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: 1490813
Sex: F
Age: 33
State: CA

Vax Date: 01/15/2021
Onset Date: 04/05/2021
Rec V Date: 07/21/2021
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: sulpha; allergic to Lychee and it's family

Symptom List: Dysphagia, Epiglottitis

Symptoms: 2nd follow up report: Around April 5, I had arthritis all over my body especially my hands. I went to the doctor about it and they did an autoimmune test for it and everything came back negative. I have had phantom smells - I smell smoke when there isn't any present. I smell lit very strongly when others don't smell it at all. Smells have changed: whenever I smell urine or feces - it doesn't smell like that it smells like rotting flesh. (I'm a nurse.) I've been having insomnia - can't sleep. If I do go to sleep, I just keep waking up. I'm still having insomnia; I'm getting arthritis every once in a while. It's not gone. My phantom smells are mostly gone but a smell issue is still there. The doctor said to do smell therapy - to smell different essential oils - if I try to smell peppermint, I can't find it. I can't smell tea tree - only has a slight smell and it's not a tea tree smell, it smells like an old attic. Same thing with lavender and orange - they either smell or or not at all. There is no other treatment for the smell thing. My doctor told me to take vitamins for the arthritis. For the insomnia, I take melatonin but that just puts me to sleep. It doesn't keep me asleep. The forgetfulness that I reported in the previous report has improved since then - it hasn't completely gone away but it's improved.

Other Meds: no

Current Illness: no

ID: 1490814
Sex: F
Age: 21
State: DC

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/21/2021
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: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.

Other Meds:

Current Illness:

ID: 1490815
Sex: F
Age: 64
State: PA

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

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

Lab Data:

Allergies: Penicillin, pseudoephedrine, benadryl, doxycycline, Lipitor, Zocor.

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

Symptoms: 2 months later. Pain at right thumb joints, stiff, weak, strength loss. Started July 7 to present. Also one and a half month after had seasonal allergy attack, never had one in all my life. Late June for 2 straight weeks.

Other Meds: Synthroid, Metaprolol, baby aspirin, Eliquis, Azathioprine, Crestor, multi vitamin, calcium with D, B complex, D3, biotin

Current Illness: None

ID: 1490816
Sex: F
Age: 79
State: IL

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

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

Lab Data:

Allergies: penicillin, sulfa, neominstine , statin, ibuprofen, aspirin, alot of arteritis drugs, juniper berries, gin, cumin, dill, cilantro, nylon thread,

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: shot was given around 11am and around 1-2 she began to get chills and body aches worse than covid, exhausted, several weeks later she began to having issues with walking, she will get pains in her knees and legs, its hard to walk she begins to walk like a penguin, she is now using a cane.

Other Meds: prednisone, multi vitamin,

Current Illness:

ID: 1490817
Sex: M
Age: 26
State: GA

Vax Date: 04/13/2021
Onset Date: 05/01/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies: Ceclor antibiotic, dogs, pollen sensitive

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

Symptoms: I have had a lingering cough since about 05/2020 and at the time I was very sick with Covid like symptoms. I got tested and it was negative. Then I had a cough that sounded very ill. I am working with my PCP to try to figure out the source of this cough. My PCP said that there is a possibility that this is heart burn. I have never had a problem with that. What happened after a month after my second dose is that I started having symptoms of heart burn. No medical tests done. I contacted my doctor and all was done via email. They gave me Nexium. Since the Nexium I have not have any issues with heart burn.

Other Meds: Zyrtec, Flonase

Current Illness: None

ID: 1490818
Sex: F
Age: 12
State: MA

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/21/2021
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 felt nausea, felt like fainting. occurred few minutes after receiving the vaccine. had patient smell ammonia inhalant, lay down to observe for 15 minutes. gave juice as well as patient had not had anything to eat since 8am per patient and mother. checked blood pressure, oxygen level, and heart rate.

Other Meds:

Current Illness:

ID: 1490819
Sex: F
Age: 17
State: DC

Vax Date: 07/18/2021
Onset Date: 07/18/2021
Rec V Date: 07/21/2021
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: Kelfex

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?

Other Meds:

Current Illness:

ID: 1490820
Sex: F
Age: 0
State: MI

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/21/2021
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: notified Doctor, health department , family of patient and supervisor immediately.

Other Meds: NONE

Current Illness: NONE

ID: 1490821
Sex: M
Age: 17
State: DC

Vax Date: 07/17/2021
Onset Date: 07/17/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.

Other Meds:

Current Illness:

ID: 1490822
Sex: F
Age: 44
State: MD

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/21/2021
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: nka

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination

Other Meds:

Current Illness:

ID: 1490823
Sex: F
Age: 32
State: TX

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

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

Lab Data:

Allergies: wheat, corn, soybean, seasame seeds, peanut per SN testing

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

Symptoms: Patient had child via c-section on 6/9/2021. Received dose #1 of Pfizer 6/15/2021. Had normal post-partum bleeding. Second dose 7/6/2021. Approximately 7/7/2021 she started having increased vaginal bleeding, darker and with an odor following by intermittent generalized abdominal pain. Pain progressed to become constant and included low back pain and some nausea. OBgyn ruled out other causes of increased increased post-partum bleeding, suspected having early menses (though is breastfeeding) vs AE of recent Pfizer vaccines. On 7/14/2021 she had sudden severe abdominal pain, and was diagnosed with acute appendicitis in the ER (Presbyterian Dallas).

Other Meds: pre-natal, stool softener, Breo, albuterol PRN

Current Illness: Pfizer #1 6/15/2021, delivered baby via c-section 6/9/2021

ID: 1490824
Sex: F
Age: 51
State: NJ

Vax Date: 07/15/2021
Onset Date: 07/16/2021
Rec V Date: 07/21/2021
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 sensitivity

Symptom List: Rash, Urticaria

Symptoms: Dizziness vertigo and nausea. Ongoing but impact has lessened in last 2 days. Stayed immobile for 36 hours Headaches on going. Take ibuprofen or acetaminophen.

Other Meds: Multivitamins

Current Illness: None

ID: 1490825
Sex: F
Age: 21
State: DC

Vax Date: 07/11/2021
Onset Date: 07/11/2021
Rec V Date: 07/21/2021
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: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?

Other Meds:

Current Illness:

ID: 1490826
Sex: F
Age: 79
State: LA

Vax Date: 03/09/2021
Onset Date: 07/18/2021
Rec V Date: 07/21/2021
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: Augmentin

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

Symptoms: Breakthrough COVID19 infection

Other Meds: Amlodipine, Nexium, Metoprolol, Glucosamine, Mobic, Fosamax

Current Illness:

ID: 1490827
Sex: F
Age: 50
State: PA

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 07/21/2021
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: Ceclor; wheat gluten; dairy; lactose; meat

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

Symptoms: Moderate flu symptoms persisted for 21/2 weeks, after first vaccination shot. Symptoms included fever, congestion, runny nose, headaches. PCR (after 2weeks of symptoms) was negative for COViD, and also negative for Influenza A & B. Please update vaccination info handouts to reflect that vaccination side effects may last longer than the current ? 3 days ? stated on the info sheets. It is irresponsible to tie up healthcare facilities for simple vaccination side effects. My test and trip would not jave been necessary if the information provided to me was accurate.

Other Meds: None

Current Illness: None

ID: 1490828
Sex: F
Age: 48
State: TX

Vax Date: 07/15/2021
Onset Date: 07/15/2021
Rec V Date: 07/21/2021
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, Erythromycin

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

Symptoms: Swelling, itching lips, upper back and scalp. History of anaphylactic reaction to medications. Patient was given one dose of epinephrine, responded well and was transported to the ED for further observation.

Other Meds: Zoloft

Current Illness: None known

ID: 1490829
Sex: F
Age: 30
State: DC

Vax Date: 07/11/2021
Onset Date: 07/11/2021
Rec V Date: 07/21/2021
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: None

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

Symptoms: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?

Other Meds:

Current Illness:

ID: 1490830
Sex: F
Age: 68
State: TX

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies: Codeine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: After my second vaccination I developed a very severe rash over my lower extremities that left scars. I spoke with my physician and he did not give me anything to treat it. I purchased store bought over the counter medications to heal. It took approximately 2 months to subside.

Other Meds: At the time of the vaccination I was taking Levothyroxine 150mcg, Tumeric 800mg, MSM 1000MG, Magnesium 400 mg DMannose 500mg, B12 2000mg, Vitamin D 2000MG, Fiber.

Current Illness: I was diagnosed with Colitis.

ID: 1490831
Sex: F
Age: 45
State: DC

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/21/2021
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: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.

Other Meds:

Current Illness:

ID: 1490832
Sex: M
Age: 65
State: PA

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Patient received shot, waited 15 minute time frame, was feeling well and left store. Received call from individual who was with patient about 10 minutes later reporting pt having left sided facial and arm numbness. Advised pt to seek emergency medical care, that this was not a normal side effect of vaccine but with concern for stroke should be followed up with immediately.

Other Meds: Unknown

Current Illness: unknown

ID: 1490833
Sex: F
Age: 16
State: IL

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/21/2021
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: Client experienced dizziness and lightheadedness six minutes post vaccination. Client was aided to thefloor in a supine position with feet elevated. Ice packs were applied to client?s neck bilaterally. Patient reported resolution of symptoms at 20 minutes post vaccination. Patient then moved to sitting position, tolerated well. After 5 minutes patient assumed standing position, tolerated well. No additional treatment needed.

Other Meds:

Current Illness:

ID: 1490834
Sex: F
Age: 24
State: DC

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/21/2021
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: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?

Other Meds:

Current Illness:

ID: 1490835
Sex: M
Age: 21
State: NY

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/21/2021
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

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

Symptoms: 7/14-7/16 chills, SEVERE migraine, vomiting 7/17 heart pounding My son has NEVER been so sick! As of 7/21, he is still not back to normal.

Other Meds: Vitamin C and D

Current Illness: none

ID: 1490836
Sex: F
Age: 78
State: KY

Vax Date: 02/10/2021
Onset Date: 07/20/2021
Rec V Date: 07/21/2021
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: positive for covid-19

Other Meds:

Current Illness:

ID: 1490837
Sex: F
Age: 56
State: UT

Vax Date: 03/15/2021
Onset Date: 04/15/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: she had soft tissue inflammation in her hands, and joints. this was a few weeks after her second dosing. she complained of muscle pain, upper extremities and her back.

Other Meds: celebrex 200 mg each day omeprazole 20 mg each day

Current Illness: back surgery 3/2021

ID: 1490838
Sex: F
Age: 86
State: DC

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/21/2021
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: nka

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

Symptoms: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination

Other Meds:

Current Illness:

ID: 1490839
Sex: F
Age: 69
State: VA

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 07/21/2021
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: Shellfish Almonds Lisinopril Metropolol Ranitidine Omeprazole

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Severe pain at injection site, subsided in 3 days. 101 degree fever subsided 2 days after taking Excedrin. Chills, muscle aches and arthritis inflammation. Migraine headache. Took Excedrine 36 hours after injection. Most symptoms eased up after a week. However, migraines increased to 3 to 4 a week, with blurry vision, light flashes and vertigo. They have become less frequent but am still having one or two per week. They have Never been this frequent and I have never experienced vertigo with them.

Other Meds: Amlodipine Besylate 5 mg Terazosin 2 mg 2 x a day Vitamin D 2000mg 2 x a day Potassium 99mg 2 x a day Claritan 2 x a day

Current Illness: None

ID: 1490840
Sex: F
Age: 23
State: WI

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 07/21/2021
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: High fever of 105, vomiting, sweats for multiple days. Then after that, my taste and smell have been strange for months. Constant heart pain, fast heartbeat, fatigue, out of breath

Other Meds: NONE

Current Illness: NONE

ID: 1490841
Sex: F
Age: 25
State: MO

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 07/21/2021
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: pumpkin; Lorazepam and Fentanyl

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

Symptoms: My main symptoms is brain fog - not feeling disoriented but it is brain fog. The night of vaccine, I had a fever 102 and I had chills and was nauseated and I had diarrhea. That lasted for 24 hours to 36 hours. I also had headache and that lasted 3 or four days. I was also extremely tired and that lasted for three or four days. I had the brain fog for about two weeks. Waited a bit longer for second vaccine (three months) because I had such bad reactions that I didn't want to get again. No treatment.

Other Meds: Xanax ER -0.25 mg before bed; Vit D - 5000 IUs; Women's multi-vitamin; Folic Acid

Current Illness: COVID symptoms - 6 weeks prior - I got it around November 2020 . Positive COVID test.

ID: 1490842
Sex: M
Age: 28
State: DC

Vax Date: 07/17/2021
Onset Date: 07/17/2021
Rec V Date: 07/21/2021
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: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.

Other Meds:

Current Illness:

ID: 1490843
Sex: M
Age: 69
State: TN

Vax Date: 03/13/2021
Onset Date: 04/03/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Injection site pain

Symptoms: After 3 weeks he came down with gout and knee started hurting. Never had gout or knee problems before taking the vaccine

Other Meds: carnaval, worfin, benazepril

Current Illness: no

ID: 1490844
Sex: M
Age: 25
State: TX

Vax Date: 07/16/2021
Onset Date: 07/16/2021
Rec V Date: 07/21/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient sustained syncopal episode following vaccination administration, falling and striking head on the floor. Injuries to mouth, nose and left side of the face. Neurologic and vital signs stable. Transported for further evaluation to the ED.

Other Meds:

Current Illness:

ID: 1490845
Sex: F
Age: 4
State: CA

Vax Date: 06/11/2021
Onset Date: 07/02/2021
Rec V Date: 07/21/2021
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: amoxicillin

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

Symptoms: Patient has had 2 GTC seizures which started while sleeping, first one on 7/2/2021, seen in ER, ~1 hour post ictal period No treatment at that time. Second GTC seizure while sleeping on 7/16/2021, seen again in ER, similar post ictal period, started on Keppra.

Other Meds: none

Current Illness: none

ID: 1490846
Sex: F
Age: 48
State:

Vax Date: 07/16/2021
Onset Date: 07/21/2021
Rec V Date: 07/21/2021
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: Grass.

Symptom List: Tremor

Symptoms: Broke out in hives.

Other Meds: Levothyroxine, Desloratadine, Flonase, Vitamin C, Vitamin D3, Zinc.

Current Illness: Covid19/Pneumonia in February-May and Shingles.

ID: 1490847
Sex: F
Age: 32
State: VA

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: A vaccine that was drawn up into a syringe on 7/7/21 and placed into a refrigerator was accidentally used on 7/14/21. It should have been discarded on 7/7/21, after a no show appointment. It was placed into the refrigerator and then accidentally used on 7/14/21. The nurse thought it was a fresh syringe from 7/14/21.

Other Meds:

Current Illness:

ID: 1490848
Sex: F
Age: 16
State: MI

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

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

Symptoms: Patient is 16 years of age and received Moderna covid vaccine. Vaccine is licensed for 18 and up currently.

Other Meds: Buspar, prenatal vitamins, phenergan

Current Illness:

ID: 1490849
Sex: M
Age: 44
State: DC

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/21/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination

Other Meds:

Current Illness:

ID: 1490850
Sex: F
Age: 37
State: MN

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 07/21/2021
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: Non-celiac gluten intolerance.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Chills and fever, wake up drenched in sweat, fatigued, muscle aches, 100.6-degree fever, sleeping fitfully, unable to shower, take medicine, etc. Took until 14-16 days later to recover, took Aleve on 5/23, did not help. Dr visit on 5/25, on 5/27 had hives on abdomen and arms, generally itchy everywhere, spread whenever scratched. Entirely gone by 6/3.

Other Meds: Wellbutrin XL; Glycopyrrolate; Venlafaxine; Adderall XR; Depo; Multivitamin w/iron.

Current Illness: N/A

ID: 1490851
Sex: M
Age: 30
State: NC

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/21/2021
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: Vagal syncope- patient passed out, extreme sweating, some muscle twitching, slowing of pulse rate, loss of consciousness Laid patient on ground, propped legs up Duration of 10 minutes before fully regaining consciousness

Other Meds:

Current Illness:

ID: 1490852
Sex: M
Age: 67
State: DC

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/21/2021
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 received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.

Other Meds:

Current Illness:

ID: 1490853
Sex: F
Age: 50
State: KY

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/21/2021
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: within 10 minutes after receiving the vaccine, she reported that she developed a metallic taste in her mouth

Other Meds: ESTRACE VAG 0.1MG/GM CRE; ULTRAM 50MG TAB; ZANAFLEX 4MG TAB; AIMOVIG 140MG/ML INJ; L-METHYLFOLA 15MG TAB; CELEXA 40MG TAB

Current Illness: n/a

ID: 1490854
Sex: U
Age: 23
State: CA

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/21/2021
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

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

Symptoms: The patient received the Janssen vaccine at 10:30, approximately 10 minutes later, around 10:40, the patient was feeling lightheaded with clammy, sweaty, and pale skin. The onset of syncope occurred at 10:41, heart rate was 102 BPM, O2 Sat 98%. The patient was put into a supine position with both legs elevated on a chair. The total syncope time was approximately 30 seconds. At 10:43, her HR was 79 BPM, O2 sat 98%, alert and oriented. The patine remained supine for another 5 minutes and stayed for another 5 minutes in a sitting position, had some fluid and snack before leaving, the last HR was 81 BPM, O2 Sat 97%.

Other Meds: Unknown

Current Illness: Unknown

ID: 1490855
Sex: F
Age: 14
State: DC

Vax Date: 07/17/2021
Onset Date: 07/17/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.

Other Meds:

Current Illness:

ID: 1490856
Sex: F
Age: 51
State: OH

Vax Date: 01/28/2021
Onset Date: 02/01/2021
Rec V Date: 07/21/2021
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: grains prednisone - injections tobacco cat fur

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

Symptoms: The first shot, I did not have any reactions. It was like it didn't happen. However, when I got the 2nd dose, the injection site was swollen and red for 2 days. At the week and a half mark, I felt like I had covid. My chest was tight, I couldn't smell, I couldn't taste, and I was fatigued. I felt every symptom. I was told I had to take 14 days off of work and was not pleased about that. I was having body aches. Everything hurt. When I tried to change the channel on the remote, and it hurt. I was coughing and everything felt like a chore. It was so hard to do anything. I was coughing up foam. Towards the end, I started getting a more solid cough. It was pea-sized yellow chunks. There was no blood. It was never green or clear. Everything was either white or off white. It felt a lot like pneumonia. My oxygen was slightly down. I was not okay. I was doing really great and then all of a sudden I couldn't hardly get from the bathroom to the bed. It was a drastic and sudden change in my abilities. I have never had hip problems before and I appeared to have an infection. I was having to go to the chiropractor and get regular adjustments. They put me on an antibiotic and that caused the inflammation to go down. I get winded pretty easily. I am not back to work. I am still not well. I get tired really easily. I am going to physical therapy. I didn't have an injury. The only thing in my life that changed was that I got the vaccine. I know that I did not contract covid because my test was negative. I started into menopause and my periods were coming every 27 days exactly. After the vaccine, my periods were a whole lot worse. I was bleeding so much that I was going through a pad an hour. It was unmanageable. It hasn't really tapered off at all. I am passing huge clots. The OBGYN can not find anything wrong that could be causing it. All of my labs came back totally normal. I never went to the ER. I was told not to go anywhere or do anything. I was told to stay home.

Other Meds: Meloxicam - 7.5mg/1xday Montelukast - 1xday/7.25mg evening primrose - 1xday

Current Illness:

ID: 1490857
Sex: M
Age: 38
State:

Vax Date: 05/29/2021
Onset Date: 07/19/2021
Rec V Date: 07/21/2021
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: NKA

Symptom List: Vomiting

Symptoms: Several episodes of facial burning and tingling. Bilateral eye burning. R sided weakness, headache and dizziness. Several episodes from 7/19-7/21. Was determined to have an acute ischemic stroke. Given heparin, phenylephrine, aspirin, clopidogrel, and eventually underwent embolectomy today. Still hospitalized.

Other Meds: Anastrozole, aspirin, testosterone

Current Illness: None

ID: 1490858
Sex: F
Age: 53
State: CO

Vax Date: 05/21/2021
Onset Date: 05/22/2021
Rec V Date: 07/21/2021
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: Doxycycline

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt. states that after receiving the Phizer 2nd dose 05/21/2021, 3 weeks after starting experiencing release of pressure/swelling, pain from Non-Specific Mixed Tissue Disease lessening's. States pain and pressure release lasting about a week's time. 06/16/2021 Primary visit stating possible "placebo effect".

Other Meds: Tylenol, Vitamins

Current Illness: N/A

ID: 1490859
Sex: M
Age: 55
State: WI

Vax Date: 03/28/2021
Onset Date: 07/16/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: SARS-CoV-2 RNA Resp Ql NAA+probe~SARS-CoV-2, qPCR performed on 7/18/21. Test came back positive. Case investigation interview completed as of this note. Documentation from case manager mentions case experienced starting 7/16/21 cough, muscle aches, fever and fatigue.

Other Meds:

Current Illness:

ID: 1490860
Sex: F
Age: 58
State: DC

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/21/2021
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: nka

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination

Other Meds:

Current Illness:

ID: 1490861
Sex: M
Age: 40
State: FL

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient received his Covid19 Jannsen vaccine April 8, 2021 and came in June 28th, 2021 and insisted on getting the first of the 2 dose series Covid19 Moderna vaccine. The patient pleaded that he needed to protect himself against the Delta variant. Patient received the Moderna vaccine. I was asked to report this to Moderna vaers.

Other Meds: N/A

Current Illness: N?A

ID: 1490862
Sex: F
Age: 55
State: CA

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 07/21/2021
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: amoxicillin

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

Symptoms: fter 20 minutes in the observation area on 5/15/2021, client reported numbness and tingling in both feet that progressed to the thighs. Client reported she was observed for 2 hours by vaccination staff. Mobility was unaffected and no intervention medications administered on-site. Client reported she went home and numbness and tingling resolved after 2 more hours. Client reported she woke up the next day with headache and chills, which she treated with a single dose of Tylenol. Headache and chills resolved over 3 days.

Other Meds: Janumet, lisinopril, Lipitor, aspirin.

Current Illness: Denied.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm