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: 1470611
Sex: M
Age: 27
State: KS

Vax Date: 06/17/2021
Onset Date: 07/10/2021
Rec V Date: 07/14/2021
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: NONE.

Symptom List: Dysphagia, Epiglottitis

Symptoms: SARS-COV-19 Infection. Congestion, Diarrhea, Loss of taste, loss of smell, shortness of breath, fatigue, muscle aches.

Other Meds: Wellbutrin.

Current Illness: None.

ID: 1470612
Sex: F
Age: 32
State: WI

Vax Date: 03/01/2021
Onset Date: 07/01/2021
Rec V Date: 07/14/2021
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: Vaccinated by Pfizer on 3/1/20 and 3/22/21. Symptom onset 7/1/21 with cough, runny nose, muscle aches, loss of smell, loss of taste, sore throat, nasal congestion, headache,, fatigue. Tested positive for Covid-19.

Other Meds:

Current Illness:

ID: 1470613
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 07/14/2021
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: Patient due to extenuating circumstance, received intermixing of vaccines. First vaccine product was Moderna, and second vaccine product was Pfizer. Patient was given the option of receiving Moderna at another clinic, but due to mobility constraints, patient requested we give him Pfizer. Vaccine was administered 28 days post 1st vaccination.

Other Meds:

Current Illness:

ID: 1470614
Sex: F
Age: 47
State: IL

Vax Date: 04/07/2021
Onset Date: 04/18/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: PCN, cephlosporin,

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Diarrhea 3 mo post vaccine. Diarrhea started at end of April the 3rd week, 10-15 times per day and went to ED, stool cultures and blood work and all WNL, lost 27 lbs through June, slowed down in past 2 weeks. Vaccines April 7 and 29. Not continuing to lose weight at this point. Diarrhea twice yesterday, immodium does not work. Has GI appt in October and colonoscopy and endoscopy then.

Other Meds: Fluoxetine, Abilify, Norethindrone, clonazepam, lithium, prilosec.

Current Illness: none

ID: 1470615
Sex: F
Age: 66
State: WA

Vax Date: 02/25/2021
Onset Date: 05/01/2021
Rec V Date: 07/14/2021
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: Tinnitus with loss of sleep and headaches

Other Meds: Anastrazole, gabepentin, omeprozole, vitamins- D/E, B,calcium, costochondritin, omeprozole, flex seed

Current Illness:

ID: 1470616
Sex: F
Age: 16
State: NY

Vax Date: 07/02/2021
Onset Date: 07/09/2021
Rec V Date: 07/14/2021
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: no

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

Symptoms: Having a stabbing pain in the center of her chest, went on for a few days. Was taken to the dr whom advised them to take her to the ER.

Other Meds: Zyrtec

Current Illness: no

ID: 1470617
Sex: M
Age: 20
State: OH

Vax Date: 05/21/2021
Onset Date: 06/16/2021
Rec V Date: 07/14/2021
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: peanuts penicillins pollen dust mite extract molds

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: the client receives allergy shots every 2 weeks. On 5-21-21 he received his first moderna vaccine with no problem. He received an allergy shot on 6-15-2021. On 6-16-2021, he experienced tingling on the left side of the tongue. His symptoms increased to being unable to smile on the left, unable to control blinking on the left. On 6-18-21 he went to Urgent Care and was diagnosed with Bell's Palsy and started on prednisone for 16 days. He reports that his symptoms subsided in 2 weeks before completing the prednisone.

Other Meds: Allergy Shots every 2 weeks fluticasone 50 mcg nasal daily singulair 10 mg daily albuterol inhaler as needed epipen as needed

Current Illness: None

ID: 1470618
Sex: F
Age: 25
State: HI

Vax Date: 06/18/2021
Onset Date: 07/13/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Asymptomatic COVID disease on 7/13/21

Other Meds: Loratadine

Current Illness: allergic rhinitis

ID: 1470619
Sex: M
Age: 26
State: VA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: Cefzil, pollen

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Sore shoulder: This lasted about 4 days, with the pain lessening after each day

Other Meds: Zyrtec, Fish Oil Supplements, One-A-Day Vitamins, Prozac

Current Illness: None

ID: 1470620
Sex: F
Age: 16
State: NY

Vax Date: 05/01/2021
Onset Date: 05/03/2021
Rec V Date: 07/14/2021
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: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: vaccine error, moderna not approved for under 18

Other Meds: N/A

Current Illness: N/A

ID: 1470621
Sex: F
Age: 32
State: WI

Vax Date: 03/22/2021
Onset Date: 07/01/2021
Rec V Date: 07/14/2021
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: Vaccinated with Pfizer on 3/1/21 and 3/22/21. Symptom onset 7/1/21 - cough, runny nose, muscle aches, loss of smell and taste, sore throat, nasal congestion headache and fatigue. Tested positive for Covid19 on 7/13/21.

Other Meds:

Current Illness:

Date Died: 04/05/2021

ID: 1470622
Sex: F
Age: 64
State: VA

Vax Date: 04/01/2021
Onset Date: 04/05/2021
Rec V Date: 07/14/2021
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: Latex allergy

Symptom List: Rash, Urticaria

Symptoms: Acute heart attack on 4/5/2021 that lead to death on 4/5/2021 at 9:58am.

Other Meds: Losartan hydrochlorothiazide (Hyzaar) 50mg tablets once a day Morphine (MS IR) 30 mg tablet every 4 hours when needed during Sickle Cell pain crisis Amlodipine 5mg once a day Lipitor 40mg at night Sertraline 25mg at night Apixaban 2.5 mg t

Current Illness: Pneumonia resolved 2 weeks prior to death on 4/5/2021

ID: 1470623
Sex: F
Age: 26
State: VA

Vax Date: 04/07/2021
Onset Date: 04/01/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Rash on both arms. Still persisting 3 months post injection. Menstrual cycle has also been off.

Other Meds: None

Current Illness: Recently stopped breastfeeding.

ID: 1470624
Sex: F
Age: 19
State: NC

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/14/2021
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: Anaphylaxis to Bee stings

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

Symptoms: Pt is a 19 y/o F who suddenly endorsed feeling dizzy, hot, short of breathe, and peri-oral itchiness ~ 10min after receiving first dose of Pfizer vaccine (done at 1357). PMHx pertinent for hx of anaphylaxis to bee stings, currently being treated with allergy shots, last injections given 12JUL21. Pt was immediately evaluated, with initial VS done at 1415 with BP 110/70, SPO2 99%, HR of 94, RR >20. Endorse chest tightness. Lungs CTA B/L, pt noted to be diaphoretic. Patient had a near syncopal episode and was placed in supine position and given an epi-pen 0.3mg at 1418. EMS was called. Repeat VS at 1420 found BP of 115/60, SpO2 100%, HR 100, RR >20. Lungs still CTA b/l. Patient endorsed improved SOB and less peri-oral itching. Chest tightness improved, Pt was AOX3. EMS arrived at 1435, pt stable. Transferred pt to EMS.

Other Meds: Ibuprofen 400mg po q8 prn pain. Zyrtec 10mg po daily.

Current Illness: Hx of CoVID-19 (symptomatic 23JUN21, + PCR 27JUN21)

ID: 1470625
Sex: F
Age: 43
State: NV

Vax Date: 01/07/2021
Onset Date: 06/14/2021
Rec V Date: 07/14/2021
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: Five months after the vaccine I was feeling very fatigued after I had experienced flu-like symptoms. I was diagnosed with Thyroiditis one week after the illness. One week later I started to get chest pain and palpitations and after a visit to the ER I was diagnosed with Pericarditis. My heart rate was also elevated at the time. I took steroids for one month and every time I tried to reduce the dose the chest pain returned. My symptoms continued but I am still taking the medication and I need to monitor my Thyroid function for a few months. I am also taking a Beta Blockers for the heart problems. It has been five week s ago and it has been six months since my vaccine.

Other Meds: Vitamins

Current Illness:

ID: 1470627
Sex: F
Age: 52
State: FL

Vax Date: 05/08/2021
Onset Date: 06/12/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Severe heartburn, acidity causing severe cough and sore throat at night especially.

Other Meds: none

Current Illness: none

ID: 1470628
Sex: M
Age: 14
State: OH

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/14/2021
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: AMOXIL

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

Symptoms: PATIENT RECEIVED SHOT. FEW SECONDS LATER HE FAINTED. PHARMACY CALLED 911. PHARMACIST CHECKED PULSE AND PT WAS DOING OK. NO EPIPEN WAS GIVEN. EMS TOOK PATIENT TO THE HOPSITAL TO GEIT IT CHECKED OUT.

Other Meds:

Current Illness:

ID: 1470629
Sex: M
Age: 27
State: VA

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: Cefzil, pollen

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Sore arm began at 3:00 PM and lasted for four days, with pain lessening as time went on Fever began at 9:00 PM and went away sometime in the middle of the night (around 3:00 or 4:00 AM) Fatigue started at 09:00 PM and lasted until the morning of Friday, April 9, 2021

Other Meds: Prozac, Zyrtec, One-A-Day Vitamins, Fish Oil Supplements

Current Illness:

ID: 1470630
Sex: F
Age: 51
State: CA

Vax Date: 01/20/2021
Onset Date: 01/25/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: Allergic to penicillin, allergy to pollen

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I started to experience heart palpitations in Jan. I am not entirely certain whether or not they started before or after the first vaccine. I had never experienced them in the past and they briefly worsened after the second vaccine.

Other Meds: Estrogen patch, fish oil, vitamin D, B12

Current Illness: None

ID: 1470631
Sex: M
Age: 72
State: MN

Vax Date: 03/25/2021
Onset Date: 05/25/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: I noticed the AE, 2 months after the vaccination:Dr diagnosed me with deep vein thrombosis in my lower right leg, at the Department. So basically it's a blood clot. I was prescribed a blood thinner: Xarelto. I don't know if I have recovered from the AE because I don't know if I still have the blood clot.

Other Meds: Simva statin 30 mg 1 x day calcium 500 mg 2 x day zinc 30 mg 1 x day vita c 1000 mg OD vita d 400 units 2 x day

Current Illness: no

ID: 1470632
Sex: F
Age: 63
State: WA

Vax Date: 05/11/2021
Onset Date: 05/12/2021
Rec V Date: 07/14/2021
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:

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

Symptoms: Patient came into the clinic on 07/13/2021 for a diabetes check. During assessment, patient stated that her left arm still hurts from having her second COVID vaccine over a month ago. No redness noted, no swelling, tender to the touch

Other Meds:

Current Illness:

ID: 1470633
Sex: F
Age: 44
State: MD

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: Pneumonia vaccine made my arm swell and would not go down until steroids were prescribed.

Symptom List: Unevaluable event

Symptoms: Feeling of lightheadedness almost right away. Went on to have shortness of breath, severe anxiety, chest tightness, confusion, brain fog, feeling uneasy and antsy, and headache.

Other Meds: Prozac 10mg a day, xanax taken only as needed, vitamin C and vitamin D

Current Illness: None

ID: 1470634
Sex: F
Age: 67
State: IL

Vax Date: 02/12/2021
Onset Date: 06/11/2021
Rec V Date: 07/14/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: 3 month after I had a second Pfizer I developed vertical diplopia. Saw ophthalmologist, neuro ophthalmologist, did MRI/MRA with/without infusion of brain which was normal. Was advised to start Vit.B12 and other Vit B vitamins and do certain types of exercise for my eyes. Due to elevated BP my regular MD increased Metoprolol to 100 mg./day

Other Meds: Metoprolol 37mg once a day, Rosuvostatin 10mg 3 times a week, Aspirin 81mg once a day

Current Illness: None

ID: 1470635
Sex: F
Age: 28
State: WA

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/14/2021
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: Tree nuts, Citrus seeds

Symptom List: Injection site pain, Pain

Symptoms: Patient received first Moderna dose on June 8, 2021 and second dose on July 6, 2021. Patient started having flu-like symptoms such as, Fever (but doesn't know what temperature as she did not measure but she felt hot) and chills. After 1-2 days of flu-like symptoms she began to have painfulness around the left arm where she received both of her Moderna vaccines. This painfulness started 3-4 days after receiving the 2nd dose of Moderna vaccine. Patient was also having symptoms of pinching, aches, cramps on left arm along with light-headedness and dizziness. Patient visited the Emergency Department on July 12, 202 and confirmed by the Doctor that there is a blood clot on the left arm. The doctor at the Emergency Department wanted patient to reach out to the pharmacy and report the incident. Patient is currently prescribed for a blood thinner and will follow up with doctors tomorrow 07/15/2021 and another doctor in a week. Patient has allergies to Tree nuts and citrus seeds and was on a birth control Estarylla 0.25-0.035mg tablets until the day she found out that she has a blood clot (07/12/2021).

Other Meds: Per patient, she is on a birth control (Estarylla 0.25-0.035mg Tablets). But stopped on the day visit to the ER on 07/12/2021 after finding out that she has a blood clot.

Current Illness: n/a

ID: 1470636
Sex: F
Age: 56
State: MI

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 07/14/2021
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: Injection site pain, Menorrhagia

Symptoms: fever, chills, shakes for 4 days, and then stiffness in joints and unable to walk effectively

Other Meds: no

Current Illness: no

ID: 1470637
Sex: F
Age: 17
State: AL

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/14/2021
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 reported per mother

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

Symptoms: Rash within minutes that led to coughing uncontrollably and her throat felt "weird"

Other Meds: Unknown

Current Illness: None reported

ID: 1470638
Sex: M
Age: 16
State: NY

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 07/14/2021
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: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: VACCINE ERROR, MODERNA NOT APPROVED FOR UNDER 18

Other Meds: N/A

Current Illness: N/A

ID: 1470639
Sex: M
Age: 12
State: GA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Nose bleed 45 minutes after administration and then 8 more subsequent nose bleeds over the last 3 weeks.

Other Meds: None

Current Illness: None

ID: 1470640
Sex: F
Age: 42
State: WA

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 07/14/2021
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: Bee venom

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

Symptoms: Circular rash with erythema, swelling, and hives.

Other Meds: MultiVitamin. Melatonin 10mg

Current Illness: None

ID: 1470641
Sex: F
Age: 57
State: PR

Vax Date: 06/04/2021
Onset Date: 06/08/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: Biaxin, iodine

Symptom List: Nausea

Symptoms: About 4 days later after the vaccine, I had flu like symptoms- extreme fatigue, whole full body aches, neuropathy and pain in both feet, headaches, fever, and chills. I went to see my doctor and she gave me a shot for the pain (I can not remember the name). I got test for flu and covid and both tests were negative. I could not work. I was still feeling very ill and I started having chest pains and chest heaviness. I went to the ER. They did all the tests (EKG, X-ray) and found inflammation around my chest. They gave me 2 shots for pain and inflammation in the ER (I can not remember name). I was discharged with a prescription for Prednisone. I am still not feeling well and having symptoms of extreme fatigue, forgetfullness, brain fog, dizziness, and cardiac symptoms of chest pains, tachycardia, and arrythmias. I went back to see my doctor who has referred me to a neurologist and cardiologist. I haven't been back to work since getting the vaccine.

Other Meds: Atorvastatin, Sertraline, Omeprazole, Mulitivitamins, Vitamin B, Vitamin C

Current Illness: none

ID: 1470642
Sex: M
Age: 34
State: TX

Vax Date: 03/28/2021
Onset Date: 03/29/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: Seasonal Allergies to grass/pollen

Symptom List: Injection site pain

Symptoms: The day after my 1st vaccine dose, I had chills, light fever, diarrhea, upset stomach, nausea, fatigue, and cough. Chills and the low grade fever lasted for 7 days, but the cough lasted for 4 weeks after my 1st dose. So I went to my PCP to get a check up, they ran all my blood tests, and I was recommended to NOT receive my 2nd dose yet.

Other Meds: Alive Men Multivitamin Vitamin D 10,000 ICU

Current Illness: None

ID: 1470643
Sex: F
Age: 46
State: AR

Vax Date: 04/09/2021
Onset Date: 06/10/2021
Rec V Date: 07/14/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: I have fever of 104. I had backaches, nausea, and vomiting. I went to ER. I was hospital 5 days first time and 4 days the second time. They did blood work, CT scan, and x-ray. I was diagnosed with kidney infection.

Other Meds: Leve mere 15unit, Novolog 30unit, Aleve 1xday

Current Illness:

ID: 1470644
Sex: M
Age: 66
State: MI

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 07/14/2021
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: NKA

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

Symptoms: Sore arm, after shot and still sore 3 months later. Described as muscle cramps in his arm, especially at night. He also has a little scab from the injection site and it has not healed and keeps scabbing over and over.

Other Meds: Unknown

Current Illness: Unknown

ID: 1470645
Sex: F
Age: 92
State:

Vax Date: 07/08/2021
Onset Date: 07/09/2021
Rec V Date: 07/14/2021
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:

Symptom List: Tremor

Symptoms: 102 FEVER, UPPER ARM CELLULITIS, HOSPITALIZED AT : MEDICAL CENTER ADMITTED 7/10/21; DISCHARGED 7/13/21

Other Meds:

Current Illness:

ID: 1470646
Sex: F
Age: 57
State: CA

Vax Date: 05/03/2021
Onset Date: 05/05/2021
Rec V Date: 07/14/2021
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: Pollen Mold Dust Ragweed Grass Cats

Symptom List: Erythema, Pruritus

Symptoms: Chills Chronic respiratory cough

Other Meds: Milk Thistle Iron Vitamins Fish oil

Current Illness:

Date Died: 05/08/2021

ID: 1470647
Sex: M
Age: 92
State: MI

Vax Date: 02/16/2021
Onset Date: 02/18/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PER SPOUSE, HE HAD A CUT ON HIS LEG THAT DID NOT STOP BLEEDING. THEY WENT TO CLINIC TO GET IT CAUTERIZED. DAY LATER HIS BODY HAD MULTIPLE BRUISES, THEN HE WAS EVEN BLEEDING FROM HIS PENIS. AT HOSPITAL THEY TOLD HIM HE HAD LOW PLATELETS AND WAS BLEEDING OUT. HE WENT INTO HOSPICE AND PASSED AWAY ON 5/8/2021

Other Meds:

Current Illness:

ID: 1470648
Sex: F
Age: 78
State: CA

Vax Date: 03/17/2021
Onset Date: 04/28/2021
Rec V Date: 07/14/2021
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

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

Symptoms: TIA, right side of body weakened to point of not being able to stand, left side of face numb, emergency hospital 24 hours for monitoring and tests.

Other Meds: thyroid medication. vit C,D,E and B. Calcium Magnesium.

Current Illness: none

ID: 1470649
Sex: M
Age: 68
State: MN

Vax Date: 02/09/2021
Onset Date: 07/12/2021
Rec V Date: 07/14/2021
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: Received Pfizer vaccines on 1/20/21, 2/9/21. Tested positive for COVID-19 by PCR on 7/12/21, symptom onset 7/8/21 with new cough, fatigue, H/A, mylagia; known exposure to COVID, received monoclonal Antibody therapy on 7/14/21.

Other Meds:

Current Illness:

ID: 1470650
Sex: M
Age: 17
State: NY

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/14/2021
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: NKA

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

Symptoms: FIRST COVID VACCINE WAS SUCCESSFULLY ADMINISTERED & WHILE PATIENT STILL SEATED IN CHAIR, BEGAN TO FALL TO ONE SIDE. THE IMMUNIZER GRABBED HIS ARM SO THAT HE WOULDN'T FALL OVER AND NOTICED HE WAS SHAKING. HE QUICKLY GAINED CONCIOUSNESS AND WAS BREATHING NORMALLY AND AWARE. HE WAS VERY PALE AND SWEATING & WHEN WE CHECKED HIS BP IT WAS LOW. WE ALSO APPLIED ICE PACK TO HIS FOREHEAD, BACK OF NECK AND WRISTS & CALLED EMS. THEY ARRIVED AND CHECKED PATIENT AND EVERYTHING WAS NORMAL.

Other Meds: N/A

Current Illness: NONE

ID: 1470651
Sex: F
Age: 12
State: MD

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 07/14/2021
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: NKA

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

Symptoms: Pfizer vaccine not diluted before being administered

Other Meds: n/a

Current Illness: n/a

ID: 1470653
Sex: F
Age: 14
State: WV

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/14/2021
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: Pain in extremity

Symptoms: sharp stabbing pain in left shoulder at injection site constant for 7 days

Other Meds: none

Current Illness: none

ID: 1470654
Sex: F
Age: 41
State: CA

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: Iodine Morphine

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

Symptoms: Immediately post vaccination @ 1217, Pt c/o chest pain that radiates to left arm & up left side of neck. EMS called. Initially pt states pain 6/10, denies any other Sx. Pt VS @ 1219: 132/60, HR 75, O2 99% RA, RR 16, 98.7. @ 1220 states 3/10, @ 1230, prior to EMS arrival, pt states 0/10. EMS arrival @ 1235, EKG NSR, per EMS, pt refuses hospital transport & signs AMA form. Pt d/c w/family & spouse @ 1248.

Other Meds: Patient denies

Current Illness: Patient denies

ID: 1470655
Sex: M
Age: 65
State: KY

Vax Date: 03/13/2021
Onset Date: 06/23/2021
Rec V Date: 07/14/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Tingling feeling in hands and feet that started 3 months after vaccine was administered. Tingling has subsided in feet after 2nd week. I now only have slight numbness in both my thumbs.

Other Meds: None

Current Illness: None

ID: 1470656
Sex: M
Age: 62
State: CA

Vax Date: 04/05/2021
Onset Date: 04/10/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Excruciating Inflammation, blood clots, pains in joints and muscles, and burning nerve sensations in legs/feet and slight numbing in hands.

Other Meds: None

Current Illness: None

ID: 1470657
Sex: M
Age: 55
State: PR

Vax Date: 04/09/2021
Onset Date: 06/10/2021
Rec V Date: 07/14/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: No Known Allergies

Symptom List: Vomiting

Symptoms: Adverse Events: Headache, Fever, Diarrhea, Nasal Congestion, Leg Pain, Weakness, Paralysis Dx. Guillain Barre Treatment: Immunoglobulin, Sodium Chloride 0.9%, Respiratory Bypass, Oxygen Outcomes: Patient actually in Intensive Care Unit at Hospital receiving treatment. Continue with oxygen by nasal cannula, whole body paralysis with urinary and feccal incontinence (foley and diaper). Symptoms begin since June 10,2021. Admission to Hospital on June 17, 2021 to present.

Other Meds: Irbesartan-Hydrochlorothiazide 150-12.5 mg

Current Illness: Hypertension

ID: 1470658
Sex: M
Age: 12
State: MS

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/14/2021
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: Inflamed, sore, hot to touch, large raised knot at injection site and spanning across entire width of upper arm. Numbness, tingling, and pain in left arm and shoulder radiating to neck. Headache, fatigue, nausea, diarrhea, fever/chills.

Other Meds: none

Current Illness: none

ID: 1470659
Sex: F
Age: 63
State: TN

Vax Date: 03/01/2021
Onset Date: 03/06/2021
Rec V Date: 07/14/2021
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: Sulfa

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

Symptoms: Three days (03/06) I had go to the emergency room. I was diagnosed with a Pulmonary embolism. I couldn't breathe good.

Other Meds: Fish oil, baby aspirin, calcium

Current Illness:

ID: 1470660
Sex: M
Age: 42
State: OH

Vax Date: 02/01/2021
Onset Date: 02/03/2021
Rec V Date: 07/14/2021
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: Amoxicillin.

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Shortness of breath, chest heaviness and pressure on chest, worse with deep breath.

Other Meds: None

Current Illness: None.

ID: 1470661
Sex: F
Age: 48
State: WY

Vax Date: 03/01/2021
Onset Date: 04/05/2021
Rec V Date: 07/14/2021
Hospital:

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

Lab Data:

Allergies: NO

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

Symptoms: GOT THE SHOT IN LEFT ARM NOW UNABLE TO LIFT ARM IN FULL MOTION RANGE OR LIFFT ARM ABOVE HEAD SINCE THE SHOT NOR CAN MOVE ARM BEHINDE BACK EITHER.

Other Meds: DIAZEPAM 5MG

Current Illness: NO

ID: 1470662
Sex: M
Age: 68
State: NY

Vax Date: 06/25/2021
Onset Date: 07/14/2021
Rec V Date: 07/14/2021
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: NKA

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

Symptoms: No adverse events reported but patient previously received two doses of Moderna on 2/14/21 and 3/15/21 at a different pharmacy. He wasn't aware that he was already fully vaccinated. He asked for and received first dose of Pfizer on 6/25/21 and we discovered that he shouldn't have when he came in for his 2nd dose of Pfizer. Patient reported no side effects or issues. However, he was very confused.

Other Meds: Alprazolam, Lunesta, Sildenefil

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm