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: 1471066
Sex: F
Age: 18
State: AZ

Vax Date: 04/21/2021
Onset Date: 05/12/2021
Rec V Date: 07/14/2021
Hospital: Y

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

Lab Data:

Allergies: Late

Symptom List: Dysphagia, Epiglottitis

Symptoms: Nausea dizzy tremors seizurez

Other Meds: Prozac and lamitcal and pencillan

Current Illness: No

ID: 1471067
Sex: M
Age: 33
State: NY

Vax Date: 05/14/2021
Onset Date: 05/15/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Arm pain and fatigue. Waking up with shooting pain in arm. Numbness and fatigue in legs. Persistent fatigue and muscle twitching still two months after injection. In forearms, thighs, calves, buttocks, eye area. Neck stiffness. inflamed lymph nodes. longer recovery times from exercise. mild to moderate chest pain. severe shoulder pain return in left arm after exercise. Occasional

Other Meds: none

Current Illness: none

ID: 1471068
Sex: M
Age: 18
State: FL

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None reported

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

Symptoms: Pt grandmother reported him feeling dizzy, Never lost consciousness. Never had difficulty breathing. Vomited on the floor several mins following vaccine. Rescue was called per pt request. Cleared by EMTs.

Other Meds: N/A

Current Illness: None reported -- hadn't eaten all day

ID: 1471069
Sex: F
Age: 16
State: NV

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: na

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Second dose completed on day 47 instead of the recommended by 42 days

Other Meds: protonix pepcid

Current Illness: na

ID: 1471070
Sex: M
Age: 31
State: NJ

Vax Date: 05/03/2021
Onset Date: 05/05/2021
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: None

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

Symptoms: Two days after vaccine I was having trouble breathing, irregular heart beat, congestion, bloating, swelling. Went to hospital and nothing was found in tests. A month and a half later I was having similar symptoms and went to the hospital where they found I was having heart failure. My heart was preforming 10-15%.

Other Meds: Vyvanse (for ADHD)

Current Illness: None

ID: 1471071
Sex: F
Age: 43
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
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:

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

Symptoms: Patient reports inflamed shoulder bursa. Patient has been treating with rest, cold, and hot therapy. Patient has continued limited range of motion. Patient advised to seek follow up evaluation and care with primary care provider.

Other Meds:

Current Illness:

ID: 1471072
Sex: M
Age: 54
State: AZ

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: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Severe deltoid pain. Worse than any other immunization

Other Meds: Vitamin D

Current Illness: None

ID: 1471262
Sex: M
Age: 15
State: TN

Vax Date: 06/03/2021
Onset Date: 06/18/2021
Rec V Date: 07/14/2021
Hospital: Y

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: ER visit with severe abdominal pain and vomiting. Admitted to hospital due to high liver enzymes and lymph node activity. Follow up exams including extensive labs, CT, MRI and ultrasound point to autoimmune hepatitis.

Other Meds: None

Current Illness: None

ID: 1471263
Sex: M
Age: 55
State: OH

Vax Date: 06/09/2021
Onset Date: 06/22/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: June 17-swelling of hands and arms, pain, tingling, burning sensations in arms and legs. Dizziness and fatigue.

Other Meds: Buspar, Pantoprazole, Duloxetine, Vitamin D, Amlodipine, Losartan, Lamotrigine, Vitamin B-1, Folic Acid

Current Illness: Barrett's Esophagus

ID: 1471264
Sex: F
Age: 61
State: IL

Vax Date: 04/30/2021
Onset Date: 05/02/2021
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: milk, yogurt, strawberries, eggplant, adhesives, biaxin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I had a low fever, severe chills, pink eye, tiredness, dry skin, hair loss, sore throat, dizziness, mental fatigue, extra dry lips--lasted 24 hours and required a day off work. I experienced the same symptoms exactly (timing, duration, and severity) after the second dose on 05/21/2021 (also Pfizer, Lot EW 0178) AND after my "immunity day" of 06/04/2021. I was very surprised at the third instance, but my work supervisor, who took the same brand of vaccine with similar timing and at the same Fairgrounds, had the same thing happen.

Other Meds: gabapentin, cyclobenzaprine, venlafaxine, lisinopril, ...

Current Illness:

ID: 1471265
Sex: M
Age: 46
State: NY

Vax Date: 02/03/2021
Onset Date: 03/12/2021
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: X-Ray Contrast

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

Symptoms: Contracted shingles a few weeks later. Did a study and found a small percentage of test subjects contracted shingles.

Other Meds: None

Current Illness: N/A

ID: 1471266
Sex: F
Age: 45
State: CA

Vax Date: 06/25/2021
Onset Date: 06/25/2021
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: No

Symptom List: Rash, Urticaria

Symptoms: Muscle pain (up to 7 days after vaccination) Joints and body pain (up to 11 days after vaccination) Weakness and dizziness (after vaccination until now) Tiredness (after vaccination until now) Chills (after vaccination until now) Headaches (after vaccination until now) I took Tylenol Eye pain (after vaccination until now) A blood vessel burst in my left eye on 7/7/21 and I still recovering from that.

Other Meds: Zoloft 100mg Omeprazole 20mg

Current Illness: No

ID: 1471267
Sex: M
Age: 38
State: NV

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: na

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

Symptoms: Received 2nd dose on day 120 instead of the recommended by day 42.

Other Meds: na

Current Illness: na

ID: 1471268
Sex: F
Age: 66
State: WA

Vax Date: 01/27/2021
Onset Date: 02/05/2021
Rec V Date: 07/14/2021
Hospital: Y

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: sulfa, penicillin

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

Symptoms: Woke up shaking, heart pounding. Had red rash on arm. Got in to see Dr the next day, ecg results warranted an echocardiogram. Results came back with a ruptured cord to a mitral valve leaflet. Have had minimally invasive mitral valve repair surgery on 4/15/2021.

Other Meds: levothyroxine 50 mcg, baby aspirin

Current Illness: none

ID: 1471269
Sex: F
Age: 46
State: CA

Vax Date: 02/12/2021
Onset Date: 02/17/2021
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: LA

Lab Data:

Allergies: NKDA

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

Symptoms: She developed numbness and tingling in the hands which spread to her feet 2/17/21, approximately 5 days after the 1st dose of the moderna vaccine. She was was found to have MRI brain consistent with demyelinating disease and was originally thought to have ADEM. however, she subsequently developed RU weakness and had new MRI lesions and was diagnosed with multiple sclerosis (which is accurate) It is unclear if this is a true vaccine related event given very short onset after the vaccine.

Other Meds: lactulose colace

Current Illness: hx appendectomy sinus bradycardia

ID: 1471270
Sex: M
Age: 36
State: CA

Vax Date: 06/07/2021
Onset Date: 06/07/2021
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: Erythromycin

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

Symptoms: After the first shot I had extreme soreness in my arm/shoulder. The pain began the 2nd day and was only sore at first, by the end of that day I could not lift my arm higher than my shoulder. This lasted another day and then by the 4th day after the shot I could move my arm normally but it was still sore until the 6th day after the shot. After the second shot I began experiencing a lot of join pain in my hands and fingers and my feet and toes. The pain was mild, maybe a 4 out of 10 and lasted for about 3 days. Earlier this year I had similar issue's with joint pain that lasted a while but it had been gone for almost two months before returning immediately after the second shot.

Other Meds: None

Current Illness: None

ID: 1471271
Sex: F
Age: 44
State: IL

Vax Date: 06/24/2021
Onset Date: 06/25/2021
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: Nnone

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

Symptoms: None stated.

Other Meds: Gabapentin, amitriptalin, metapropolol, ecchinecea, vitamin D, and C, multivitamin, bedesonide

Current Illness: Not sick at vaccination day- had a low grade fever and general flu like symptoms. A couple weeks letter- woke up feeling like swallowing razors. Low grade fever, body aches, sneezing, chills, headache and extreme fatigue.

ID: 1471272
Sex: F
Age: 77
State: CA

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

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Resident given Pfizer dose 1 after having received Moderna two dose series in April. Resident remains free from adverse reaction at this time.

Other Meds: Aspirin Tablet 81 MG,Metoprolol Tartrate Tablet 25 MG,Oyster Shell Calcium/Vitamin D Tablet 500-200 MG-UNIT (Calcium Carbonate-Vitamin D),Cholecalciferol Tablet 50 MCG (2000 UT),amLODIPine Besylate Tablet 10 MG, Gabapentin Capsule 100 MG, T

Current Illness: A-FIb, DM,SCHIZOAFFECTIVE DISORDER, UNSPECIFIED SEQUELAE OF CEREBRAL INFARCTION, HTN,

ID: 1471273
Sex: F
Age: 53
State: HI

Vax Date: 03/22/2021
Onset Date: 04/03/2021
Rec V Date: 07/14/2021
Hospital: Y

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

Lab Data:

Allergies: No known allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt started with toe tingling around 4/3 - 4/7. Came to ER on 5/6 and had an US that was negative for DVT. Admitted to the hospital on 7/8/21 with an ischemic left foot. Underwent arteriogram LE, angiojet thrombectomy left pop artery, penumbra thrombectomy and thrombolysis catheter placement in the left PT/Pop artery. Back to OR on 7/10 for open thrombectomy tibio-peroneal trunk, patch angioplasty left TP trunk, open thrombectomy DP and distal PT arteries. Back to OR on 7/12 for an open thrombectomy left ATA and PTA, arteriogram left LE. Then again to the OR on 7/13 for a left BKA.

Other Meds: Levothyroxine

Current Illness: None

ID: 1471274
Sex: F
Age: 48
State: ME

Vax Date: 07/10/2021
Onset Date: 07/11/2021
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: PENICILLIN

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

Symptoms: PATIENT CALLED SAYING SHE HAS HAD 3 DIZZY SPELLS SINCE 4 PM TODAY (7/14/2021). SHE ALSO REFERRED TO THEM AS FEELING LIKE IN A TUNNEL. THE FEELING IS NOT CONSTANT. SHE FIRST STARTED WITH FEVER, DIARRHEA, VOMITING ON 7/11/2021 AND HAS FELT "OFF" SINCE THEN. I ASKED HER IF SHE THOUGHT SHE NEEDED TO BE SEEN BY A DOCTOR TONIGHT, SHE WAS NOT SURE. I THEN SAID SHE SHOULD BE EVALUATED BY A DOCTOR TOMORROW WHICH IS 7/15/2021.

Other Meds: UNKNOWN

Current Illness: PATIENT DID NOT STATE ANY OTHER ILLNESSES

ID: 1471275
Sex: F
Age: 29
State: CA

Vax Date: 02/10/2021
Onset Date: 02/11/2021
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: none

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

Symptoms: 1) Approximately 16 hours after shot: nausea, vomiting (1 time), fainting (1 time), profuse sweating. These occurred together in one episode and did not recur 2) 16 hours after shot until about 36 hours after shot: fever, chills, muscle aches, fatigue 3) Beginning 1 or 2 days after shot, resolving about 3 weeks after shot: racing, pounding heart, feeling of chest pressure, periods of intermittent fast pulse occurring with light-headedness and fatigue. Did not change in response to physical exercise, time of day. Most frequent and intense for about the first 10 days after shot, lessening after that to resolving without treatment 3 weeks after shot

Other Meds: Multivitamin tablet, vitamin D tablet, omega-3 capsule, calcium supplement tablet

Current Illness: Minor pain in upper right rib area at site of previous fracture, doctor determined likely an irritation or minor irritation of old fracture injury

ID: 1471276
Sex: F
Age: 75
State: CA

Vax Date: 02/01/2021
Onset Date: 02/15/2021
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: Unevaluable event

Symptoms: Blood pressure rose and stayed high, treated with Benazapril (40mg) once a day and Amlodipine (5 mg) once a day. Now stable.

Other Meds: Zetia, alendronate sodium

Current Illness: none

ID: 1471277
Sex: M
Age: 36
State: KY

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: shortness of breath

Other Meds:

Current Illness:

ID: 1471278
Sex: F
Age: 29
State: OH

Vax Date: 06/14/2021
Onset Date: 06/16/2021
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: N/a

Symptom List: Injection site pain, Pain

Symptoms: I am 30 weeks pregnant. Due Sept 25, 2021. I had pain in left arm of injection. Then the pain started to generate through my pinky finger and finger next to it. I waited for it it subside. I had tingling sensation and it still occurs. It sometimes have a numb like feeling and muscle weakness. I struggle using that hand due to muscle weakness. I wi drop things often while holding it. I didn't have this issue until after the vaccination.

Other Meds: Pre-natal

Current Illness: N/a

ID: 1471279
Sex: F
Age: 30
State:

Vax Date: 07/08/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Early menstruation, bleeding, spotting

Other Meds:

Current Illness:

ID: 1471280
Sex: M
Age: 12
State: CA

Vax Date: 07/10/2021
Onset Date: 07/12/2021
Rec V Date: 07/14/2021
Hospital: Y

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

Lab Data:

Allergies: nka

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

Symptoms: 12 Y 4 M old male with a history of chest pain that started two days ago on Monday. On 7/11 night, he didn't feel well felt nauseous. He was able to sleep but had chest pain the following morning that improved after he vomited. The chest pain is midsternal and feels pressure-like. It lasted a few hours. He swam on 7/12 without problems (at a swim club) for an hour. He had his second dose of COVID-19 vaccine on Saturday 7/10/21. There has not been any fevers. Elevated troponin and CRP with recent COVID-19 vaccine, suspicious for post-vaccine myocarditis. He is hemodynamically stable with normal vitals and no evidence of ventricular ectopy or depressed left ventricular function. His troponin peaked at 11.05 and trended down, but his most recent value is slightly up at 8.2 from 7.6. Recommended continuing to trend the troponins for now (if they show a downward trend then twice daily is adequate, unless he develops chest pain). At this time, IVIG is held unless he becomes unstable or the troponins trend upward .

Other Meds:

Current Illness: None

ID: 1471281
Sex: M
Age: 16
State: NJ

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no known

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 2nd dose given at 15 days

Other Meds:

Current Illness:

ID: 1471282
Sex: M
Age: 52
State: IL

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient received vaccine and seat to wait for 15 minutes, then started feeling dizzy and sweating. Took patient's blood pressure and was slightly elevated, revised blood pressure and after third reading BP was lower and patient started feeling better.

Other Meds:

Current Illness:

ID: 1471283
Sex: F
Age: 17
State: NY

Vax Date: 06/26/2021
Onset Date: 06/01/2021
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: RA

Lab Data:

Allergies: none

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

Symptoms: irregular menstrual cycle after both doses pain at the site of injection

Other Meds: adderall xr 15 mg iron, vitamin c, melatonin supplements

Current Illness: minor cold

ID: 1471284
Sex: F
Age: 34
State: MI

Vax Date: 01/19/2021
Onset Date: 02/23/2021
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: Penicillin, sulfa, cephalosporins

Symptom List: Nausea

Symptoms: February 23 woke up in the middle of the night with sudden left peripheral vision loss. Developed severe eye pain and light sensitivity, pain with eye movement one week later. Saw ophthalmology, referred to neuroopthamology. Has increased eye pressure in left eye and brimodine drops started. Having scotoma-like vision changes in left eye along with intermittent eye pain and jaw pain. Pain and vision changed lasted 3.5 months before resolving. Eye pressure elevation resolved. Also saw retina specialist and PCP. Had MRI, CTA, US all performed to find underlying cause. No cause was found. Assumption is inflammatory response of some sort, cannot explain Visio loss, vision change, eye a s jaw pin, and increased eye pressure.

Other Meds: Topamax, tri-sprintec , vitamin d, Zyrtec, Flonase, melatonin, vitamin c

Current Illness: None

ID: 1471285
Sex: F
Age: 60
State: OH

Vax Date: 05/21/2021
Onset Date: 06/17/2021
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: narcos, augmentin, doxycyline, benedryl, latex

Symptom List: Injection site pain

Symptoms: i developed a vitriol detachment a couple of weeks after my injection. i see vein-type things in my eye and now am under a doctor's care for it. i'm not sure when it started, to the exact date, however, it was after my second dose. i can't find on the calendar when i went to see dr. i have a follow-up appointment next week. so, the date is approximate on this form.

Other Meds: d3, verapomil, nexium 40 mg. vit. c, b-12, milk thistle, glucosamine chrondroiten, coq10, magnesium, calcium citrate, eye vitamin, probiotic, biotin, fish oil, multi vitamin,

Current Illness:

ID: 1471286
Sex: F
Age: 25
State: NY

Vax Date: 04/12/2021
Onset Date: 04/13/2021
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: None

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

Symptoms: Visual disturbances began. "Sunspot" like symptoms began and an increase in headaches/eye soreness began. I have been seen by multiple medical professionals (my primary care physician, a neurologist, an opthamologist, and a retina specialist). I have had multiple blood test work ups and the only "solution" anyone was able to provide to me is that I was slightly vitamin B12 deficent. I have been taking supplements for the past month and have not seen a significant increase in my symptoms. It has been three months and I still have the visual disturbances, and no answers. Prior to the vaccine, I was a healthy young women without health issues.

Other Meds: Sprintec, daily multi-vitamins

Current Illness: None

ID: 1471287
Sex: M
Age: 45
State: AZ

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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: First dose administered 5/14/21, second dose administered outside the recommended interval on 7/14/21 (on day 61). Patient expressed no adverse effects.

Other Meds:

Current Illness:

ID: 1471288
Sex: F
Age: 63
State: KY

Vax Date: 07/12/2021
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: ARB-Angiotensin Receptor Antagonist, Bactrim, Codeine, Demerol, Lisinopril, Morphine, Reglan, Topiramate

Symptom List: Tremor

Symptoms: Late entry @ 1025 HeplisaV- B 20 mg IM was given @1106 patient started C/O chilling temp 99.5 @ 1108 treatment ended and patient rinsed back. @1111 was called over by the LPN to assess patient that was chilling and now N/V B/P. I asked the patient how she was feeling and she stated "something isn't right, I don't feel good" I asked her is she was having a had time breathing and she stated "yes a hard time" @ 1113 Diphenhydramine 50 mg IVP was given followed by Solu medrol 125 mg IVP over 5 minutes. @1125 Patient stated she was feeling better and SOB was going away. Chilling has subsided and Temp 97.5 B/P 247/120 clonodine 0.1mg was given. Had patient remain in her chair until B/P came down. @ 1226 B/P 151/69 patient disconnected and discharged Husband informed. Dr. also informed.

Other Meds: Clonidine, Drisdol, Flonase Allergy Relief, Hydralazine, Lantus, Lasix, Lipitor, Lyrica, Nicoderm CQ, Norco, Novolog U-100 Insulin Aspart, Potassium Chloride, Protonix, Proventil HFA, Renal Caps, Singular, Symbicort, Synthroid, Toprol, Vali

Current Illness: ESRD on dialysis, Type 1 DM, Diabetic neuropathy, Anxiety, IBS, Acute diastolic congestive heart failure, Essential HTN, Osteoarthritis

ID: 1471289
Sex: F
Age: 13
State: AL

Vax Date: 07/06/2021
Onset Date: 07/09/2021
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: Erythema, Pruritus

Symptoms: Motor and verbal tics similar to Tourettes without coprolalia. Tics last for about 3-4 secs involving the shoulders, neck and arms with 1-2 words repeated during tic. The intervals can range from 1 min to 30 secs.

Other Meds: None

Current Illness: None

ID: 1471290
Sex: M
Age: 71
State: NJ

Vax Date: 04/28/2021
Onset Date: 04/29/2021
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: penicillin, aspirin

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

Symptoms: Woke at 6:00 AM with severe nausea, then started severe retching and severe vomiting, every 10 to 15 minutes. After 30 minutes, when bile started coming up, I called the doctor's office for instructions; he said to go to the hospital emergency room immediately. By then, I was too weak to stand or walk any distance, so I called for an ambulance. Taken to Hospital(arrival about 9:00 AM) where i received Zofran intravenously, along with saline drip. Spasms gradually tapered off and stopped within an hour. I was kept for observation and rest the remainder of the day and the following night, then released from the hospital at 4:00 AM (!!) the next morning.

Other Meds: Oxycontin, Oxycodone, Genvoya, Tizanidine, Proscar, Crestor, Linzess, Dexilant, Reglan, Pepcid, Zofran, Meclizine, Multi-Vitamin, Myralax, Gaviscon, Valtoren.

Current Illness: Fibromyalgia, diverticulosis, myelo-dysplastic syndrome, spinal arthritis, stenosis of the spine

ID: 1471291
Sex: F
Age: 44
State: MD

Vax Date: 02/25/2021
Onset Date: 04/18/2021
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: Cortisone

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

Symptoms: On April 18, 2021 I woke up with severe vertigo which I had never had before it lasted approximately 16 hours. Then on April 28, 2021 I became very uncoordinated, slurred speech, depth perception was off a lot of neuropathic pain something just wasn?t right. Was check to make sure I wasn?t having a stroke, and I followed up with my primary care. For seven days I couldn?t drive I couldn?t walk without assistance and my whole world was in just an upside down moment. My primary care physician ordered an MRI and a ton of bloodwork to see if it was possibly MS. The MRI came back negative with a normal brain scan but my blood work came back positive for neuromyelitis optica NMO for short. I have never had a history of any form of autoimmune disease. Demyelinating disease nothing like that. My whole world is literally shattering around me because now I?ve been diagnosed with this NMO, And trying to find a provider that can possibly help me with such a very rare autoimmune disorder. The more I read about the COVID-19 vaccine I think the Covid vaccine has caused this rare disorder and I?m scared to death I don?t want anyone else to have to go through this.

Other Meds: Hctz 25 mg, Effexor 125mg, Vit D, losarten 50mg

Current Illness: None

ID: 1471292
Sex: M
Age: 58
State: NJ

Vax Date: 07/03/2021
Onset Date: 07/11/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Severe psoriasis symptoms. Itching. Rashes and hives on back, armpits, stomach, groin area, buttocks, wrist, legs, feet. Symptoms subsided after taking a total of 4 Benadryl tablets. Milder symptoms mostly on legs started to come back on the next day. Cleared up after taking 2 Benadryl tablets. No symptoms since. Typically suffer from mild psoriasis. Have never experience such a severe episode before.

Other Meds: Benadryl.

Current Illness: None.

ID: 1471293
Sex: F
Age: 72
State: CA

Vax Date: 04/11/2021
Onset Date: 04/11/2021
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: Sulpha drugs codeine

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

Symptoms: Same night of vaccine had the most intense bout of the periperal neuropathy I frequently get from degenerative disks and pinched nerves I have suffered with for years. It was in both legs and feet and I usually only have one side stabbing me at night after I lay down. It lasted all night long as it usually does but the intensity was hard to deal with. It did stop the next day but really shocked me after receiving the J and J

Other Meds: Lisinipril 20 mg nifedipine30mg

Current Illness:

ID: 1471294
Sex: M
Age: 59
State: IN

Vax Date: 06/05/2021
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: None

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

Symptoms: Patient notified us today that he just recently started having tingling in different parts of his body and requested we report this information to you.

Other Meds: Unknown

Current Illness: None

ID: 1471295
Sex: M
Age: 18
State:

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Attende reported lightheadedness immediately after vaccine administration, however opted to remain seating over the offered cot. Frequent Vital signs taken, all within normal history of attendee (per report). Declined EMS call. Observed for a longer span of time. Ambulated with standbyAssistx1 to bathroom, continued remainder of Observation period with improvement to point of discharge and ambulated without assistance upon departure.

Other Meds:

Current Illness:

ID: 1471296
Sex: F
Age: 52
State: MS

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: NONE REPORTED

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

Symptoms: PATIENT FELT LIGHT HEADED AND FELT LIKE SHE WAS GOING TO PASS OUT. SHE REQUESTED TO SIT ON THE FLOOR. UPON MOVING TO THE FLOOR, SHE TOLD HER HUSBAND SHE WAS GOING TO PASS OUT. HER EYES CLOSED SO 911 WAS CALLED IMMEDIATELY. SHE OPENED HER EYES SHORTLY AFTER AND WAS TOLD HELP WAS ON THE WAY. EMS CAME, ASKED HER SOME QUESTIONS, TOOK HER BLOOD PRESSURE AND BLOOD GLUCOSE. EMS WALKED HER OUT OF THE STORE.

Other Meds: NONE KNOWN

Current Illness: NONE REPORTED

ID: 1471297
Sex: F
Age: 46
State: PA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine, latex, vancomycin,

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: All over body hives started 3 hrs after receiving vaccine. 2 doses of prednisone, pepcid bid x 5 days, Singulair 10 MG at bedtime. Hives come back when off prednisone. Atarax for itching. Lymph nodes in armpits, elbows. Neck, behind necks all enlarged and swollen. Day # 28 still have hives, swollen lymph nodes. Per doctor has to run course. Not enough data

Other Meds: Met forming 1000mg bid, Farxiga 5mg daily, lisinopril 40 MG daily, zyrtec 10 MG daily, lipitor 20 MG q hs

Current Illness: N/a

ID: 1471298
Sex: F
Age: 57
State: CA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 07/14/2021
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: polyethylene glocol, lisinopril, lossatan, hyrochlorthiazide, penicillin, cipro, vicodin, clindamycin, codeine, tramadol, doxycycline

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

Symptoms: dry throat, sore throat, headache, body aches, then breathing became difficult gradual. I was then hospitalized 2, 5 then 4 days at Hospital and for breathing and lung pain. I am stil on oxygen at home and being treated by my primary doctor and pulmonary doctor.

Other Meds: levothyroxine, diltiazem, Duloetine, Atrovastatin,

Current Illness: none

ID: 1471299
Sex: F
Age: 56
State: FL

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 07/14/2021
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: No

Symptom List: Vomiting

Symptoms: Within 22 Hours of second dose, she heard a loud noise in her right Ear and then suddenly she could not hear anything. She also experienced dizziness and severe headaches.

Other Meds: No

Current Illness: No

ID: 1471300
Sex: M
Age: 22
State: MN

Vax Date: 02/01/2021
Onset Date: 02/01/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: sudden hearing loss requiring hear aids, ear canal swelling and itching, axillary gland enlargement and pain

Other Meds: Insulin, Victoza, Treseba, Actos, Lopressor, zoloft

Current Illness: Diabetes, HTN, enlarged spleen, enlarged liver

ID: 1471301
Sex: M
Age: 4
State: FL

Vax Date: 06/29/2021
Onset Date: 06/30/2021
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: RA

Lab Data:

Allergies: Red dye.

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

Symptoms: Within hours of injection full body raised rash with itchiness and swelling of the injection site.

Other Meds: None

Current Illness: None

ID: 1471302
Sex: M
Age: 58
State: MA

Vax Date: 03/12/2021
Onset Date:
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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vaccine #1 was Pfizer, Vaccine #2 was Moderna. The hospital called us 3 months later (July 9, 2021) to inform us of the error on their part!!!

Other Meds: None

Current Illness: No

ID: 1471303
Sex: F
Age: 78
State: KY

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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Two days following Covid vaccine2,I woke up with severly painful red left eye. I went to opthamologist on emergency. Treated for split/cornea above above the pupil, then covered with contact patch & given antibiotic & drops for redness; returned for several follow up visits w/associate, Dr. who continued treating me even with oral antibiotics to try to treat the severe redness now in both eyes. He also prescribed Rx for dry eyes. I was referred to eye specialist. Dr. diagnosed as immune reaction to Covid vaccine. I saw all Drs. still visual impairment persists!

Other Meds: On file

Current Illness:

ID: 1471304
Sex: F
Age: 24
State: AK

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: body aches, fever, chills, nausea

Other Meds: none

Current Illness: no

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm