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: 1466980
Sex: M
Age: 36
State:

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient fainted and exhibited "seizure-like" activity approximately 2 minutes after vaccination. Patient regained consciousness and felt better after resting. Patient was released to home.

Other Meds:

Current Illness:

ID: 1466981
Sex: M
Age: 16
State: WA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 07/13/2021
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: n/a

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient did not experience an adverse event, rather was administered a vaccine at the incorrect age.

Other Meds: n/a

Current Illness: n/a

ID: 1466982
Sex: F
Age: 56
State: GA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1466983
Sex: F
Age: 48
State: FL

Vax Date: 04/03/2021
Onset Date: 04/24/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: This was my first Covid-19 Vaccine. Within about 3 hours of the injection I began to experience numbness and tingling in my hands and in the left side of my face. It lasted for about 24 hours. It was significant enough that I had to move my hands continually to be able to use them to grip something firmly.

Other Meds: Alegra, Flonase, Prilosec

Current Illness: None

ID: 1466984
Sex: M
Age: 52
State: WV

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Staff did not dilute Pfizer vaccine before administration. According to the Pt's received 0.3mL of undiluted Pfizer vaccine.

Other Meds:

Current Illness:

ID: 1466985
Sex: M
Age: 63
State: NM

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
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: Extreme tiredness, nausea, no fever but had chills, joint pain neck and hips

Other Meds: atenolol 100mg -1 daily

Current Illness: none

ID: 1466986
Sex: F
Age: 14
State: CA

Vax Date: 07/06/2021
Onset Date: 07/08/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Swellenband painful lymph nodes behind ears. Fever rash over 100%of body . Started day two after vaccine it is now day 7post vaccine rash getting worse

Other Meds: Advil

Current Illness: Headache

ID: 1466987
Sex: F
Age: 42
State: CA

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Pharyngeal swelling

Symptoms: slight dizziness, Nausea and Headache the night after injection soreness in the injection site (arm)

Other Meds: NAC, multi-vitamin, coQ-10

Current Illness: not sure

ID: 1466988
Sex: M
Age: 69
State: VA

Vax Date: 03/07/2020
Onset Date: 03/14/2020
Rec V Date: 07/13/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: tingling,, pain, weakness in in left arm since vaccination

Other Meds:

Current Illness:

ID: 1466989
Sex: M
Age: 51
State: FL

Vax Date: 04/27/2021
Onset Date: 05/02/2021
Rec V Date: 07/13/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Chest pains, heart fluttering, dizziness, unusual heart rhythm First admission: Diagnosed with Atrial fibrillation Second admission: Pericarditis and a pacemaker was administered

Other Meds: Lipitor 40mg once daily

Current Illness: None

ID: 1466990
Sex: M
Age: 27
State: PA

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1466991
Sex: F
Age: 32
State: UT

Vax Date: 02/25/2021
Onset Date: 02/27/2021
Rec V Date: 07/13/2021
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: About 36 hours after receiving the vaccine, started having heart palpitations/flutters. Happened after both the first dose and the second dose. Learned that they are actually PVC's. Have never had pvc's in the past, so I assume that they are linked to the vaccine. Pvc's were very frequent at first and then slowed a bit to only a few a day, after the second dose, they resumed again.

Other Meds:

Current Illness:

ID: 1466992
Sex: M
Age: 45
State: OH

Vax Date: 04/26/2021
Onset Date: 04/27/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: Penn

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

Symptoms: Numbness in left arm from elbow to 4th and 5th digits. The numbness largely went away but persists to this day with the sides of the ring finger and pinky finger remaining numb. I fear at this point is is permanently damaged nerves

Other Meds: Paxil

Current Illness: none

ID: 1466993
Sex: F
Age: 13
State: GA

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 07/13/2021
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: none

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

Symptoms: Pt. left the vaccination room and walked over 2 isles and then up past the middle of the store. Pt grabbed the mother's arm and the mom helped her slow her decent to floor. Mom stated pt. fainted and unresponsive for a couple of minutes. Pt. regained consciousness and needed no further treatment.

Other Meds: Not known

Current Illness: none

ID: 1466994
Sex: F
Age: 15
State: CA

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 07/13/2021
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: No known allergies

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

Symptoms: Patient threw up 8 minutes after the vaccine was administered. Felt a little dizzy after the shot she said. No other side effect. Heart rate was normal. Sat down for 30 min in our waiting room. After 20 min mark, patient was given Gatorade. Felt better, dizziness went away. Left after 30 min. Offered to call 911 patient refused. Possibly related to nerves

Other Meds: None

Current Illness: None

ID: 1466995
Sex: F
Age: 43
State: GA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/13/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1466996
Sex: F
Age: 68
State:

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 07/13/2021
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:

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

Symptoms: After needle was retracted following vaccination, the needle broke away from the hub and a drop of vaccine fell on the patient. It was determined that a sufficient dose was given and the patient was released to home.

Other Meds:

Current Illness:

ID: 1466997
Sex: M
Age: 56
State: MA

Vax Date: 03/26/2021
Onset Date: 04/16/2021
Rec V Date: 07/13/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillins

Symptom List: Ear pain, Hypoaesthesia

Symptoms: He presented to the emergency room at Hospital 4/16/21 with chest pain and shortness of breath. D-dimer was elevated. Bilateral pulmonary embolism diagnosed by CT 4/16/21

Other Meds: Nephrocaps 1mg, Mesalamine 1000mg suppository, vedolizumab 300mg injection, vitamin d3

Current Illness:

ID: 1466998
Sex: F
Age: 84
State: OH

Vax Date: 03/21/2021
Onset Date: 06/12/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: hands became almost paralyzed, swelling, using arthritic gloves hurt badly

Other Meds: High blood pressure diabetes medicine insulin

Current Illness: no

ID: 1466999
Sex: F
Age: 41
State: CO

Vax Date: 06/07/2021
Onset Date: 05/04/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: Bactrim

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

Symptoms: On 05/04/2021 I had sinus congestion, a cough, a slight runny nose, body aches, loss of smell and taste, and fatigue. I went to urgent care and they did a Covid test, which was positive. About 4 days in I was given Dexamethasone a 7 day course due to the cough. I still have a lingering cough.

Other Meds: Prilosec 40 mg twice a day

Current Illness: None

ID: 1467000
Sex: F
Age: 42
State: OH

Vax Date: 06/19/2021
Onset Date: 06/21/2021
Rec V Date: 07/13/2021
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: Aleve Zithromax

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

Symptoms: Extreme body aches fever, tingling in fingers and arm. 36 hours post vaccine I had hives in multiple areas of my body. Due to my history of delayed onset reaction with Zithromax that was associated with lip and tongue tingling and a trip to the ER, I was told not to get the second shot

Other Meds: Birth control

Current Illness: Covid 19 on 04/02/2021

ID: 1467001
Sex: F
Age: 48
State: FL

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: About 3 hours after the injection I had numbness and tingling in my hands and down my left side. It was similar to the response I had to the first injection in the series. It was significant enough that I had to concentrate to grip something firmly.

Other Meds: Allegra, Flonase, Prilosec

Current Illness: None

ID: 1467002
Sex: F
Age: 44
State: PA

Vax Date: 05/26/2021
Onset Date: 06/17/2021
Rec V Date: 07/13/2021
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: Celiac, penicillin

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

Symptoms: On the 27th and 28th I felt kind of tired and slept a lot. The next week I was fine. Around 6/16, I saw what I thought was a mosquito or spider bite. It was just an itchy red bump, so I didn?t pay much attention to it. By the 6/21, the hives started coming up a little. On 6/26, it got bigger, and it was spreading on my back. I went into the ER thinking it was a spider bite. They took a look and diagnosed me with shingles. I was given gabapentin and an anti-viral. I had a bad reaction to the gabapentin, so I took it once and stopped. The antiviral is done, and the rash has crusted over and came off. I still have pain on my left side that I have ever experienced before. I am following up with my doctor regarding this.

Other Meds: Diamox, fluoxetine, potassium citrate

Current Illness: No

ID: 1467003
Sex: M
Age: 59
State: ME

Vax Date: 03/06/2021
Onset Date: 07/13/2021
Rec V Date: 07/13/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Injection site pain, Pain

Symptoms: Guillain-Barre

Other Meds: No medications

Current Illness: No known illnesses

ID: 1467004
Sex: M
Age: 17
State: CA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1467005
Sex: F
Age: 46
State: IA

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 07/13/2021
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: Biaxin, ciprofloxacin, clindamycin, Oflaxacin, Ibuprofen, Imitrex, cherries

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

Symptoms: My symptoms started 06-10-2021 and my symptoms are worsening. I am now now experienced very red, little bumps all over my body. These bumps are like blisters that are full of pus but when they break open the pus is a brown liquid form. I also have skin peeling and my throat is really swollen. I had a biopsy done where my doctor found out my symptoms are related to the Ccovid vaccine. Before the vaccine, I had no issues. I also itch horribly throughout the days. I have applied topical creams, Benadryl and I have also taken steroids for over a month. Since receiving my second dose vaccine, I have slept for three hours every night. Even when I lie down flat on my bed I start coughing. My PCP has referred me out to see a second specialist who will examine me and try to find out why I am experiencing these symptoms. My PCP does not know why I am experiencing these symptoms. The specialist I will be seeing soon is located in another town. I have applied so many creams, also received two steroid treatments that have not helped and I do not know what else to do and my symptoms are not going away.

Other Meds: Topiramate, Lamictal, omeprazole, Propranolol

Current Illness:

ID: 1467006
Sex: F
Age: 57
State: MA

Vax Date: 04/02/2021
Onset Date: 07/08/2021
Rec V Date: 07/13/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: In reviewing the system - it was discovered that based on documentation patient may have received a mixed series of COVID vaccine. The patient is documented in our computer system to have received Pfizer Covid Vaccine Lot EN6206 on 3/12/21 and Moderna Covid Vaccine Lot 021B21A on 4/2/21. Only Pfizer was administered in clinic on 3/12/21 and Both Pfizer and Moderna were being administered in clinic on 4/2/21. Patients vaccine care noted pfizer for both doses but lot numbers were as above with Moderna lot as second dose. The patient was notified of this and was consulted by our ID physician. Many checks and balances are in place to prevent such errors ? but based on documentation feel patient may have received a mixed series.

Other Meds:

Current Illness:

ID: 1467007
Sex: M
Age: 29
State:

Vax Date: 06/26/2021
Onset Date: 06/26/2021
Rec V Date: 07/13/2021
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 reported itching face and spots on face within 30 minutes of vaccination. No SOB or other symptoms. Patient felt better after resting and was released to home.

Other Meds:

Current Illness:

ID: 1467008
Sex: F
Age: 52
State: GA

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/13/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1467009
Sex: F
Age: 22
State: MO

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: I was exhausted and very sick, ran a fever, and threw up multiple times. I felt that way all day Saturday and Sunday and only started to feel better on Monday

Other Meds: Iron

Current Illness: none

ID: 1467010
Sex: F
Age: 19
State: PA

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
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: Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Severe

Other Meds:

Current Illness:

ID: 1467011
Sex: F
Age: 25
State: ND

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: Peanuts, Tree Nuts, Pollen, Apples, Miralax (developed after first Pfizer dose in January 2021)

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

Symptoms: Client received Pfizer in January and had a significant reaction, including hives for several days and a chest pain with a subsequent diagnosis of cardiomyopathy. She consulted with her provider who recommended that she try to take some Miralax to see if she had a reaction, which she did, including swelling of her face/lips. She states that her provider then recommended the Janssen as a second dose instead of the Pfizer. Client received the vaccine at 12:12 pm, noticed two small hives on her left forearm a few minutes later, and then reported that she did not feel well at 12:20 pm. She was placed on a cot with a BP reading of 130//72, P -88, O2-99%. She took some oral Benadryl that she brought at 12:30 pm. She reported that her face felt "funny" and she felt hot, but started to feel better when she laid down. 12:40 pm BP 118/76, P-82, O2 98%. Client reported that her throat felt a little scratchy, but that she was also very anxious. 12:50 pm Client reported that she started to feel better. 12:52 pm O2 98%, P - 80. 1:00 P- 85, O2 99%. Client felt well and left with her father.

Other Meds: Unknown

Current Illness: N/A

ID: 1467012
Sex: F
Age: 56
State: FL

Vax Date: 03/01/2021
Onset Date: 03/24/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: 13 days after the second dose i started getting hives really bad. Everytime I drink it eat anything dairy it gets worse. I was out on steroids and the only thing that helps is just cutting dairy from my diet. I was never allergic to food before this.

Other Meds: Heart pills

Current Illness:

ID: 1467013
Sex: M
Age: 39
State:

Vax Date: 06/29/2021
Onset Date: 06/29/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Incorrect brand for second dose--patient received Moderna for his first dose and Pfizer for his second dose. No AE.

Other Meds:

Current Illness:

ID: 1467014
Sex: M
Age: 55
State: IL

Vax Date: 02/13/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
Hospital: Y

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: Erythema, Pruritus

Symptoms: first vaccination given 02/13/21 and second 03/13/2021. Positive 07/09, admitted 07/12 to hospital

Other Meds: bendamustine/rituximab on 02/04-02/05

Current Illness:

ID: 1467015
Sex: M
Age: 15
State: MD

Vax Date: 05/13/2021
Onset Date: 06/02/2021
Rec V Date: 07/13/2021
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: Anaphylaxis to peanuts, tree nuts, and shellfish. No known drug allergies.

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

Symptoms: On June 2, 2021, he awoke and complained of feeling hot, tired, and not hungry. His mother had been sick with acute gastroenteritis symptoms 2 days earlier. Over the course of the day, he had a fever to 101.6 F, and began to have loose stools (twice). He received Ibuprofen 400 mg by mouth every 6 hours for the fever, and drank plenty of fluids. On June 3, 2021, he continued to have fevers to 101.5 F, loose stools (twice again), and poor oral intake of food. I canceled his scheduled 2nd Pfizer-BioNTech vaccine, and got him a NP swab test for SARS-CoV-2 through the health department. On June 4, 2021, he had no fever but now complained of a rubbing left parasternal chest pain. On physical examination, his BP was elevated (130s/90s), he had a slight tachycardia (90s), and was afebrile. On auscultation, I heard a S4 gallop and took him immediately to the local ER.

Other Meds: None

Current Illness: Rhinorrhea and nasal congestions (seasonal allergies) treated with Cetirizine 10 mg by mouth once a day. Not taking at the time of vaccination.

ID: 1467016
Sex: F
Age: 17
State: TX

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 07/13/2021
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: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1467017
Sex: M
Age: 58
State: MA

Vax Date: 04/02/2021
Onset Date: 07/08/2021
Rec V Date: 07/13/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: In reviewing Immunization Information System - it was discovered that based on documentation patient may have received a mixed series of COVID vaccine. The patient is documented in our computer system to have received Pfizer Covid Vaccine Lot EN6206 on 3/12/21 and Moderna Covid Vaccine Lot 021B21A on 4/2/21. Only Pfizer was administered in clinic on 3/12/21 and Both Pfizer and Moderna were being administered in clinic on 4/2/21. Patients vaccine care noted pfizer for both doses but lot numbers were as above with Moderna lot as second dose. The patient was notified of this and was consulted by our ID physician. Many checks and balances are in place to prevent such errors ? but based on documentation feel patient may have received a mixed series.

Other Meds:

Current Illness:

ID: 1467018
Sex: M
Age: 47
State: OH

Vax Date: 03/08/2021
Onset Date: 04/10/2021
Rec V Date: 07/13/2021
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

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

Symptoms: Presented with intermittent right shoulder pain and ristricted mobility. Symptoms emerged in early April and worsened through early June. Diagnosed with adhesive capsulitis of right shoulder in June. Treated with steroid injection, oral non-steroidal anti-inflammatory and physical therapy. Pain subsided, mobility improved but not returned to pre-symptomatic level. Oral anti-inflammatory and physical therapy continuing.

Other Meds: Alphagan, Cosopt, Zioptan, Omega-3 supplement

Current Illness: None

ID: 1467019
Sex: F
Age: 17
State: PA

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild

Other Meds:

Current Illness:

ID: 1467020
Sex: F
Age: 16
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient presented to School COVID Vaccination Clinic on 7/9/2021 for her 2nd dose of the COVID Vaccination. At this time it was discovered that she had received her 1st dose as a Moderna vaccine, despite not meeting the age requirements. Patient did not report any symptoms or adverse effects from the first vaccine and was subsequently given her 2nd dose Moderna lot # 001C21A on 7/9/21 to complete her vaccination series.

Other Meds:

Current Illness:

ID: 1467021
Sex: F
Age: 36
State:

Vax Date: 07/02/2021
Onset Date: 07/02/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient developed hives on her arms and hands within 15 minutes of vaccination. Also had itchy ears and red cheeks. Given two doses of Benedryl and symptoms improved. She was released to home.

Other Meds:

Current Illness:

ID: 1467022
Sex: M
Age: 64
State: MI

Vax Date: 06/29/2021
Onset Date: 06/30/2021
Rec V Date: 07/13/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Normal soreness at injection site on day 1. Day 2 pain occurred from upper arm to lower lateral arm area, It radiated around to scapula and up into the left side of the neck. Two weeks post injection the pain is still prominent, and seems to at times rotate between the above sites, and sometimes all sites. Pain on a 1-10 scale ranges from a 3 - 7 and muscles and skin are tender to the touch. Acetaminophen 500mg q6hrs was of little help. Methocarbamol 750mg q6 hrs was not useful. Ice seemed to help while applied but not much after. Pain was that felt after a muscle spasm or charlie horse subsides - chronic ache and sometimes a throb. Next will try gabapentin starting 7-13-21.

Other Meds: Ozempic 0.5mg s.q. weekly; losartan 50mg; sertraline 50mg; aspirin 80mg; simvistatin 40mg; Xigduo XL 5/1000

Current Illness: none

ID: 1467023
Sex: M
Age: 50
State: NM

Vax Date: 04/08/2021
Onset Date: 06/27/2021
Rec V Date: 07/13/2021
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: I am allergic to Cipro.

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

Symptoms: After having the vaccination I experienced chronic diarrhea that has not subsided. I scheduled an appointment with my physician to discuss symptoms.

Other Meds: At the time of vaccination I was taking Claritin and Nexium. I was also taking Finasteride and Dutasteride.

Current Illness: No other illnesses at the time of vaccination.

ID: 1467024
Sex: M
Age: 24
State: GA

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/13/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1467025
Sex: F
Age: 68
State: IN

Vax Date: 03/24/2021
Onset Date: 03/26/2021
Rec V Date: 07/13/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: March 26 - 27: 101 degree fever, chills, headache and fatigue; March 28 - 29: headache and fatigue continued; March 30 - 31: bedridden with nausea and diarrhea; April 1 - 3: fatigue continues with no appetite; April 4 - 12: severe head cold with chest congestion and continued fatigue. Additional ongoing symptoms: periodic episodes of losing sense of balance.

Other Meds: vitamins - E, C/zinc/echanacia

Current Illness: non

ID: 1467026
Sex: M
Age: 30
State: CA

Vax Date: 04/16/2020
Onset Date: 04/16/2021
Rec V Date: 07/13/2021
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: Vitamin B

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

Symptoms: 25 Minutes after receiving vaccine he got numbness and tingling in his face, lip, under his eye and temple. he also had red whelps on his neck, right arm

Other Meds: Lexapro

Current Illness: Anxiety

ID: 1467027
Sex: M
Age: 63
State: NY

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 07/13/2021
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: Penicillin; Advil

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I got symptoms like allergies but I don't know if they were allergies or not. Nothing that I thought wasn't more seasonal than anything else. The worst was extreme macular aches and pains and severe join paints. Muscles spams and cramps to the point of muscle tearing. Nothing has changed for me and time has gone on and I'm not getting them muscle spasms or pains. I'm not sure if the headaches I was getting was in relation to it or not.

Other Meds: Rocklatan; Aleve; Tylenol as needed

Current Illness: None

ID: 1467028
Sex: F
Age: 64
State:

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/13/2021
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: Patient COVID-Vaccination Registration form indicates patient has not received a different covid vaccine product. Given Pfizer vaccine today. When documenting, noted to have received Janssen vaccine on 3/13/2021 Patient states she was advised by her cardiologist and Dr. to receive Pfizer vaccine as a booster. Patient advised this is not the recommended practice and she will not receive another covid vaccine here. No adverse side effects noted

Other Meds:

Current Illness:

ID: 1467029
Sex: F
Age: 50
State: TX

Vax Date: 01/23/2021
Onset Date: 01/27/2021
Rec V Date: 07/13/2021
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: SULFA

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

Symptoms: 3 days after receiving my first dose, my body started attacking itself. My joints everywhere hurt. It got so bad that I couldn't bathe, dress or care for myself. I was soon diagnosed with high blood pressure and RA. Due to all the pain meds required to get me thru the day, I was taken to the ER twice and diagnosed with Colitis of the colon. Recent colonoscopy has revealed that I have IBS due to medications. I would never have taken this vaccination if I had known this was going to happen. To this day I deal with brain fog, depression and colon pain.

Other Meds: NONE

Current Illness: NONE

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm