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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1485653
Sex: M
Age: 59
State: CA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 07/19/2021
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: Medical consult text was sent to medical lead since client reported with the first Pfizer COVID vaccine, he had diarrhea in the middle of the night then six to seven episodes of diarrhea on the first day. For an additional 5 days, he had two to three diarrhea episodes a day. He stated had occasional diarrhea with milk consumption but denied milk consumption prior to those episodes. He treated the diarrhea with Pepto Bismol. He denied other signs or symptoms of anaphylaxis or dizziness. He stated he didn't have a follow-up with PCP. He reported he has history of hypertension but discontinued medications on his own. He reported no known allergies.

Other Meds:

Current Illness:

ID: 1485654
Sex: F
Age: 63
State: CA

Vax Date: 07/15/2021
Onset Date: 07/16/2021
Rec V Date: 07/19/2021
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: Azithromycin

Symptom List: Anxiety, Dyspnoea

Symptoms: Sore arm at injection site, slight swelling and redness, body aches, headache, chills, nausea. This lasted for two days. The redness near the injection site continues (day 3).

Other Meds: None

Current Illness: None

ID: 1485655
Sex: M
Age: 50
State: CA

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/19/2021
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: NO ADVERSE REACTION , IT WAS NOTED IN ENTERING THE VACCINE DATA THAT THE PATIENT HAD THE FULL SERIES OF PFIZER DOSE ONE ON 04/08/2021 AND DOSE TWO ON 04/29/2021. THE PATIENT DENIED HAVING A COVID VACCINE IN THE PAST BOTH ON THE FORM HE SUBMITTED AND TO ME WHEN I ASKED. THE PHONE NUMER HE PROVIDED FOR A FOLLOW UP CONVERSATION IS NOT ATIVE

Other Meds: UNKNOWN

Current Illness: NONE REPORTED

ID: 1485656
Sex: M
Age: 14
State: PR

Vax Date: 07/17/2021
Onset Date: 07/18/2021
Rec V Date: 07/19/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Severe chest pain (he said it hurt to breath) Fever for 2 days. He had acetaminophen every 4 hours.

Other Meds: Only acetaminophen after vaccination.

Current Illness: N/A

ID: 1485657
Sex: F
Age: 58
State: GA

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/19/2021
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: after the 2nd dose, 2 days later the patient felt she has arthritis, legs and hands were swollen, nuckles are swollen and painful and the patient can barely walk. she hiked 4 miles a day and now she cannot even go room to room

Other Meds: multi-vitamins

Current Illness:

ID: 1485658
Sex: F
Age: 75
State: NC

Vax Date: 03/17/2021
Onset Date: 03/19/2021
Rec V Date: 07/19/2021
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: Gluten Sensitivity

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

Symptoms: Shoulder joint pain, limited movement, swollen hard muscle at approximate sight of injection, sometimes nerve pain extending from shoulder to hand and other times entire arm searing heat or cold sensation, and sometimes muscle ache. Unable to get into comfortable position to sleep. Difficulty sleeping. Difficulty doing routine movements and avoid doing some things wearing clothes that require certain movements or drying hair, etc.

Other Meds: Dorzolamide HCI and Timilol Maleate Opthalmic Solution, PreserVision Areds 2 + Multi Vitamin, Calcium plus Vitamin D3

Current Illness: None

ID: 1485659
Sex: M
Age: 38
State: WA

Vax Date: 06/21/2021
Onset Date: 07/19/2021
Rec V Date: 07/19/2021
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: n/a

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: No adverse outcomes. Patient arrived to our site 7/19/21 to receive his planned second dose of Moderna. After verifying his vaccination information, our greeter noted he had previously received 2 dose of Pfizer earlier (12/29/20 and 1/19/21). It's unclear why this was missed for his first dose, as it is our practice to verify all patients before they are vaccinated. In discussing with the patient, he stated he didn't remember getting the Pfizer shots earlier in the year. He reported he worked at a long-term care agency at the time. We explained he had already been fully vaccinated, so we couldn't give him his 2nd Moderna shot. If he is concerned the initial Pfizer doses were reported in error, he needs to contact DOH to update his records so we can provide him his second Moderna shot.

Other Meds: n/a

Current Illness: n/a

ID: 1485660
Sex: F
Age: 16
State: CA

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

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

Lab Data:

Allergies: n/a

Symptom List: Pharyngeal swelling

Symptoms: Patient received the Janssen vaccine at 16y.o. when the vaccine is only approved under the Agency's rule for use in those ages 18 and older. When the mistake was noticed, around 15 minutes after the vaccination, patient was notified of the event. Patient received information and reported no current ill effects. Patient was encouraged to register and report to system.

Other Meds:

Current Illness:

ID: 1485661
Sex: F
Age: 42
State: VA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 07/19/2021
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: Starting around 5:30 pm, arm starting feeling "dead", yet painful. By 7:00 pm, could not move left arm unless it was moved using the right arm and also started having shaking and chills followed by an awful headache. As the night progressed, felt like blood was on fire and I was burning from the inside out, but my body was having chills and I was hallucinating. By 10:00 am the next day, I was feeling better but continued with the headache for another 24 hours and complete loss of appetite until 5 days after 2nd dose was administered.

Other Meds: None

Current Illness: None

ID: 1485662
Sex: F
Age: 16
State: WA

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Jannsen Covid vaccine given to 16 year old patient

Other Meds:

Current Illness:

ID: 1485663
Sex: F
Age: 1
State: CA

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

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

Lab Data:

Allergies: no

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

Symptoms: Mom states 2 days after the vaccines she noted the baby had left facial paralysis with droopy left eyelid and left corner of mouth also drooling from left mouth. She was seen at urgent care and days later at hospital ER and given Prednisone and Acyclovir po according to mom she seems to be getting slightly better. she had cold sores in march 2021 and Cx was positive for Herpes Simplex virus

Other Meds: none

Current Illness: no

ID: 1485664
Sex: F
Age: 44
State: TX

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/19/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Patient presented with blister below right arm near deltoid muscle. Blisters have ruptured and left hyper pigmentation and redness around the entire arm. The patient said it was easily irritated and couldn't wear any clothes that could rub against the skin. Patient can now wear clothing without feeling irritated. Blisters have popped.

Other Meds: None

Current Illness: None

ID: 1485665
Sex: M
Age: 27
State: CA

Vax Date: 07/09/2021
Onset Date: 07/17/2021
Rec V Date: 07/19/2021
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: Half body paralysis.

Other Meds: None

Current Illness: None

ID: 1485667
Sex: F
Age: 24
State: CA

Vax Date: 07/05/2021
Onset Date: 07/16/2021
Rec V Date: 07/19/2021
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: Sulfa

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

Symptoms: Rash, treated with steroids and Benadryl

Other Meds:

Current Illness: Strep Throat

ID: 1485668
Sex: F
Age: 77
State: CA

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 07/19/2021
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: aspirin, lactose intolerant

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

Symptoms: Fever , chills, tireness, redness and swelling after 6 hours. took tylenol every 4 hours for 2 day, then starting taking 2 times daily.

Other Meds: vit b12, vit b9, vit D, stool softner.

Current Illness: Rheumatoid arthritis

ID: 1485669
Sex: F
Age: 18
State: AZ

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/19/2021
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 noted by patient

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

Symptoms: Patient presented to the clinic for covid vaccine at approximately 2:20pm. She received her Pfizer #1 vaccine without incident. The patient was notified to wait 15 minutes in the waiting area for monitoring. While she was waiting she became pale, was heavily perspiring, and was vomiting. She was A+ O x3 during the event. She did not lose conciousness. Vitals were 100/60, HR 60, O2 99. She was moved to a lying position with her legs bent on the exam table. She began to feel better. Paitent was then sat up and monitored x 10 minutes. Patient was feeling better so she was moved to a chair in the waiting room and monitored for another 10 minutes. She left with her family without assistance. Patient verbalized she was feeling better.

Other Meds:

Current Illness:

ID: 1485670
Sex: F
Age: 32
State: CA

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/19/2021
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: cipro

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

Symptoms: Within seconds of receiving vaccine RN asked client if she was feeling fine as she appeared pale. Client stated "I feel lightheaded". RN signaled lead PHN assistance. RN set up anti-gravity chair and client was able to transfer self without assistance. Client reported medical history of acute psychosis and schizophrenia, no current medication and allergies to Cipro. PHN took first set of vitals at 1402: blood pressure 104/70, pulse 65, oxygen sat 99%. PHN observed client start coughing to clear throat and asked client to elaborate new onset. Per client no shortness of breath, denied throat closing, but felt "heaviness over throat, like when you eat popcorn". PHN did not note any swelling or redness on face or neck area, no tongue swelling and client able to speak in full sentences. Client declined blurry vision, headache, or chest pain. PHN offered client Benadryl and client declined due to not having a ride and taking public transportation, per client would wait a few more minutes for symptoms to improve. At 1405 client reported throat feeling not improving and wanted Benadryl, per client "does not like shots and wants oral". At 1406 PHN gave client Benadryl 50mg PO. Vitals at 1407: blood pressure 100/60, pulse 50, oxygen sat 99%. Per client dizziness same and "throat itch improved". Per client swallowing saliva just fine. Per client had no breakfast this morning, RN brought client juice and client begin to take small sips. At 1410 PHN took pulse manually, 53. Per client is aware pulse and blood pressure run low, and has not followed up with primary provider, but has been seen at ER when she felt chest pain 2 weeks ago. PHN advised client to make appointment with provider. Vitals at 1413: blood pressure 97/73, pulse 54, oxygen sat 99%. Per client dizziness and throat discomfort resolved and stated "I feel tired". PHN Ivonne gave client ER precautions and advised client to follow up with provider. At 1415 PHN reminded client of possible side effect of drowsiness with Benadryl, client verbalized understanding and stated "I live close, bus stop is right in front of my house." Vitals at 1419: blood pressure 110/69, manual pulse 48, oxygen sat 99%. Per client "feeling fine". Denied lightheadedness, headache, blurry vision, shortness of breath or chest pain. Per client wanted to leave. Client left facility with steady gait against medical advice at 1424.

Other Meds: none

Current Illness:

ID: 1485671
Sex: F
Age: 40
State: MO

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 07/19/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Menstrual bleeding occurred 1 day after each of my COVID vaccines. Light spotting and only lasted 1 day. But occurred after each of the covid vaccine and was approximately 8 days after my menstrual cycle had ended.

Other Meds: none

Current Illness: none

ID: 1485672
Sex: F
Age: 30
State: TX

Vax Date: 06/23/2021
Onset Date: 06/24/2021
Rec V Date: 07/19/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: My ovaries felt like they were going to fall out of my body. Not only that but the same thing happened to my friend. It lasted about an hour and I could hardly stand straight.

Other Meds: None

Current Illness: None

ID: 1485673
Sex: F
Age: 54
State: CA

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 07/19/2021
Hospital:

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

Lab Data:

Allergies: Unknown

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

Symptoms: About 30-45 minutes after the vaccine. I had to lay down and I couldn?t move. And my arms went numb. Called my husband to come home from work. Almost called 911. I started feeling like I was gonna faint. I had Difficulty breathing and speaking. I was having Short breaths. Severe nausea . Thought I was gonna have Diarrhea but didn?t. Laid down for almost an hour before I finally felt I could move. And started feeling better.

Other Meds: None

Current Illness: None

ID: 1485674
Sex: M
Age: 15
State: MT

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/19/2021
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: 10 days of fatigue, headache, body aches

Other Meds:

Current Illness:

ID: 1485675
Sex: F
Age: 39
State: AZ

Vax Date: 05/18/2021
Onset Date: 06/03/2021
Rec V Date: 07/19/2021
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: On 3 June my arm left forearm started to swell and there it was tight, I did hot and cold regiments thinking I injured it somehow, after the pain persisted I went to the my PCP and he ordered an ultrasound where it was discovered I had a DVT. This was 18 June. I received my second shot on 8 June. And last week I had the same symptoms, I contacted the hematologist and he ordered another ultra sound and now I have another DVT.

Other Meds: Multi vitamins , Levothyroxine

Current Illness: Blood clots. I?ve had two blood clots since receiving the Pfizer vaccine. Both have been a DVT. The first one started after the first dose on the 3rd of June. I received my second dose June 8th. My second blood clot started the July 12th. I have no history of having one ever.

ID: 1485824
Sex: M
Age: 57
State: CA

Vax Date: 04/01/2021
Onset Date: 05/15/2021
Rec V Date: 07/19/2021
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: Penecillan

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

Symptoms: Cramping in my left hand index finger. Becomes stiff and unable to move

Other Meds: None

Current Illness: None

ID: 1485825
Sex: M
Age: 52
State: CA

Vax Date: 06/23/2021
Onset Date: 06/24/2021
Rec V Date: 07/19/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Reported with the first Pfizer COVID vaccine, he had dizziness the next day along with nausea and tiredness which lasted for two to three days. He reported he didn't eat with the first dose of Pfizer COVID vaccine. He denied other signs or symptoms of anaphylaxis. He stated he didn't have a follow-up with PCP and denied any known allergies or any chronic health conditions.

Other Meds:

Current Illness:

ID: 1485826
Sex: M
Age: 61
State: CA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 07/19/2021
Hospital:

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

Lab Data:

Allergies: Amphicillin alergy

Symptom List: Injection site pain, Menorrhagia

Symptoms: Became ill with flu like symptoms for approximately 20+ hours. Achy and very tired. Stayed in bed most of the next day after 2nd dose.

Other Meds: None

Current Illness: None

ID: 1485827
Sex: M
Age: 17
State: NY

Vax Date: 07/15/2021
Onset Date: 07/16/2021
Rec V Date: 07/19/2021
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: Amoxicillin

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

Symptoms: Symptoms began morning after shot. Sore arm (left), headache, high fever, facial swelling, left axillary lymph node inflammation, general discomfort and pain. Lasted approximately 2-3 days.

Other Meds:

Current Illness:

ID: 1485828
Sex: F
Age: 54
State: CA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 07/19/2021
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 very serious

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: severe nausea May 8 @ 10 PM - May 10 @ 1 PM severe chills/insomnia May 8 @ 10 PM - May 9 @ 6 AM 103.6 fever May 9 @ 6 AM- May 11 @ 10 PM body pain, sweating, shaking, dizziness for the duration dizziness, confusion, shortness of breath on and off to present

Other Meds: aplenzin synthroid pristiq cytomel

Current Illness: none

ID: 1485829
Sex: F
Age: 32
State:

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/19/2021
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: Extreme pain at injection site. Nauseous, dizzy, blood pressure drop

Other Meds:

Current Illness:

ID: 1485830
Sex: M
Age: 29
State: OR

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/19/2021
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: NKA

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

Symptoms: PATIENT FAINTED SHORTLY AFTER RECEIVING THE VACCINE. HE LOOKED PALE AND SWEATY. COMPLAINED FROM NUMBNESS OF HIS CHIN, AND HIS EXTREMITIES. FELT SICK TO HIS STOMACH TOO.

Other Meds: NOT NONE

Current Illness: NONE

ID: 1485831
Sex: F
Age: 15
State:

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: 15 without Preexisting Conditions, conveys feeling Nausea, hot, shakiness. Noted to be pale. Laid down to cot, cold pack to forehead. VS taken within acceptable limits but for temperature starting at 91.5F from the neck. Monitored without ALOC, self resolved symptoms. Temp improved to 93.5F. Able to ambulate out without assistance with mother.

Other Meds:

Current Illness:

ID: 1485832
Sex: M
Age: 15
State: TX

Vax Date: 07/13/2021
Onset Date: 07/14/2021
Rec V Date: 07/19/2021
Hospital:

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

Lab Data:

Allergies: nkda

Symptom List: Injection site pain

Symptoms: Patient's Mom Reported on 7/19/2021 Heart/Artery inflammation

Other Meds: Hydrocortisone ointment Benzoyl Peroxide Wash Clindamycin Gel

Current Illness: unknown

ID: 1485833
Sex: F
Age: 36
State: MS

Vax Date: 01/01/2021
Onset Date: 03/01/2021
Rec V Date: 07/19/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: About 3-4 weeks after the second Moderna vaccine, I developed shingles on my right torso. It was a fairly mild- moderate rash with a lot of pain in the area. The rash itself lasted about 2 weeks. The pain and itching lasted longer.

Other Meds: Na

Current Illness: Na

ID: 1485834
Sex: M
Age: 39
State: OR

Vax Date: 05/18/2021
Onset Date: 06/04/2021
Rec V Date: 07/19/2021
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: Nerve pain, armpit rash, shortness of breath, heavy heart beat.

Other Meds:

Current Illness:

ID: 1485835
Sex: F
Age: 68
State: IL

Vax Date: 04/11/2021
Onset Date: 05/03/2021
Rec V Date: 07/19/2021
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: Ibeprophen

Symptom List: Tremor

Symptoms: Before the shot I was fine. Once taken, a month later i began feelkng worse and needed to go the the hospital. Some of the symptoms are, Pins and needles feeling in face hands and feet, bloated stomach.

Other Meds: Perscription: Plavics and one i cant remember at the moment.

Current Illness: None

ID: 1485836
Sex: F
Age: 46
State: SD

Vax Date: 01/08/2021
Onset Date: 03/15/2021
Rec V Date: 07/19/2021
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: Na

Symptom List: Erythema, Pruritus

Symptoms: Hashimotos diagnosis

Other Meds: Claritin, 5 mg amlodopine

Current Illness: Na

ID: 1485837
Sex: F
Age: 38
State: CA

Vax Date: 05/04/2021
Onset Date: 05/06/2021
Rec V Date: 07/19/2021
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: Pepper and foods containing capsaicin.

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

Symptoms: Symptoms consistent with MCAS, ME/CFS, neuropathy, anxiety, panic attacks, anaphylaxis, swelling of throat and tongue, dysautonomia, heart palpitations, widespread inflammation and neuropathy especially at sites of old or previous injury. Cognitive issues consistent with brain fog and extreme confusion.

Other Meds: None

Current Illness: None diagnosed.

ID: 1485838
Sex: M
Age: 37
State: WA

Vax Date: 06/26/2021
Onset Date: 06/26/2021
Rec V Date: 07/19/2021
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: Rash/Hives within 2 hours of vaccine administration. Rash/Hives reappeared the next day.

Other Meds:

Current Illness:

ID: 1485839
Sex: F
Age: 50
State: LA

Vax Date: 06/30/2021
Onset Date: 07/07/2021
Rec V Date: 07/19/2021
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: unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: pt said she got covid arm 1 week after dose administered and now has tingling and numbness in her arms and legs

Other Meds: unknown

Current Illness: uknown

ID: 1485840
Sex: F
Age: 49
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: Chest pain dizziness shortness of breath headache

Other Meds:

Current Illness:

ID: 1485841
Sex: F
Age: 14
State: LA

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/19/2021
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: nkda

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

Symptoms: Patient had an syncope episode following a pfizer covid 19 shot. She had shortness of breath and appear to have a seizure afterwards. Gave 1 dose of an epipen and patient vitals was stable.

Other Meds: n/a

Current Illness: Fainting episode from past vaccine.

ID: 1485842
Sex: F
Age: 21
State: ID

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

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

Lab Data:

Allergies: Gabapentin, Sertraline.

Symptom List: Pain in extremity

Symptoms: Patient reported via consent form that she was due for the 2nd COVID vaccine. She stated on the consent form that she had received Pfizer as the 1st dose. Pharmacist doubled checked that she had received 1st dose Pfizer at intake window and she confirmed. Pharmacist also checked again prior to vaccination that she needed a 2nd dose Pfizer and patient confirmed. Patient did not come in with vaccine card for 1st dose. Several hours later patient returned stating that she had checked with the 1st pharmacy where she had received the 1st dose and they stated that she had been given a Moderna vaccine, not a Pfizer vaccine. Patient also stated at time of return that she had not been given a vaccine card showing proof of vaccination from first pharmacy where she received the first dose. Patient did not report any adverse events other than that stated above.

Other Meds: N/A

Current Illness: N/A

ID: 1485843
Sex: M
Age: 11
State: CA

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

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

Lab Data:

Allergies: cats

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

Symptoms: On the consent form, mother wrote that patient is 12 years old so pharmacist quickly assumed that it was good to go without double checking the birthdate which was 2 days away from patient turning 12 years old. Today's date: 7/19/2021.

Other Meds: unknown

Current Illness: unknown

ID: 1485844
Sex: F
Age: 70
State: HI

Vax Date: 03/16/2021
Onset Date: 07/07/2021
Rec V Date: 07/19/2021
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: Sulfa and Thimerosal

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

Symptoms: Positive covid test 7/7/2021. Pt did report of a negative covid test done outside of clinic after this positive.

Other Meds: ? Estradiol (ESTRACE) 0.01 % (0.1 mg/gram) Vagl Crea INSERT 1 GRAM INTRAVAGINALLY ONCE A WEEK 42.5 g PRN ? RETIN-A 0.1 % Top Crea Apply to affected area(s) daily 20 g 99 docusate sodium, vit, bcomplex. mag

Current Illness:

ID: 1485845
Sex: F
Age: 60
State: CA

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 07/19/2021
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: Penicillin, tuna

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

Symptoms: Severe vertigo and nausea with any movement , but most severe when putting head down. Symptoms started 3 days after the first vaccine , lasted 2 weeks . Vertigo and nausea returned much worse the morning after getting the second vaccine and symptoms continued for 3 weeks. Currently still has slight vertigo and imbalance intermittently.

Other Meds: Tirosent 75 mcg, Active Nutrients w/out iron 1/day, D3 5,000 international units/day and alternates with D3/K2 drops, Regenemaxx Plus 1 cap/day, Acetyl L-Carnitine 500mg 1/day, Omega 690mg 1/day, D Hist 2/day to reduce constant PND, Orthodi

Current Illness: No

ID: 1485846
Sex: F
Age: 23
State: NC

Vax Date: 03/31/2021
Onset Date: 04/04/2021
Rec V Date: 07/19/2021
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: Bell Palsy

Other Meds:

Current Illness:

ID: 1485847
Sex: M
Age: 54
State: CA

Vax Date: 06/19/2021
Onset Date: 06/21/2021
Rec V Date: 07/19/2021
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: Patient presented to pharmacy complaining of welts that look like burns on back of shoulder, deltoid and chest on side where second Pfizer Covid dose was given almost one month prior. Patient states he did see a physician but was unclear (unable to explain or evasive) about treatment he received. He stated that the welts are not itchy, swollen or hot.

Other Meds:

Current Illness:

ID: 1485848
Sex: F
Age: 59
State: KS

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/19/2021
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: PEANUTS, LEVAQUIN, BEE STINGS, CAULIFLOWER, TORADOL

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

Symptoms: SHORTLY AFTER RECEIVING HER SECOND COVID SHOT, PATIENT STATED THAT SHE WAS FEELING ITCHY. PATIENT TOOK 25MG OF DIPHENHYDRAMINE. PATIENT CONTINUED TO HAVE ITCHING FOR THE FOLLOWING 15 MINUTES, BUT NO WORSENING OF THE SYMPTOMS.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1485891
Sex: F
Age:
State: OH

Vax Date:
Onset Date: 06/23/2021
Rec V Date: 07/19/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: No additional AE's reported; She states that a patient had already received 2 doses of MMRlI, 1 at 15 months and 1 at 4 years old but she was given a 3rd dose of MMRlI instead of the required VARIVAX/Misuse of MMRlI; was given MMRII insted of the requiered VARIVAX/Misuse MMRII; was given MMRII insted of the requiered VARIVAX/Missed dose of VARIVAX; This spontaneous report was received from an office manager, concerning an 18-year-old female patient. No information was provided regarding the patient's pertinent medical history, concomitant medications and previous drug reactions or allergies. The patient was vaccinated on an approximately unspecified date in 2004 (reported as at 15-month-old) and in 2007 (reported as at 4-year-old) with a dose of Measles, Mumps, and Rubella (Wistar RA 27-3) Virus Vaccine, Live (M-M-R II). Then, on 23-JUN-2021, the patient was vaccinated with a third dose of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, recombinant human albumin (rHA) (M-M-R II) (extra dose administered) lot number S039310 (which had been verified to be a valid lot number, upon internal validation) and expiration date 04-DEC-2021 as prophylaxis (dose, vaccination scheme frequency, route of administration and anatomical site of vaccination were not reported), instead of a dose of varicella virus vaccine live (Oka/Merck) (VARIVAX) (interchange of vaccine products and product dose omission issue). No adverse events were reported.

Other Meds:

Current Illness:

ID: 1485892
Sex: U
Age:
State: NY

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 07/19/2021
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: No other adverse events reported; improperly stored dose of proquad was administered.; This spontaneous report was received from a medical assistance concerning a patient of unknown age and gender. No information was provided regarding the patient's pertinent medical history, concomitant medications and previous drug reactions or allergies. On 21-JUN-2021, the patient was vaccinated with an improperly stored dose Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live ( recombinant human albumin (rHA) PROQUAD) 1 injection subcutaneously (lot number T034824 which was determined to be valid upon internal review with expiration date 11-APR-2022 but reported as 23-FEB-2022) (vaccination scheme frequency, route and anatomical location of administration were not reported) as prophylaxis (product storage error). The administered vaccine experienced a temperature excursion of 28 grades Fahrenheit (F) during a time frame of 4 hours, as recorded by data logger. There was not a previous temperature excursion. No other adverse events were reported.

Other Meds:

Current Illness:

ID: 1485893
Sex: F
Age:
State: GA

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

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

Lab Data:

Allergies:

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

Symptoms: receiving HPV vaccination before delivery; This literature market report has been received from authors of a published article, referring to a 26 years old female patient. The patient's medical history and concomitant medication were not provided. On an unknown date, the patient became pregnant. The last menstrual period (LMP) and estimated date was not reported. On an unknown date, the patient was vaccinated with human papillomavirus (HPV) vaccine (strength, dose, route, anatomical location, lot number and expiration date were not provided) for prophylaxis (vaccine exposure during pregnancy). On an unknown date, the patient delivered an infant of unknown gender. The pregnancy outcome was live birth. The fetal outcome was unknown. The outcome of vaccine exposure during pregnancy was considered as recovered. A copy of the published article is attached as further documentation of the patient's experience. This is one of two reports regarding the same literature (linked case# 2107USA005600).; Sender's Comments: US-009507513-2107USA005600:

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm