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: 1490915
Sex: M
Age: 32
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: nka

Symptom List: Dysphagia, Epiglottitis

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: 1490916
Sex: F
Age: 26
State: WI

Vax Date: 04/16/2021
Onset Date: 07/19/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: SARS-CoV-2 (2019-nCoV) Nucleic Acid Amplified Test performed on 7/19/21 at 16:46. Test came back positive. Case investigation interview with patient has not been conducted as of the time of this note.

Other Meds:

Current Illness:

ID: 1490917
Sex: F
Age: 16
State: MO

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Moderna COVID-19 vaccine administered to 16-year-old.

Other Meds: No known allergies

Current Illness: None known

ID: 1490918
Sex: F
Age: 16
State: WV

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

Lab Data:

Allergies: nka

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: PATIENT WAS GIVEN THE COVID VACCINE AND DIDN'T WAIT THE FULL 15 MINUTES. WHEN THE PATIENT WENT TO LEAVE SHE PASSED OUT AND LANNDED FACE FIRST ON THE FLOOR.

Other Meds: Sertraline 25 mg

Current Illness: none

ID: 1490919
Sex: F
Age: 29
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 erythema, 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. Pregnancy information is unknown

Other Meds:

Current Illness:

ID: 1490920
Sex: F
Age: 61
State: ID

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

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

Symptoms: contracted covid-19 after vaccination

Other Meds:

Current Illness:

ID: 1490921
Sex: F
Age: 35
State: VA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 07/21/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: About 45 moments later, I had a Fibromyalgia flare up. I was so achy I had to take ibuprofen and lay down. A couple weeks later, I had a flare up with my endometriosis as well. I started getting bad pain in my pelvis area. I went to the gynecologists' because the pain was so bad. The pain was off and on for several weeks. The doctor gave me pain meds and performed an ultrasound. They found a cyst. These symptoms continued on, during, and after my second dose. I received surgery to remove the cyst and some scar tissue.

Other Meds: birth control, an allergy med, Lexapro, two allergy nose sprays

Current Illness: none

ID: 1490922
Sex: F
Age: 45
State: HI

Vax Date: 04/05/2021
Onset Date: 07/19/2021
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: Pharyngeal swelling

Symptoms: patient was exposed to someone with COVID on 7/16/2021, she has been asymptomatic, tested positive on 7/19/2021

Other Meds:

Current Illness:

ID: 1490923
Sex: M
Age: 41
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:
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: 1490924
Sex: M
Age: 71
State: WA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
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: Codeine Doxycycline

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 02/08/2021 I got the vaccine, and got home, and in the evening, I had an alert on my watch that I had an Afib episode, This lasted until morning, saw DR next day. Beta blocker treatment, Afib went away. Echo ordered, echo normal, saw cardiologist Feb 18th, had another EKG. April 2nd, noticed Afib on watch again. I took a beta blocker and it went away and I have not had any sense.

Other Meds: Losartan Amlodipine Terazosin Finasteride Atorvastatin Famotidine D3 B12 Folic Acid B6 C A K2 COq10

Current Illness: None

ID: 1490925
Sex: F
Age: 44
State: CO

Vax Date: 04/08/2021
Onset Date: 06/26/2021
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: no

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

Symptoms: Erythema Multiforme on both hands and arms. Red bumps run up to about mid-upper arm on both sides. Started Prednisone 10mg and Valacyvlovir 500mg on June 30th. Erythema Multiforme mostly resolved by July 8, 2021

Other Meds: Iron, B-12, Multivitamin, calcium, Clarartin, L-Lysine

Current Illness: none

ID: 1490926
Sex: M
Age: 59
State: VA

Vax Date: 03/15/2021
Onset Date: 06/21/2021
Rec V Date: 07/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Sulfa

Symptom List: Rash, Urticaria

Symptoms: Shingles like rash various places. Face. Hip. Arms. Legs.

Other Meds: Biktarvy. Desipramine. Flomax. Centrum silver Multi-vitamin Vitamin C. Metoprolol.

Current Illness: Hiv+.

Date Died: 07/21/2021

ID: 1490927
Sex: F
Age: 59
State: CA

Vax Date: 06/21/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Patient presented to hospital with acute hypoxemic resp failure. Pt had history of COVID19 infection in Nov 2020. Pt has chronic medical conditional including but not limited to marginal zone lymphoma on chemo, h/o aspergillus, MAC on atovoqone and voriconazole. Pt received moderna vaccine in May (1st shot), and June (2nd shot). Pt admitted on 7/16 found to have positive covid infection second time. Pt resp status steadily worsen from NC to reservoir, and then HFNC. Despite on remdesivir, prednisone, antibiotics, and antifungal. Pt had code blue due to resp arrest, intubated, then coded again in ICU for over 1 hour. Family elevated make patient DNR, and she died soon after on 7/20.

Other Meds:

Current Illness: Aspergillus lung infection, MAC prophylaxis

ID: 1490928
Sex: F
Age: 53
State: HI

Vax Date: 06/17/2021
Onset Date: 07/17/2021
Rec V Date: 07/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: patient developed cough, runny nose, and body aches on 7/17/2021. She tested positive for COVID on 7/19/2021.

Other Meds:

Current Illness:

ID: 1490929
Sex: F
Age: 45
State: MS

Vax Date: 05/01/2021
Onset Date: 05/01/2021
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:

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

Symptoms: Confused, fatigue, freezing cold but sweating. Could not walk

Other Meds:

Current Illness:

ID: 1490930
Sex: M
Age: 64
State: CA

Vax Date: 07/12/2021
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: no

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

Symptoms: numbness on three fingers and back

Other Meds: ezetimbe, aloloapine, Lipitor

Current Illness:

ID: 1490931
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: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: reported an allergic reaction to an unspecified vaccine in the past

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

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: 1490932
Sex: M
Age: 67
State: WI

Vax Date: 04/26/2021
Onset Date: 05/14/2021
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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Anxiety, confusion, and inability to sleep . Numbness is hands and feet

Other Meds: none

Current Illness: none

ID: 1490933
Sex: M
Age: 82
State: TN

Vax Date: 01/25/2021
Onset Date: 04/02/2021
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: Pt. states about 3 months after receiving second Covid vaccine started having shoulder, hip and thigh pain. Went to several different doctors - orthopedic, PCP and got referred to a rheumatologist. After several months, finally got diagnosed with polymyalgia rheumatica. States symptoms have improved since being on Prednisone 12.5 mg PO daily. Pt. states sister was also diagnosed with same condition after receiving her Covid Moderna vaccine.

Other Meds: Cardura 8 mg PO daily (HTN)

Current Illness: None

ID: 1490934
Sex: F
Age: 71
State: LA

Vax Date: 02/03/2021
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: Mobic

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

Symptoms: Breakthrough COVID19 infection

Other Meds: Crestor, Norco, Telmisartan, HCTZ, ASA

Current Illness:

ID: 1490935
Sex: M
Age: 61
State: CA

Vax Date: 04/25/2021
Onset Date: 04/30/2021
Rec V Date: 07/21/2021
Hospital: Y

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: penicillin

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

Symptoms: shortness of breath chest pain both would come and go i waited about 3 months before i went to hospital i would wake up in middle of the night hyperventilating got to the point i could not walk up a small hill with out going completely out of breath and forced to stop and try to breath

Other Meds: none

Current Illness: none

ID: 1490936
Sex: F
Age: 55
State: GA

Vax Date: 03/22/2021
Onset Date: 03/30/2021
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: clindamycin Victoza

Symptom List: Unevaluable event

Symptoms: Upper arm swollen, red and warm at site of vaccination. This lasted for 3 days, from March 30-April 1, with some slight warmth and swelling persisting for a few more days. I called my primary care doctor's office to consult with them. They said they were seeing this delayed response with a number of patients (not sure whether they specified that the patients all had received Moderna vax) and to contact them again if it got worse, didn't go away, or if I had further concerns. I felt reassured and let the symptoms take their course without additional treatment, feeling grateful to have had the vaccine at all!!

Other Meds: ibuprofen Vitamin C Vitamin D Trulicity Avorastatin 2 others I can name if necessary but would rather not say right now, due to privacy concerns.

Current Illness: none known

ID: 1490937
Sex: F
Age: 20
State: ID

Vax Date: 03/09/2021
Onset Date: 07/20/2021
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:

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

Symptoms: Covid-19 contracted after vaccinaton

Other Meds:

Current Illness:

ID: 1490938
Sex: F
Age: 36
State: SD

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin: hives

Symptom List: Injection site pain, Pain

Symptoms: Headache x 20 minutes. Left posterior pharynx felt dry and itchy. Generalized itching without hives

Other Meds: none

Current Illness: none

ID: 1490939
Sex: M
Age: 21
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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

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: 1490940
Sex: F
Age: 84
State: TX

Vax Date: 06/23/2021
Onset Date: 07/07/2021
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: no

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

Symptoms: had pink cheeks and tired, a week later woke up with chills and shivering, had heart palpitations, and tightness in upper chest

Other Meds: valsartan 160mg, norvasc 2 1/2mg, prolec 15mg

Current Illness: no

ID: 1490941
Sex: F
Age: 73
State: WV

Vax Date: 05/06/2021
Onset Date: 06/22/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Total numbness in hand and arm.

Other Meds: Motoprolol,Nifedipine ER,Tramadol,Aspirin.Fish Oil,Vit.D

Current Illness:

ID: 1490942
Sex: F
Age:
State:

Vax Date: 07/13/2021
Onset Date: 07/14/2021
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: No

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Severe stomach pain for the last 10 days since receiving the vaccine

Other Meds: Oveerna contraceptive pill

Current Illness: Covid positive over a month prior

ID: 1490943
Sex: F
Age: 45
State: TX

Vax Date: 05/21/2021
Onset Date: 05/24/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: 5/24 - nausea (zofran ODT) resolved 6/03 - nausea / vomiting (Zofran ODT) resolved; increased arthralgia (tramadol w/acet 1000mg QD PRN) improved not resolved, more prominent malar rash (no treatment) with moderate warmth at rash site; fatigue / malaise. (missed 2 days of work) 6/24 - moderate to severe arthralgia to major joints (increased tramadol w/acet to BID/PRN) improved, not resolved; n/v (Zofran ODT) improved but lingered; weakness, fatigue / malaise (missed 2 days of work) 7/12 - n/v (changed to zofran as ODT increased n/v), pain / arthralgia moderate to severe (tramadol w/acet 1000mg increased to TID PRN & methylprednisolone 4mg dose pack); Migraine headache x4 days unrelieved (Imitrex, Aleve, & Acet. rest

Other Meds: Requip, tramadol, trazodone, Lipitor, Aleve, Prilosec, Imitrex

Current Illness: none

ID: 1490944
Sex: F
Age: 38
State: TN

Vax Date: 01/21/2021
Onset Date: 02/12/2021
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: Not that I am aware of.

Symptom List: Nausea

Symptoms: I had a cold virus and it didn't seem to be getting better, so I went to the urgent care center thinking I might have a sinus infection or something. Turns out that it was just a nasty cold virus. I was also tested for COVID-19 at another facility and it was negative.

Other Meds: Duloxetine, Lamotrigine, Dyazide, Levothyroxine, Zyrtec, Metformin, Carvedilol, Lisinopril, Iron supplement, Multivitamin, Fish Oil

Current Illness: None.

ID: 1490945
Sex: F
Age: 77
State: TX

Vax Date: 03/01/2021
Onset Date: 03/01/2021
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: Phenergan, Sulfa

Symptom List: Injection site pain

Symptoms: A few days after her second COVID vaccination, she developed severe tinnitus, cognitive impairment, difficulty with speech and language

Other Meds: Trazadone, clonazePAM

Current Illness: Mild baseline tinnitus

ID: 1490946
Sex: M
Age: 26
State: CA

Vax Date: 06/30/2021
Onset Date: 07/02/2021
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: Lactose Intolerant

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

Symptoms: patient, a 26yo male, was presenting for a 2nd dose Pfizer COVID vaccine. Client reported that approximately 3 days following his 1st dose he began to have transient chest pain lasting a few minutes, resolving and then returning 20-30 minutes later. He stated the transient chest pain has been occurring intermittently since his 1st dose and noticed the pain mostly at night when he would lie down. He reported being borderline hypertensive and denied any other pertinent medical conditions. Client stated he did not have any allergies to medications/environment/foods however, is lactose intolerant. Lead RN took client's blood pressure 158/108 and HR: 60. Client stated he did have periodic palpitations, denied any shortness of breath, dizziness, headache or numbness and tingling. Lead RN consulted with operations Lead RN to approve delaying 2nd dose and recommendation of referral of client to ED or Urgent care to rule out myocarditis. Operations Lead RN approved ED referral and delay of 2nd dose Pfizer COVID vaccine. Lead RN educated client on myocarditis, elevated BP and recommendation to go directly to ED or Urgent care. Client denied any current chest pain, dizziness, palpitations and declined EMS transport to ED. Client agreed with plan and stated he would proceed to nearest ED. He left the site on his own accord with a steady gait.

Other Meds: None

Current Illness: None

ID: 1490947
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: nka

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

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: 1490948
Sex: F
Age: 78
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Tremor

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: 1490949
Sex: F
Age: 39
State: MA

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: Shellfish and Seasonal allergies

Symptom List: Erythema, Pruritus

Symptoms: I went to pharmacy and get my first dosage of Moderna vaccine for COVID19 by 11:45 am and after the first 10 minutes of the shot I started feeling a mild allergic reaction with numb sensation on the back of my mouth and at the end of my tongue. They requested me wait for a full half an hour to see how my reaction develop. After 25 mints the numbness started on my nose and a little on my face (not swellings at all only the numbness sensation). After the half hour the numbness and pain start in the area of my arm where I was vaccinate. After 45 minutes of waiting with no more new reactions they sent me home. I arrived home by 12:45 pm and took aTylenol 650 mg and a Benadryl. By 2:00 pm the numbness of the mouth reduced and the one in the nose too. I send a note to my Primary Care who answered me back and requested me to fill inform my synths to the CDC. Around 10:00 pm the numbness tried to start again and I decide to take a Cetirizine 10 mg and went to bed. I wake up next day around 6:00 am with a strong headache and a little sensitive on my nose. I took another Tylenol 650mg around 10:00 am and after 1 hour pass no more headache or any other symptom (only the soreness and pain in the vaccine area. I'm afraid to take my second dosage. Any recommendations?

Other Meds: Levothytoxine 175mg

Current Illness:

ID: 1490950
Sex: M
Age: 0
State: PA

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

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

Symptoms: Pt stated shaking and stomach pain and his parent wants to call 911

Other Meds:

Current Illness:

ID: 1490951
Sex: F
Age: 62
State: TX

Vax Date: 06/23/2021
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: LA

Lab Data:

Allergies: iodine

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

Symptoms: Patient stated her arm was a little red and itchy right away, then the redness and a lot of itchiness occurred again 3 weeks later.

Other Meds:

Current Illness:

ID: 1490952
Sex: F
Age: 50
State: TX

Vax Date: 04/05/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: After about a month after her COVID vaccinations ending April 5, 2021, Moderna, she developed increased excessive abdominal pain and she started passing bloody clots through her rectum. Within a few days of this, she became unresponsive at home and was taken by EMS to the hospital. She was found to be in a severe shock and was treated with Levophed. She was hospitalized for 4 to 5 days and diagnosed with "sepsis" and severe diverticulitis with bloody stools. She was treated with IV antibiotics and discharged on Cipro and Flagyl. . Post this event, she is having overwhelming fatigue and generalized neuropathic pain, muscle pain, and bone pain. She is also having chronic gut dysbiosis

Other Meds:

Current Illness:

ID: 1490953
Sex: M
Age: 0
State: VA

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: NKA

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

Symptoms: The pt presented to the clinic for the moderna vaccine. The MA drew up the vaccine and administered the vaccine to the pt. Once the MA was documenting the vaccine, she received an error message stating the pt should not receive the vaccine. I was notified at the end of the day. Contacted the CDC and was informed to have pt monitor for CP, SOB, or palpitations, and seek care at the nearest ER if he develops any symptoms.

Other Meds: none

Current Illness: None

ID: 1490954
Sex: F
Age: 25
State: DC

Vax Date: 07/18/2021
Onset Date: 07/18/2021
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:

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 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: 1490955
Sex: F
Age: 39
State: TX

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: unknown

Symptom List: Pain in extremity

Symptoms: Patient had a seizure 15 minutes after second dose of moderna vaccine.

Other Meds: unknown

Current Illness: unknown

ID: 1490956
Sex: M
Age: 0
State: MI

Vax Date: 07/20/2021
Onset Date: 07/20/2021
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: Rash: right side of face broke out in red maculopapular rash at giving of RotaTeq. No swelling of tongue lips. (note that patient drools a lot and medication dripped on that side of face).

Other Meds: Nothing

Current Illness: None

ID: 1490957
Sex: F
Age: 58
State: MO

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

Lab Data:

Allergies: alphagal

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

Symptoms: trouble breathing, pain left thigh, dizzy, burning skin,

Other Meds: lethanoprol hydrochlorociocide levathyroxine

Current Illness:

ID: 1490958
Sex: F
Age: 33
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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: 1490959
Sex: F
Age: 65
State: IL

Vax Date: 07/17/2021
Onset Date: 07/18/2021
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:

Symptom List: Vomiting

Symptoms: RASH AT INJECTION SITE WARM TO THE TOUCH, RAISED AND RED, NOT ITCHY. LOW FEVER APPROX 99.3,

Other Meds:

Current Illness:

ID: 1490960
Sex: F
Age: 31
State: TX

Vax Date: 02/10/2021
Onset Date: 02/10/2021
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: Dairy, gluten, soy, nut

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: My face started to get numb, my throat started to get scratchy, cheeks got red, lip tingle

Other Meds: No

Current Illness: no

ID: 1490961
Sex: F
Age: 47
State: AZ

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: none

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

Symptoms: PATIENT RECIEVED FIRST DOSE AT OTHER LOCATION ON 4/8/21. RECIEVED 2ND DOSE AT OUR LOCATION ON 7/21/21.

Other Meds: n/a

Current Illness: none

ID: 1490962
Sex: F
Age: 36
State: NE

Vax Date: 07/16/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Penicillian

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Ongoing sudden flashes of hot sensations that move down my legs and occasionally my arms. They're more dominantly on my left side but have felt them on my right leg on occasion since Sunday following my injection. These are reoccurring sensations all day/night. I have not had it checked out by a doctor. I started a new job and cannot afford the time off or a dr visit.

Other Meds: Natures Way Vitamin C, Natural Factors Vitamin D3, Flonase sensimist, Norethindrone Acetate and Ethinyl Estradiol Tablets 1mg/.02mg (Birth control)

Current Illness: None

ID: 1490963
Sex: F
Age: 59
State: GA

Vax Date: 01/09/2021
Onset Date: 01/10/2021
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: codeine and sensitive diary products /lactose intolerant

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

Symptoms: started the sunday am after the vaccine. I started vomiting, chills, nausea, body ache, Diarrhea , headache and dizziness, fatigue, my eye were sensitive to light and I had a cough and a runny nose and a cough for two weeks. I felt sick and couldn't sleep. My doctor could not see me because of covid, I did a covid test.

Other Meds: no

Current Illness: no

ID: 1490964
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: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: nka

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

Symptoms: 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:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm