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: 1501066
Sex: M
Age: 13
State: TN

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: idiopatic syncope, patient fainted immediately after injections awoke in about 15 seconds was weak and a little unstable we called 911 at moms request, paramedic concurred with a diagnosis of ipiopathic syncope

Other Meds: none

Current Illness: patient has a heart stent related to a heart valve problem, she did not inform me of this till after the vaccination, she did not list in on the VAR and told me he had no health conditions we I questioned her before the vaccination

ID: 1501067
Sex: F
Age: 49
State: FL

Vax Date: 07/22/2021
Onset Date: 07/24/2021
Rec V Date: 07/24/2021
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: No

Symptom List: Anxiety, Dyspnoea

Symptoms: Itchy, red rash on stomach and back this morning. I feel fine, but the rash is a bit strange and I thought it was worth reporting, as when I googled it, others have had a rash as well.

Other Meds: Zzzquil

Current Illness: No

ID: 1501068
Sex: M
Age: 57
State: GA

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 07/24/2021
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: NA

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

Symptoms: Ringing in my beard srtednwithim an hour of vaccination. Still prevalent 10 hrs. later

Other Meds: Lisinipril and. Hunter Test (supplement)

Current Illness: NA

ID: 1501069
Sex: F
Age: 47
State: TN

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Large red welt at injection site; hard and hot to touch, painful to touch; chills, muscle ache, headache and horrible neck pain

Other Meds: None

Current Illness: None

ID: 1501070
Sex: M
Age: 44
State: TX

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 07/24/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: I woke up the next day after getting vaccinated and had a 30 second seizure at 10:30 a.m.

Other Meds: Mirtazapine, Gabapentin, Klonopin, methylphenidate

Current Illness:

ID: 1501071
Sex: F
Age: 24
State: FL

Vax Date: 07/21/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
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: Aleve Lamictal Wellbutrin Various antidepressants

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

Symptoms: Severe hives, skin allergy, pancake hives, itchiness, full body rash that lasted more than 24 hours

Other Meds: Colace, magnesium, St. John?s wort, fish oil, probiotics

Current Illness: Interstitial Cystitis Pelvic Floor Dysfunction

ID: 1501072
Sex: F
Age: 18
State: AK

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
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: PENICILLIN

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: PATIENT FAINTED 5 TO 10 MINUTES POST ADMINISTRATION. SHE WAS NOT UNCONSCIOUS FOR ANY MEASURABLE AMOUNT OF TIME. SHE DID REMAIN DIZZY AND LIGHT HEADED FOR APPROXIMATELY 15-20 MINUTES BUT RECOVERED AFTER DRINKING SOME WATER AND ORANGE JUICE.

Other Meds: NONE

Current Illness: NONE

ID: 1501073
Sex: F
Age: 23
State: VA

Vax Date: 07/15/2021
Onset Date: 07/17/2021
Rec V Date: 07/24/2021
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: I had a rash come up bilaterally in my arms, legs, hands, and feet. I am currently taking Benadryl every 6 hours, Zyrtec, prednisone, and hydrocortisone cream . Twice a day. I?ve been in this medication for three days. It?s getting better but not fully there.

Other Meds: Nexplaon

Current Illness:

ID: 1501074
Sex: M
Age: 78
State: TN

Vax Date: 02/03/2021
Onset Date: 06/22/2021
Rec V Date: 07/24/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Four months after the second injection I was awakened after midnight by a painful red rash from my neck to my feet that burned and itched for about 2 hours. I put a wet towel on my chest and neck, but it did not stop the pain and the redness. I began rubbing my body from my neck down to my waist. After about 20 minutes the pain and redness began to disappear very slowly. I then began to rub my chest and legs for another 20 to 45 minutes and the pain and redness begin to be releaved. Last night (7/23/2021) I awoke at 1:30 AM with a painful red rash on both legs that itched like mosquito bites. The rash was primarily on the inside of both legs and down to my feet. I started using Cortizone 10 (it did not help), then I switched to Triamcincolone Acetonide Cream USP, 0.1% (that did not help) and then Halonate .005% (that did not help). It took almost an hour of rubbing my legs before the itching and burning subsided.

Other Meds: No prescriptions - OTC: Align - 1 caplet, B-12 -1 tablet 500 micro grams, D-3 125 10000 ius 2 per day, Dulcolease 400 milligrams, 4 per day, Magnesium 500 milligrams, 1 per day and Melatonin 10 milligrams - 1 per day

Current Illness: None

ID: 1501075
Sex: F
Age: 32
State: PA

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/24/2021
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: 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: Sprintec 0.25 mg-35 mcg Provera 10 mg

Current Illness:

ID: 1501076
Sex: F
Age: 56
State: NY

Vax Date: 03/29/2021
Onset Date: 04/04/2021
Rec V Date: 07/24/2021
Hospital: Y

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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Chronic numbness in the face and chronic gallbladder infection/inflammation. There was a gallstone before vaccine but after vaccine the gallbladder became inflamed and numbness on the face was chronic.

Other Meds:

Current Illness: Gallbladder stone and some intermittent pain

ID: 1501077
Sex: F
Age: 43
State: PA

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/24/2021
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: Peanut adhesive bandage

Symptom List: Rash, Urticaria

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: hydroxyzine HCI 25mg metoclopramide 5 mg

Current Illness:

ID: 1501078
Sex: M
Age: 86
State: NY

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: UPON ENTERING THE INFORMATION ON NYSIIS I HAD FOUND THAT EVEN THOUGH THE PATIENT STATED THAT HE HAD NEVER BEEN VACCINATED FOR COVID-19 . BY ANY OF THE THREE VACCINES THAT HE HAD INDEED BEEN VACINATED TWICE WITH THE MODERNA VACCINE LOT#012C20A ON 1/12/21 AND ON 02/12/21 MODERNA LOT 012M20A AT URGENT CARE.

Other Meds:

Current Illness:

ID: 1501079
Sex: F
Age: 64
State: PA

Vax Date: 07/06/2021
Onset Date: 07/06/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 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:

Current Illness:

ID: 1501080
Sex: F
Age: 11
State: PA

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/24/2021
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: n/a

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

Symptoms: Patient was sitting in the exam table while her vaccines were being given Immediately after the above vaccines were given, even as band aid was being applied to immunization sites . patient leaned forward, looked very pale, she was assisted to lie on the exam table. She had an LOC and a tonic seizure . The office code for such an emergency was called, patients vitals were measured, she became responsive and alert within a few minutes, was oriented to place and person. She was able to go home without any further incidence or complications

Other Meds: n/a

Current Illness: n/a

ID: 1501081
Sex: M
Age: 50
State: IL

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
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: 15-20 minutes after vaccine pain in chest on left side near heart, sharp for 10-15 sec and than tingling constant dull pain, sharp pain happened multiple times since the injection. Went to ER on advice from physician, had multiple tests including blood work, EKG, CT angiogram d-dimer high, did not show heart issues but it did show minimal basilar atelectasis. Currently still having pain and started incentive spirometer.

Other Meds:

Current Illness:

ID: 1501082
Sex: F
Age: 47
State: NC

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 07/24/2021
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: For three days after vaccine had head and body ache, chill, fever. Felt better after this for a few days. On April 26 went for a walk with neighbor, heart shaking and pounding very tired. Over next few weeks at different times felt very tired heart pounding near faint low and high pulse at times. May 24 almost pass out dizzy heart pounding. Tried to see Dr. no appoints available. On June 11 went to urgent care and referred to hospital emergency room, did many test, told had Premature Ventricular Contractions. June 18 saw cardiologist. Did EKG Holter monitor. July 19 cardiologist said had "Right Ventricular Outflow Tract Tachycardia. Will see heart specialist at the hospital on August 3, 2021. Patient currently can not do any physical activity. Many times she feels she is having a heart attack. Her life has changed dramatically. We will see what the Special Cardiologist recommends for treatment on August 3rd. Patient was in excellent health before this. Never has smoke or drank alcohol. Would drink one cup of coffee in morning and drink water the rest of the day. Eats healthy lean meat and vegetables etc. Exercises regularly. No one in her family (parents siblings) has had any heart problems. For three days after vaccine had severe flu like symptoms. Felt better for a few days and then went on a 2 mile walk with a 73 year old neighbor. A walk that she has done many times before this with no problems Had reaction during walk as state above. We feel the vaccine caused something to happen with her heart. She had never had any issue before the vaccine and was in excellent health.

Other Meds: iron supplement

Current Illness: none

ID: 1501083
Sex: M
Age: 12
State: SC

Vax Date: 07/18/2021
Onset Date: 07/24/2021
Rec V Date: 07/24/2021
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: Welt and rash on the left arm, 3 inches below the injection site. Itching and redness. Welt appeared days after vaccine.

Other Meds: None

Current Illness: None

ID: 1501084
Sex: M
Age: 41
State: KS

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/24/2021
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: Full Hearing loss in left ear the next day after receiving the 1st shot. Also light headed as if my head was full of helium.

Other Meds:

Current Illness:

ID: 1501085
Sex: F
Age: 13
State: MS

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: Penicillin- rash

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

Symptoms: The patient is a 13 year old girl who was inadvertently enrolled to receive Moderna vaccine after her mother, gave permission for her daughter to be vaccinated. She looked older than 18 years and so her age was not double checked at the time of administration. Patient was observed for 30 min after the immunization and looked well at the time of discharge.

Other Meds: None

Current Illness: none

Date Died: 03/28/2021

ID: 1501086
Sex: F
Age: 91
State: MO

Vax Date: 03/17/2021
Onset Date: 03/26/2021
Rec V Date: 07/24/2021
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: Day 8 following 2nd Moderna vaccine shot, patient began experiencing heaviness, dull pain in chest. She layed down which seemed to help alleviate the chest issues. Day 10 after receiving the second Moderna shot, patient died suddenly while sitting in her recliner of cardiac arrest. There were no symptom s leading up to the event.

Other Meds: Metformin, Irbesartin, Gabapentin, Atorvastatin, Naproxen, Vit D3, Krill Oil

Current Illness: None

ID: 1501087
Sex: F
Age: 46
State: FL

Vax Date: 02/24/2021
Onset Date: 07/05/2021
Rec V Date: 07/24/2021
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: Unevaluable event

Symptoms: Bell?s palsy

Other Meds: Wellbutrin Pristiq Lo loestrin

Current Illness: None

ID: 1501088
Sex: F
Age: 37
State:

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
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: Initial dizziness immediately after vaccine administered; then confusion after leaving facility. Difficulty driving and operating vehicle. Confusion cleared up after a light snack.

Other Meds: Herbal supplements; Prilosec; Magnesium

Current Illness:

ID: 1501089
Sex: M
Age: 78
State:

Vax Date: 02/11/2021
Onset Date: 07/20/2021
Rec V Date: 07/24/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Pt presents with cough, fever. Diagnosed with pneumonia w/ groundglass opacities.

Other Meds:

Current Illness:

ID: 1501091
Sex: F
Age: 43
State: CT

Vax Date: 05/01/2021
Onset Date: 05/02/2021
Rec V Date: 07/25/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Insomnia and fever in middle of the night along with racing pounding heart. Extreme heartburn began the next day following vaccination lasting approximately 6-8 hours. Heartburn meds, such as antacid and famotadine, did nothing to help. Was ready to go to ER due to severity of pain but it spontaneously resolved at approx 8pm. I didn't report because it resolved on it's own so completely but now wonder if it was an inflammatory response. I do have a trivial heart murmur which I forgot to mention in the previous section. Thanks for reading this.

Other Meds: N/A

Current Illness: N/A

ID: 1501092
Sex: F
Age: 42
State: CA

Vax Date: 04/01/2021
Onset Date: 04/09/2021
Rec V Date: 07/25/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: April 9th at 07.50 in the morning I had a acute left middle cerebral artery stroke. Paralyzed on all of the right side. Impaired speech. Brought in by ambulance at 08.10

Other Meds: Cosentyx

Current Illness:

ID: 1501093
Sex: F
Age: 30
State: CA

Vax Date: 12/24/2020
Onset Date: 01/11/2021
Rec V Date: 07/25/2021
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 at the time of vaccination.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 5/15 I began experiencing hives, now I'm diagnosed with Chronic Hives.

Other Meds: NA

Current Illness: None

ID: 1501094
Sex: F
Age: 62
State: MI

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

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

Lab Data:

Allergies: Levaquin, codeine, dairy and now heightened chemical sensitivity to antibacterial cleaning products now due to COVID prevention and recommendations for wiping down food and surfaces since March of 2020.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: After the Pfizer injection, I waited for 30 minutes at the hospital. I drove home and began having a terrible headache/migraine (which I do NOT get/have). My left arm was sore which I expected based on family members input. I then broke out with a slight rash on my left arm and then welts began to appear on my left shoulder. I showered with an oatmeal bar to help relieve the itching and reduce the swelling. I continued to drink fluids on Wednesday from 5 to 1030 p.m. The nurse at the hospital that gave me the injection suggested Tylenol and fluids. I did both. On Thursday from 7 a.m. to approx 1 p.m. the headache and pounding remained. I was lethargic and just slept. Very little energy and had sensitivity to light on Thursday. Loss of appetite. This occurred from Thursday through late Saturday afternoon. I also began to have shingles appear/small bumps that have now begun to fade on my left trunk, calf and right calf. They began to appear early Thursday a.m. My headache is now gone as of Sunday 7/25 @ 12:12 a.m.

Other Meds: Vitamin C, Vitamin D (which my physician recommends due to my osteoporosis)

Current Illness: MINOR Shingles outbreak occurred (even though I had the SHINGREX) vaccine at age 60 the morning after my 1st Pfizer covid shot. NOTE: I also reported my reaction to the SHINGREX vaccine (1st and 2nd injection) to the CDC and my doctor.

ID: 1501095
Sex: F
Age: 33
State:

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

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

Lab Data:

Allergies: None

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

Symptoms: Tennis ball size allergic reaction at site of injection. Warm to touch, itchy, very painful, red. Started day after the receiving the vaccine. Taking ibuprofen and Benadryl to help, but it is continuing to get bigger.

Other Meds: Trivora birth control, fluoxetine, methocarbamol

Current Illness: None

ID: 1501096
Sex: F
Age: 15
State: IL

Vax Date: 07/01/2021
Onset Date: 07/08/2021
Rec V Date: 07/25/2021
Hospital:

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

Lab Data:

Allergies: I have post nasel drip & I?m probably allergic to Red-Dye.

Symptom List: Nausea

Symptoms: The symptoms happened after a few days my throat started to hurt a lot & I still have the throat pain as I keep continuing typing this & my throat pains gets worse at night, it?s hard to pass down saliva, eat, drinking or even talking. I feel like there?s a rock inside my throat.

Other Meds: I only took medication for depression & anxiety.

Current Illness: No but ever since getting the Pfizer COVID 19 vaccine my throat is hurting a lot like in 2 weeks.

ID: 1501097
Sex: M
Age: 32
State:

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/25/2021
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: Tachycardia, shortness of breath, slight chest pain, low grade fever, overall discomfort I

Other Meds: Tylenol we

Current Illness: None

ID: 1501098
Sex: M
Age: 42
State: NY

Vax Date: 03/19/2021
Onset Date: 04/20/2021
Rec V Date: 07/25/2021
Hospital:

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

Lab Data:

Allergies: basil, soy & pea proteins

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

Symptoms: The first was the Janssen on 3/19/21 in which I felt fever-like symptoms that was mainly an achy, weak body that begin about 12 hours since the shot and lasted for 36 hours. This was the most sever experience. The second was the Pfizer on 6/30/21 in which I felt fever-like symptoms again in the same way as above 12 hours after getting the shot, which lasted for about a day. The third was the second Pfizer on 7/21//21 in which I felt the same as above except it began 6 hours after the shot and, though less sever than the previous two, it lingered for 2 and a half days.

Other Meds: Sertraline (50 mg)

Current Illness: no

ID: 1501099
Sex: F
Age: 58
State: OH

Vax Date: 07/25/2021
Onset Date: 07/25/2021
Rec V Date: 07/25/2021
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: Peniclian Multiple # sexier/control meds tried with my Traumatic Brain injury Also latex

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

Symptoms: Sharp pain to *temple of head,* Irradic heart BP & *Pulse * Severe Swelling of Limbs Extra On the Left Side Arms got rash that was bumpy and would burn *Also Sternum to Waiste Water retention took weight 185 To 207 over night *** Still occurring Sweeting profusely, Temperature {My norm is 87.8} Heavy breath wheezing Mucus white crystallized/hard Nebulizer air pro inhailet high 101.8 & very low 94? Dehydration Diarrhea stomach cramps chills

Other Meds: Attenol, Hydrochlorthiazide, Asprin.Remeron,Prozac, Vitm. D5,000 IU Potassium 30 meq 3 tab 1 x daily Xanax ER 1st, Prozac. Remeron Adderall, Imitrex, Prilosec, Pepcid, St Johns Whort 300mg

Current Illness: Immediately I got a shooting pain in Right temple Profuse sweeping pulse rate claimed 109-119 Irradic Blood pressure 154/135 Pulse 109 168/145 Pulse 119 My legs swelled, Left hand & arm Stomach from Sternum to waisted. Water retention Wheezing while breathing, nasel drainage upon waking hard white crystalizef

ID: 1501100
Sex: M
Age: 32
State: TX

Vax Date: 06/21/2021
Onset Date: 07/09/2021
Rec V Date: 07/25/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Tremor

Symptoms: Burning pain in chest on left side after 3rd day of receiving shot. 24 hrs after the shot fatigued,nausea, and headache developed. Those symptoms went away after 2 days. 18 days after the 2nd shot I had a heart palpitations and still burning pain on left side of chest. I continued to have heart palpitations for the next 11 days every other day. The severity of each one got less severe as time went. Emergency doctor gave me 6 days of steroids and Ibuprofen 800 MG 3 times a day. After 2 days of steroids and ibuprofen, the pain in my chest went away. It has been 16 days of bland diet and water and I still have not fully recovered. I still sometimes get sharp pains in my chest but the rapid heart beat has not come back.

Other Meds: none

Current Illness: none

ID: 1501101
Sex: F
Age: 16
State: UT

Vax Date: 07/21/2021
Onset Date: 07/22/2021
Rec V Date: 07/25/2021
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: Latex

Symptom List: Erythema, Pruritus

Symptoms: PT is reporting involuntary trembling and shaking of her arms and/or legs that lasts for a short period. She is reporting that this has happened about four times since getting the shot, with the first time occurring in the middle of the night the day after getting the shot. Last instance was tonight around 8pm.

Other Meds: None

Current Illness: None

ID: 1501102
Sex: F
Age: 49
State: TX

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 07/25/2021
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: Bactrim - Hives. Scopolamine - overdosed by incorrect prescription once; eyes fully dilated and stayed that way for 8 days. Now if I put even a tiny piece of patch on, eyes instantly dilate. Geodon - psychotic feelings

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

Symptoms: Anaphylaxis. Throat closed and I could not breath or swallow. Pharmacist contacted clinic that was on-site. The nurse and dr/PA (not sure) ran over. I am not sure of everything they did, as this triggered a seizure. After several minutes, I was able to whisper and then talk. 911 was called and an ambulance was dispatched. I heard, at that time when they were relaying vital signs, etc. that an epi pen was used on me. The EMTs then checked me over (quick physical for any injuries, rashes), took vitals and advised me to go to the ER because I was still having some issue with swallowing and because I had had the seizure. They wanted to make I was okay because I was still having some symptoms.

Other Meds: Valtrex, Nuvigil, Lamictal, Topirimate, Viibryd, Claritin

Current Illness: Non-epileptic seizures

ID: 1501103
Sex: F
Age: 69
State: CA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 07/25/2021
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: sore arm with moderate pain, redness and swelling at the site of the injection, tiredness, muscle pain, headache, shivering, fever, stomach pain, nausea and vomit

Other Meds: Effexor XR and Neurontin, Calcium, Vitamin E, Zinc, Methylcellulose , alendronate

Current Illness: none

ID: 1501104
Sex: F
Age: 21
State: NC

Vax Date: 07/22/2021
Onset Date: 07/24/2021
Rec V Date: 07/25/2021
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: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Two days after first dose of vaccine. Welts and severe itching occurred all over patients body.

Other Meds: Birth control, Zyrtec

Current Illness: N/A

ID: 1501105
Sex: F
Age: 12
State: UT

Vax Date: 07/21/2021
Onset Date: 07/22/2021
Rec V Date: 07/25/2021
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: Latex

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

Symptoms: Pt is reporting two or three instances where her leg began to shake involuntarily, with the fist instance happening during the night after she received her vaccination.

Other Meds: None

Current Illness: None

ID: 1501107
Sex: F
Age: 54
State: GA

Vax Date: 07/21/2021
Onset Date: 07/23/2021
Rec V Date: 07/25/2021
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 Sulfa Mycin meds

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

Symptoms: Chest pains

Other Meds: Progesterone Estradiol Citalopram Ciproflaxin

Current Illness: UTI

ID: 1501109
Sex: M
Age: 24
State: CA

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 07/25/2021
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: Nausea, diarrhea, chills, body aches, shortness of breath, fatigue, muscle aches, headache, sore throat

Other Meds: None

Current Illness: None

ID: 1501111
Sex: F
Age: 23
State: FL

Vax Date: 03/30/2021
Onset Date: 04/01/2021
Rec V Date: 07/25/2021
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: I received my first Pfizer vaccine dose 3/8/21 and my second 3/30/21. A few weeks later, I went to the dentist with jaw pain. She said she's seen a lot of mouth inflammation after the vaccine. The pain went away. I went back to the dentist a few weeks later for a cleaning, and she noticed I had an enlarged thyroid. I didn't get it checked out until July because we moved internationally. The doctor referred me for a neck ultrasound and bloodwork. The ultrasound indicates thyroiditis, perhaps Hashimoto's, and my Thyroid Peroxidase Ab levels are over 1300 IU/ml.

Other Meds: Zyrtec, multivitamin

Current Illness:

ID: 1501113
Sex: F
Age: 15
State: CA

Vax Date: 07/20/2021
Onset Date: 07/24/2021
Rec V Date: 07/25/2021
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: Cucumbers

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

Symptoms: Fainting, weakness, light headed, loss of consciousness, nausea

Other Meds:

Current Illness:

ID: 1501114
Sex: M
Age: 12
State: MO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 07/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Difficulty Breathing-Medium, Additional Details: about 10 minutes after vaccine, patient reports has difficulty breathing, but stable. checking BP 113/65. pt can breath. Check with pt every 5 minutes, and stable breathing, BP is 99/59 after 10 minutes. Pt reports feeling better (without any intervention). Asked pt to wait for 30 minutes mark. Pt then said his throat is tight, but can still breath with no whezzing. Discuss with mom and want 911 call. No epipen is given.

Other Meds:

Current Illness:

ID: 1501115
Sex: M
Age: 52
State: TX

Vax Date: 06/17/2021
Onset Date: 06/18/2021
Rec V Date: 07/25/2021
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: All side effects

Other Meds:

Current Illness:

ID: 1501116
Sex: F
Age: 42
State: VA

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 07/25/2021
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: Error: Wrong Dose of Vaccine - Too Low-

Other Meds:

Current Illness:

ID: 1501117
Sex: F
Age: 33
State: TX

Vax Date: 07/21/2021
Onset Date: 07/22/2021
Rec V Date: 07/25/2021
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: Systemic: Lymph Node Swelling-Mild

Other Meds:

Current Illness:

ID: 1501118
Sex: F
Age: 12
State: WA

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 07/25/2021
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: Systemic: Fainting / Unresponsive-Mild, Systemic: Shakiness-Mild, Additional Details: Patient's father reported that she had not eaten or drank much, if anything, prior to the vaccination appointment in the afternoon. Patient is a premenstrual, young girl, of thin build and small stature, who just turned 12 the prior month. She expressed anxiety about shots and needles. Immunizing technician and father noticed that she slouched dramatically a couple minutes after the shot. But her face became ashen, she slouched more rigidly, and jerked. ~5-10 seconds later she was back to normal

Other Meds:

Current Illness:

ID: 1501119
Sex: F
Age: 52
State: TX

Vax Date: 06/16/2021
Onset Date: 07/22/2021
Rec V Date: 07/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium

Other Meds:

Current Illness:

ID: 1501120
Sex: M
Age: 20
State: MA

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 07/25/2021
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: Systemic: Dizziness / Lightheadness-Medium, Additional Details: Had pt. lay down for 15 minutes; obtained VS

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm