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: 1502036
Sex: M
Age: 33
State:

Vax Date: 06/17/2021
Onset Date: 06/18/2021
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: n/a

Symptom List: Dysphagia, Epiglottitis

Symptoms: brain fog since first injection, unable to remember common words used in everyday communication joint pain of neck, lower back and elbows fatigue that has continued since first injection headaches that has continued since first injection

Other Meds: n/a

Current Illness: n/a

ID: 1502037
Sex: M
Age: 19
State: TN

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: antibiotics

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt came to hospital 07/26/2021 for his first COVID-19 vaccine accompanied by his girlfriend. Pt completed appropriate paperwork. LPN reviewed paperwork with pt and gave pt Moderna vaccine Lot# 027B21A expire 09/18/2021 at about 1000 in Right Arm. Pt proceeded to the lobby with girlfriend. At about 1010 pt was witnessed falling from chair in lobby. Staff activated the emergency response protocol crash cart and 02 tank was brought to pt side within a few seconds. Staff called 911. On assessment pt was lying supine in lobby breathing normal and pulse WNL diaphoretic and pale. RN noted that pt eyes where rolling back. Pt head was supported, few seconds later pt came was awake. BP was checked 138/82 in left arm. Breathing WNL and HR WNL. Pt states "I was afraid this was going to happen I had this happen about 5 yrs ago with a booster shot". Pt girlfriend stated that he turned to her and stated I don't feel good and he leaned back into the chair then fell onto the floor bottom first then onto left side then onto back. Pt states he is not hurting anywhere other than where he got his shot. Pt was then assisted to the sitting position on floor. pt stated he felt better just week pt then was assisted to the chair. While sitting in chair pt was diaphoretic and pale pt was given a cold bottle of water and a cool wet paper towel. Pt continued to improve after that. EMS arrived at 1020. EMS got vitals and pt signed EMS document refusing transport to hospital. EMS left at 1027 Pt girlfriend called for a ride because he was driving. Pt back to normal by the time his ride got here at 1043 last vitals WNL BP 126/80.

Other Meds: none

Current Illness: none

ID: 1502038
Sex: F
Age: 45
State: OR

Vax Date: 07/24/2021
Onset Date: 07/24/2021
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: CAPERS, LATEX, SEAFOOD

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

Symptoms: PATIENT FELT DIZZY AND REPORTED THAT HER THROAT FEELS SCRATCHY AS IF SHE'S BEEN EATING FISH . I GAVE HER BENADRYL AROUND 1:20, I STAYED WITH HER WATCHING HER CLOSELY FOR ANY SIGNS OF DISTRESS. SHE WAS TRYING TO CLEAR HER THROAT CONSTANTLY AND COUGHING. I HAD HER LAYING DOWN ON THE FLOOR AND INSTRUCTED A TECHNICIAN TO CALL 911. THEY INSTRUCTED ME TO HAVE THE PATIENT SIT . SHE REPORTED TO ME SHE FEELS NAUCIOUS. I TOOK HER BLOOD PRESSURE AND IT WAS 130/100. ABOUT 5 MINUTES LATER EMS CAME AND CHECKED THE PATIENTS VITALS, THEY STABILIZED HER AND SHE DIDN'T WANT TO GO TO HOSPITAL WITH THEM. THEY TOLD ME THAT SHE IS STABLE AND IF SHE IS READY SHE COULD GO. I GAVE HER ANOTHER DOSE OF BENADRYL, AND SHE LEFT THE PHARMACY ACCOMPANIED BY HER HUSBAND .

Other Meds: UNKNOWN

Current Illness: NO

ID: 1502039
Sex: F
Age: 56
State: TX

Vax Date: 03/28/2021
Onset Date: 04/04/2021
Rec V Date: 07/26/2021
Hospital: Y

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

Lab Data:

Allergies: Gluten and Soy allergy

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: headaches, neck pain, nausea - started on 4/6/2021; First ER Visits on 4/20/21 - Blood tests, MRI, CT; Ongoing symptoms from 4/6/2021 - 6/11/2021 during that time Hematology visits with additional blood tests, Ophthalmology visit due to pressure behind right eye, Neurology visits with MRI/MRV due to neck pain, headaches and nausea; 6/12/21 ER Visit and admitted inpatient for observation - more blood tests, MRI, CT and Lumbar Puncture due to intensified symptoms with Tremors all over body, inability to walk, difficulty swallowing and difficulty speaking - these symptoms have been constant from 6/12/21 up through today 7/26/21

Other Meds: Fluoxetine - 20mg + 40mg - capsule; Bupropion - 300mg - 24 hour release tablet

Current Illness: None

ID: 1502040
Sex: M
Age: 62
State: MN

Vax Date: 12/22/2020
Onset Date: 07/19/2021
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: NKA

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

Symptoms: Patient calls with report of irregular heart rate, shortness of breath, chest congestion, sinus congestion, loss of smell. There have been three positive COVID cases at his work. He is full vaccinated. Reports hx of afib.

Other Meds: amoxicillin (AMOXIL); dilTIAZem CD (CARDIZEM CD/CARTIA XT); Eliquis; flecainide (TAMBOCOR); MULTIVITAMIN; pantoprazole (PROTONIX); tamsulosin (FLOMAX)

Current Illness:

ID: 1502041
Sex: M
Age: 73
State: TX

Vax Date: 04/01/2021
Onset Date: 06/01/2021
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: none

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

Symptoms: Two months after the second shot I began having what I thought was a sinus infection and cough.. As this persisted I went to my local doctor who prescribed a Z pack and antibiotics. A week later I felt some difficult breathing went back to the doctor who prescribed an inhaler. By week three I started to see improvements and by week four I was back to normal.

Other Meds: Many

Current Illness: none

Date Died: 07/25/2021

ID: 1502042
Sex: M
Age: 60
State:

Vax Date: 04/01/2021
Onset Date: 03/26/2021
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: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Death 7/25/21 N17.9 - AKI (acute kidney injury) K92.2 - Gastrointestinal hemorrhage, unspecified gastrointestinal hemorrhage type

Other Meds:

Current Illness:

ID: 1502043
Sex: F
Age: 51
State: CO

Vax Date: 04/20/2021
Onset Date: 04/21/2021
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: none

Symptom List: Pharyngeal swelling

Symptoms: tired, body aches and fever of 103

Other Meds: hydrocodine, vitamin d and fish oil

Current Illness: none

ID: 1502044
Sex: F
Age: 37
State: NC

Vax Date: 03/29/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: penicillin, shellfish

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Worsened tinnitus; more frequent migraines; sinusitis requiring treatment with azithromycin x2; telogen effluvium Typical reaction (fatigue, myalgia, mild headache) resolved in 2 days

Other Meds: Kyleena, vitamin D

Current Illness: none

ID: 1502045
Sex: M
Age: 1
State: SC

Vax Date: 07/12/2021
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: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Had bumps all over body. Not itchy but bright red. Doctor said from MMR. Lasted 3 days.

Other Meds: Started amoxicillin that day

Current Illness: Had had a cough for a month

ID: 1502046
Sex: M
Age: 81
State: IL

Vax Date: 03/16/2021
Onset Date: 03/31/2021
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: Levimire

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

Symptoms: Sever abdominal pain extending up center of chest to ears and down center of back. Sever pain if trying to lay flat. Initial occurrence March 31,2021 approximately two weeks after 2nd Pfizer vaccination, Released from hospital same day but unable to lay flat for four days. Same symptoms reoccurred on May 26, 2021 and was admitted to the hospital for three days and it was determined my condition was pericarditis.

Other Meds: Daliresp (roflumilast) tablets 500mcg per tablet (AM) Fluoxetine 10MG (AM) Armodafinil (Nuvigil) ? 250MG

Current Illness: None

Date Died: 06/12/2021

ID: 1502047
Sex: F
Age: 24
State: OH

Vax Date: 04/16/2021
Onset Date: 06/12/2021
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: allergic to bee stings and mosquito bites. She got bit up by mosquito's on Sunday June 6, 2021 the bites swelled up but she wouldn't put any antiseptic cream on them

Symptom List: Rash, Urticaria

Symptoms: Patient found deceased in her bed on june 12, 2021, reported to Strongsville Police Department at 10:15am., taken to Cuyahoga Medical Examiner's Office the same day. Autopsy done. Results still pending for 4-5 months.

Other Meds: Vyvanse 40 mg

Current Illness: no

ID: 1502048
Sex: F
Age: 11
State: CT

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: LA

Lab Data:

Allergies: nkda

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

Symptoms: patient had a near syncope event after administration of vaccines. Gardasil administered last in left arm. Patient seemed weak and was moved from exam table to chair,felt dizzy and became quiet and pale, difficulty answering questions. Legs were elevated on a chair, pt was given water to drink but only took a few sips, eyes were closing and could not hold cup of water. Weak radial pulse noted, systolic BP ~ 80 (was initially 100 at start of visit). Patient was monitored for approx 5 more minutes, after which time she said she felt better, pulses returned to normal, BP back up to 80. entire episode lasted ~ 10 minutes.

Other Meds: none

Current Illness: none

ID: 1502049
Sex: F
Age: 48
State: AR

Vax Date: 07/20/2021
Onset Date: 07/21/2021
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: Pt called today and reported that her arm has been sore since the day following the vaccine. I recommended that she contact her primary care.

Other Meds:

Current Illness:

ID: 1502050
Sex: F
Age: 47
State: MI

Vax Date: 07/21/2021
Onset Date: 07/22/2021
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: None

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

Symptoms: Skin to this day is sore to the touch. Constant paid at a level 5 on a scale of 0-10 in armpit and chest of right side of body. Continues headache since day after shot. Muscles still sore.

Other Meds: None

Current Illness: None

Date Died: 07/25/2021

ID: 1502051
Sex: F
Age: 55
State:

Vax Date: 03/09/2021
Onset Date: 07/25/2021
Rec V Date: 07/26/2021
Hospital: Y

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: Death R65.10 - SIRS (systemic inflammatory response syndrome)

Other Meds:

Current Illness:

ID: 1502052
Sex: F
Age: 66
State: TX

Vax Date: 06/25/2021
Onset Date: 07/23/2021
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 received 2 doses of the Moderna COVID-19 vaccine from our pharmacy. First dose on 6/25/21, second dose on 7/23/21. Patient was screened using the CDC COVID-19 vaccine screening questionnaire and answered "no" to previous COVID-19 vaccinations. Patient's insurance paid for both vaccinations insurance claims. Both doses were reported. No evidence of previous COVID-19 vaccination were apparent until we were logging her 2nd dose from our facility. Upon further investigation of the patient's vaccine history, she received 2 doses of Moderna COVID-19 vaccine from a different facility on 4/30/21 and 5/28/21. In summary, the patient has received 4 doses of the Moderna COVID-19 vaccine. The patient denied receiving any previous COVID-19 vaccinations upon our questioning.

Other Meds:

Current Illness:

ID: 1502053
Sex: F
Age: 21
State: PA

Vax Date: 07/15/2021
Onset Date: 07/15/2021
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: Amoxicillin, Cefdinir

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Felt nauseous and broke out into a sweat. Reported lightheadedness and dizzy. Felt like she would pass out. Reported tingling in fingertips. Laid down for an hour. Tingling subsided and felt lightheadedness subsided; however, continued to feel nauseous. Denies vomiting, chest pain, SOB, et.c

Other Meds:

Current Illness:

ID: 1502054
Sex: M
Age: 16
State: TX

Vax Date: 07/24/2021
Onset Date: 07/25/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Child taken to ER with tachycardia symptoms. Heart rate 120 and BPP at 158/89. Treated with fluids and released at 99 heart rate and BP at 139/85. This morning self check: HR 108 and BPP 134/85. Doctors appointment scheduled this afternoon. Child?s normal resting heart rate at 80 and BP at 115/75.

Other Meds: Insulin

Current Illness:

ID: 1502055
Sex: F
Age: 46
State: SC

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: Lactose sensitivity, omega 3 fish oil, skelaxin

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

Symptoms: Dizziness, feeling faint, weakness, light sensitivity, nausea, sleepiness, cold and hot flash at the same time, increased HR, and increased BP. These symptoms occurred in 15 mins after receiving the vaccine. 3 nurses helped me to a room via wheelchair. They monitored my HR and BP every 15 mins for an hour. They allowed me to rest, supplied cold compresses and ginger ale. The symptoms subsided after an hour, which gave me time to get home, but the symptoms re-occurred in waves for a week.

Other Meds: Plaquenil, Zyrtec, Folic Acid, Meloxicam, Spruce CBD oil, eye drops, Incruse Ellipta, Dulera.

Current Illness:

ID: 1502056
Sex: F
Age: 15
State: NC

Vax Date: 07/26/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: n/a

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

Symptoms: Pt received the vaccine, she said she was fine and stood up immediately to move to another chair. Her mom asked her again how she was and she said actually I don't feel good. She put her head between her legs and after that she went unconscious and fell to the ground. 911 was called immediately. She came to in about 30 seconds. MS arrived in less than 5 minutes. They took her temperature, BP, pulse and BS. All normal. They think she had a vasovagal response. She did not go with MS. She is going to her pediatrician today to get looked at further

Other Meds: sertraline

Current Illness: n/a

ID: 1502057
Sex: M
Age: 16
State: IN

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: LA

Lab Data:

Allergies: NKDA

Symptom List: Unevaluable event

Symptoms: Patient pre-screened and given 1st dose of Pfizer vaccine then transferred to the post vaccine waiting area. After 15 minutes patient was on his way to the car and accompanied by mother and sister. At exit threshold patient reported "feeling woozy" and fell forward onto his face possibly chipping 2 teeth. Patient's mother rolled him to a supine position and called for help. Upon arrival this RN instructed mother to lower head. 2nd RN, arrived and elevated feet. Pt responding to verbal stimuli, unable to recall syncopal episode but otherwise oriented to person, place, time, and all events leading up to episode. During assessment patient stated he works outside and has been participating in football conditioning/practice outside and not drinking enough fluids or replacing electrolytes. Mother confirmed. Vital signs taken and as follows: HR 74, Bp 86/70, SpO2 100%, Pulse strong and regular, breath sounds clear on auscultation. No generalized redness, rash, or hives. Patient denies shortness of breath. Snack and juice provided. After 10 minutes patient reports improvement and was assisted to an upright position. No dizziness or lightheadedness reported. Patient assisted to a standing position prior to being seated in a wheelchair. Patient wheeled to and assisted to personal vehicle driven by mother who took the patient to Emergency Room across the street. Assisting RN,, called report to receiving ER.

Other Meds:

Current Illness: None reported

ID: 1502058
Sex: M
Age: 59
State: CA

Vax Date: 02/25/2021
Onset Date: 02/25/2021
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: none reported

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

Symptoms: Client received 2nd dose Moderna with 23 day interval; 5 days earlier than recommended 28 day interval per Manufacture and FDA EUA. Client did not accurately answer pre-vaccination screening checklist indicating the correct date of initial Moderna COVID-19 vaccination from another agency on 02 FEB 2021. No adverse reactions reported post vaccination to program personnel.

Other Meds: none reported

Current Illness: none reported

ID: 1502059
Sex: M
Age: 55
State: MD

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Injection site pain, Pain

Symptoms: Patient came in for a Moderna Vaccine but received a Janssen Covid Vaccine. Did not know that there were still signups available on our website scheduling system, so I did not know that he was coming specifically for a Moderna Covid Vaccine. Usually we do let them know it is the Janssen one shot vaccine, but in this case I did not. He was provided with the information about the vaccine but after it was administered. Patient was very upset and really wanted the Moderna. I apologised for the error and I immediatly took any mention of the Moderna vaccine off of our website and scheduler.

Other Meds: N/A

Current Illness: N/A

ID: 1502060
Sex: M
Age: 38
State: NY

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: SYR
Vax Site: LA

Lab Data:

Allergies: NO

Symptom List: Injection site pain, Menorrhagia

Symptoms: Headache, muscle soreness, chills and fatigue.

Other Meds: NO

Current Illness: NO

ID: 1502061
Sex: M
Age: 53
State: UT

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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: are of none

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

Symptoms: At approx. 11:05 I injected patient with the vaccine, as I began to explain the accompanying documents he said, "I think I am having a reaction" I listened. He said, "I feel hot".... at 11:11 am. I observed droplets of sweat on his forehead and offered him some Kleenex and observed his arms to be clammy as I took his temperature to be 96.8 degrees and his blood pressure 132/112. I called for my technician to bring me an adult dose Epi-pen and my cell phone.. I continued to personally monitor the patient. At 11:15 he said "I think it's starting to come back" I assumed he meant he was starting to come back from the reaction, at 11:19 am his temperature was 97.0 degrees. At 11:28 I was called out of the area, before I left I instructed a technician to personally sit with the patient until I returned. At 11:33 am I went back to the patient and took his blood pressure, it was 112/79. His arms did not feel clammy, his face had cleared. At 11:36 am the patient said he felt well enough to leave.

Other Meds: Tramadol, Gabapentin, Tamsulosin unsure of over-the-counter, dietary supplements or herbal remedies

Current Illness: none

Date Died: 07/25/2021

ID: 1502062
Sex: M
Age: 61
State:

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

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: death E87.1 - Hyponatremia J18.9 - Pneumonia, unspecified organism E87.1 - Hypo-osmolality and hyponatremia D69.6 - Thrombocytopenia, unspecified

Other Meds:

Current Illness:

ID: 1502063
Sex: F
Age: 55
State: TN

Vax Date: 04/09/2021
Onset Date: 04/22/2021
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: Contact Allergy - Carba-Mix and Nickel and Quarternium-15 Medicine Allergy - Depa-Medrol (unsure if reallyallergic-foot swelled when got a shot in toe 2013)

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Around April 22 2021 smelled trash/garbage (like rotting vegetables), lasted almost two weeks, then off and on. First of June began smelling electrical burning smell for a week. Following week began to smell ashes like those from a cigarette (no one smokes at my house). I did use Fluticasone spray and AYR spray during each time to see if it would help but it did not. Made appointment with doctor for June 18 as I felt something has to be wrong. She ordered a CT of sinus July 15. Result showed nothing and only mild deviated septum.

Other Meds: Crestor 20mg 1xday / Ezetimibe 10 mg 1xday

Current Illness: None

ID: 1502064
Sex: F
Age: 12
State: KS

Vax Date: 07/23/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Patient's mother put age on Covid Vaccine Documentation form at 2009. When entering information Patient Birthdate is 2010 per Records.

Other Meds:

Current Illness:

ID: 1502065
Sex: M
Age: 49
State: CA

Vax Date: 03/24/2021
Onset Date: 05/21/2021
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: RA

Lab Data:

Allergies: Mussels

Symptom List: Nausea

Symptoms: Shingles about a month after second shot. Lasted about 4-6 weeks.

Other Meds: Shingles with symptoms starting on same arm covid vaccine was administered.

Current Illness: None that I am aware of.

ID: 1502066
Sex: F
Age: 30
State: CA

Vax Date: 07/16/2021
Onset Date: 07/16/2021
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: Avocado severe.

Symptom List: Injection site pain

Symptoms: Patient experienced S/S of epileptic episode immediately after administration of Pfizer COVID-19 vaccine. Disclosed history of SA and Rx Methadone for cessation therapy. Undisclosed history of epilepsy and non-compliance with Rx KEPPRA. According to field reports and verbal debrief, patient had: brief unresponsiveness + nystagmus + upper extremity contraction. During episode, patient's partner disclosed to nurses her PMHx epilepsy and non-compliance with KEPPRA. After a minute or so, S/S ceased and patient was AOX4. No concern by RN after VS measurement and monitoring. Paramedics summoned for second-eye assessment. No concern by paramedics. Patient verbalized feeling OK. Released after a further 30minute observation.

Other Meds: Methadone. KEPPRA sans compliance.

Current Illness: Substance abuse. Epilepsy.

Date Died: 07/25/2021

ID: 1502067
Sex: M
Age: 80
State:

Vax Date: 02/18/2021
Onset Date: 07/04/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: death J18.9 - Pneumonia, unspecified organism N17.9 - Acute kidney failure, unspecified

Other Meds:

Current Illness:

ID: 1502069
Sex: F
Age: 49
State: GA

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

Lab Data:

Allergies: nkda

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

Symptoms: Complaint of headache after receiving COVID vaccine then lip and face swelling 2 days later. 5 days later complaints of joint redness and warmth at joints.

Other Meds: dextroamphetamine-amphetamine (ADDERALL) 20 mg Tab drospirenone-e.estradioL-lm.FA 3-0.02-0.451 mg (24) (4) Tab hydroCHLOROthiazide (HYDRODIURIL) 25 MG tablet lisinopriL (ZESTRIL) 10 MG tablet phentermine (ADIPEX-P) 37.5 mg tablet

Current Illness:

ID: 1502070
Sex: F
Age: 24
State: MN

Vax Date: 05/04/2021
Onset Date: 07/20/2021
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: Doxycycline, Pneumococcal 23-valent Polysaccharide vaccine

Symptom List: Tremor

Symptoms: Patient presented to ED with weakness found to be Covid + and tachycardic. Attended funeral and was exposed to a COVID+ person. 2 days laters she had runny nose and lost her sense of smell, developed tightness in her chest, nausea and headaches. Feels very weak, lightheaded, short of breath, also has c/o fevers, denies chills or sweats.

Other Meds:

Current Illness:

ID: 1502071
Sex: M
Age: 49
State: OR

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Citalopram Hydrobromide.

Symptom List: Erythema, Pruritus

Symptoms: Patient already received a Covid vaccine

Other Meds: unknown

Current Illness:

Date Died: 07/24/2021

ID: 1502072
Sex: M
Age: 58
State:

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

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: death J18.9 - Pneumonia, unspecified organism K92.2 - Gastrointestinal hemorrhage, unspecified N17.9 - Acute kidney failure, unspecified

Other Meds:

Current Illness:

ID: 1502073
Sex: F
Age: 42
State: OR

Vax Date: 12/18/2020
Onset Date: 05/04/2021
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: Oxycodone

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

Symptoms: Tired, groggy feeling, flu like symptoms, felt run down

Other Meds: Allergy Medicine

Current Illness: None

ID: 1502074
Sex: F
Age: 34
State: PA

Vax Date: 07/15/2021
Onset Date: 07/15/2021
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: Penicillin, tomato, peanut-derived, latext, lanolin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: SOB and chest tightness after vaccine. Pulse and RR within normal limits. Gave albuterol - examined by physician in office. Felt to be of anxiety or panic attach related and the albuterol was maybe more of a placebo effect.

Other Meds:

Current Illness:

ID: 1502075
Sex: F
Age: 44
State: IL

Vax Date: 04/28/2021
Onset Date: 05/05/2021
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: cephalexin

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

Symptoms: subacute thyroiditis

Other Meds: multivitamin; vitamin D

Current Illness: none known

ID: 1502076
Sex: F
Age: 70
State: AZ

Vax Date: 07/26/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Ampicillin

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

Symptoms: Patient came in for her first dose of Moderna vaccine. After she received her vaccine she was in the waiting area and began to complain of dizziness and stated she felt as if she was going to faint. She also began to complain of arm tingling on the left side. When I went to check her blood pressure, she felt very clammy to the touch. Prior to calling EMS, her blood pressure was taken twice approximately ten minutes apart. The first reading was 93/52 mmHg with a pulse of 45 and the second reading was 93/62 mmHg with a pulse of 68. EMS arrived and monitored her for approximately ten minutes and stated her vitals were beginning to stabilize and she would not need to be transported to a medical facility. I monitored the patient for an additional ten minutes after to this to ensure she felt okay before allowing her to leave.

Other Meds: Losartan, hydrochlorothiazide, propranolol. No medications were taken the day of vaccination.

Current Illness: Not applicable

ID: 1502077
Sex: F
Age: 40
State: PA

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: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Severe fatigue and had all of the symptoms of Covid and they were gone by 24 hours. Had a miscarriage in my first trimester.

Other Meds: Nausea medicine

Current Illness: None

ID: 1502078
Sex: F
Age: 29
State: TN

Vax Date: 07/13/2021
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: N/a

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

Symptoms: The following day after receiving the vaccine, I started spotting and cramping. Within hours this became more intense and the bleeding became very heavy. This was outside of my usual menstrual cycle as well as very abnormal for me. I became extremely weak and fatigued. Combined my symptoms lasted for 12days and counting. My doctor eventually prescribed me a very low dose of Provera to take for 5days in order to control the heavy bleeding and hopefully return my cycle back to normal.

Other Meds: Levothyroxine

Current Illness: N/a

ID: 1502079
Sex: M
Age: 75
State: AZ

Vax Date: 07/20/2021
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: Levofloxacin, nafcillin, rifampin (Caused Drug fever) OxyContin/ make me very sick Bees

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

Symptoms: Tempt 101.5, high blood pressure swollen arms redness hot to touch Hospital gave me saline

Other Meds: Amlodipine 5mg 1 X Daily Triamterene 37.5 mg/HCTZ 25mg 1 X Daily Aspirin .81 mg 1 X Daily Testosterone inject .5ML (100 MG/ 200mg/ML) Etodolac ? 400MG 1X daily

Current Illness: None

ID: 1502080
Sex: M
Age: 49
State: NE

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 07/26/2021
Hospital: Y

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

Lab Data:

Allergies: metformin

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

Symptoms: arm pain from the moment he received tie injection. Hands and fingers went numb. was told arthritis in shoulder. Went to Er on the 20th of july and a CT scan was done . Had stroke on the 21st . two blood clots were found

Other Meds: dextramer, lipazide

Current Illness: no

ID: 1502081
Sex: M
Age: 48
State: NM

Vax Date: 04/20/2021
Onset Date: 04/22/2021
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: Liquid albuterol, Lirico,

Symptom List: Vomiting

Symptoms: After receiving the vaccine I had the occasional sore arm and pain at the vaccination site. The second day after I started to feel my chest started to burn, which was accompanied by trouble breathing. It was a pain that I have never experienced before in my chest it felt tight and was burning very bad. I started to feel light headed as if I was going to faint while doing my normal daily activities. I decided to stop doing anything that caused my heart to beat too fast. So later on that night i decided to go to the ER, where they did an ekg and some blood work. They also did a scan of my chest where the doctor said everything came back and looked normal. Over time the pain and everything I was experiencing started to get better. I still have a hard time breathing every now and then. Also after the vaccine I experienced a slight cough and runny nose.

Other Meds: Insulin 1x day, vitamin c 1000mg, simvastatin 50mg 2x day,

Current Illness:

ID: 1502082
Sex: F
Age: 14
State: PA

Vax Date: 07/22/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Vasovagal response. Passed out immediately after the vaccine. Had dry heaving. Caught by father.

Other Meds:

Current Illness:

ID: 1502083
Sex: F
Age: 36
State: MI

Vax Date: 07/26/2021
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:

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

Symptoms: Patient had a first dose of MODERNA Covid-19 vaccine administered on 06/25/21. Patient came into the pharmacy for second dose of MODERNA and was given a dose of Pfizer vaccine by mistake. No adverse effects are reported at this time.

Other Meds:

Current Illness:

ID: 1502084
Sex: M
Age: 41
State: CO

Vax Date: 07/09/2021
Onset Date: 07/26/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: None that we are aware of. This report is because this individual has been vaccinated a total of 7 times with COVID vaccines, 2 doses of Moderna, 2 doses of Pfizer, and 3 doses of Janssen. He has presented at different clinics to get vaccinated. Tried to get vaccinated again over this past weekend, and was turned away, when his record in the medical records was reviewed and it was found that he had multiple doses of the vaccines.

Other Meds:

Current Illness:

ID: 1502086
Sex: F
Age: 41
State: PA

Vax Date: 07/08/2021
Onset Date: 07/08/2021
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: Percocet & environmental

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

Symptoms: about 30 minutes after the shot my throat began to feel strange and then I started coughing. I realized that my throat was swelling some. I coughed and was nervous for about an hour and then my throat start to let up. I felt very disoriented for several days and was unable to drive a vehicle...felt very dizzy. I felt tightness in my chest/lungs and it hurt to breath and finally after a week of this, I went and saw my PCP. I discussed what has happened and he said that he did not recommend that I get the second covid shot but if I did that I should wait the full 6 weeks. I was put on a steroid and a nebulizer.

Other Meds: Seroquel, lorazepam, famatodine, vit a & c, omega 3, fenugreek, multi vit, biotin

Current Illness: no

ID: 1502087
Sex: M
Age: 54
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
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: none

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

Symptoms: middle finger on left arm has been slightly numb ever since the day of vaccination

Other Meds: Tamsulosin, Levothyroxine, simvastatin, lorsartan potassium

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm