rate etc.

Other Meds: None

Current Illness: None

ID: 1464656
Sex: F
Age: 39
State: OR

Vax Date: 05/01/2021
Onset Date: 07/04/2021
Rec V Date: 07/12/2021
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: None known

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

Symptoms: I've been feeling unusual/new joint and nerve pain in toes, first on right side and then also on the left, and tingling in extremities as well as joint/pain in hands. The vaccine also caused unusual cramping and changing the timing of my menstrual cycle.

Other Meds: Levothyroxine

Current Illness: None

ID: 1464657
Sex: F
Age: 34
State: OH

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 07/12/2021
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: Grass/grain allergy

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

Symptoms: Left Arm became numb in elbow/ulnar nerve region for approximately 10 hours. Was possibly attributed to sleeping oddly at the time but is still exhibiting symptoms of inflammation and numbness 2 months later.

Other Meds: None

Current Illness: Abrasion to leg with TDAP administration two weeks prior to COVID-19 J&J vaccine

ID: 1464659
Sex: F
Age: 11
State: WA

Vax Date: 07/11/2021
Onset Date: 07/11/2021
Rec V Date: 07/12/2021
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: Dose given to an 11 year old patient

Other Meds:

Current Illness:

ID: 1464660
Sex: F
Age: 59
State: GA

Vax Date: 04/09/2021
Onset Date: 04/23/2021
Rec V Date: 07/12/2021
Hospital:

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

Lab Data:

Allergies: Yes. Molds, Pollen, hay, dust. Antibiotics incl penicillins, oxytetracyclin doxycycline Cows milk.

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

Symptoms: I had normal couple of days feeling feverish, tired, headache and body aches immediately after vaccine. Then I felt great, better than for over a week. Then 2 weeks after vaccine, had numbness and tingle in feet hands and arms. Followed by severe migrating nerve pains. First in right forearm, moving to hand within 2 days. Then i had headaches and nerve pains in my face, that was worse when i laid down. Then a couple of days later, severe nerve pains in left upper arm migrating over 3 days down arm to wrist then hand. Then a day or 2 later, severe awful nerve pain in groin, that stayed 2days, then moved down the back of left leg (sciatica like pain) traveling over several days to back of knee, lower leg, ankle and then outer toes. Was so painful, I could hardly walk for a week. I was also exhausted for 3 weeks. About a month after the pains started, the vanished as quickly as the came.

Other Meds: None

Current Illness: None

ID: 1464661
Sex: F
Age: 21
State: MO

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/12/2021
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: Numb hands

Other Meds: Women?s daily, hair skin and nails

Current Illness:

ID: 1464662
Sex: M
Age: 34
State: OR

Vax Date: 06/21/2021
Onset Date: 06/23/2021
Rec V Date: 07/12/2021
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: Ocycodine

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

Symptoms: Chest pain starting on the second day after the second dose. Still occurring as of this submission. Presumed pericarditis after my last appointment with Cardiologist. Colchicine and ibuprofen.

Other Meds: None

Current Illness: None

ID: 1464663
Sex: F
Age: 31
State: TX

Vax Date: 01/02/2021
Onset Date: 06/30/2021
Rec V Date: 07/12/2021
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: n/a

Symptom List: Vomiting

Symptoms: MISCARRIAGE AT 7 WEEKS 5 DAYS GESTASTIONAL AGE, 1 PREVIOUS HEALTY PREGNACY IN 7/17/2019, NO PREVIOUS HISTORY OF MISCARRIAGE

Other Meds: cetirizine 10mg

Current Illness: n/a

ID: 1464665
Sex: F
Age: 57
State: CA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 07/12/2021
Hospital: Y

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

Lab Data:

Allergies: Proplene glycol, polyethlene glycol, penicillin, doxycycline, codeine, Biaxin, Tramadol, Losartan. Lisinopril, hydrochlorothiadide, cipro, clindamycin, vicodin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Dry throat, sore throat, headache, body ache, breathing difficulty ( hospitalized twice for breathing) low oxygen levels, back pain, severe fatigue/weakness

Other Meds: Atrovastatin 40mg, Duloxetine 50 mg, Diltiazem 360 mg, Levothyroxine 137

Current Illness: high blood pressure diabetes

ID: 1464666
Sex: F
Age: 30
State: CA

Vax Date: 01/08/2021
Onset Date: 05/23/2021
Rec V Date: 07/12/2021
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: Ceftriaxone

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

Symptoms: I began having notable palpitations after my 2nd vaccine in January. Palipitations continued getting worse until I began having SVT episodes in late May 2021. I was officially diagnosed with SVT and will need a cardiac ablation.

Other Meds: Sertraline, levothyroxine, pre natal vitamin, vit c, vit d, fish oil

Current Illness: No

ID: 1464667
Sex: M
Age: 14
State: AZ

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/12/2021
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: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Chest pain for two days after 2nd vaccination. Chest pain resolved with ibuprofen.

Other Meds: Melatonin 5mg, Depakote ER 500mg, guanfacine 1mg, olanzapine 7.5mg

Current Illness: None

ID: 1464668
Sex: F
Age: 72
State: WI

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 07/12/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Irregular heartbeat started when contracted Covid-19 in October 2020. Exacerbated again after receiving both doses of the Moderna vaccine. Since October 2020 to present, she has had two event monitors placed. One event monitor was 2 weeks in length, the other was 30 days in length. She is a patient of cardiologist, Dr. She has also seen electrophysiologist, Dr. and internist Dr. She has an appointment for a second opinion on 8/2/2021 with electrophysiologist Dr. She has been treated for high cholesterol for the past 40 plus years. She has been treated for hypertension for the past 40 plus years. Starting with Covid-19 in October 2020, she has had the sensation of ?needles sticking up? which goes around the neck, up to the ears, and along each joint of her jaw. She was placed on a blood thinner by Dr. around 6/2/2021. Dr. also has placed her on Diltiazem to treat her blood pressure issue. As of today, 7/6/21, the sensation is subsiding and is nothing like when she had Covid-19.

Other Meds:

Current Illness:

ID: 1464669
Sex: F
Age: 17
State: CO

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 07/12/2021
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: Patient was too young to receive Janssen vaccine, but received it by mistake We need to be more diligent about asking date of birth. We have staff who are contractors who should review papers before sending patients to the vaccinator. We need to double check before vaccinating.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm