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: 1494291
Sex: F
Age: 66
State: MT

Vax Date: 07/16/2021
Onset Date: 07/16/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Shingrix was not reconstituted and client only received diluent. She was notified and will come in for a repeat dose.

Other Meds:

Current Illness:

ID: 1494292
Sex: F
Age: 49
State: TX

Vax Date: 01/15/2021
Onset Date: 06/01/2021
Rec V Date: 07/22/2021
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: A few months after receiving the second dose, I got shingles. Diagnosed by a physician.

Other Meds: Vitamin D, B vitamin, and a multivitamin

Current Illness: None

ID: 1494293
Sex: F
Age: 52
State: MO

Vax Date: 04/04/2021
Onset Date: 04/07/2021
Rec V Date: 07/22/2021
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: Not that I know of, but I do have an allergy to environmental mold.

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

Symptoms: I got what is described as "Moderna Arm" or "Covid Arm" several days after the vaccine, around the injection site I had a large hard red rink. Not a full rash, just hard and a little itchy and hot.

Other Meds: multi vitamin

Current Illness: No.

Date Died: 03/08/2021

ID: 1494294
Sex: F
Age: 67
State: NY

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 07/22/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Approximately 24 hours after receiving the first dose of the COVID vaccine, patient fell ill with extreme tiredness, profuse vomiting and loss of consciousness. Patient never regained consciousness, pronounced brain dead after AVM rupture and died on 3/8/21.

Other Meds: propafenone, levothyroxine, diltiazem ER, esomeprazole, Eliquis

Current Illness:

ID: 1494295
Sex: F
Age: 49
State: WA

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/22/2021
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: none

Other Meds: none

Current Illness: none

ID: 1494296
Sex: F
Age: 66
State: NY

Vax Date: 03/27/2021
Onset Date: 03/30/2021
Rec V Date: 07/22/2021
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: no

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

Symptoms: Dizziness and mild headaches that repeats all the time, numb feeling in right

Other Meds: no

Current Illness: no

ID: 1494297
Sex: F
Age: 45
State: VA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 07/22/2021
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: Pyrexia, White blood cell count decreased

Symptoms: PATIENT REPORTED FEELING "JITTERY" AND HAD MILD BILATERAL HAND TREMORS. NO DIZZINESS, SHORTNESS OF BREATH, ITCHING OR OTHER SERIOUS SYMPTOMS REPORTED.

Other Meds:

Current Illness: Bee sting

ID: 1494298
Sex: M
Age: 34
State: AZ

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: Metformin IR-diarrhea, bamlanivimab-anaphylaxis, atorvastatin/ezetimbe-cramp, increased serum creatinine

Symptom List: Pharyngeal swelling

Symptoms: RN administered Epi pen at 1059 r/t PT demonstrating difficulty swallowing/anaphylatic reaction. Rapid Response was called. PT stated he was feeling better as demonstrated by breathing and swallowing without difficulty, pulse WNL. PT was taken to the ED by RR Team for further assessment/observation. Was DC'd from ED after reassured that was feeling fine. Solumedrol adn benadryl given in ED. DC'd with epipen, benadryl, prednisone, and famotidine.

Other Meds: ALBUTEROL HFA INHALER; ALCOHOL PADS; ALOGLIPTIN 25MG TAB; AMLODIPINE 5MG TAB; CARBOXYMETH 0.5% OPHTH (REFRESH PLUS); CETIRIZINE 10MG TAB; CHOLESTYRAMINE 4GM/5GM (LIGHT) ORAL; CITALOPRAM 20MG TAB; CLOTRIMAZOLE 1% CREAM 30GM; DIPHENHYDRAMINE

Current Illness: none

ID: 1494299
Sex: M
Age: 81
State: VA

Vax Date: 01/19/2021
Onset Date: 02/01/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: Cephalosporin antibiotic (Keflex)

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pain and skin sensitivity began in right arm on Feb. 1, 2021. On the evening of Feb. 8, a rash broke out on the arm. The next morning I set up a telemedicine visit with my doctor for that afternoon (Feb. 9). In that visit I described my symptoms and showed him the rash. He diagnosed shingles. That evening I started a course of the anti-viral drug Valacyclovir. It took approximately two weeks for the pain and rash to disappear. I got my second Moderna shot on Feb. 26.

Other Meds: Pravastatin, Metformin, Losartan, Amlodipine, CoQ10, Vitamin D3, Vitamin C

Current Illness: none

ID: 1494300
Sex: F
Age: 34
State: GA

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 07/22/2021
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: Iodine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Arm pain; Fatigue; Muscle ache; Leg pain; Dizziness; Headache; Nausea; Vomiting; Diarrhea.

Other Meds:

Current Illness:

ID: 1494301
Sex: F
Age: 71
State: WV

Vax Date: 01/14/2021
Onset Date: 02/05/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: Anchovies, doxacyclin, tetracyclin, peridium, IVP dye, latex

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

Symptoms: After the first dose: pressure in ears, After second dose: marked increase in ear pressures, thought it was hearing loss, but after hearing test, did not lose any hearing. Experienced dizziness. More frequent ear pressure in car.

Other Meds: Venlafaxine, allegra, vitamin B6, vitamin B12, thyroxin, Vitamin D3, metoprolol, estradiol, Vitamin B1, somatatriptan (as needed), trimethoprim

Current Illness:

ID: 1494302
Sex: M
Age: 54
State: PR

Vax Date: 05/15/2021
Onset Date: 05/29/2021
Rec V Date: 07/22/2021
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: Penicillin, erythromycin,morphine

Symptom List: Rash, Urticaria

Symptoms: The patient's wife called the pharmacy July 19,2021 to inform of the problem. She reported that her husband was feeling excrutiating generalized pain,weakness,numbness and tingling of arms and legs,speech slurring,weakness of left side of the face causing his left eye to remain opened. She reported that they visited the emergency room and his doctor's office several times but was discharged with no diagnosis.

Other Meds:

Current Illness: no

ID: 1494303
Sex: F
Age: 77
State: WA

Vax Date: 02/12/2021
Onset Date: 02/20/2021
Rec V Date: 07/22/2021
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: NA

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

Symptoms: Pericarditis S/S: actue chest pain or pressure, Chest pain made worse bu lying down, deep inspiration or cough, Pain Hx from 3 providers Patient presents for CP that started on Sunday night. Worse with inspiration states she feels like she has to breath shallow. Reports at 3:30 this morning pain was worse. Developed this retrosternal pleuritic chest pain late Sunday that has worsened over the course of the day yesterday and early this morning. She describes it as radiating up into her neck at times. No shortness of breath or cough. The pain encompasses a large area of her central chest which can radiate up the center of her neck. It is worse with deep breaths but not worse with walking. Initial Admit for Chest pain, developed A Fib during ED admission. Seen by Cardiology. Admitted 2/16-2/18. Neg CT pulm angiogram. Disch Diag including Cardiology 1. Pleuritic chest pain, 02/17/2021 2. Atrial fibrillation, 02/18/2021 3. NSTEMI (non-ST elevated myocardial infarction), 02/17/2021 4. Pleural effusion, bilateral, 02/18/2021 Pt readmitted 2/19/21. Troponin neg at that admit. D Dimer, Quantitative: 2.62 mcg/mL FEU Troponin I: <0.030 ng/mL BNP: 227 pg/mL Cardiology consult 2/20/21 called it pericarditis On 3/10/21 admitted for salicylate toxicity (on ASA for AFib) and ED provider stated that 2/16/21 admit for chest pain states that cardiology note at 3/10/21 stated the prior admit included diagnosis of pericarditis

Other Meds: NA

Current Illness: NA

ID: 1494304
Sex: F
Age: 66
State: CO

Vax Date: 01/07/2021
Onset Date: 06/11/2021
Rec V Date: 07/22/2021
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: No

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

Symptoms: I have an MRI and it was an allegiant and infiltrate. so, then it was biopsy and shown to have inflammation. An there is some report that it has shown that this could be a side effect of the vaccine. I told by the doctor to make a report of this symptoms.

Other Meds: I take Vitamin D Supplement

Current Illness: No

ID: 1494305
Sex: M
Age: 18
State: MD

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 07/22/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Patient was given Moderna vaccine at approximately 16:30 hrs. Patient began to feel nauseous, but did not vomit.

Other Meds: None

Current Illness: None

ID: 1494306
Sex: F
Age: 54
State: NY

Vax Date: 07/20/2021
Onset Date: 07/22/2021
Rec V Date: 07/22/2021
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: Tingling in left foot and lower leg

Other Meds: Repaglinide 1mg. Meteor in Hydrocarbon. 1000 mg. Quinapril 40mg

Current Illness: Diabetes , hypertension, Heart murmur

ID: 1494307
Sex: F
Age: 62
State: TX

Vax Date: 04/13/2021
Onset Date: 06/04/2021
Rec V Date: 07/22/2021
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: After the 2nd dose vaccine, around early June 2021, I started having pain in my left eye and accompanied with blurry vision and dry eyes. I went to my eye doctor ( optometrist ) who did an eye exam and said my vision has not changed that much. I feel like my eyes are constantly straining. The eye doctor could not find the source of the pain. I was prescribed steroid drops to help with eye swelling. After using the eye drops it did help with bringing the swelling down but the pain has not resolved. He said to give it a few weeks and to follow up with an opthamologist if not resolved. I also have notice left eye pain above my eye brow. It shoots from my eye to my eye brow.

Other Meds: Sudafed, Loratadine, Vitamin D, Calcium

Current Illness: none

ID: 1494308
Sex: F
Age: 50
State: PA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: Allergic to peaches, nectarines, and apricots

Symptom List: Ear pain, Hypoaesthesia

Symptoms: After my 2nd dose, what I was experiencing woke me in the middle of the night out of a sound sleep: teeth chattering, uncontrollable shivering, could not get warm even under multiple layers of clothes, sheets and a comforter. I was able to sleep on and off for a few hours. When I woke for work around 8am, I felt like I had been run over. Every muscle in my body ached, and I felt exhausted and slightly dizzy. I could not get warm for the next few hours. Finally, around 1pm on 5/7, I crawled under an electric blanket to finally get warm, and napped for a bit. When I woke up a few hours later I was beginning to feel better. By the time I went to bed on 5/7, I felt practically back to normal. Other than the dizziness, which has continued on and off until the present time.

Other Meds: Prescription medication: Levothyroxine 50MCG

Current Illness: Today I am reporting adverse events experienced after my 2nd vaccination. However, after my 1st vaccination one month prior, I began experiencing vertigo-type dizziness: when sitting up from a position of lying flat or when lying down from a sitting position, as well as when turning my head too quickly, especially when looking away from a screen like my laptop down to my writing on a notepad.

ID: 1494309
Sex: F
Age: 52
State: MO

Vax Date: 07/20/2021
Onset Date: 07/21/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: Mold allergy to environmental mold

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Arm is hot , hard and sore around the injections site and this spread to other parts of the injection arm. A little itchy and rash like.

Other Meds: Blisovi-FE 1/20, multi vitamin, Turmeric

Current Illness: No.

ID: 1494310
Sex: M
Age: 55
State: FL

Vax Date: 04/14/2021
Onset Date: 05/01/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: I do not have any allergies.

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

Symptoms: I experienced heart fluttering. I have an app that can check for A-fib. It registered for A-fib. The number one thing that was related to this was low heart rate. Since I've been taken off nabibolol 2.5mg, I haven't had this experience in three days. While I was taking nabibolol 2.5mg, I was having this experience regularly. When I was 45, I learned that I had coronary artery disease and I had 2 stints put in. I have not experienced any other heart issues since then, until now.

Other Meds: I was taking lisinopril 10mg daily, rosuvastatin 5mg once a week, nabibolol 2.5mg daily, fenofibrate 160mg daily, metformin 500mg once daily, one 81 mg aspirin per day, diclofenac sodium 1% gel, vitamin D3, vitamin C 1000mg twice daily, men

Current Illness: I did not have any illnesses.

ID: 1494311
Sex: F
Age: 19
State: WA

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/22/2021
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: none

Other Meds: Medroxyprogesterone

Current Illness: none

ID: 1494312
Sex: M
Age: 52
State: HI

Vax Date: 06/21/2021
Onset Date: 07/17/2021
Rec V Date: 07/22/2021
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: tramadol

Symptom List: Unevaluable event

Symptoms: cough, malaise and fatigue. He states that he started to have symptoms about 3 days ago with chills, subjective fevers, cough, anosmia. He also had some chest pain that he states was left sided/substernal and felt like squeezing/heavy pain. It started yesterday morning and comes and goes. He has some SOB and he also has had a very poor oral intake.

Other Meds: none

Current Illness:

ID: 1494313
Sex: F
Age: 33
State: CA

Vax Date: 04/13/2021
Onset Date: 05/26/2021
Rec V Date: 07/22/2021
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: I developed a cough on May 26th. That cough got worse over a 10-day period. It got so bad that I started to throw up. On June 9th, I saw an urgent care physician via health visit. He prescribed Venotone and cough syrup. It began to get better and then got worse again. I saw my PCP and she refilled the cough syrup and Venotone medication. After taking that round I started to feel better.

Other Meds: Remicade; Calcium Supplement; Prenatal Multivitamin

Current Illness:

ID: 1494314
Sex: F
Age: 16
State: IL

Vax Date: 07/10/2021
Onset Date: 07/14/2021
Rec V Date: 07/22/2021
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: Seasonal allergies, seafood, nuts

Symptom List: Injection site pain, Pain

Symptoms: Three days after vaccine,case reported blurry vision, hands and legs numbness and tingling, near syncope. Ten days after vaccine case reported near syncope while riding bike.

Other Meds: Multivitamin, Rescue inhaler

Current Illness: Bruising. PCP did blood test revealing elevated bilirubin

ID: 1494316
Sex: M
Age: 64
State: GA

Vax Date: 06/21/2021
Onset Date: 06/29/2021
Rec V Date: 07/22/2021
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: Swollen lymph node that is extremely painful in the groin area going on 3 weeks.

Other Meds: Prescriptions, yes for hypertension

Current Illness: No other illnesses. Reaction to J&J Covid Vaccine. Swollen groin lymph node on the left side of the body. Extreme pain.

ID: 1494317
Sex: M
Age: 26
State: WA

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/22/2021
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: none

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

Symptoms: Patient passed out and felt on the floor after receiving Covid 19 Moderna vaccine. Pulses were normal per pharmacy manager. Contacted 911, and the team came over and checked on him; they said he was ok. Pt stayed in the observed pharmacy area for additional 30 minutes and his mom picked him up.

Other Meds: none

Current Illness: none

ID: 1494318
Sex: F
Age: 48
State: WA

Vax Date: 06/25/2021
Onset Date: 06/26/2021
Rec V Date: 07/22/2021
Hospital: Y

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: Sulfa

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Developed numbness in arms/hands that spread within minutes to both legs. High fever, high heartrate and low oxygen levels, Couldn't talk normally (stuttering) confusion at about 10 am. Was driving at the time for work and pulled into a customers yard and collapsed. They called 911 and I was transported to Hospital. They tested for stroke since that's what the symptoms pointed to. Performed Cat Scan, X-rays, and multiple blood and urine tests. They could find nothing that would have caused it. They concluded it was an adverse reaction to the Moderna Vaccine I received the day before. I was released and then was walking out of hospital my DR. stopped me and readmitted me because he

Other Meds: None

Current Illness: None

ID: 1494319
Sex: F
Age: 62
State: ND

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin, Ibuprofen, Levaquin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt states right upper arm hurt immediately upon 2nd COVID-19 vaccination on 7/9/21 and the pain has continued but has lessened in severity. Pt saw provider on 7/22/21 who recommended pt use acetaminophen to help with pain. Provider reviewed arm and noted there was still bruising to the area and noted that injection was done higher than normal. Discussed injection placement with vaccinator.

Other Meds: Levemir, Novolog, Clopidogrel, Lisinopril, Alogliptin, Aspirin, Metformin, Simvastatin, Metoprolol, Carboxymethylcellulose

Current Illness: None

ID: 1494320
Sex: M
Age: 20
State: CA

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/22/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: projectile vomiting dizziness weakness

Other Meds:

Current Illness:

ID: 1494321
Sex: M
Age: 74
State: WA

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Nausea

Symptoms: none

Other Meds: Clopidogrel; Enalapril; Acetaminophen; Atorvastatin; Levemire; Xigduo

Current Illness: none

ID: 1494322
Sex: F
Age: 40
State: PA

Vax Date: 01/10/2021
Onset Date: 05/26/2021
Rec V Date: 07/22/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Contracted covid between doses of the vaccine, and had AFIB several months later in May (4 months after). Hospitalized, given IV cardizan, prescribed PRN cardizan, have not had to use it since, have not had another episode.

Other Meds: Probiotic, multivitamin,

Current Illness: Contracted Covid between doses of the vaccine

ID: 1494323
Sex: M
Age: 35
State: VA

Vax Date: 07/05/2021
Onset Date: 06/01/2020
Rec V Date: 07/22/2021
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: None stated.

Other Meds:

Current Illness:

ID: 1494325
Sex: F
Age: 15
State: WA

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/22/2021
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: none

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

Symptoms: none

Other Meds: Nexplanon; Quetiapine; Vistaril; Fluoxetine

Current Illness: none

ID: 1494327
Sex: M
Age: 46
State: WI

Vax Date: 01/22/2021
Onset Date: 07/21/2021
Rec V Date: 07/22/2021
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: Tremor

Symptoms: 2019 Coronavirus SARS-CoV-2~2019 Coronavirus SARS-CoV-2 performed on 7/21/21 at 16:29. 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: 1494328
Sex: F
Age: 23
State: CA

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: no signs or symptoms after event.

Other Meds: None

Current Illness: None

ID: 1494329
Sex: F
Age: 53
State: MN

Vax Date: 03/11/2021
Onset Date: 07/22/2021
Rec V Date: 07/22/2021
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: Patient stated that she got the Janssen vaccine on 3/11/2021. Patient registered through DOH conformation number 2730458. On DOH website shows patient to be a no show. Unable to determine if patient got vaccine.

Other Meds:

Current Illness:

ID: 1494330
Sex: M
Age: 23
State: CA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 07/22/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Patient fainted approximately 5 minutes after the vaccination.

Other Meds: None

Current Illness: None

ID: 1494331
Sex: M
Age: 68
State: CA

Vax Date: 02/24/2021
Onset Date: 04/15/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Sensorineal Hearing Loss , right ear with Tinnitus. No improvement.

Other Meds: Folic Acid, Tradjenta, Omega 3 Acid Ethyl Esters, Glipizide, Atovastatin, Fenofribrate, Multi Vitamin

Current Illness: None

ID: 1494332
Sex: M
Age: 37
State: IL

Vax Date: 04/08/2021
Onset Date: 04/11/2021
Rec V Date: 07/22/2021
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: None known

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

Symptoms: I've had skin rashes on hands and fingers (similar to a form of contact dermatitis in appearance) since April 11th. I've had what appears to be angular cheilitis since June. I've had irritation, itchiness, and skin peeling around both eyes since June.

Other Meds: Vitamin D3 (125 mcg daily), Vitamin K2 (100 mcg daily)

Current Illness: None

ID: 1494333
Sex: F
Age: 12
State: PA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 07/22/2021
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: nka

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

Symptoms: vasovagal syncope

Other Meds: none

Current Illness: none stated by patient or parents

ID: 1494334
Sex: F
Age: 12
State: CA

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/22/2021
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: Approximately 3 minutes after injection, our daughter was sitting next to her mother, her head lolled over the back of her chair and she began to have a seizure. The event only lasted about 45 seconds before she came out of seizing. She had a bright orange ring around her mouth, trouble breathing and vision issues. the pharmacist called an ambulance. These symptoms were mostly cleared up before medical arrived, with only dizziness, disorientation and slight vision issues remaining.

Other Meds: none

Current Illness: none

ID: 1494335
Sex: F
Age: 25
State: LA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 07/22/2021
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: Pt was fine receiving the vaccine. Right afterward, she started feeling faint, and she broke out in a sweat. We called 911, and layed her down on the ground, so she wouldn't fall. We gave her water and an ice pack. The paramedics came here and checked her vitals. All was fine. She fully recovered and was able to go home. Pt's faintness was due to anxiety after receiving the vaccine.

Other Meds: n/a

Current Illness: n/a

ID: 1494336
Sex: F
Age: 51
State: WA

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/22/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: none

Other Meds: Ibuprofen Cyclobenzaprine Metroprolol Estradiol Metformin Omeprazole Rosuvastatin Levothyroxine

Current Illness: none

ID: 1494337
Sex: M
Age: 25
State: AZ

Vax Date: 01/20/2021
Onset Date: 07/03/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Follow up report: This time that it happened: I had on Saturday morning - urinating pain followed by blood in my urine. That persisted for the next two days. I went to an Urgent Care - this time. They did Urinalysis - confirmed blood in my urine; also leukocytes were high - they gave me course of antibiotics and it resolved that same day but I continued the seven day course of antibiotics - Bactrim. I thought it might be kidney stones but I never saw anything come out and it seemed to resolve pretty quickly. Yet it almost seemed resolved before I really started taking the antibiotics. They also gave me an ultrasound of my kidneys at the Urgent Care.

Other Meds: Baclofen

Current Illness: None

ID: 1494338
Sex: F
Age: 52
State: CT

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 07/22/2021
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: After I received my first dose, I had headaches, exhaustion, and body aches for about 24 hours on 1/7/2021. With my second dose, I started having symptoms at between 6 and 7 PM on 2/3/2021. I had pain at the injection site this time, but I hadn't with the first. I had received lip fillers on 12/23/2020 or 12/24/2020. After the second vaccination, I noticed there were internal bumps on my lips and external bumps where the filler had been injected. When I woke up the next morning on 2/4/2021, the swelling was more pronounced. My lips were so swollen, sore, and red, I couldn't bear to touch them. I called a medical facility, and they prescribed me a 5-day prednisone pack. They also recommended that I take over-the-counter antihistamines. This relieved the symptoms until the prednisone ran out, and then the swelling returned. I called them again, and this time they prescribed me a 2-week pack of prednisone, which ended up lasting 30 days, as they had recommended that I cut the doses in half. I also stayed on the antihistamine for 3 months. After that, everything was fine and the symptoms were gone.

Other Meds: Levothyroxine, liothyronine, stironlactone.

Current Illness: None.

ID: 1494339
Sex: F
Age: 62
State: AR

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: PFIZER COVID VACCINE WAS GIVEN ON DAY 11 INSTEAD OF DAY 21. PATIENT REPORTED MINOR ARM PAIN SIMILIAR TO FIRST SHOT

Other Meds: paproxetine 20mg, indapamide 1.25mg, atorvastatin 10mg

Current Illness:

ID: 1494340
Sex: F
Age: 14
State: WA

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/22/2021
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: mile

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

Symptoms: none

Other Meds: none

Current Illness: none

ID: 1494341
Sex: M
Age: 11
State: CA

Vax Date: 07/17/2021
Onset Date: 07/19/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Developed hives within 3 days of the vaccine, followed by diffuse joint pain (wrist, hands, knees, elbows, ankles, feet) 2 days afterwards

Other Meds: NOne

Current Illness: None

ID: 1494342
Sex: F
Age: 55
State: GA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 07/22/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Patient was sitting and waiting her 15 minute waiting period. patient stood up and fell on floor in pharmacy waiting area. Patient hit her head and starting crying for help. Technician and pharmacist went to patients help. Pharmacist examined patient and observed patient was experiencing vasovagal syncope. Another technician called 911. Patient was taken to hospital by ems.

Other Meds: unknown

Current Illness: unknown

Date Died: 07/12/2021

ID: 1494343
Sex: F
Age: 59
State: MI

Vax Date: 03/10/2021
Onset Date: 03/15/2021
Rec V Date: 07/22/2021
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: NKDA

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

Symptoms: Started with suspected seizure onset after 3/10/21 covid vaccine and subsequently deceased of unclear etiology on 7/12/21. Family is concerned it is covid vaccine related.

Other Meds: wellbutrin 150 mg daily, plaquenil 200 mg daily, effexor 150 mg daily

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm