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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1501884
Sex: F
Age: 81
State:

Vax Date: 04/13/2021
Onset Date: 07/22/2021
Rec V Date: 07/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Dose 1 given 4/13, dose 2 given 5/4, symptomatic covid infection identified 7/22/21

Other Meds:

Current Illness:

ID: 1501885
Sex: F
Age: 56
State: IN

Vax Date: 01/19/2021
Onset Date: 02/19/2021
Rec V Date: 07/26/2021
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: Penicillin; Grass; Bees.

Symptom List: Anxiety, Dyspnoea

Symptoms: Month later blood sugar went to hyperglycemia your prior dosage insulin was not working and blood increased to 300-500 range. Prior range was 100-200 blood sugar range. Increase insulin, April/May sugar levels went to hyperglycemia and having to sick insulin. Body swelling leg, foot, and ankle and he is on a lot of medicine and checking to see if in congestion heart failure and upcoming test to check for blood clots.

Other Meds: Lisinopril; Carvedilol; Amlodipine; Insulin Aspart; Tresiba; Aleve.

Current Illness: No.

ID: 1501886
Sex: M
Age: 41
State: MD

Vax Date: 01/14/2021
Onset Date: 07/22/2021
Rec V Date: 07/26/2021
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: COVID positive after vaccination

Other Meds:

Current Illness:

ID: 1501887
Sex: F
Age: 70
State: ND

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: This patient received an expired vaccination. It had been taken out of the fridge on 4/28/21 so it should've been used by 5/28/21. The expiration on the bottle was 11/09/21. This patient did not experience any adverse effects.

Other Meds:

Current Illness:

ID: 1501888
Sex: F
Age: 38
State: WI

Vax Date: 05/28/2021
Onset Date: 07/19/2021
Rec V Date: 07/26/2021
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: Case investigation interview completed and case manager wrote, "started having symptoms on 7/19- cough, advised isolation period, lives w/ baby who was recently sick but tested negative, case has thyroid problems, has not traveled recently."

Other Meds:

Current Illness:

ID: 1501889
Sex: F
Age: 41
State: MD

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 07/26/2021
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: Cypral

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

Symptoms: I experienced low heart rate, chest pains, tiredness and my right lymph node is swollen.

Other Meds: Lexapro

Current Illness:

ID: 1501890
Sex: F
Age: 25
State: CO

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 07/26/2021
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: Peanuts, tree nuts, animal fur and dander, pollen. No known medical allergies.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: About 12 hours after receiving second dose of COVID-19 Vaccine I began feeling nauseous and I vomited twice. Within 36 hours I was feeling better, but on day 3 post-vaccine I experienced more nausea and vomited daily for about 9 days. I saw multiple healthcare providers and no clear answer was determined. On day 5 post-vaccine I started taking a PPI treatment (Omeprazole). On day 11 post-vaccine the vomiting stopped. 4/12/21 - vaccine administered 4/12/21 - first symptoms 4/14/21 - symptoms seem to be gone 4/15/21 - symptoms return 4/23/21 - last date of symptoms

Other Meds: None

Current Illness: None

ID: 1501891
Sex: F
Age: 12
State: TX

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

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

Lab Data:

Allergies: Unknown

Symptom List: Pharyngeal swelling

Symptoms: Patient was asked if she had eaten anything and answered that she had not. With mom's permission, nurse gave patient lollipop which she begin to eat. Nurse also instructed patient to wait in chair after vaccinations for a few minutes before going to lobby to continue waiting 15 minutes. At approximately 11:15 a.m, within a minute of receiving the last vaccination (HPV), patient put her head in her lap and appeared to be fainting. Nurse supported patient so she would not fall on floor, mom got paper towels and wet them, nurse applied cold wet paper towels to patient's face, neck, arms, and hands. After several minutes, patient begin to open her eyes and get color back in her face. Chair was moved into place, and patient raised her legs onto chair. Mom supported patient while nurse went and got cold water bottle and crackers. Patient sipped slowly on cold water for several minutes. Nurse continued to apply wet towels, cold pack (brought by other nurse), and assist patient with cold water bottle sips and lollipop. At no time did patient fall to floor or become injured. At 11:45 a.m. mom determined that patient had recovered. Nurse and mom assisted patient as she ambulated into lobby where she continued to wait, observed by front office staff. At approximately 11:50 a.m. mom and patient walked from lobby after front office staff asked if patient was feeling better, and they stated she was o.k.---RN

Other Meds: Unknown

Current Illness: Unknown

ID: 1501892
Sex: M
Age: 82
State: CA

Vax Date: 01/19/2021
Onset Date: 04/24/2021
Rec V Date: 07/26/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Heart attack

Other Meds:

Current Illness:

ID: 1501893
Sex: F
Age: 57
State: ND

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/26/2021
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: This patient received an expired vaccination. It had been taken out of the fridge on 4/28/21 so it should've been used by 5/28/21. The expiration on the bottle was 11/09/21. This patient did not report any adverse effects.

Other Meds:

Current Illness:

ID: 1501894
Sex: F
Age: 71
State:

Vax Date: 03/04/2021
Onset Date:
Rec V Date: 07/26/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Fatigue, achy, can not stand on own, arms are swelling, can not raise arms, knee caps are swelling with a large knot.

Other Meds: Vitamin D, Levothyroxine.

Current Illness:

ID: 1501895
Sex: F
Age: 36
State: WA

Vax Date: 04/16/2021
Onset Date: 07/13/2021
Rec V Date: 07/26/2021
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: sensitivity to Valtrex medication

Symptom List: Rash, Urticaria

Symptoms: Severe headache and coughing significantly (increased coughing) resulting vomiting on occasion. Extreme lethargy and a slight fever. Duration: lasted about six days. And the course of treatment recommended by the doctor: rest and lots of fluids and a fever reducer. Wednesday, July 14th, Urgent Care - when I sought care, I had them do a COVID test - rapid and PCR and both turned out to be negative.

Other Meds: Levothyroxine; Phentermine; Prilosec OTC; 4000 IU of Vit D

Current Illness: no

ID: 1501896
Sex: F
Age: 59
State: ID

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/26/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Inflammation of lymph node in left arm pit. Pain at inflammation site. Treatment has been ibuprofen 600-800 mg once daily for pain and swelling as well as downward massage of arm pit. Ice to site too. The swelling started on Saturday night while also experiencing chills, muscle pain, joint pain, and nausea. The swelling is worse in the morning. It continues to swell at this documentation time.

Other Meds: Calcium plus D3-500mg plus 25 mcg Daily MVI-500mg tab D3-1000 IU

Current Illness: None

ID: 1501897
Sex: F
Age: 26
State: ND

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/26/2021
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: This patient received an expired vaccination. It had been taken out of the fridge on 4/28/21 so it should've been used by 5/28/21. The expiration on the bottle was 11/09/21. This patient experienced sore arm, body aches, fatigue, and chills.

Other Meds:

Current Illness:

ID: 1501898
Sex: F
Age: 14
State: IL

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/26/2021
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: NKA

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

Symptoms: None

Other Meds: N/A

Current Illness: N/A

ID: 1501899
Sex: F
Age: 47
State: WA

Vax Date: 07/25/2021
Onset Date: 07/25/2021
Rec V Date: 07/26/2021
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 reported

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

Symptoms: Gave dose of Pfizer after patient had already received Johnson & Johnson COVID-19 vaccine on 3/31/2021. No adverse events during 15 minute monitoring, no treatment necessary.

Other Meds: unknown

Current Illness: unknown

ID: 1501900
Sex: F
Age: 54
State: MN

Vax Date: 04/28/2021
Onset Date: 05/11/2021
Rec V Date: 07/26/2021
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:

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

Symptoms: Patient presented to the ED with chest pain within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1501901
Sex: F
Age: 47
State: FL

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/26/2021
Hospital:

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

Lab Data:

Allergies: Sulfa sensitivity

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Received the 1st injection on Friday. That evening started noticing redness and arm was tender. Wasn't worried because I expected this. On Saturday noticed that the redness was spreading and shot site was very warm, painful to the touch and swollen. Sunday redness has spread even more, still very painful to touch, swollen and hot feeling. Today, Monday, site still red, hot, swollen and has gotten bigger. Still painful to the touch. I have documented with pictures.

Other Meds: Provitalize herbal menopause supplement Collagen supplement Vitamin B-12 Vitamin D Cymbalta 20mg BID Bariatric multivitamin Gabapentin 300mg at bedtime Nasacort Tylenol PM at bedtime Singulair Wegovy

Current Illness: None

ID: 1501902
Sex: F
Age: 33
State: WI

Vax Date: 04/30/2021
Onset Date: 07/23/2021
Rec V Date: 07/26/2021
Hospital:

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

Lab Data:

Allergies: Allergic contact dermatitis due to cosmetics.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Urgent care visit on 7/23/21. Symptoms included fatigue, chills, generalized body aches and sinus problem. Antigen test performed on 7/23/21 and came back detected. Case investigation interview with patient has not been performed as of time of this note.

Other Meds:

Current Illness:

ID: 1501903
Sex: F
Age: 61
State: NH

Vax Date: 04/14/2021
Onset Date: 05/03/2021
Rec V Date: 07/26/2021
Hospital:

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

Lab Data:

Allergies: No known allergies.

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

Symptoms: I had a sore arm and very fatigue.

Other Meds: I am taking Levothyroxine, Estrogen gel and gabapentin 100mg.

Current Illness: No illnesses at the time of vaccination.

ID: 1501904
Sex: F
Age: 30
State: AZ

Vax Date: 04/15/2021
Onset Date: 07/02/2021
Rec V Date: 07/26/2021
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: Intense stomach pain 3 months post injection, 8/10 pain level and doctors determined it was my appendix being inflamed and needed to be removed

Other Meds: Thc edibles (5-10mg, night for sleep)

Current Illness: None

ID: 1501905
Sex: M
Age: 35
State: ND

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 07/26/2021
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: Unevaluable event

Symptoms: This patient received an expired vaccination. It had been taken out of the fridge on 4/28/21 so it should've been used by 5/28/21. The expiration on the bottle was 11/09/21. This patient experienced sore arm, body aches, fatigue, and chills.

Other Meds:

Current Illness:

ID: 1501906
Sex: F
Age: 61
State: MO

Vax Date: 07/19/2021
Onset Date: 07/23/2021
Rec V Date: 07/26/2021
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: sulfa allergy

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

Symptoms: 3 days after 2nd Moderna shot give, pt experienced a rash down her arm, heat on the arm, and itch. Pt went to Dr office to have it looked at. She was told it happens now and then and is considered COVID arm. Pt used triamcinolone cream to treat, along with ice packs, claritin, and benadryl. Arm is better as of 3 days after reaction.

Other Meds: vitamin d, latanoprost

Current Illness: Breast Cancer. Glaucoma

ID: 1501907
Sex: F
Age: 62
State: KS

Vax Date: 07/24/2021
Onset Date: 07/26/2021
Rec V Date: 07/26/2021
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: Bactrim [Sulfamethoxazole-trimethoprim] RASH Codeine RASH, STOMACH UPSET Doxycycline RASH, STOMACH UPSET

Symptom List: Injection site pain, Pain

Symptoms: At the facility where the vaccine was administered, Moderna COVID-19 vaccines are prepared in a sterile compounding space and given a BUD of 12 hours under refrigeration. The vaccine was prepared at 07:43 am on 7/23 and set to expire at 07:43 pm on 7/23. The vaccine was given to the patient on 7/24 at 03:00 pm (~ 19 hours beyond BUD). The attending physician was notified and the patient is being closely monitored. As of the day of this report, the patient has not reported any adverse reactions.

Other Meds: acetaminophen (TYLENOL EXTRA STRENGTH) 500 mg tablet, Take 500-1,000 mg by mouth every 6 hours as needed for Pain. Max of 4,000 mg of acetaminophen in 24 hours., albuterol sulfate (PROAIR HFA) 90 mcg/actuation HFA aerosol inhaler, Inhale tw

Current Illness: Presented to emergency room with generalized weakness and lower extremity swelling. Admitted and treated for: - AKI - SSTI - Ventricular tachycardia - UTI

ID: 1501908
Sex: M
Age: 54
State: NC

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 07/26/2021
Hospital:

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

Lab Data:

Allergies: Darvocet Penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Massive headache daily, ringing in the ears since the vaccine, nausea

Other Meds: Gabapentin 400mg (twice daily)

Current Illness: None

ID: 1501909
Sex: M
Age: 14
State: IL

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/26/2021
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: NKA

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

Symptoms: Patient was injected with moderna instead of pfizer

Other Meds: N/A

Current Illness: N/A

ID: 1501910
Sex: F
Age: 89
State: WA

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/26/2021
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: Allergies Betamethasone Shortness of breath, Nausea Not Specified Allergy 1/1/1989 Gentamicin Rash, Swelling Not Specified Allergy 1/1/1985 Adverse Reactions/Drug Intolerances Ibuprofen Other High Intolerance Mouth sores Albuterol Other Not Specified Intolerance 4/28/2009 Atenolol Drowsiness Not Specified Intolerance 3/29/2005 Digoxin Other Not Specified Intolerance 10/2/2008 Felodipine Other Not Specified Intolerance 3/28/2005 Lisinopril Unknown Not Specified Intolerance 1/1/1997 Nortriptyline Drowsiness Not Specified Intolerance 9/23/2013 2013 Oxycodone Anxiety, Other Not Specified Intolerance 2/28/2005 Sulfa (sulfonamide Antibiotics) Nausea Not Specified Intolerance 1/1/1989

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Per Walk In Clinic's notes: Patient 89 year old female presents today to clinic with complaints of #Vaccine reaction - Located on right upper arm - Received shingles vaccine on 21 July 2021 and notes symptoms started a few hours later - Now has redness, painful lump and area warm to touch - Denies shortness of breath, chest tightness Assessment and Plan: (T50.Z95A) Vaccine reaction, initial encounter (primary encounter diagnosis) Plan: - Discussed symptoms are a reaction to recent shingles vaccine - Outlined area of concern for monitoring - Recommend supportive home care; OTC Tylenol not to exceed 3,000mg/24 hours and cold compresses to the area - Will have clinic RN submit VAERS report - Follow-up with PCP as needed for concerns Return precautions given for fever, chills, chest pain/tightness, shortness of breath, palpitations, abdominal pain, nausea/vomiting, numbness/tingling/weakness in extremities, symptoms that worsen or don't improve with treatment plan

Other Meds:

Current Illness:

ID: 1501911
Sex: F
Age: 38
State: MO

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/26/2021
Hospital:

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

Lab Data:

Allergies: shellfish, biaxin, penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: diarrhea started 23 hours after the vaccine. It has continued into day 3. Slight nausea, but stomach mostly okay and has hunger. Within 30min-1hr after eating, diarrhea occurs and continues. Sore arm Headache during the first 24 hours but this has resolved.

Other Meds: multi vitamin, allegra

Current Illness: na

ID: 1501912
Sex: F
Age: 40
State: IN

Vax Date: 04/06/2021
Onset Date: 05/20/2021
Rec V Date: 07/26/2021
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: Aspirin, NSAIDS

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

Symptoms: I had been having these health issues since January 2020 but believe I was being misdiagnosed with panic attacks by my GP and not certain this was from the COVID vaccines. On May 20, 2021 around 10pm my heart rhythm got out of sync and it felt like my heart was flipping. I had my husband take me to the ER at 3am (May 21, 2021). The ER had to sedate and shock my heart to get a normal heartbeat. I was ultimately asked if I had had COVID and diagnosed with POTS. Our family believes we had COVID in January 2020 but no testing was available to know for sure.

Other Meds: woman's multi-vitamin, Lisinopril, Zyrtec, Albuterol, Levothyroxine

Current Illness: allergies, Hashimotos disease, Morphea

ID: 1501913
Sex: F
Age: 35
State:

Vax Date: 07/22/2021
Onset Date: 07/23/2021
Rec V Date: 07/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Itchy at injection site, random rashes through my body that would come and go. Sore throat and and sore chest developed 4 days after injection.

Other Meds: Pantaprozole, macrobid

Current Illness: None

ID: 1501914
Sex: F
Age: 15
State: MO

Vax Date: 07/21/2021
Onset Date: 07/23/2021
Rec V Date: 07/26/2021
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: Injection site pain

Symptoms: Mother called clinic to report two days after receiving Covid-19 vaccine pt. experienced syncope during a sports practice. Mother reports pt was taken to hospital where she was given IV fluids for "severe dehydration".

Other Meds:

Current Illness:

ID: 1501915
Sex: F
Age: 14
State: ID

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 07/26/2021
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 who is 14 years old received incorrect second dose of COVID-19 vaccine. First dose was Pfizer and second dose was Moderna. No adverse reactions have been noted since administration.

Other Meds:

Current Illness:

ID: 1501916
Sex: M
Age: 50
State: WA

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 07/26/2021
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: The patient reports that he received his first dose of the Moderna COVID-19 vaccine on Thursday, February 11, 2021. Initially he reports having had a headache that is similar to his baseline migraines. Then on February 13, he developed right leg and foot numbness which spread to the left leg, then he felt as though his legs did not want to move. This started involving sensory loss in the right arm and then he presented to the emergency department. He was noted to have brisk reflexes, CT of the head was normal. Around 9 PM on February 13, the patient's symptoms progressed, he noted weakness on the right side and the left leg, and then on the 14th he started noticing numbness in the left hand he returned to the emergency department. Postcontrast MRI showed no abnormal enhancement, and mild to moderate cervical spondylolysis C5-C7. However a repeat scan 3 days later showed abnormal cord signal at C5-C6 and T1 suggestive of myelitis. He was also noted to have urinary retention. Examination showed diffuse hyperreflexia, Hoffmann sign, and bilateral Babinski signs. He did start showing improvement over his hospital stay, and was discharged to inpatient rehab. There are ongoing muscle spasms, spasticity, and decreased sensation.

Other Meds:

Current Illness:

ID: 1501917
Sex: M
Age: 52
State: FL

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 07/26/2021
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 known.

Symptom List: Tremor

Symptoms: After receiving the 1st shot in my left shoulder, I have experienced chronic pain in my right elbow.

Other Meds: Dexmethylphenidate 20 mg 2x day; Lutien; Vitamin D3; Magnesium; Elderberry; Mito-Q

Current Illness: None known.

ID: 1501918
Sex: F
Age: 48
State: NY

Vax Date: 01/28/2021
Onset Date: 02/14/2021
Rec V Date: 07/26/2021
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: Sulfa, amoxicillin, sodium lauryl sulfate, mushrooms

Symptom List: Erythema, Pruritus

Symptoms: A few days after my first shot on 1/28/21 I developed a rash around the injection site and was having a persistent ache in my left armpit, My PCP put me on Amoxicillin for this rash. After taking the Amoxicillin, I woke up with hives all over my body which continued to spread over the course of a few hours. These hives were not raised, they did not itch, they were not painful and they did not secrete any fluids. At the Urgent Care visit on 2/14, the doctor prescribed Prednisone, 20mg, Famotidine, 20mg, and Benadryl, 50mg for 3 days to help relieve the hives that they believed were caused by the Amoxicillin. The hives did recede after 5-6 days.

Other Meds: Cryselle, multi-vitamin, melatonin

Current Illness: None

ID: 1501919
Sex: F
Age: 15
State: FL

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 07/26/2021
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: nka

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

Symptoms: Client complained of feeling lightheaded. Client evaluated by EMS on site. V/S per EMT BP 90/40, R 14Min, HR 72. Evaluated after 15 min. observation. Client verbalized she was feeling better. Sent home with her parent.

Other Meds: no

Current Illness: no

ID: 1501920
Sex: F
Age: 76
State: VA

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 07/26/2021
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: alcohol, narcotics, sulfur, prednisone sensitive to dairy

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

Symptoms: hot, red, itchy and felt like bees stinging me 2nd day severe Vertigo and vomiting 3-4 days severe diarrhea (with nausea) 9 days later arm swelled and got very red and sore for over a week Still hurts 6 months later

Other Meds: antibiotic for UTI, Vit D, Probiotic, Collagen powder, several other herbal supplements that I can't remember as I am not longer on

Current Illness: none

ID: 1501921
Sex: M
Age: 28
State: WI

Vax Date: 04/07/2021
Onset Date: 07/17/2021
Rec V Date: 07/26/2021
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: Cough,runny nose,loss of smell,sore throat,nasal congestion,headache,fatigue,loss of taste

Other Meds:

Current Illness:

ID: 1501922
Sex: F
Age: 32
State: MI

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/26/2021
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: Shell fish Penicillin

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

Symptoms: Uncontrollable temperature Uncontrollable blood sugar Massive sharp pains throughout my body Hard time breathing

Other Meds: Tramadol Hydrocodone Farxiga Trulicity Lisinopril Hydroxyzine Gabapentin

Current Illness:

ID: 1501923
Sex: F
Age: 56
State: MA

Vax Date: 01/27/2021
Onset Date: 07/21/2021
Rec V Date: 07/26/2021
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: Amoxicillin

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

Symptoms: Pt. tested positive for Covid 19 by PCR on 07/21/2021

Other Meds: Arava daily

Current Illness:

ID: 1501924
Sex: F
Age: 1
State: NY

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/26/2021
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: ActHib administered on 7/21/21 expired on 6/8/21. No adverse effects noted from the patient as of this time.

Other Meds: none

Current Illness: none

ID: 1501925
Sex: F
Age: 12
State: CA

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 07/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: no

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: 12 year old daughter a few minutes after vaccine, says she didn't feel well and eyes closed and she dropped. I quickly grabbed and held her as she would have hit her head from passing out. The paramedics came and she lost 20 points of blood pressure and then ambulance took her to the hospital where she was released.

Other Meds: no

Current Illness: no

ID: 1501926
Sex: M
Age: 78
State: MO

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/26/2021
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: This patient received a full, diluted multi-dose vial of the Pfizer COVID-19 vaccine instead of the single dose of .3mL. The patient was notified on Friday July 23, two days after receiving shot and reported a sore arm, but did not feel it was anything beyond what was expected.

Other Meds:

Current Illness:

ID: 1501927
Sex: M
Age: 57
State: IN

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 07/26/2021
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: PENICILLIN

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

Symptoms: 1. Macular edema OS; patient reports reduced vision , patient reports symptoms started 24 hours after vaccine, macular edema first observed at exam 20 days after vaccine (4/21/21) when vision reduced from previously 20/20 to 20/40; treated with Avastin injection left eye 5/7/21 and 06/21 (exact date unknown); as of 7/26/21 condition has not resolved and best corrected vision is 20/40 in left eye. Note that patient has known risk factor of diabetes with moderate non-proliferative diabetic retinopathy but had negative eye exam 1/25/21 without macular edema. Patient is also pseudophakic in left eye. Patient feels that symptoms started after vaccine and patient feels that vaccine contributed to macular edema. Practitioner feels that diabetes is the most likely risk factor for macular edema in left eye. 2. Numbness in left hand and fingertips, symptoms started 24 hours after vaccine and resolved 72 hours after symptoms started.

Other Meds: 1) ACCU-CHEK GUIDE (GLUCOSE) TEST STRIP USE 1 STRIP FOR ACTIVE TESTING FOUR TIMES DAILY USE WITH ACCU-CHECK TO TEST BLOOD GLUCOSE. 2) ALBUTEROL 90MCG (CFC-F) 200D ORAL INHL INHALE TWO ACTIVE

Current Illness: none

ID: 1501928
Sex: F
Age: 41
State: NJ

Vax Date: 05/24/2021
Onset Date: 06/04/2021
Rec V Date: 07/26/2021
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: 2nd shot received on 5/24. Back pain days 1 and2. Headache, chest pain, neck pain days 1-3. Day 4, right half of tongue swollen, 5 canker sores on bottom. Day 5, difficulty swallowing, prescribed Prednisone. Mouth healed within 5 days of medication. Headache started on June 4th. Mild for 2 weeks then increased in pressure and duration. Visited doctor on 7/1, CT scan pending insurance approval. Advil does not help at all. Allergy medicine and nose spray have no effect. Benadryl & Excedrin Migraine work for a couple of days then stop. Debilitating pain that I cannot deal with any longer.

Other Meds: ADVAIR, PRILOSEC, ZYRTEC, AUROVELA, MULTI-VITAMIN

Current Illness:

ID: 1501929
Sex: F
Age: 34
State: CA

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 07/26/2021
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: Starting on 04/15/2021 for the first couple months, numbness weakness on right side from head to toe, also some joint pain on right side of body, minor tingling right side of body. 07/20/2021 Evolved into pain in neck shooting from right to left but mostly on the right and pain in my face all on right side. Increase in tingling on right side of body.

Other Meds: None

Current Illness: None

ID: 1501930
Sex: F
Age: 101
State: MA

Vax Date: 01/26/2021
Onset Date: 07/26/2021
Rec V Date: 07/26/2021
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: No known allergies/adverse reactions

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

Symptoms: No Adverse events noted

Other Meds: Lasix 10 mg tab Levothyroxine sodium 50 mcg tab Amlodipine besylate 5 mg tab Morphine Sulfate 20 MG/1 ML SOL, give 0.25ml SL Metoprolol tartrate 25 mg tab Lorazepam 0.5 mg tab

Current Illness: Age-related physical debility Muscle weakness (generalized) Feeding difficulties Adult failure to thrive Unspecified lack of coordination Dysphagia, oropharyngeal phase Type 2 diabetes mellitus without complications

ID: 1501931
Sex: M
Age: 44
State: WA

Vax Date: 07/12/2021
Onset Date: 07/25/2021
Rec V Date: 07/26/2021
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: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient describes "numbness" in his left arm. He also claims that this is the same arm of which he has had surgery on in the past.

Other Meds: -hctz -lisinopril -loratadine -

Current Illness: HTN, & rhinitis

ID: 1501932
Sex: M
Age: 25
State: NY

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

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

Lab Data:

Allergies: NO

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

Symptoms: 5 minutes after vaccine was received, the patient's eyes rolled back and he fell off his chair. his body stiffened up and he seized. We called the ambulance and they arrived shortly after. Water was given and back support was provided until the EMT and the patient's mother arrived.

Other Meds: SERTRALINE 50MG

Current Illness: NO

ID: 1501933
Sex: F
Age: 74
State:

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/26/2021
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: Patient did not experience any adverse events. The 2nd dose was just administered after 3 weeks instead of 4 weeks.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm