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: 1490863
Sex: M
Age: 77
State: AL

Vax Date: 01/12/2021
Onset Date: 07/07/2021
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: unknown

Symptom List: Dysphagia, Epiglottitis

Symptoms: Exhaustion and was given blood test, and given test for HIV, Eventually was told he had the Antibodies for HIV.

Other Meds: blood pressure heart eye nose back pain

Current Illness: unknown

ID: 1490864
Sex: F
Age: 63
State: DE

Vax Date: 03/16/2021
Onset Date: 03/16/2021
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: Sulfa

Symptom List: Anxiety, Dyspnoea

Symptoms: I experienced 10 days of severe migraines requiring multiples doses of Sumitriptan every day. I have a history of migraines which have been under control for years. I take one dose of Topiramate daily and rarely experience a migraine. When I do, it is mild and only require a single dose 50 mg of Sumitriptan for relief. The migraines I experienced after receiving the first Moderna vaccine were severe and did not remit for 10 days. No problem after second dose.

Other Meds: Amlodipine 10mg: Topiramate 25mg; Venlafaxine ER 75mg; Potassium Cit ER 1620mg; Calcium; Vit D3 1000 IU

Current Illness: None

ID: 1490865
Sex: F
Age: 25
State: MO

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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: pumpkin; Lorazepam and Fentanyl

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

Symptoms: My symptoms were similar - fever, nausea, diarrhea, arm soreness, headache, tired. All lasted 24 hours except headache started for about a week. The brain fog also started the next morning after the vaccine again. It hasn't resolved yet. I have been out of work since May 10th. That is when I started with it being a significant problem. I lost my job due to it sort of. I started going to Psychiatrist - and have had lab work - my primary care - Anxiety. My Psychiatrist - COVID vaccine and some of my anxiety as well. I started anew job now but it's been hard. I'm pushing through . We have done around 11 medication changes with my psychiatrist to see if anything will help and nothing has helped the brain fog symptoms to improve. I don't feel like I've had any cognitive side affects. It is almost a disassociation that my mind and body isn't working together. It's almost like I have put on the wrong prescription glasses on. I can function. But I still feel impairment from it and it invokes a lot of anxiety because it's not a normal feeling. I am currently on treatment and have changed all the meds. 75 mg of Wellbutrin ER. in the AM and I'm doing 0.25 of Xanax ER in the morning. My vitamins are the same. Before bed 0.5 mg of Xanax extended release. As needed 0.5 immediate release of Xanax during the day. Have been seeing a chiropractor as well for treatment.

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

Current Illness: no

ID: 1490866
Sex: M
Age: 42
State: KY

Vax Date: 07/19/2021
Onset Date: 07/21/2021
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 and any derived medicene

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Vertigo

Other Meds:

Current Illness: No

ID: 1490867
Sex: F
Age: 57
State: IN

Vax Date: 02/23/2021
Onset Date: 07/14/2021
Rec V Date: 07/21/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Massive bilateral pulmonary embolism. Tachycardia, chest pain, shortness of breath

Other Meds: Synthroid Vitamin D

Current Illness:

ID: 1490868
Sex: F
Age: 71
State: DC

Vax Date: 07/17/2021
Onset Date: 07/17/2021
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: None

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

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: 1490869
Sex: M
Age: 90
State: DE

Vax Date: 03/19/2021
Onset Date: 03/25/2021
Rec V Date: 07/21/2021
Hospital: Y

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

Lab Data:

Allergies: NONE

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient experienced a heart attack 5 days after Covid 19 Injection and then a Stroke. Hospitalized for 3 weeks and had 2 months of Rehab.

Other Meds: Crestor daily

Current Illness: NONE

ID: 1490870
Sex: M
Age: 13
State: MO

Vax Date: 07/05/2021
Onset Date: 07/06/2021
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: truncal and upper thigh rash - appears c/w pityriasis rosea; small focus, slightly itchy at first after first dose, resolved/improved and then spread rapidly after second dose

Other Meds: NONE

Current Illness: NONE

ID: 1490871
Sex: F
Age: 66
State: TX

Vax Date: 03/16/2021
Onset Date: 04/16/2021
Rec V Date: 07/21/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 9 days after last Pfizer vaccination on April 6th, developed acute encephalopathy with auditory and visual hallucinations

Other Meds:

Current Illness:

ID: 1490872
Sex: M
Age: 49
State: ME

Vax Date: 07/20/2021
Onset Date: 07/20/2021
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: No known drug allergy

Symptom List: Diarrhoea, Nasal congestion

Symptoms: The dose administered to the patient had come from a vial that had been punctured the day before and left in the fridge over night and had exceeded the 12 hour beyond use date recommended by the manufacturer.

Other Meds: Allopurinol, Bupropion, Xarelto

Current Illness: None known

ID: 1490873
Sex: M
Age: 9
State: TX

Vax Date: 07/13/2021
Onset Date: 07/13/2021
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: red dye

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

Symptoms: Respiratory Distress Chest pain Fever 103.4 Fahrenheit Migraine Sore throat, that caused raspy voice elevated heartbeat overall weakness

Other Meds: no

Current Illness: none

ID: 1490874
Sex: F
Age: 64
State: ID

Vax Date: 02/09/2021
Onset Date: 07/20/2021
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: nka

Symptom List: Rash, Urticaria

Symptoms: contracted covid-19

Other Meds: CALCIUM-VITAMIN D 1250 MG-200 IU ORAL CHOLECALCIFEROL 125 MCG (D3-5,000UNIT) IBUPROFEN 400MG TAB LOSARTAN 25 MG ORAL TABLET

Current Illness:

ID: 1490875
Sex: M
Age: 60
State: MS

Vax Date: 05/27/2021
Onset Date: 06/25/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Swelling in cheek. Patient states swelling was at the site of nerve in cheek. Nerve felt hard. Was not painful, just slightly tender if touched. Patient read online to take Benadryl. Swelling subsided in a couple of days.

Other Meds:

Current Illness:

ID: 1490876
Sex: F
Age: 74
State: CA

Vax Date: 07/20/2021
Onset Date: 07/01/2021
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: PENICILLIN, CODEINE

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

Symptoms: PT DID NOT REPORT ANY ADVERSE REACTIONS.

Other Meds: OMEPRAZOLE 20MG QAM

Current Illness: N/A

ID: 1490877
Sex: F
Age: 40
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

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: 1490878
Sex: M
Age: 14
State: DC

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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: 1490879
Sex: F
Age: 41
State: IL

Vax Date: 03/06/2021
Onset Date: 03/28/2021
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: No

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

Symptoms: Since the vaccination, my menstrual cycles are not the same. They last way longer and I pass very large blood clots that are not normal for me, to the point that I feel very weak. They have been like this every month since, the pain it?s excruciating at times and I?m not someone that complains, but this doesn?t feel normal.

Other Meds: No

Current Illness: No

ID: 1490880
Sex: F
Age: 41
State: PA

Vax Date: 03/19/2021
Onset Date: 03/23/2021
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: Sulfa antibiotics,

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 4 days after 1st dose: flare up of anterior uvyitis (had gone almost 1.5 years without flare up), extreme pain in eye, could have been vaccine but unsure, given pregnazone eye drops. After 2nd dose: had covid

Other Meds:

Current Illness:

ID: 1490881
Sex: F
Age: 56
State: WA

Vax Date: 02/02/2021
Onset Date: 07/14/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Breakthrough COVID case

Other Meds:

Current Illness:

ID: 1490882
Sex: F
Age: 86
State: MI

Vax Date: 03/06/2021
Onset Date: 03/06/2021
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: no

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

Symptoms: patient was given a third Moderna vaccine

Other Meds: unknown

Current Illness: unknown

ID: 1490883
Sex: F
Age: 46
State: CA

Vax Date: 03/29/2021
Onset Date: 03/29/2021
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: None

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

Symptoms: Tingling in both arms and hands, right arm tingling sensation was very strong for about an hour. Lips went numb for about 45min

Other Meds: Water and Tylenol Methimazole 15 mg daily

Current Illness: None

ID: 1490884
Sex: F
Age: 74
State: PA

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: Allergy to penicillin, bees

Symptom List: Unevaluable event

Symptoms: Patient experienced tingling down her right arm. She felt better within 1 hour and refused any further treatment

Other Meds:

Current Illness:

ID: 1490885
Sex: F
Age: 61
State: NJ

Vax Date: 01/27/2021
Onset Date: 02/13/2021
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: LA

Lab Data:

Allergies: none

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

Symptoms: Had the shingles for the first time ever. Woke up nauseous, felt achy later in the day. Had 101 fever. Felt exhausted for two days with lower back pain. Tested negative for covid. Day 3, woke up at 110%, no symptoms whatsoever. Within 2 days, started getting a pain on the left side along the ribs and on the left side in the groin at the upper thigh. Pain was pretty bad and touching it made it worse. Within a day, started to see pimples which turned into blisters forming around an old scar on my left inner arm.

Other Meds: Synthroid Cytomel magnesium align

Current Illness: none

ID: 1490886
Sex: F
Age: 41
State: PA

Vax Date: 03/19/2021
Onset Date: 03/23/2021
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: Sulfa antibiotics

Symptom List: Injection site pain, Pain

Symptoms: Flareup of eye pain 4 days after 1st dose, given pregnazone. Had covid arm after 2nd dose.

Other Meds:

Current Illness:

ID: 1490887
Sex: F
Age: 55
State: IN

Vax Date: 04/24/2021
Onset Date: 04/28/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt. states that after receiving the 2nd Moderna shot 04/24/2021, 04/28/2021 started experiencing shortness of breath with difficulty walking. Wheezing with coughing productions. Still continuing to experience daily. 07/22/2021 planned Primary visit.

Other Meds: Albuterol, Nebulizer, Wellbutrin, Clazapan, Platonics, Prisidone, Levithirozian, Vitoza

Current Illness: N/A

ID: 1490889
Sex: M
Age: 62
State: NC

Vax Date: 06/01/2021
Onset Date: 06/23/2021
Rec V Date: 07/21/2021
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: Penicillin, Memantine

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

Symptoms: Suffered an unwitnessed fall this evening ~ 0130. Prior to this he had been ambulating in the dayroom around midnight without difficulty at his baseline and interacting with staff. He then went to his room. During rounds ~0130, the staff found him in the bathroom face down. He stated he lost his balance but was not able to provide more information. He was assisted up and he had difficulty walking . RN noted three abrasions on his forehead and one on his chin. His vitals were 146/86, 20, 74, 97.2. He had a change in his baseline mentation and ambulatory status at that time. Patient transferred to local ED, where he was seen by two providers. At that time, patient was noted to be using his right arm and left.

Other Meds: Clozapine, Metoprolol ER, Cholecalciferol

Current Illness: Schizophrenia (F20.9); Major neurocognitive disorder (F02.81);

ID: 1490890
Sex: M
Age: 53
State: AL

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Unknown

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: About 5 minutes after vaccine patient slowly fell to the ground and lost consciousness. His body slightly twitched but did not observe eye rolling into back of head, or incontinence. Patient stated prior to receiving vaccine he began feeling lightheaded and has a phobia of needles. Has a history of seizures when an adolescent and last seizure was when he was 19 years old.

Other Meds: Unknown

Current Illness: Unknown

ID: 1490891
Sex: F
Age: 36
State: CO

Vax Date: 04/16/2021
Onset Date: 04/16/2021
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: Nexilin.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I experienced fatigue, body aches, and the urge to urinate often.

Other Meds: Gabapentin; Lithium; Aricept; Remeron; Zyprexa.

Current Illness: No.

ID: 1490892
Sex: F
Age: 32
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Cat dander.

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

Symptoms: The patient's received the injection at 10:00. After 20 minutes the patient experienced bilateral arm hives with redness and pruritus from the site of injection down to the forearm region, the skin was cool to the touch. Appromextily 11:15, the redness and pruritus have improved. The patient declined any medication to relieve the hive. The patient was recommended to take anti-histamine and a cold pad to relieve the reaction and follow up with her primary care physician. She stayed under observation till 11:20.

Other Meds: Unknown.

Current Illness: Unknown.

ID: 1490893
Sex: F
Age: 24
State: FL

Vax Date: 07/14/2021
Onset Date: 07/15/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Nausea

Symptoms: Extreme pain in both shoulders that has lasted for a week. I feel an intense sharp pain within my shoulder, not in the deltoid region. I can't physically move my shoulders from the sharp pain that I have. It feels like nerve pain within my shoulder, not the muscle. My primary care physician prescribed Methylprednisolone 4mg dospak 21S. The pain has started to subside some, but my full range of motion is not completely back.

Other Meds: escitalopram

Current Illness: n/a

ID: 1490894
Sex: F
Age: 57
State: WI

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:

Symptom List: Injection site pain

Symptoms: This client came to clinic and requested/received a first Pfizer dose. Upon entry of the dose in the immunization registry, it was discovered this client received a Janssen vaccination on 03/18/2021. The client was called. A voicemail was left requesting a call back.

Other Meds:

Current Illness:

ID: 1490895
Sex: M
Age: 38
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: None

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

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: 1490896
Sex: M
Age: 25
State: TX

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Rocephin

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

Symptoms: Pt was administered Moderna on 07/14/2021. Pt called on 7/20/2021, left a Voice Mail stating he would like a call back to discuss side effects to the vaccine. I called patient back the morning of 07/21/2021, the patient states to me that two hours after the vaccine was administered he started to shake uncontrollably and was very cold, then he blacked out (Patient states he may have had a seizure.) Pt woke up outside behind his vehicle in a pool of his own vomit. I asked if 911 was called and the patient said no because he could not move or walk. The patient also stated that he felt bad all day, Thursday (07/15/2021), the day after the vaccine was administered, woke up on Friday (07/16/2021) feeling relatively normal still feels the urge to vomit when eating certain foods.

Other Meds: N/A

Current Illness: N/A

ID: 1490897
Sex: F
Age: 59
State:

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

Symptom List: Tremor

Symptoms: Rectal Bleeding. Diagnosed as an Ischemic Colitis event. 3 days on liquid then soft diet.

Other Meds: Centrum Silver, Valtrex, Ropinorale, Synthroid, Oreacea

Current Illness: none

ID: 1490898
Sex: F
Age: 48
State: NC

Vax Date: 04/13/2021
Onset Date: 04/19/2021
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: no

Symptom List: Erythema, Pruritus

Symptoms: shortness of breath and cant do to much movement, Dr prescribed her a pump. Have slight headaches

Other Meds: metformin 500mg, hydralazine 50mg, amlodipine 10mg, daily vit, daily aspirin, gabapentin 300mg, lisinopril

Current Illness:

ID: 1490899
Sex: M
Age: 68
State: GA

Vax Date: 03/31/2021
Onset Date: 04/01/2021
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: Codeine Penicillin

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

Symptoms: Patient report tingling in both legs, dehydrated, chills, dark spots all over body w/ burning sensation, and shaking

Other Meds: Lisinopril Chlorchalidone netformin lantus (insulin) lispro (insulin) Atorbastatin Glipizidexl

Current Illness: no

ID: 1490900
Sex: F
Age: 53
State: CO

Vax Date: 07/20/2021
Onset Date: 07/20/2021
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: obviously vaccines

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

Symptoms: Sore throat, coughing, dizziness, headache, arm at injection fatigued and painful, crabby, irritable, frustrated and regretful, nasal drippage, sinus pain, sneezing, restless, ear plugging and ear ache

Other Meds: allergy medication, acid reflux medication, pregestrone and patches for homonal pre menopause

Current Illness:

ID: 1490901
Sex: F
Age: 25
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: nka

Symptom List: Asthenia, Chills, Headache, 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 information about pregnancy is unknown

Other Meds:

Current Illness:

Date Died: 07/19/2021

ID: 1490902
Sex: F
Age: 37
State:

Vax Date: 07/15/2021
Onset Date: 07/19/2021
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: morphine (Anaphylaxis) immune globulin intravenous (Rash)

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

Symptoms: Pfizer COVID vaccine dose #2 administered 15 Jul 2021 @ 07:59. ED physician documentation on 19 Jul 2021: "37-year-old female came the emergency department after found down by her husband. Has a history of attempted overdose in the past,, she was found down by her husband at 545, and unresponsive on scene. Medic was on scene and patient was noted to be in V. fib and therefore CPR was started, compressions were in progress upon arrival, however the patient remained in cardiac arrest. Other history was able to be gathered from the patient or family, however EMS stated that they had found that her glucose was 99 on scene, and she been given full dose Narcan as well on scene. And was shocked 3 times a 200 J, she was given 2 doses of epinephrine, as well as 300 of amiodarone. They attempted to intubate the patient however the patient was clamped down, and therefore they could not pass any sort of apparatus to control the airway, therefore they placed a nasal trumpet. Pertinent physical exam findings: Jaw clamped shut, pupils fixed, and was obviously cyanotic, no palpable pulses. No chest rise. EKG as interpreted by me (ED attending): Monitor showed that the patient was in asystole the entire time. Medical Decision making and plan of care: Patient was immediately moved from gurney onto bed, and chest compressions were continued without interruption. Given that the patient was in V. fib in the field, we did decide to place dual pads for dual sequential defibrillation, is on the plats however, the patient was noted to be in asystole, therefore chest compressions were continued, epinephrine, as well as calcium, as well as bicarb. See code chart for further details. IO was also placed in the patient's left proximal tibia. Regarding the patient's airway, several attempts were made to pass an ET tube, as well as paralyzed the patient with rocuronium, however tube passing was unsuccessful, and therefore I performed a cricothyrotomy. Followed by bilateral finger thoracostomies. See procedure notes below for further details. Despite 5 rounds of ACLS, with multiple doses of epinephrine, as well as bicarb and calcium carbonate administered, the patient remained in cardiac arrest, death was declared at 1851."

Other Meds: diphenhydrAMINE/lidocaine/aluminum hydroxide/magnesium hydroxide/simethicone mucous membrane suspen , HX SIG - FOR REFERENCE ONLY: SWISH AND SPIT 5 ML BY MOUTH EVERY TWO HOURS AS NEEDED FOR SORE THROAT, MOUTH IRRITATION OR PAIN, Mouth or th

Current Illness: Sarcoidosis with recurrent syncope and possible tachyarrhythmia, concern for possible cardiac vs CNS sarcoid (7/9/21) Bipolar disorder Chronic pain/opioid use

ID: 1490904
Sex: F
Age: 43
State: FL

Vax Date: 02/05/2021
Onset Date: 02/07/2021
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: Seasonal allergies

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

Symptoms: After receiving the vaccine, I was really tired and had common vaccine symptoms. I had developed bell's palsy. I did a telephone call with the doctor. The doctor prescribed me a steroid for it. I used over the counter lubricated eye drops to help with it as well.

Other Meds: Emgality monthly injectable Prevacid 15mg, 1xday Multi Vitamin

Current Illness: Sore throat

ID: 1490905
Sex: M
Age: 60
State: ID

Vax Date: 01/27/2021
Onset Date: 07/20/2021
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: nka

Symptom List: Pain in extremity

Symptoms: contracted covid-19 after being vaccinated

Other Meds: AMLODIPINE 5 MG ORAL TABLET ASPIRIN 81MG EC TAB CARVEDILOL 25MG TAB ERGOCALCIFEROL (VIT D2) 50,000UNIT CAP FERROUS SULFATE 325MG TAB GLIPIZIDE 10 MG ORAL TABLET INSULIN,GLARGINE 100 UNT/ML 3ML SOLOST LOSARTAN 100MG TAB SIMVASTATIN 20MG T

Current Illness:

ID: 1490906
Sex: F
Age: 40
State: DC

Vax Date: 07/16/2021
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

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: 1490907
Sex: F
Age: 95
State: SD

Vax Date: 07/20/2021
Onset Date: 07/20/2021
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: Ceftin Amoxil

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

Symptoms: Nurse intended to give Tdap but pulled Kinrix instead

Other Meds: ASA 81 mg, Bactroban 2% ointment both nostrils, Brilinta 90 mg BID, Calcium/Vit D 600 mg-200 unit BID, Levemir 100 units at bedtime, Losartan 50 mg daily, Metoprolol 50 mg daily, Nitrostat 0.4 mg as directed, Novolog 100 units as directed,

Current Illness: none

ID: 1490908
Sex: M
Age: 11
State: CA

Vax Date: 07/19/2021
Onset Date: 07/19/2021
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: N/A

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

Symptoms: Mother falsified the patient's DOB in order to make patient eligible to receive Pfizer's Covid 19 vaccine. She provided the pharmacy with a fictitious DOB, when in reality the patients actual DOB is different, of which we verified via 2 independent resources; the patients insurance and primary care physician at. We have made multiple attempts to reach patients mother to verify the true DOB, but have been unsuccessful.

Other Meds: N/A

Current Illness: N/A

ID: 1490909
Sex: F
Age: 19
State: TN

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/21/2021
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: none

Symptom List: Vomiting

Symptoms: face numbness left side and it's the side i got shot on

Other Meds: none

Current Illness: none

ID: 1490910
Sex: F
Age: 66
State: PA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
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: Penicilin, Sulfa antibiotics, tefflex

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After vaccine, had severe joint and muscle aches, chills, headaches, lasted about 24 hours, then had extreme fatigue, nauseauh, 99.6 fever (usually 97).skipped work. Took advil

Other Meds: Aspirin, Recuvastatin, Hydrochloric Iodine, Losartan

Current Illness:

ID: 1490911
Sex: F
Age: 19
State:

Vax Date: 07/19/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Chills and sweating 8-12 hours after vaccine Abnormally HEAVY menstrual bleeding July 20+ - never in 7 years has it been this heavy. - normally, I only need to use light-normal pads ?? now I might need a diaper.

Other Meds: None

Current Illness: None

ID: 1490912
Sex: F
Age: 17
State: CO

Vax Date: 07/20/2021
Onset Date: 07/20/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: pt was nervous about getting covid 19 vaccine before entering store and after vaccine she said her heart felt like it was beating strongly and her vision was blurred she got extremely warm to touch and clamie skin she was "tingeling" felt weird

Other Meds:

Current Illness:

ID: 1490913
Sex: F
Age: 67
State:

Vax Date: 02/22/2021
Onset Date: 06/01/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: In June the patient started experiencing dry mouth leading to increase fluid intake. This has lead to extra fluid retention and the need for extra dialysis runs.

Other Meds:

Current Illness:

ID: 1490914
Sex: M
Age: 63
State: TN

Vax Date: 03/26/2021
Onset Date: 04/09/2021
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: none

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

Symptoms: Thursday night going into Friday, 4/9/2021, I had some issue with my heart. Fluctuations ? 3 to 4 rapid beats that felt like they were from the top of my heart followed by a very slow booming 2 beats that felt like they came from the bottom left side of my heart. I tried coughing to get back into rhythm without success. Felt light headed but no nausea. Went and laid on the sofa and put my feet above my head. Couldn?t stay in that position due to size of the love seat. This started around 10 PM Thursday and lasted until about 6 AM on Friday. I finally fell asleep around 6 AM and stayed in bed until around 9 AM. Got up and putted around the house cleaning, coffee, dressing. She came home around 10:30 AM and called clinic for an appointment to get an EKG. We went to clinic at 11:00 AM and were able to get an EKG around 12:30 PM. All was normal with the EKG. She brought a double cheese burger for a snack when she picked me up. No blood pressure was taken, so I purchased a BP machine at store after eating. When I took my BP around 1:30 PM, it was very low - 90/52. Later that evening, we made a beef taco dinner (slightly salty). When I took my BP after dinner settled, it was more normal ? 118/70.

Other Meds: Baby aspirin, fish oil, vitamin E, saw palmetto, vitamin D, multi-vitamin, tumeric

Current Illness: periodontal disease

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm