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: 1502189
Sex: M
Age: 19
State: PA

Vax Date: 07/21/2021
Onset Date: 07/25/2021
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: NONE

Symptom List: Dysphagia, Epiglottitis

Symptoms: Rash on torso of body

Other Meds: NONE

Current Illness: NONE

ID: 1502190
Sex: M
Age: 13
State: KY

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: Unknown

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient lost consciousness for a few seconds, turned pale, and was put in a wheel chair. Patient offered ambulance. Moved to private room and laid down on crash pad. (13:25)HR - 86 / R-14 / BP - 118/74. (13:26) more alert talking, oriented, pale, color improved. (13:29) - HR-94 Psox - 98% - BP-115/75. (13:43) - patient sat up and vital signs measured - HR - 92 / BP - 127/86. (13:53) vitals BP -128/82 - HR-90 / Psox- 98% (14:01) Standing BP - 109/86 - HR-92 / O2 Sat- 99%. Dad went to pick up car. Patient standing and walking without problem . Parents declined EMS, stating patient had had similar episode in the past.

Other Meds: Concerta - medicines for ADD and ADHD Probably Behavioral issues

Current Illness: Unknown

ID: 1502191
Sex: M
Age: 50
State: FL

Vax Date: 05/13/2021
Onset Date: 07/19/2021
Rec V Date: 07/26/2021
Hospital: Y

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: Betadine, codeine, morphine, Percocet 5/325, Pasta (Hives)

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

Symptoms: 7/19/2021: Patient came to ER due to weakness, diarrhea and abdominal discomfort. One week prior he developed decreased appetite as well as abdominal cramping with increasing pain. Patient tested positive for COVID on 7/19/21. diagnosed with: sepsis due to COVID-19 infection, bilateral pneumonia 7.25.21: discharged home. Note: COVID-19 vaccinations status: S/P 2 doses of Moderna Vaccine in April of 2021

Other Meds: CellCept 500mg PO BID, Voltaren, Lipitor 40mg PO qDay,

Current Illness:

ID: 1502192
Sex: F
Age: 56
State: FL

Vax Date: 03/16/2021
Onset Date: 07/14/2021
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: Ceclor, cephalosporins, penicillins, shellfish

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 7/20/2021: Patient came to ER due to coughing, diarrhea and feeling lightheaded. While in the ED patient had a hypotensive episode, her blood pressure increased and she was started on broad spectrum antibiotics. Patient stated she tested positive for COVID on 7/15/21. Diagnosed with: COVID-19 pneumonia, acute hypoxic respiratory failure 7/26/21: patent is still admitted the day of this report submission. Note: patient received 2 shots of Moderna COVID19 vaccines, second dose in March 2021.

Other Meds: carvedilol, levothyroxine, mag ox, aspirin, nifedipine, predni prednisone, diclofenac, tacrolimus, mycophenolate mofetil

Current Illness:

ID: 1502193
Sex: F
Age:
State: CT

Vax Date: 05/01/2021
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:

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

Symptoms: My arm hurt a lot right after the shot. A few hours after like about 5 my entire right side went numb and I couldn?t feel it. I also get intense headaches everyday after I got the shot. I was also very tired for the next 3 days.

Other Meds:

Current Illness:

ID: 1502194
Sex: M
Age: 59
State: IL

Vax Date: 07/10/2021
Onset Date: 07/14/2021
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: Patient states he went to his doctor when he had an oozing rash in several spots on his left forearm, left leg, and right knee 4 or 5 days after shingles vaccination. He states MD gave him some cream and acyclovir. Rash was not painful, did not burn but did itch. I asked the patient if he had been doing yard work. He stated that he had.

Other Meds: unknown

Current Illness: unknown

ID: 1502195
Sex: F
Age: 46
State: TN

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no known allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Withinn 24 hours of receiving vaccination, pt started having symptoms of another shingles outbreak. Pt called Pfizer and was told by a representative that this effect has been reported with the Pfizer vaccine. Instructed pt to go to urgent care clinic to get started on treatment for shingles right away, since it was Saturday.

Other Meds: no record

Current Illness: none

ID: 1502196
Sex: F
Age: 44
State: AL

Vax Date: 03/18/2021
Onset Date: 03/19/2021
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: Anaphylactic reaction. Fever. full body hives - Went to urgent care and Emergency room for treatment. Had low oxygen lvels and hives. Eyes swollen and lips swollen.

Other Meds: Klonopin, Synthroid, Lipitor

Current Illness: none

ID: 1502197
Sex: M
Age: 44
State: TX

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: Hydrocodone

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 5 mins post administration of J and J vaccine, patient complained of flushing nausea and light headedness. Vital signs obtained 98% room air, post rate of 72, blood pressure 138/72 temp 97.1. Patient provided water and 1 cooling pack and observed for 10 mins. 2nd vital signs were obtained which was 98% room air 72 heart rate 130/70 and 98.1. Patient was observed until symptoms resolved. final vital signs showed 98 room air, 74 heart rate 126/78 BP 98.1 temp. Patient was safely discharge without further incident.

Other Meds: venlafaxine HCL extend release 45 mg 3/day Olmesartan 20 mg

Current Illness: unknown

ID: 1502198
Sex: F
Age: 64
State: IL

Vax Date: 06/22/2021
Onset Date: 06/29/2021
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: trazodone, chloride, oxybutynin, clindamycin, shell fish, adhesive tape, dust mite , pineapple, tramox-pe-dlycerin-petroleum, mold, smut cashew nut oil, ethanoyl , ranitidine, silicon

Symptom List: Diarrhoea, Nasal congestion

Symptoms: hair started falling out, when she brushes her hair there has been alot of hair in her brush

Other Meds: eliquis 5mg, folic acid, levothyroxine, 125mcg, loratadine 10mg, simvastatin 40mg, methotrexate 2.5mg, omeprazole 20mg, furosemide 40mg, montelukast 10mg, buspirone 15 mg, duloxetine 60mg, dicyclomine 50mg, solifenacin 10mg, topiramate 100

Current Illness: lymphedema, chronic swelling that cause blood clots in legs

ID: 1502199
Sex: F
Age: 35
State: HI

Vax Date: 02/01/2021
Onset Date: 07/25/2021
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: Erythromycin

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

Symptoms: Covid positive in fully vaccinated

Other Meds: unknonw

Current Illness: none

ID: 1502200
Sex: F
Age: 49
State: AZ

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: no

Symptom List: Rash, Urticaria

Symptoms: I HAD A STROKE

Other Meds: omega 3 clonazepam

Current Illness: mo

ID: 1502202
Sex: F
Age: 74
State: PA

Vax Date: 03/28/2021
Onset Date: 04/11/2021
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: wellbutrin, medical adhesive

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

Symptoms: Patient had migraine headache, diarrhea, difficulty breathing, angina, restless legs at night.

Other Meds: phosphatidyl choline, duloxetine dr, omeprazole, melatonin, B6, metoprolol er succinate, folic acid, irbesartan, meloxican, D3, methotrexate, aspirin, zetia, ropinirole, acetaminophen, insulin

Current Illness:

ID: 1502203
Sex: M
Age: 59
State: IL

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: The patient experienced arm and joint pain developing on Thursday July 22nd. Those symptoms went away by July 23rd. The patient woke up with severe pain in his side on Monday July 26th. He went to the emergency department and was diagnosed with pleurisy.

Other Meds:

Current Illness:

ID: 1502204
Sex: F
Age: 26
State: TN

Vax Date: 07/18/2021
Onset Date: 07/18/2021
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: no

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

Symptoms: swelling in arm, quarter size has not gone away in 10 days. also itching.

Other Meds: birth control

Current Illness: no

Date Died: 05/25/2021

ID: 1502205
Sex: M
Age: 74
State: MN

Vax Date: 04/05/2021
Onset Date: 05/19/2021
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:

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

Symptoms: Death. Last known May 19, 2021. Found May 25, 2021

Other Meds:

Current Illness:

ID: 1502206
Sex: F
Age: 58
State:

Vax Date: 07/07/2021
Onset Date: 07/12/2021
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: NKA

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

Symptoms: Cough for over 2 weeks, sore throat

Other Meds: Amlodipine Calcium with D Tumeric duoneb

Current Illness: None

ID: 1502207
Sex: F
Age: 44
State: CA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
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: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: chills, night sweats, and body aches, particularly back pain that was very intense and required me to visit a chiropractor to help find relief. Took 2 extra strength Tylenol and still felt pain. A few days later it was better. It took a few weeks to go away completely. It came on very suddenly.

Other Meds: None

Current Illness: None

ID: 1502208
Sex: F
Age: 14
State: AR

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

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: patient had syncopal episode 20 minutes after vaccine administration-mom reported patient unconscious for 20 seconds, but no issues since --EMS contacted and assessed patient

Other Meds: N/A

Current Illness: none known

ID: 1502209
Sex: F
Age: 50
State: FL

Vax Date: 03/07/2021
Onset Date: 07/10/2021
Rec V Date: 07/26/2021
Hospital: Y

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 drug allergies

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

Symptoms: 7/21/2021 presented to ED for SOB and cough. Patient stated that she developed cough, congestion and body aches 7/14/2021. Patient son tested positive for COVID and she subsequently went to Urgent care to be tested positive for COVID 7/18/2021. Patient stated that she received the Johnson and Johnson vaccine in April 2021. diagnosed with COVID-19 pneumonia and viral sepsis, acute hypoxic resp failure. Remdesivir through 7/26. 7/26: patient still admitted as of the time of this report submission.

Other Meds: naproxen, acetaminophen/dextromethorphan/PE

Current Illness:

ID: 1502210
Sex: M
Age: 72
State: GA

Vax Date: 04/29/2021
Onset Date: 04/29/2021
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: Diagnosed w/ G6PD Deficiency. Diagnosed with heart attack apprx 20 yrs, never had any known symptoms until x-ray scar tissue.

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

Symptoms: Burning sensation in area of vaccine , severe muscle pain in upper arm, shoulder, and neck

Other Meds: Hydrocodone 10/325, Lisinopril 40mg, Amplodipine 10mg, Atorvastin 20mg, Equate stool softener, Tizanidine 4mg, Ibuprofen 200mg.

Current Illness: Prostate Cancer, Asti Arthritis

ID: 1502211
Sex: F
Age: 35
State: SC

Vax Date: 07/09/2021
Onset Date: 07/14/2021
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: Latex

Symptom List: Unevaluable event

Symptoms: After the second dose 09/07/21 I started with a rash on both arms. A lot of blisters covered the top of my hands and arms. three days later I had a bad cold.

Other Meds: Vitamin C; Green Tea Pill; Vitamin D; Folic acid

Current Illness: No

ID: 1502212
Sex: F
Age: 11
State: MN

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

Lab Data:

Allergies: None

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

Symptoms: No adverse event but administered outside of ACIP guidelines. Guardian represented the DOB incorrectly. Pt was actually 11 years old at time of administration.

Other Meds: None

Current Illness: None

ID: 1502213
Sex: M
Age: 39
State: FL

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

Symptom List: Injection site pain, Pain

Symptoms: patient was given third dose of moderna inadvertently due to patient seeking vaccination and healthcare provider asking if patient was previously immunized or not against coronavirus. Patient indicated no previous vaccine. It was later found that the patient's expiration date was entered as the BUD on the florida SHOTS record. When the pharmacist went to make the correction and FL SHOTS record was pulled, it was discovered that the patient was previously fully vaccinated with Moderna in February and final dose in March 2021. The patient did not recall either event, but upon further prompting from pharmacist, patient demonstrated recall of vaccine (both.) Patient claimed not to have any record or proof of prior vaccination or COVID vaccine card. Pharmacist instructed patient that the patient would NOT be receiving any additional doses at this time. They should follow up with the administering pharmacist if any issues develop.

Other Meds: not known at this time customer does not fill any medication with us

Current Illness: none

ID: 1502214
Sex: F
Age: 61
State: IL

Vax Date: 07/16/2021
Onset Date: 07/17/2021
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: Unknown

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reports having shooting arm pain up her left arm and neck the day after her vaccination. Difficulty sleeping and pain in her arm.

Other Meds: Gabapentin 100mg, Medrol dose pak, Clonazepam 1mg, sertraline 100mg, dexamethasone 6mg,.

Current Illness:

ID: 1502215
Sex: F
Age: 13
State: KS

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:

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

Symptoms: Patient felt nauseous, dizzy , lightheaded, and hot and sweaty after a minute after receiving both the HPV and TDAP. Took vitals. BP- 90/61, 90/60 pulse- 80 temp- 97.3 oral After some cool water and relaxed in the room for about 10 minutes, patient stated she was starting to feel better.

Other Meds:

Current Illness:

ID: 1502216
Sex: M
Age: 16
State: WI

Vax Date: 05/18/2021
Onset Date: 07/18/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: (mother positive first), Sx onset 7/18/21 cough, runny nose, chills, headache, muscle aches, loss of smell & loss of taste.

Other Meds:

Current Illness:

ID: 1502217
Sex: F
Age: 43
State: OK

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Client received first dose of Pfizer Covid 19 Vaccine in left deltoid. At the end of the 15 minute waiting period after the vaccine, the client complained of tingling in left arm. Client verbally referred to follow up with primary care provider.

Other Meds: Fumodetine, multivitamin, calcium, D3, B12, Iron, Vitamin C, Biotin

Current Illness: None

ID: 1502218
Sex: F
Age: 63
State: TX

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: Doxycycline

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

Symptoms: ? Extreme exhaustion. Unable to perform daily functions. As of 7/26/21 I am still experiencing this debilitating adverse effect. ? Severe Headaches. I had never experienced such severe headaches before and now I have them frequently. ? Brain Fog. Frequently I am unable to think clearly. ? Swollen lymph nodes. These come & go but 3 months after the vaccination I still have knots that come & go in my armpit area. ? Cough. ( I have never smoked not been subjected to 2nd hand smoke ). I now frequently have a cough that has not gone away since the vaccination. ? Vomiting. I have vomited more since the vaccination than I have in my entire life combined. The vomiting does not appear to be related to eating and I?m fine afterward until the next episode. My entire life changed the day I received the Moderna COVID-19 second dose vaccination. I no longer have the energy to exercise. Prior to the vaccination I was walking 5-7 miles daily and had been for more than 15 years. I no longer can enjoy life as I am too exhausted to function normally.

Other Meds: Levothyroxin 88 mcg One a Day Multivitamin Low Dose Aspirin

Current Illness: None

ID: 1502219
Sex: M
Age: 12
State: FL

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Patient recieved Moderna vaccine and is under the age of 18.

Other Meds:

Current Illness:

ID: 1502220
Sex: M
Age: 47
State: AR

Vax Date: 07/19/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NA

Symptom List: Injection site pain

Symptoms: Vaccine was given 7 days early. No side effects reported.

Other Meds: NA

Current Illness: NA

ID: 1502221
Sex: F
Age: 11
State: MN

Vax Date: 07/24/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: No adverse reaction. Guardian misrepresented DOB of children for a walk-in vaccine. Vaccine was given to 11-year-old outside of guidelines.

Other Meds: None

Current Illness: None

ID: 1502222
Sex: M
Age: 16
State: WI

Vax Date: 06/08/2021
Onset Date: 07/18/2021
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:

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

Symptoms: (mother positive first), Sx onset 7/18/21 cough, runny nose, chills, headache, muscle aches, loss of smell & loss of taste.

Other Meds:

Current Illness:

ID: 1502223
Sex: F
Age: 55
State: PA

Vax Date: 03/28/2021
Onset Date: 03/30/2021
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: Tremor

Symptoms: Patient stated that her finger went numb like four days after taking the vaccine. In June she started gaining a little feeling in her fingers. Patient stated that her index finger still has not gain full sensation. Patient took a nerve test on 7/26/2021.

Other Meds: McMorphine

Current Illness:

ID: 1502224
Sex: F
Age: 21
State: TX

Vax Date: 07/01/2021
Onset Date: 07/01/2021
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: N/A

Symptom List: Erythema, Pruritus

Symptoms: Patient had done a form online and on that form asked for Janssen. When arrived the form was not found and our technician gave her another form unaware "Pfizer" was printed on the form. The vaccinator understood that patient wanted Pfizer based on the form and administered the vaccine. Patient was very upset she received Pfizer in place of Janssen. Checked on patient the next day and she reported normal expected side effects that she understand were normal and expected. She said she was alright. No further effects were reported to the Pharmacist

Other Meds: N/A

Current Illness: N/A

ID: 1502225
Sex: F
Age: 99
State: MN

Vax Date: 01/27/2021
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: lipitor, metronidazole, valtrex, codeine, latex, levaquin, pravachol, penicillamine, crestor, simvastatin

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

Symptoms: Exposed to daughter on Tuesday. 7/24/21 Sinus congestion and cough

Other Meds: Metoprolol, aspirin, acetaminophen, calcium+D, multivitamin,tramadol, lisinopril

Current Illness: unkown

ID: 1502226
Sex: F
Age: 56
State: MD

Vax Date: 06/30/2021
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: Cortisone, Epinephrine, Ioversol, Influenza, Promethazine, Sulfanilamide, tetanus, NSAIDs, Ibuprofen, Diphenhydramine, Iodinated contrast, codeine

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

Symptoms: Patient was given the second dose of the Moderna shot a week prior to when she was due. Patient reported on July 23, 2021 that she had aching, fever of 101.8, swollen arm, head cold, eye pressure, high blood sugar levels and diarrhea.

Other Meds: Flaxseed oil, Albuterol Sulfate, Arnuity Ellipta, Vitamin D, Metformin, Zetia, Lisinopril

Current Illness: Tick bite

ID: 1502227
Sex: F
Age: 60
State: WI

Vax Date: 03/05/2021
Onset Date: 07/16/2021
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: Nasal Congestion

Other Meds:

Current Illness:

ID: 1502228
Sex: F
Age: 17
State:

Vax Date: 05/16/2021
Onset Date: 05/17/2021
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: None.

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

Symptoms: Fatigue, enlarged left breast and lymph nodes. Dizziness, had the feeling of blacking out, headache, muscle weakness, BP was stable 58-60 when patient sitting, spikes to 100 when she stands.

Other Meds: Birth control (Yaz)

Current Illness:

ID: 1502229
Sex: F
Age: 15
State: KY

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: Unknown

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

Symptoms: Patient received vaccine at (13:22) directly afterwards, patient states "I feel hot, my eyes are turning black, I cannot see." "I am sweating bad." Patient was noted to be pale and offered wheel chair. Patient was taken to private room and assisted to lie down at (13:30). Patient continued to be oriented (BP - 118/40) HR-76 / O2 -97. Patient complains of dizziness and black spots in vision. Continued to monitor. Cool rag applied to forehead (1:34 PM - BP -123/69 HR - 75 / O2-98) (1:36) (13:37) Patient assisted to sitting position. BP -114/59 Voiced feeling better. (13:40 PM) BP - 120 /75 / (13:40 - stood patient up and assisted to chair. Patient was normal and fine while sitting in chair. (13:50) Patient was clammy, stated she felt as though she would pass out. BP - 119/27 / HR - 89 O2 98 / assisted to lie down, continued to complain of dizziness. Clammy, (13:59) EMS called / BP -115/92 - HR -76. Ambulance arrived at (14:05). Before transfer of care BP - 125/71 - HR 107 / O2- 98

Other Meds: Lexapro Vistaril

Current Illness: Depression

ID: 1502230
Sex: M
Age: 54
State: AZ

Vax Date: 12/23/2020
Onset Date: 12/23/2020
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, Keflex, clindamycin

Symptom List: Pain in extremity

Symptoms: Inflammation, angioedema mouth, face, cheek, eye closed, swollen tongue. 25 mg oral Benadryl twice, Motrin 600 mg three time, medications taken over 24 hours.

Other Meds: None

Current Illness:

ID: 1502231
Sex: F
Age: 33
State: CA

Vax Date: 05/12/2021
Onset Date: 05/12/2021
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: NONE

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

Symptoms: patient received first dose of Moderna vaccine on 5/12/21. Bagan experiencing palpitations and tachycardia shortly after. Reports experiencing palpitations and tachycardia daily which wakes her from her sleep. Also reports diarrhea and hyper vivid dreams, the diarrhea has since subsided however. She has had 2 syncopal episodes since the vaccination.

Other Meds: NONE

Current Illness: NONE

ID: 1502232
Sex: F
Age: 70
State: PA

Vax Date: 01/22/2021
Onset Date: 02/22/2021
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: Codeine

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

Symptoms: After having RA symptoms managed for 23 years, I began having severe joint pain in knees, wrists, hands, feet, arms, shoulders. Pain started as slow process and by the time I received second dose ( Feb. 21), had to phone my rheumatologist.

Other Meds: Humira, lisinopril, atorvastatin, Celebrex, singulaire, calcium supplement with D

Current Illness: None

Date Died: 07/25/2021

ID: 1502233
Sex: F
Age: 84
State: MN

Vax Date: 03/16/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Received Pfizer vaccines on 2/19/21, 3/16/21. Tested positive for COVID-19 on 7/10/21. Symptoms began on 7/6/21 w/ cough, dysgeusia, fatigue. Hospitalized on 7/13/21; transferred to ICU on 7/22/21. Patient expired on 7/25/21 due to pneumonia d/t COVID-19. Patient was intubated; given dexamethasone 6 mg x9 d, 5 day course of remdesivir, one dose of tocilizumab for COVID pneumonia. PMH significant for past medical history significant for pulmonary sarcoidosis, on prednisone 5 mg daily; immune thrombocytopenic purpura, on rituximab.

Other Meds:

Current Illness:

ID: 1502234
Sex: F
Age: 50
State: VA

Vax Date: 01/21/2021
Onset Date: 02/12/2021
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: N/A

Symptom List: Vomiting

Symptoms: headache and lower back pain

Other Meds: Celebrex multi menerial Tylenol vit b multi vit vit e

Current Illness: N/A

ID: 1502235
Sex: F
Age: 63
State: MA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
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: penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Instant headache after vaccine then malaise. Next day mild upper respiratory symptoms, fatigue and malaise. Fatigue and headache for 4 days. Slept most of the next 3 days. I took tylenol with little effect

Other Meds: sulfasalazine losartan omeprazole premarin allergra D 12 hour

Current Illness:

ID: 1502236
Sex: M
Age: 23
State: IL

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

Lab Data:

Allergies:

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

Symptoms: Patient reported that 3-5 minutes after the injection his vision was gone and his hearing was diminished. He did not report this until 2:25. The symptoms resolved by the time he reported them to the nurse. Denied dizziness, shortness of breath, chest pain, or any other problems. Said he has a history of "passing out" if he gets overheated, but this episode did not feel like those other episodes. Released to the care of his mother at 2:35pm.

Other Meds:

Current Illness:

ID: 1502237
Sex: M
Age: 16
State: CA

Vax Date: 05/28/2021
Onset Date: 05/31/2021
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: Mepivicaine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Dysosmia - meat and vegetable smell like garbage

Other Meds: Cetirizine

Current Illness: No

ID: 1502238
Sex: F
Age: 59
State: DC

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

Lab Data:

Allergies: n/a

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

Symptoms: That evening at about 6 pm, I got up off the couch and had a sharp, shocking pain from my butt (sciatica) down my leg to my ankle. Could barely walk and was not comfortable in bed on any side. Came on all of a sudden the night of my shot.

Other Meds: Zolpidem Tartrate

Current Illness: n/a

ID: 1502239
Sex: M
Age: 17
State: WI

Vax Date: 05/18/2021
Onset Date: 07/14/2021
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: Sx onset 7/14/21 cough, sore throat, muscle aches, headache, fatigue, loss of smell & loss of taste.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm