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

Date Died: 06/25/2021

ID: 1498269
Sex: M
Age: 83
State: GA

Vax Date: 01/05/2021
Onset Date: 06/15/2021
Rec V Date: 07/23/2021
Hospital: Y

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: Patient hospitalized and died due to COVID after being vaccinated.

Other Meds:

Current Illness:

ID: 1498270
Sex: F
Age: 58
State: CA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 07/23/2021
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: 10 min after vaccine had numbness and tingling primarily on hands but also arms. This persisted for a couple of months including a buzzing sensation like after you've had an electric shot, it progressed to the legs with slight loss of sensation and altered sensation, when hands pointing down a feeling of having a rubber band around the wrist, as of two weeks ago it's on and off.

Other Meds: none

Current Illness: none

ID: 1498271
Sex: M
Age: 17
State: MA

Vax Date: 06/26/2021
Onset Date: 06/26/2021
Rec V Date: 07/23/2021
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:

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

Symptoms: Patient was given a COVID-19 vaccine not authorized for their age group. Patient was monitored for 15 minutes after the injection and no side effects were observed at that time. To this date, patient and/or guardian have not reported any side effects or symptoms since being vaccinated. Patient has since completed the vaccination series as recommended by the CDC which can be found on the COVID-19 Administration Errors and Deviations document. A discussion has occurred about how the error took place and strategies have been implemented to ensure that the error does not happen again.

Other Meds:

Current Illness:

ID: 1498272
Sex: F
Age: 42
State: KY

Vax Date: 04/20/2021
Onset Date: 04/23/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache every single day since the second dose of the covid vaccine in April, 2021. Cough and/or shortness of breath every day since second dose in April, 2021

Other Meds:

Current Illness:

ID: 1498273
Sex: F
Age: 58
State: FL

Vax Date: 07/14/2021
Onset Date: 07/21/2021
Rec V Date: 07/23/2021
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: rash on arms...worst on left arm and itching all over

Other Meds: none

Current Illness: none

ID: 1498274
Sex: F
Age: 25
State: TN

Vax Date: 04/05/2021
Onset Date: 04/12/2021
Rec V Date: 07/23/2021
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: Ibuprofen

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

Symptoms: Patient with headache to crown of head since 4/12/21. No history of thrombosis. Tylenol resolves the headache for 4 hours, then it comes back. Patient is treated with IV Tylenol and IV fluids.

Other Meds: birth control pills

Current Illness: none

ID: 1498275
Sex: M
Age: 53
State: CA

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/23/2021
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 listed per patient

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient received Janssen Covid 19 vaccine on 04/09/2021, then came to pharmacy and received the complete series of Pfizer vaccine. Patient stated that he never received a covid-19 vaccine on 06/30/21 was verbally asked and answered a questionnaire and signed off never received a vaccine. Patient received a Pfizer vaccine (dose 1) on 06/30/21 and Pfizer vaccine (dose 2) on 07/21/21. Follwed up with patient on 07/22/21 at approx 5pm patient has no complaints and no side effects, advised patient to be watchful and seek medical treatment immediately if experience any sign of side effect. Patient was given VSAFE handout on 06/30/21

Other Meds: none that we know of

Current Illness: none listed

ID: 1498276
Sex: F
Age: 78
State: NV

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

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

Lab Data:

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: (07/20/2021) sharp pain in right heel, usually walks 5 miles/day without pain. Experienced sharp pain (10), during walking. After icing the foot, got it down to a 5 on the pain scale.

Other Meds: Advair Diskus; Singulair; Albuterol; Allegra; Mucinex Flonase; Astelin; Zolpidem; C; VitaFusion MultiV Womans; D3; Iron; Green Superfood capsules; Chamomile

Current Illness: None

ID: 1498277
Sex: M
Age: 15
State: CO

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

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

Lab Data:

Allergies: No

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: A vial of Pfizer-BioNTech vaccine was punctured at 10:00 am on 7/22/2021. Vial was in refrigerator and stayed there between 8 and 30 degrees Celsius until 4:47 pm on the same day. At 4:47 pm, 2 doses were drawn from vial and administered one to, and one to another patient. 4:47 pm was 47 minutes past the 6 hour use by time listed on the fact sheet from the CDC and the manufacturer. Per CDC guidance on their "COVID-19 Vaccine Administration Errors and Deviations" fact sheet, Pfizer manufacturer was contacted on 7/22/2021, and again on 7/23/2021. On 7/23/2021, a representative of Pfizer's medical team, RN was spoken with. She verified that according to Pfizer's studies, the Pfizer COVID-19 vaccine maintains viability for up to 24 hours at 8-30 degrees Celsius in refrigerator. Additionally she stated that I, and my colleagues should use our clinical judgement due to this information being outside of the fact sheet recommendations, as to if patient's dose of Pfizer's COVID-19 is valid, or needs to be repeated. No adverse effects were stated although a report was escalated to Pfizer's safety department out of an abundance of caution, and waiting to hear back.

Other Meds: No

Current Illness: N/A

ID: 1498278
Sex: F
Age: 48
State: SC

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/23/2021
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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient given 1 ml instead of .5 ml .

Other Meds: Patient given 1 ml of covid vaccine . Was patients second dose.

Current Illness: None

ID: 1498279
Sex: F
Age: 55
State: MI

Vax Date: 07/09/2021
Onset Date: 07/10/2021
Rec V Date: 07/23/2021
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 known allergies

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

Symptoms: Tingling in toes/feet initially, then tingling in hands - numbness in feet and hands, generalized weakness in the mornings

Other Meds: Claritin Levothyroxine Multi-Vitamin Vitamin D-3

Current Illness: None noted

ID: 1498280
Sex: M
Age: 59
State: ID

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 07/23/2021
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:

Symptom List: Rash, Urticaria

Symptoms: The patient received an initial dose of the Moderna vaccine 02/10/21 from store pharmacy, on 06/15/21 they received a Pfizer vaccine from Medical Center, and on 07/23/21, the patient received a second dose of Pfizer from our location (Store Pharmacy )

Other Meds:

Current Illness:

ID: 1498281
Sex: F
Age: 58
State: FL

Vax Date: 07/14/2021
Onset Date: 07/15/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies: Sulfer

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

Symptoms: Pain at sight, hard and swollen around the area of sight, itchiness, area is still swollen today

Other Meds: None

Current Illness: None

ID: 1498282
Sex: M
Age: 35
State: MN

Vax Date: 07/08/2021
Onset Date: 07/13/2021
Rec V Date: 07/23/2021
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: NKA

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

Symptoms: Pt had vaccine on 7/8 and had a seizure on 7/13. He was at work and was found with blood on his ear and a mark on his face. He had no memory of the incident. Last seizure was at least 7 months prior.

Other Meds: Zonisamide multivitamin

Current Illness: none

ID: 1498283
Sex: F
Age: 50
State: CA

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/23/2021
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: milk, mushrooms, tetracycline

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

Symptoms: Twenty minutes after pfizer was administered, pt felt her throat closing and was unable to talk. O2 sat on RA was 81, HR 79. Epinephrine immediately administered and 911 called. Pt place on 15 L non rebreather. Pt O2 sats increased to 100% . HR 120. Paramendics arrived at 10:32 and took over care, transported by ambulance to ER.

Other Meds: albuterol, ventolin, singulair, spiriva, dulera, K-tab, imitrex, lisinopril, prednisone, topamax, cequa, kenalog ointment, voltaren.

Current Illness:

ID: 1498284
Sex: M
Age: 45
State: NY

Vax Date: 07/21/2021
Onset Date: 07/22/2021
Rec V Date: 07/23/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Extremely high fever 105.9, confusion, severe headache, body aches, fatigue, mottling of hands and feet, weakness, lethargy, dehydration

Other Meds: None

Current Illness: None

ID: 1498285
Sex: F
Age: 49
State: PA

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/23/2021
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: PCN Azithromycin

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

Symptoms: Vaccine given on 7/6/2021 which was day 35 in refrigeration . Vaccine was moved from freezer on June 1 2021 and was labeled in refrigerator as hitting the beyond use date on July 1. This was an oversight on monitoring. Pfizer was notified and patient notified and counseled on next steps. No adverse events reported by patients prior to or after notification .

Other Meds: Metformin 1000mg lisinopril 20mg Omeprazole 20 mg Celexa 20 mg

Current Illness:

ID: 1498286
Sex: M
Age: 15
State: PR

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

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

Lab Data:

Allergies: Na

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Syncope fainting

Other Meds: Na

Current Illness: Na

ID: 1498287
Sex: F
Age: 33
State: NC

Vax Date: 06/30/2021
Onset Date: 07/04/2021
Rec V Date: 07/23/2021
Hospital: Y

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: 1st shot was on 6/2/21-was in bed sick for 3 days. 2nd shot was on 6/30/21-in bed sick for two days Then on 7/ 8 she start feeling severe pain in left leg along with swelling. She couldnt put any weight on leg. She was taken to ER on 7/14. She was diagnosed with a blood clot in her left leg and discharged on 7/15. On 7/21 she saw her primary doctor and was admitted back to hospital for 7 days to be monitored and to be given heparin.

Other Meds: none

Current Illness: none

ID: 1498288
Sex: F
Age: 49
State: FL

Vax Date: 04/08/2021
Onset Date: 04/10/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies: Latex, augmentin

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

Symptoms: Immediately after the second shot, injection site red and irritated. Within 24 hours the injection site was swelling. The swelling has not gone down?3 months later I have a massive lump and chronic pain/spasms at site. I have tried anti inflammatory cream, pain pills, anti inflammatory pills, medical marijuana cream, CBD Oil, ice, heat?nothing has reduced the lump.

Other Meds: Rybelsus, Adderall, Pantoprozole, Norco, NuvaRing

Current Illness: Nothing

ID: 1498289
Sex: F
Age: 61
State: OR

Vax Date: 01/29/2021
Onset Date: 07/20/2021
Rec V Date: 07/23/2021
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: penicillin

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

Symptoms: Trigeminal Neuralgia

Other Meds: venlafaxine, diclofenac sodium topical gel, fluocinonide topical solution, metronidazole gel, Rosuvastatin, ventolin HFA, Alvesco ciclesonide

Current Illness:

ID: 1498290
Sex: M
Age: 39
State: CT

Vax Date: 05/26/2021
Onset Date: 07/07/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Unevaluable event

Symptoms: Sudden out of the blue testicular pain that comes and goes and now became more like dull and my testicles can easy feel slight pain even when sitting on a chair.

Other Meds: none

Current Illness: none besides non-stopping dry cough that comes and goes since I acquired the sars in May 2020.

ID: 1498291
Sex: F
Age: 61
State: GA

Vax Date: 04/28/2021
Onset Date: 06/27/2021
Rec V Date: 07/23/2021
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:

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

Symptoms: Hospitalized for COVID after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1498292
Sex: F
Age: 20
State: NC

Vax Date: 03/12/2021
Onset Date: 07/14/2021
Rec V Date: 07/23/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Tested positive with COVID-19

Other Meds: None

Current Illness: None

ID: 1498293
Sex: F
Age: 51
State: IN

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient called and complained that starting the evening of the injection, she had: fever, headache, shortness of breath and fatigue. She states her symptoms continued for 36 hours. She states as of today she still has the shortness of breath and has seen several doctors but so far no help or explanation. She has an upcoming cardiologist appt as well as a pulmonologist.

Other Meds:

Current Illness:

ID: 1498294
Sex: M
Age: 15
State: NJ

Vax Date: 07/12/2021
Onset Date: 07/13/2021
Rec V Date: 07/23/2021
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:

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

Symptoms: CHEST PAIN, DIFFICULTY SWALLOWING

Other Meds: OMEPRAZOLE, ZENZEDI, CLONIDINE, VISTARIL, LEVOTHYROXINE SODIUM, ESCITALOPRAM, SINGULAIR

Current Illness:

ID: 1498295
Sex: F
Age: 69
State: OK

Vax Date: 07/21/2021
Onset Date: 07/22/2021
Rec V Date: 07/23/2021
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: None stated.

Other Meds: estradiol, levothyroxine, glipizide

Current Illness:

ID: 1498296
Sex: M
Age: 63
State: MI

Vax Date: 05/20/2021
Onset Date: 07/15/2021
Rec V Date: 07/23/2021
Hospital: Y

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

Lab Data:

Allergies: Thimeresal (reports he had this in contact solution, it cause irritation to his eyes), Penicillins, Proton Pump Inhibitors, Seafood, Sulfa drugs, Losartan

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fully vaccinated patient who tested positive for COVID upon admission screening to hospital. Admitted through ED for STEMI. No fever, cough, or loss of taste or smell. No s/s of COVID throughout stay. Discharged on 07/17/21. Of note - patient recovered from COVID in 11/2020.

Other Meds: Eliquis, Aspirin, Cinnamon bark, Plavix, liraglutide, lisinopril, claritin, metformin, metoprolol, multivitamin, omega-3 fatty acids, crestor, saw palmetto, sour cherry extract

Current Illness: None

ID: 1498297
Sex: M
Age: 65
State: PA

Vax Date: 07/08/2021
Onset Date: 07/09/2021
Rec V Date: 07/23/2021
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: Chest pain and discomfort accompanied by fast pulse. Has been continuing now for 2 weeks. Have visited cardiologist and is monitoring. EKG normal. Pain improves when upright and worsens when lying flat. Mostly presents as dull ache just below left breast. Possible acute onset pericarditis.

Other Meds:

Current Illness:

ID: 1498298
Sex: M
Age: 16
State: MA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Patient was given a COVID-19 vaccine not authorized for their age group. Patient was monitored for 15 minutes after the injection and no side effects were observed at that time. To this date, patient and/or guardian has not reported any side effects or symptoms since being vaccinated. Patient has since completed the vaccination series as recommended. A discussion occurred about how the error took place and strategies have been implemented to ensure that the error does not happen again.

Other Meds:

Current Illness:

ID: 1498299
Sex: M
Age: 55
State: WI

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs, Clauvenic Acid (Augmentin but not allergic to penicillin), unable to digest eggs/chicken/dairy products (causes sever stomach pain)

Symptom List: Injection site pain

Symptoms: After the second dose, I had a high fever/chills/body aches/soreness at the site of injection for three days. After three days of the second dose, started feeling pain/pulling of chest muscles on the left side. After continued feeling of chest pain/muscle pulling for two days, I contact a doctor on the third day, who advised me to go to ER and have examined by a physician. I went to the ER where a lot of blood tests were done and an x-ray of the chest was taken. But the ER doctor ruled out any heart-related problem. This pain started gradually reducing and reappearing every few days along with the injection site becoming sore. I started reappearing every week, then every 10 days and now it appears every two weeks. After about two weeks had the first gout attack. The doctor did not advise taking any medicine(s) to reduce uric acid before - had annual physical in Jan. Now taking Febuxostat 40 mg once daily. Also, blood work showed giant/big platelets suggesting BSS (to be investigated by a specialist on August 9)

Other Meds: Vitamin D - 5000 IU

Current Illness: none

ID: 1498300
Sex: M
Age: 16
State: MA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient was given a COVID-19 vaccine not authorized for their age group. Patient was monitored for 15 minutes after the injection and no side effects were observed at that time. To this date, patient and/or guardian have not reported any side effects or symptoms since being vaccinated. Patient has since completed the vaccination series as recommended by the CDC which can be found on the COVID-19 Administration Errors and Deviations document. A discussion has occurred about how the error took place and strategies have been implemented to ensure that the error does not happen again.

Other Meds:

Current Illness:

ID: 1498301
Sex: M
Age: 75
State: MI

Vax Date: 02/15/2021
Onset Date: 07/23/2021
Rec V Date: 07/23/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Breakthrough case: Tested positive in ICU, breathing difficulties, on B-Pap,

Other Meds:

Current Illness:

ID: 1498302
Sex: F
Age: 60
State: OR

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 07/23/2021
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: I just had a regular reaction for two days after receiving the vaccine. I started getting bilateral lymphatic breast tenderness. That lasted for a little over 2 weeks. I went to see my doctor. My doctor informed me to rest for the next week. I got a mammogram done a year ago it was negative, but the mammogram I had recently was positive. I am now diagnosed with breast cancer.

Other Meds:

Current Illness:

ID: 1498303
Sex: F
Age: 32
State: GA

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: patient got nauseous after the shot. I have checked her vital. She was ok after 15 minutes and left the waiting area.

Other Meds:

Current Illness:

ID: 1498304
Sex: M
Age: 77
State:

Vax Date: 02/25/2021
Onset Date: 07/22/2021
Rec V Date: 07/23/2021
Hospital: Y

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: 07/22- Patient is a very pleasant 78-year-old gentleman with a history of pancreatic cancer on chemotherapy who presents today for evaluation of fever and chills. Patient states he began feeling unwell overnight last night. He developed shaking and chills. He contacted the clinic and was referred to the emergency department. He states he has had a mild cough. He has had no abdominal pain. He has had diarrhea which is somewhat chronic. He has had no urinary symptoms.

Other Meds:

Current Illness:

ID: 1498305
Sex: M
Age: 74
State: GA

Vax Date: 02/04/2021
Onset Date: 07/18/2021
Rec V Date: 07/23/2021
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:

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

Symptoms: Patient is hospitalized due to COVID-19. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1498306
Sex: F
Age: 69
State: OH

Vax Date: 04/04/2021
Onset Date: 05/11/2021
Rec V Date: 07/23/2021
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: Seasonal allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: May 11, 2021 SOB began at am upon waking. May 13th doctor was contacted and a chest x-ray and blood draw was obtained. Results of the D-dimer were elevated and the doctor ordered a CT scan for the morning of May 14th, 1 hour later doctor called and wanted patient to go to ER as a large blood clot was noted on the CT in the pulmonary artery. Patient went to ER and started IV Heparin and was sent to Hospital for admit over night there obtained and ECHO and more blood work which was inconclusive in determining why she got the clot.

Other Meds: Aspirin 81 mg 3 times a week by mouth Claritin 10 mg daily po Glipizide 5 mg bid po Metformin 1,000 mg bid po Losartan potassium 25 mg daily po Pravastatin 20 mg daily po Hydrochlorothiazide 12.5 mg PRN po Calcium 770 with Vitamin D3 1,00

Current Illness: None

ID: 1498307
Sex: F
Age: 30
State: TX

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 07/23/2021
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: no

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

Symptoms: The day after my vaccination, 02/10/2021, extreme swelling on Right arm, fever of 102, fluctuating throughout day, I felt like I got hit by the bus because I had body aches, fever, chills. The next day, 02/11/2021 the swelling increased from the top of my shoulder to about 2 inches to my elbow and it was hot to the touch and red. I talked to a tele-doc on 02/11/2021, because I was concerned about the swelling on my arm. The tele-doc diagnosed me with localized swelling, mass on my Right upper limb. The doctor said it should go away on it's own. If it's still the same in 2 or 3 days to call my local provider.

Other Meds: none

Current Illness: no

ID: 1498308
Sex: F
Age: 53
State: IN

Vax Date: 04/14/2021
Onset Date: 07/13/2021
Rec V Date: 07/23/2021
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: Penicillin, Trees, and Latex

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

Symptoms: On July 13th I had a very sore throat. I had a strep test and it came back negative. Throughout the night, my mouth and throat became itchy and red. My uvula swelled it was gagging me. I went to the doctor in the morning and received a steroid shot and mouthwash to reduce the pain and swelling. After about 48 hours I began to feel better. I'm not sure this was caused by the COVID-19 vaccination, but I had never had this type of reaction before.

Other Meds: Prilosec, Wellbutrin, Hydroxyzine, Allegra, Montelukast, Xolair (1st dose on June 11th), Vitamin D3, and Biotin.

Current Illness: None

ID: 1498309
Sex: F
Age: 54
State: TX

Vax Date: 03/12/2021
Onset Date: 03/14/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies: Oranges

Symptom List: Pain in extremity

Symptoms: Patient was given a third dose of the vaccine. Dates of vaccination (1/21/21, 2/19/21, 3/12/21) She experienced injection site reaction on the third dose on 3/14/21 (Redness, mild swelling, hard to touch reported to Dr. by e-mail). Tylenol was given.

Other Meds: Calcium carbonate, Carbamazepine, Vit D, Diazepam. Fluticasone NS, Lansoprazole, Miralax, Senna, Simethicone

Current Illness: n/a

ID: 1498310
Sex: F
Age: 27
State:

Vax Date: 01/13/2021
Onset Date: 07/22/2021
Rec V Date: 07/23/2021
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: 7/22-Contact With And (Suspected) Exposure To COVID-19

Other Meds:

Current Illness:

ID: 1498311
Sex: F
Age: 47
State:

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaccine given after being refrigerated for 38 days

Other Meds:

Current Illness:

ID: 1498312
Sex: M
Age: 62
State: MD

Vax Date: 04/12/2021
Onset Date: 04/04/2021
Rec V Date: 07/23/2021
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: I was eating dinner and swallowed a steak and it got stuck at the top of my stomach. It was the next day to get the food free. I had an endoscopy.

Other Meds: Tums

Current Illness: No

ID: 1498313
Sex: F
Age: 41
State:

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 07/23/2021
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: Vaccine given after being refrigerated for 38 days

Other Meds:

Current Illness:

ID: 1498314
Sex: F
Age: 34
State:

Vax Date: 01/28/2021
Onset Date: 07/22/2021
Rec V Date: 07/23/2021
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: 07/22-Contact With And (Suspected) Exposure To COVID-19

Other Meds:

Current Illness:

ID: 1498315
Sex: M
Age: 25
State: IL

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaccine given after being refrigerated for 38 days

Other Meds:

Current Illness:

ID: 1498316
Sex: M
Age: 68
State:

Vax Date: 04/06/2021
Onset Date: 07/22/2021
Rec V Date: 07/23/2021
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: 07/22-Have you had close contact* with a person who has a LABORATORY CONFIRMED case of COVID-19 in the past 14 days?: Yes- provide quarantine instructions unless exceptions met. (Continue Screening) (7/17) In the last 48 hours, have you had a fever* OR symptoms that are unrelated to a preexisting illness?: New cough, Fever (generalized weakness and dizziness)

Other Meds:

Current Illness:

ID: 1498317
Sex: F
Age: 62
State: NC

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies: Flagyl Clindamycin

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

Symptoms: 2 days after receiving my 2nd Covid Pfizer vaccine, I noticed a burning sensation on my Bilateral Upper Inner thighs. It felt like a sunburn. In the next few days the "burn feeling" became more pronounced, especially when clothes would rub against my thighs. The area only appeared slightly pink, but would become more pronounced after irritation from clothes. What really intrigued me was the Exact Identical appearance on Both inner thighs. There were no raised areas or bumps. Only pinkness that would get redder with wearing loose pants that would rub area. When area was rubbed I felt like I had a severe sunburn...burning pain. For a week I tried Benadryl cream....switched to Non-allergic Washing liquid and re-washed all my clothes. I stopped ALL medications/supplements that I was taking...tried all creams that I had (RX & non-RX)....Nothing helped. I eventually saw a Dermatologist. They took pics, consulted about what it could be....Vehemently told me it was NOT vaccine related & DX me with Old Age Dry skin! But I came home and TRIED all the Creams they RX.....After another week of no improvement, I contacted my hospital employee health and explained my condition & IDENTICAL symptoms on Bilateral thighs.....They immediately told me that I needed oral Prednisone due to it being systemic at this point....I was prescribed a course of oral steroids....and the condition improved....However, it took over a month for me to be able to wear loose clothes that did not irritate the area and for most of the sxs to go away. I decided to report this event after I find the sxs to return slightly occasionally even now.

Other Meds: Vitamin D 50,000 units/weekly Biotin 5000 mcg Daily

Current Illness: none

ID: 1498318
Sex: F
Age: 53
State: IL

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaccine given after being refrigerated for 38 days

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm