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: 1498671
Sex: M
Age: 17
State: CA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: nka

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient felt dizzy and fell down on the floor after receiving the vaccine about 5 minutes. Pt has needle phobia. He vomited a little bit after that.

Other Meds: none

Current Illness: needle phobia

ID: 1498672
Sex: F
Age: 63
State: CA

Vax Date: 04/13/2021
Onset Date: 04/17/2021
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: NKA

Symptom List: Anxiety, Dyspnoea

Symptoms: Flu like symptoms for three weeks, possible Hashimoto's disease propagated according to naturopathic doctor and seems to have resolved and if it was that it is currently is not affecting me. 5 day cold also occurred.

Other Meds: Amlodipine; losartan

Current Illness: None

ID: 1498673
Sex: F
Age: 48
State: TX

Vax Date: 07/22/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: First does was on 7-22-21, in the evening, the injection site feels tender with a small bump. On 7-23-21 left arm is very tender with a larger bump. Very uncomfortable.

Other Meds: None

Current Illness: None

ID: 1498674
Sex: F
Age: 56
State: AZ

Vax Date: 01/19/2021
Onset Date: 03/26/2021
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: Lexapro.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I woke up with jaw pain on the right side. I had a couple of days in which I woke up with the pain on the right side of the jaw near the ear; eventually the pain subsided as the days progressed. I then started waking up with BOTH sides of my jaw hurting. After two weeks of this, the pain lasted longer throughout the day, and I began getting headaches in the afternoons and evenings. I treated myself with NSAIDs (Aleve). After about 2 1/2-3 weeks, I called the Dr., because it wasn't going away on its own. I then saw the Dr. on 5/2/2021. He did an ultrasound of my jaws and temporomandibular area. He also did a miniature CAT Scan of my jaw and face. He told me I had severe inflammation in my TMJ and jaw areas. He put me on a 5-day prednisone pack that started off at a high dose and tapered off to a lower dose. He told me to take tizanidine twice a day every day. I was already on tizanidine when I received the vaccinations, but I only took it as needed for PRN; the only difference was that I now had to take it twice a day every day. Dr. told me to take Celebrex on a daily basis; before, I only took it as needed, but now he wanted me to take it every day. Dr. referred me to a physical therapist who specializes in treating TMJ disorder. Dr. also put me on a mechanical soft diet for 90 days. Dr. also wanted me to use mouth splints all night while sleeping and to use a different pair for daytime time use. I agreed to do this, and I got fitted for the mouth splints. Dr. recommended I receive injections into both of my temporomandibular joints, which I declined. My headaches have since become severe, so on 7/12/2021 and 7/13/2021, I had the recommended injections in my temporomandibular joints and jaw area. On 7/12/2021, he gave me an occipital block for the headache.

Other Meds: Metoprolol succinate, lisinopril, Crestor, amlodipine, tizanidine, Percocet, Celebrex, Trintellix, bupropion, vitamin D3, aspirin, multivitamins.

Current Illness: None.

ID: 1498675
Sex: F
Age: 43
State: MI

Vax Date: 01/05/2021
Onset Date: 01/09/2021
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: Procardia, Vicoden and Flagyl

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

Symptoms: Raised rashes on wrist, forearm, behind bilateral legs, stomach and breast. Left breast extremely enlarged and injection site warm to touch and swelling down arm and red. Sweating profusely, extremely fatigue, unable to get out of bed, no appetite, and headache

Other Meds: Micardis, and Potassium Chloride

Current Illness: N/A

ID: 1498676
Sex: F
Age: 11
State: CA

Vax Date: 07/23/2021
Onset Date: 07/23/2021
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: none

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

Symptoms: Passed out and seized for 10 seconds, patient was confused for about 5 minutes after incident.

Other Meds: none

Current Illness: none

ID: 1498677
Sex: F
Age: 70
State: AZ

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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient received the second dose outside the CDC recommended window of 21-42 days. First dose was administered on 5/30/21, and second dose on 7/23/21 (54 days later).

Other Meds:

Current Illness:

ID: 1498678
Sex: M
Age: 23
State: NY

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient received vaccine in the left arm around 5:30 pm. About 2 minutes later, patient complained of feeling hot and lightheaded and was sweating. We gave the patient some water to drink and continued to monitor his symptoms. After about 2-3 minutes, the patient said he was feeling much better, though he had a "tingling sensation" in his hands. We continued to monitor for another 15 minutes, after which the patient stated he was feeling much better.

Other Meds:

Current Illness:

ID: 1498679
Sex: F
Age: 68
State: IL

Vax Date: 03/03/2021
Onset Date: 03/03/2021
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: sulfa; erythromiacin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Immediate extreme pain upward into the shoulder and joint. Severe pain for 30 hours then somewhat less severe for 4 weeks; slowly lessening pain but as of July 23rd still not able to have full use of arm; radiating pain in shoulder and downward below elbow and into hand.

Other Meds: Lisinopril 10 mg

Current Illness: None

ID: 1498680
Sex: F
Age: 59
State: TN

Vax Date: 07/19/2021
Onset Date: 07/20/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient stated that she started breaking out in hives the day after the injection. She described the area as down her arms, across her chest, and across her neck. She reported the reaction on 7/23/2021 and said that she was still experiencing hives.

Other Meds:

Current Illness:

ID: 1498681
Sex: F
Age: 30
State: WA

Vax Date: 04/17/2021
Onset Date: 05/28/2021
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: None

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

Symptoms: Starting a month after my 2nd vaccine I started getting extremely bad vertigo, hearing loss on my right ear, and tinnitus in my right ear. This has been ongoing since May and is still happening. I have multiple attacks a week. My OB referred me to an ENT who is not sure what the cause is and is having me see other specialist including an audiologist, cardiologist, and a neurologist. So far no cause for the vertigo has been found.

Other Meds: Prenatal vitamins Iron supplement

Current Illness: None

ID: 1498682
Sex: M
Age: 18
State: IL

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: fainting, recovered in pharmacy after about 15 minutes, was given one dose of ammonia inhalant.

Other Meds:

Current Illness:

ID: 1498683
Sex: F
Age: 59
State: WA

Vax Date: 01/11/2021
Onset Date: 03/17/2021
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: Penicillin

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

Symptoms: Two months after the second dose of the vaccine I started to have headaches. I was experiencing fatigue. I was having the headaches two to four times a week. I have not had a problem with headaches in the past. I was managing them with Tylenol and a cold washcloth over the face. I was newly diagnosed with Hypertension in April 2021. My blood pressure fluctuates between really low and really high. I am still working on treatment that controls the blood pressure.

Other Meds: Multivitamin

Current Illness:

ID: 1498684
Sex: F
Age: 49
State: CA

Vax Date: 05/26/2021
Onset Date: 05/27/2021
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: None

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

Symptoms: Headache, chills, sweating, fever, nausea and vomiting

Other Meds: None

Current Illness: None

ID: 1498685
Sex: M
Age: 33
State: NY

Vax Date: 05/26/2021
Onset Date: 06/01/2021
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: Sulfa

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

Symptoms: For about three weeks after the vaccine I had an adverse reaction to drinking alcohol even to the extent of feeling strange and bad after two drinks and having to stop drinking. The feeling has since receded.

Other Meds: Bupropion, Lisinopril, Atenolol, Amlodipine

Current Illness: None

ID: 1498686
Sex: F
Age: 27
State: NY

Vax Date: 07/21/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Patient reported mild swelling and itchiness in his hands and feet starting approximately two days after vaccination. He was advised to take diphenhydramine as directed per over-the-counter packaging. He was instructed to contact his primary care physician/urgent care if the condition were to worsen or if he were to have any difficulty breathing.

Other Meds:

Current Illness:

ID: 1498687
Sex: F
Age: 37
State: FL

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: Ceclor Sulfa Amoxicillin

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

Symptoms: Nausea, vomiting, body aches, headache, fever, chills, pain, felt worse than when I had covid.

Other Meds: Verapamil Cellcept Plaquenil Duloxetine Omeprazole Prednisone

Current Illness:

ID: 1498688
Sex: F
Age: 14
State: CA

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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: No Adverse event noted at time of administration. Patient was given 2 doses of Pfizer vaccine during 7/23/2021 visit at approx. 7:45am . Patient did not suffer any ill effect at time of visit and up to an hour after administration.

Other Meds: n/a

Current Illness: none

ID: 1498689
Sex: F
Age: 25
State: AZ

Vax Date: 04/05/2021
Onset Date: 07/19/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Blood clot

Other Meds: birth control, spironolactone

Current Illness:

ID: 1498690
Sex: M
Age: 18
State: CA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
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: NKDA

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

Symptoms: After patient was given the HPV vaccination: Pt had vasovagal response, noted to periorbital area with pallor appearance, with slight muscle twitching to face, no stop with breathing - Patient then was talking and coherent - BP rechecked: 118/78

Other Meds: Multi-vitamin

Current Illness: None

ID: 1498691
Sex: F
Age: 51
State: FL

Vax Date: 04/12/2021
Onset Date: 06/24/2021
Rec V Date: 07/23/2021
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: None

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

Symptoms: Heavy diarrhea that lead to very bloody stool. Major pain on lower right side. Dr thought perhaps it was appendix but then identified an infection in colon close to appendix . Admitted to hospital 3 days of antibiotics and not identified reason for illness. System seemed compromised. Also, Alfred vaccine, all metal objects stuck to skin where shot was administered.

Other Meds: GNC multi vitamin, primrose oil, probiotic,

Current Illness: None

ID: 1498692
Sex: M
Age: 23
State: OR

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

Lab Data:

Allergies: Propranolol Bee Stings

Symptom List: Unevaluable event

Symptoms: Chest Pains Shortness of Breath

Other Meds: Smokes Marijuana

Current Illness: no acute illness

ID: 1498693
Sex: F
Age: 17
State: WA

Vax Date: 07/06/2021
Onset Date: 07/23/2021
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: none

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

Symptoms: Blood clots near / in lungs, shortness of breath

Other Meds: Birth control pills, paxil

Current Illness: none

ID: 1498694
Sex: F
Age: 60
State: CA

Vax Date: 03/21/2021
Onset Date: 03/21/2021
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: Rx pain medications. All I?ve ever used

Symptom List: Injection site pain, Pain

Symptoms: First 3 days - headache, nausea, body pain, chills, sweats,fatigue. About 3 weeks to present. Memory loss, brain ?fog? Using the wrong word when speaking. ( not the word I was thinking ? , doing stupid things that I wouldn?t normally do , not thinking clearly. Forgetting where I?m going and what I?m doing with a long effort to recall where I am / what I?m doing.

Other Meds: Thyroid hormone Tylenol

Current Illness: None

ID: 1498695
Sex: F
Age: 41
State: OH

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Vaccine given around 4:30 PM 07/22/2021 Started feeling achy, feverish, chills and headache around 8:00 PM 07/22/2021 Went to bed around 11:30 PM tossed and turned waking every hour 07/22/2021 Temperature taken @ 3:45 AM was 101.9 and @ 5:30 AM was 102.1 07/23/2021 Called NP at 6:30 AM asking about taking Tylenol and Ibuprofen due to the pamphlet stating to check with health professional first . Was advised to alternate OTC Tylenol and Ibuprofen. 10:00 AM 07/23/2021 low grade fever, still achy and headache 7:00 PM 07/23/2021 feeling better just achy from laying around

Other Meds:

Current Illness:

ID: 1498696
Sex: F
Age: 70
State: SC

Vax Date: 04/15/2021
Onset Date: 04/18/2021
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: no

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

Symptoms: i started to get a rash on my left shoulder and i didnt know what it was. I thought it was something that happened from what i washed my clothes in. when i woke up that morning it was spreading and they thought it was shingles. i am still dealing with this.

Other Meds: vitamins

Current Illness: no

ID: 1498697
Sex: F
Age: 30
State: CA

Vax Date: 04/15/2021
Onset Date: 06/28/2021
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: chemical sunscreen, penicillin, Co-Trimoxazole

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: intense breast pain over two days. took painkillers and found it hard to sit or stand up. Mostly in left breast. unusual because I never get menstrual-related breast pain - only mild soreness. I talked to my obgyn and she suggested it was due to IUD (unusual since I've had it for four years) and/or caffeine intake.

Other Meds: asthma meds (inhaler, montelukast), allegra/benadryl

Current Illness:

ID: 1498698
Sex: M
Age: 26
State: IL

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: patient felt nauseous, so when he stood up to go the restroom, he took a few steps and then fainted.

Other Meds: unknown

Current Illness: unknown

ID: 1498867
Sex: M
Age: 20
State: NY

Vax Date: 07/23/2021
Onset Date: 07/23/2021
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: amoxcillin (not anaphylactic)

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

Symptoms: Patient received Janssen vaccination in our shot room and was able to walk to the waiting area without assistance or complaint of feeling ill. Within 5 minutes the patient passed out as he tried to move to a chair closer to his father. He fell to the floor and lost consciousness. He almost immediately regained consciousness, however, was very confused and disoriented for a short time. 911 was called. I stayed with the patient, gave him water, and made sure he stayed on the floor until EMS arrived. They checked the patient out and concluded that he was ok to leave with his father. A trip to the hospital was not necessary. The patient has a small cut behind his left ear, but otherwise was ok.

Other Meds: Not sure

Current Illness: none reported

ID: 1498868
Sex: F
Age: 32
State: MO

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

Lab Data:

Allergies: Milk Orange Juice Codeine

Symptom List: Nausea

Symptoms: I have been having chest pain that persists through to my upper back. Pain is new not something I have felt before and feels like it is located between my collar bone and breast. I have been unable to get into my pcp or an urgent care.

Other Meds: New Chapter Women's Multivitamin

Current Illness: n/a

ID: 1498869
Sex: F
Age: 21
State: FL

Vax Date: 07/09/2021
Onset Date: 07/12/2021
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: None

Symptom List: Injection site pain

Symptoms: Patient received her second dose of the Moderna covid vaccine on 07/09/2021. On 07/12/2021 the patient woke up with blurry vision in both eyes. The patient was seen by an urgent care physician, an optometrist, and a retinal eye specialist. She was diagnosed with bilateral acute macular neuroretinopathy - post covid. She was given Durezol 0.05% eye drop four times daily for one week and returned to the specialist on 07/21/2021. There was no significant improvement in her vision. The patient will continue the Durezol eye drops for one more week and be seen by the specialist again.

Other Meds: Oral contraceptive (Drospirenone 3mg and Ethinyl Estadiol 0.02mg)

Current Illness: None

ID: 1498870
Sex: F
Age: 48
State: MA

Vax Date: 04/22/2021
Onset Date: 04/23/2021
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: Onions

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

Symptoms: Arm went numb and tingly the next day along with heavy feeling. Tingling went up into neck and face. By Saturday afternoon jaw-line felt like it was down to participants chest. Sunday symptoms got much worse along with feeling of sores on head. Pimple like things on right shoulder.

Other Meds: None

Current Illness: None

ID: 1498871
Sex: F
Age: 65
State: ID

Vax Date: 02/21/2021
Onset Date: 03/31/2021
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: RA

Lab Data:

Allergies: NKDA

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

Symptoms: About 2.5 weeks after receiving her second Pfizer COVID vaccine pt started feeling sick with fevers, achiness, sciatic nerve pain, muscle pain, joint pain. On 4-11-21 she started taking hydroxichloriquine and a z-pak from the front line COVID doctors. She took the medications and seemed to do well but on the 3rd or 4th day she started hurting again. After she finished the meds she went to the Center. She was put on supplements and Ivermectin and another course of hydrochloroquine. She also was in the oxygen chamber twice. She then started taking peptide shots twice a week which really seemed to help. These started wearing off after about 3 days. She took her last one on 6-7-21 and the pain was back by her first visit with me on 6-9-21. She did test positive for COVID between getting her second vaccine and the time I saw her. By the time I had my first visit with her she had muscle aches and pains in general and severe joint pain - mostly to shoulders, hips. Her legs were constantly achy. The pain seems to migrate. Her R sided sciatic pain is more severe and stretching doesn't seem to help. She has been experiencing muscle spasms to her legs/feet at night. I started her on Low Dose Naltrexone after our first visit and got labs.

Other Meds: Vitamin D3 1000 iu, Gingo 60mg daily, magnesium 300mg daily, calcium 500mg twice a day, multivitamin daily, allegra-D daily, flonase 1 spray each nostril daily

Current Illness: None

ID: 1498872
Sex: M
Age: 21
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No Known Allergies

Symptom List: Tremor

Symptoms: Patient fainted about 15 seconds after vaccine was given. He was given water, various types of sugar products. Patient stated that he had not eaten all day. Vitals were taken and all were within normal range (119SBP, %SO2 98 and PP 85). Patient was conscious and coherent. He was observed for another hour after which final vitals were taken and he was still within normal range (129/86, %SO2 98, PP70). He was able to call a friend to pick him up.

Other Meds: Per patient does not take any medications

Current Illness: Per patient no illnesses

ID: 1498873
Sex: F
Age: 18
State: AL

Vax Date: 07/20/2021
Onset Date: 07/20/2021
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: Erythema, Pruritus

Symptoms: Headache, Fever, chills, muscle spasms, left arm pain, left hand contracture onset one hour post vaccination administration. Resolved after 400mg Ibuprofen administered. Pt returned to office after onset of symptoms. Tylenol 650mg administered and patient symptoms continued to improve. Patient remained in office from 3:15-4:45 and then discharged home. Phone call by MD at 9:00pm and symptoms completely resolved.

Other Meds: Oral contaceptives

Current Illness: None

ID: 1498874
Sex: F
Age: 34
State: ID

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/23/2021
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: topical Tide allergy

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

Symptoms: Blurry vision. Unable to stand. Extreme sweating. Able to have similar blood pressure standing and sitting by ~ 12:30. Felt off the day and a half.

Other Meds: None

Current Illness: None

ID: 1498875
Sex: F
Age: 59
State: CO

Vax Date: 07/16/2021
Onset Date: 07/16/2021
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: sulfa, contrast media

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

Symptoms: Hip and legs bone, muscle, muscle insertion extreme pain, increased heart rate, increased blood pressure, one episode of leg weakness, bright red lupus looking (malar) rash on face. It was hot to touch and burning. ER gave me toradol, steroids, and fluids. Facial rash and pain resolved that night. Bright red malar rash came back Saturday, Sunday, Monday.....comes back now when hot or out in the sun just on face.

Other Meds: low dose naltrexone, HCQ, estradiol, pantoprazole, biotin, ketotifen, restasis, serum eye drops , vit c, salt

Current Illness: Sjogrens related dysautonomia, small fiber neuropathy, POTS, dryness (eyes, mouth), PCOS

ID: 1498876
Sex: M
Age: 58
State: WA

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient was given Pfizer vaccine under direction from physician. After receiving the Pfizer shot, he disclosed that he actually received the Johnson and Johnson vaccine back in April and that he was very afraid of the variant. His physician told him that he should wait about a month in between getting a Johnson and Johnson and a Pfizer vaccine. He decided to wait about 3 months just in case. He never mentioned anything about receiving a previous COVID vaccine prior to immunization. He only disclosed that fact after the immunization.

Other Meds:

Current Illness:

ID: 1498877
Sex: F
Age: 53
State: CA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
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: Morphine

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

Symptoms: After receiving the first COVID-19 vaccine dose I have experienced severe joints pain and joints stiffness. Also, for a week I had excessive tiredness. More concerning is the postmenopausal bleeding. After 15 months of menopause I started bleeding, having a full period cycle with all the PMS symptoms. The period continued for the next two months.

Other Meds: N/A

Current Illness:

ID: 1498878
Sex: M
Age: 38
State: CA

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

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

Symptoms: Patient states that he felt a sore left arm for several days after vaccination, then it subsided, then is came back and it still hurts to this day. Patient states that he has difficulty moving his arm and it hurts a lot. (Duration 16 days and ongoing). Patient reports the side effect as "dead arm".

Other Meds:

Current Illness: unknown

Date Died: 05/07/2021

ID: 1498879
Sex: M
Age: 84
State: NJ

Vax Date: 02/12/2021
Onset Date: 03/22/2021
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:

Symptom List: Pain in extremity

Symptoms: Bilateral retinal branch vein occlusions 1 month after. Died 5/7/21

Other Meds:

Current Illness:

ID: 1498880
Sex: F
Age: 67
State: CA

Vax Date: 04/17/2021
Onset Date:
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: Flu-like symptoms: achy, headache, chills, difficulty getting out of bed.

Other Meds:

Current Illness:

ID: 1498881
Sex: F
Age: 67
State: FL

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

Lab Data:

Allergies: Morphine, Demerol

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

Symptoms: Patient reported feeling numbness in her bottom lip around fifteen minutes after the vaccine was administered.

Other Meds:

Current Illness:

ID: 1498882
Sex: F
Age: 77
State: VA

Vax Date: 03/18/2021
Onset Date: 04/21/2021
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: Developed Trimingeal Neuralgia one week after second shot

Other Meds: Janumet, Celebrex, Warfin, Atorvastatin, Allegra, Centrum Silver Women Vitamin

Current Illness: Bursitis, A-fib, diabetes, hypertension

ID: 1498883
Sex: F
Age: 62
State: VT

Vax Date: 06/03/2021
Onset Date: 06/07/2021
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: codeine

Symptom List: Vomiting

Symptoms: Raspatory issues Muscle pain fatigue Tested For congestive heart failure Severe diaheara

Other Meds: insuline umalog losartan

Current Illness: no

ID: 1498884
Sex: M
Age: 35
State: WA

Vax Date: 04/23/2021
Onset Date: 05/27/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: At the end of May I began having chest pain. At first I thought it was a sore muscle, but it got worse, not better. It got bad enough to go the the ER June 11. They discharged me after doing labs and an x-ray as they ruled out a heart attack. I then went to a cardiologist June 22nd and he looked over my labs and said I wasn?t having a heart attack. He sent me off without any other tests not sure what was causing the pain. It began subsiding around July 15th, but I still have pain every now and then.

Other Meds: None

Current Illness: None

ID: 1498885
Sex: M
Age: 16
State: CA

Vax Date: 07/23/2021
Onset Date: 07/23/2021
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: Client at vaccination table. per NP client loss consciousness less than a second. history of episode of syncope. NP at station assessing client. client did not fall or hurt himself, NP was at clients side. EMT called VS obtained at 2:48pm HR 63 BP 86/47 o2sat 97%, VS at 2:50pm HR 64 BP 91/57 o2sat 98%, last VS obtained at 3:07pm HR 77 BP 95/58 o2sat 98%. client remained in observation until 3:28pm no other complaints. client left observation with father at his side, client ambulating on his own.

Other Meds:

Current Illness:

ID: 1498886
Sex: M
Age: 41
State: MI

Vax Date: 03/18/2021
Onset Date: 03/19/2021
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: Dairy, freshwater fish

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Chronic hives. Sought treatment in May after it did not go away and became worse. Dr. prescribed 180mg Allegra and 10mg singulair. This seems to keep it under control. After 1 mo. hives came back after only stopping treatment for 1 day. Restarted treatment.

Other Meds: Alphagan P

Current Illness: None

ID: 1498887
Sex: F
Age: 68
State: CA

Vax Date: 06/04/2021
Onset Date: 06/12/2021
Rec V Date: 07/23/2021
Hospital:

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

Lab Data:

Allergies: ampicillin amox augmentin- immune complex disease-polyarthritis and rash-post root canal 1996 taxol-2005, neurontin-stevens johnsons syndrome, Pain meds- Demerol morphine ultram- vomiting, anaesthesia-dilaudid itchy

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

Symptoms: Received MMR on 6/4/21 approx 8 days later started having Joint pain R base of r big toe r knee then left knee then hand bilateral . Pain 1/10 scale_3-4/10 up to 5 _currently. Was 8/10. Now in b/l hands Precipitating Factors___sleeping on the joints very stiff______very stiff in hands in the morning_exercise Palliative Factors______Light exercising of hands Ice, motrin, needs to massage in the morning Self treating with Ibuprofen 600 mg bid Is being referred to Rheumatologist through workers comp.

Other Meds: Tylenol Arn, ibuprofen 600MG BID, Vitamin D3 2000 once a day, fish oil 1000 once a day, flax seed oil 1400 once a day. Evista 60 mg once a day bone density estrogen blocker, Denosumab q 6months im injections, 20 mg valsartan, 12.5 mg HCTZ

Current Illness: had tetanus in April 2021 5/30 complained of not feeling well that weekend- no fever self resolved

ID: 1498888
Sex: M
Age: 64
State: CO

Vax Date: 07/02/2021
Onset Date: 07/23/2021
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: No adverse events. This dose of Pfizer was administered inadvertently after the patient had received a dose of the Janssen Covid vaccine in March 2021.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm