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: 1502292
Sex: M
Age: 14
State: VA

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

Lab Data:

Allergies: NONE

Symptom List: Dysphagia, Epiglottitis

Symptoms: Vaccine given outside of approved guidelines regarding age of recipient - client receiving vaccine was 14 years of age.

Other Meds:

Current Illness:

ID: 1502293
Sex: F
Age: 63
State: NY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Sulfa; Iodine; Keflex-rash

Symptom List: Anxiety, Dyspnoea

Symptoms: The evening of the vaccine I was having a tingling sensation in my legs where I get Cellulitis. The next day my legs were painful and it got worse. I got Cellulitis in both legs and it normally only happens in one leg. I also had a rash on my right arm. It was a red swelled spot. By the time I was in the hospital the swelling was all the way above my knee. I was also wheezing but it was identified as long Covid-19 symptoms. I had Covid-19 in March of 2020. I was sent home after two days and prescribed Keflex. I was referred to a Pulmonologist.

Other Meds: Eye Drops in preparation for Laser Surgery

Current Illness:

ID: 1502294
Sex: M
Age: 46
State: UT

Vax Date: 07/20/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Client reports he had flu-like symptoms starting on 07/21/21. Client is still experiencing increased fatigue, headache at night, and dizziness in the morning

Other Meds: None

Current Illness: None

ID: 1502295
Sex: F
Age: 37
State: IN

Vax Date: 07/02/2021
Onset Date: 07/03/2021
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: Felt aching and had a mild headache and sore arm.

Other Meds:

Current Illness:

ID: 1502296
Sex: F
Age: 72
State: FL

Vax Date: 04/13/2021
Onset Date: 04/13/2021
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: Protonix

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

Symptoms: Within 2 hours after the first COVID shot I developed a dry cough that went away after 2 weeks. I then had a second shot of COVID vaccine. 05/10/2021 shot to right arm vial 003C21A I again developed a dry cough that has never gone away. Not pregnant

Other Meds: Multiple Vit 1 po qd, Probiotics 10 billion units 1 po tid, Vit B complex 1 po qd, Prilosec 20 mg1 po qd, Evista 60 mg 1 po qd; Ocuvite 1 po qd

Current Illness: None

ID: 1502297
Sex: F
Age: 29
State: CO

Vax Date: 06/26/2021
Onset Date: 06/26/2021
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: Soy sauce

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

Symptoms: Sore arm, fever, severe chills, fatigue.

Other Meds: Prenatal vitamins

Current Illness: No

ID: 1502298
Sex: F
Age: 48
State: PR

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

Lab Data:

Allergies: No

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: A 48 year old female with a history of schizophrenia report feeling dizziness in the observation area. Paramedic take the vitals sings at 4:26pm BP: 110/80 mmhg, HR: 73, SO2 97%, dextrose; 87. Then patient star to feel nauseas We give to the patient water and candy. at 4:36pm paramedic take her dextrose was 96.

Other Meds: Risperidone clonozepam zolof

Current Illness: No

ID: 1502299
Sex: F
Age: 42
State: OH

Vax Date: 07/10/2021
Onset Date: 07/11/2021
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: No

Symptom List: Pharyngeal swelling

Symptoms: Itchy raised bumps that look like bug bites. The bumps appeared the following day and continue to appear as of reporting date. As time goes on, fewer bumps appear. Itchiness continues even in areas without bumps, but has declined. On a scale from 0-10 the itchiness started at a 5 and quickly increased to a 10 within two days. At time of reporting itchiness has declined to an 8.

Other Meds: No

Current Illness: None

ID: 1502300
Sex: F
Age: 59
State: VA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
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: Biaxin; Tagamet; Penicillin; Dairy Sensitivity; Possible Gluten Sensitivity; Dogs; Cats; Trees; Pollens; Nickel; Carbon Paper; Seasonal Allergies; Latex.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Slight Headache and arm soreness right after vaccine but then I started feeling bad - aches, body aches and pain and increased reflux and started having diarrhea. I was feeling sick eating. It went off and on and off and on for awhile. Then exhaustion and it's hard to move. Joint pain and muscle cramping. I thought maybe I had Celiac Disease. I had skin rashes and I started having almost like moles that would pop up and be filled with blood and they itched like crazy. Lack of sleep but still bone tired exhaustion. Nausea is constant, I can get the heaves but I don't vomit. I made an appt with a gastroenterologist. I went in to get tested. I was told I was nuts about it being food allergies. He said I was obsessed with food. I have increased anxiety now and I have never been an anxious person. People were starting to say I needed to talk to someone for anxiety. I am feeling increased worse as days go by. I have some increased yellowing of skin and some yellowing in my eyes. I am losing weight because I can't even eat. I have pain and swelling in my mid-section. I can't sleep, can't lay on stomach (from car wreck) or either side or on my back. I get a low-grade fever and then chills. My ankles are swelling. I have chest pain, it's terrible. A couple of times, I have almost gone to ER because it feels like a heart attack. I know that it's in my esophagus, and it hurts right in the middle of my chest, it hurts when I swallow. It's like a pressure. It's hard and it's a tremendous buildup of pressure in my esophagus. Knuckles are swelling. Joint pain. I have pale stools, like a tan yellow. Goes between diarrhea to not really constipation. Lately it has been more toward normal. It's getting real hard to function.

Other Meds: Levothyroxine; Paroxetine; Montelukast; Cetirizine; Fioricet.

Current Illness: About 1 1/2 months to two month before, I was going through a sinus infection, and they had put me on a steroid as well, but they told me to not take the injection until I had been off it for a certain length of time which I did wait to do.

ID: 1502301
Sex: M
Age: 64
State: VT

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt filled out intake form and denied that he had been vaccinated. When vaccination entered in medical record pt had already received Moderna 2 doses. Pt would not answer phone or return calls to discuss further.

Other Meds:

Current Illness:

Date Died: 06/09/2021

ID: 1502302
Sex: F
Age: 61
State:

Vax Date: 02/11/2021
Onset Date: 06/07/2021
Rec V Date: 07/26/2021
Hospital: Y

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

Lab Data:

Allergies: UNK

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

Symptoms: tested positive and died after being fully vaccinated

Other Meds: UNK

Current Illness: UNK

ID: 1502303
Sex: M
Age: 1
State: NY

Vax Date: 07/15/2021
Onset Date: 07/25/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Rash and fever 8 days following vaccination. Fever to tmax 103. Also found to have right otitis media at the time

Other Meds:

Current Illness: Otitis media 2 weeks prior to vaccination.

ID: 1502304
Sex: M
Age: 21
State: OH

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:

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

Symptoms: Patient sat outside of pharmacy in a chair for approximately 5 minutes. He started to look not so well. Went to bring him back into consultation room and he passed out. He laid down on the floor for 10 minutes or so. Gave him some water and animal crackers.

Other Meds:

Current Illness:

ID: 1502305
Sex: F
Age: 85
State: NM

Vax Date: 03/12/2021
Onset Date: 06/16/2021
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: None

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

Symptoms: Blood Clot

Other Meds: Gabapenton Lisinopril Amlodipine Multi Vitamins, ADK ,Pro omega ,Zypan, St Johns Wort

Current Illness: High Blood Pressure

ID: 1502306
Sex: F
Age: 80
State: NC

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: LA

Lab Data:

Allergies: No

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

Symptoms: First Dose was given on 12/29/2020 by pharmacy and vaccine was Moderna 2nd dose was given as Pfizer

Other Meds: No

Current Illness:

ID: 1502307
Sex: F
Age: 34
State: IN

Vax Date: 07/17/2021
Onset Date: 07/17/2021
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: Sea food Tramadol

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

Symptoms: I started cramping pretty bad after the 1st shot. I do have endometriosis which is well managed & I haven't had issues with cramps for a while. I thought it would go away but I'm still having them & its been a week and 2 days. I was not on my cycle at the time of vaccination and it was not near time for it either.

Other Meds:

Current Illness:

ID: 1502308
Sex: M
Age: 30
State: MN

Vax Date: 01/13/2021
Onset Date: 07/17/2021
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: Pt reported exposure to Covid + person, reported symptoms starting 7/17/2021, unknown what symptoms experienced.

Other Meds:

Current Illness:

ID: 1502309
Sex: M
Age: 14
State: NC

Vax Date: 06/11/2021
Onset Date: 07/11/2021
Rec V Date: 07/26/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Presented with bilateral facial weakness on 7/11. Prescribed 3 day course of steroids (7/14-7/16) without improvement. Presented again on 7/18 with worsening facial weakness in addition to bilateral upper and lower extremity weakness and difficulty walking. Admitted to hospital on 7/19. On the second day of his hospitalization he was no longer ambulatory. Diagnosed with likely AIDP based on CSF studies (albuminocytologic dissociation, negative infectious work-up). Treated with 3-day course of IVIG (7/21-7/23), after which he showed significant improvement in his upper/lower extremity and facial strength and ambulation. He is being discharged with ongoing outpatient physical therapy.

Other Meds:

Current Illness:

ID: 1502310
Sex: M
Age: 14
State: NY

Vax Date: 07/11/2021
Onset Date: 07/11/2021
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: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient presented w/ fever x 1d. S/p COVID #1. Tm 99.6F; defervesce w/ antipyretics. Assoc w/ chest pain w/ breathing; denied resp distress, shortness of breath, palpitations, LOC, MS change. or other neuro/cardio/pulm difficulties. Denied cough, rhinorrhea, vomit, diarrhea, rash, or lethargy. Normal PO and UOP. Provider referred patient to visit ER on 07/12/21. On 07/13/21, nurse reached patient to follow ER visit. Patient stated that symptoms resolved after 07/12/21 visit. Patient did not went to ER.

Other Meds: Singulair 5 mg, Ventolin HFA 108 mcg, Fluticasone Propionate 50 mcg, Loratadine 5 mg, MiraLax oral powder.

Current Illness: Nose congestion.

ID: 1502311
Sex: U
Age: 56
State: GA

Vax Date: 04/08/2021
Onset Date: 07/05/2021
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:

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

Symptoms: Hospitalization PUI stated she has also experienced light sensitivity, wheezing, a burning sensation on the right side of her sinus cavity and a burning sensation in her chest. PUI stated that she is still feeling all symptoms except for the fever. PUI stated that due to sinus issues she has no sense of smell and her sense of taste is diminished. PUI is hospitalized at Medical Center since 7/5/21 and she stated she will be evaluated for discharge on 7/9/21. PUI stated she is receiving breathing treatments every 6 hours. PUI stated she has been told she does not have pneumonia, but that she does have Covid Lung (in both lungs).

Other Meds:

Current Illness:

ID: 1502312
Sex: F
Age: 24
State: DC

Vax Date: 07/09/2021
Onset Date: 07/10/2021
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: NKDA

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

Symptoms: We report a rapid onset of severe diabetes ketoacidosis (DKA) and transient profound insulin resistance in a 24-year-old female with type 1 diabetes after administration of the second dose of the COVID-19 vaccine. Patient required ICU admission

Other Meds: Insulin via insulin pump

Current Illness: type 1 diabetes

ID: 1502313
Sex: M
Age: 59
State: CA

Vax Date: 03/25/2021
Onset Date: 04/08/2021
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: LA

Lab Data:

Allergies: Sulfur

Symptom List: Unevaluable event

Symptoms: Side effects: headache, serve swelling, paint, joints painful, feels like pins sticking in my joints, most on my hands, rash, fatigue for starters

Other Meds: Levothroxine, low dose aspirin,

Current Illness: None

ID: 1502314
Sex: F
Age: 58
State: CA

Vax Date: 04/15/2021
Onset Date: 07/12/2021
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, walnuts, coriander, cumin, wool, adhesive tape

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

Symptoms: Severe abdominal pain, vomiting, diarrhea, muscle pain, headache, fever

Other Meds: Dexilant, COQ-10, Riboflavin, B-6, magnesium, Restatsis, biotin, B-12, Fish oil, D-3

Current Illness: Don't remember. But I had shingles in February.

ID: 1502315
Sex: M
Age: 55
State: IA

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

Lab Data:

Allergies: no known allergies

Symptom List: Injection site pain, Pain

Symptoms: We were notified by the state health department that he is believed to have received 3 doses of the covid shot, at our facility on 7/16 and 6/25 as well as an earlier shot on 4/17 per the state immunization registry. We have called the patient numerous times and he has not returned our calls so it is unknown if he experienced any adverse effects.

Other Meds: unknown

Current Illness:

ID: 1502316
Sex: F
Age: 55
State: IN

Vax Date: 04/28/2021
Onset Date: 04/30/2021
Rec V Date: 07/26/2021
Hospital: Y

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

Lab Data:

Allergies: penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: cardiac arrest on 4/30 followed by medically-induced coma followed by bringing back to normal body temperature followed by recovery. in ICU almost a week and heart hospital a week. Nearly full recovery at this time. Going to cardiac rehab and working to build strength/stamina.

Other Meds: multivitamin, calcium, metoprolol, low dose aspirin

Current Illness: none

ID: 1502317
Sex: M
Age: 32
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: vaccine given after being refrigerated more than 30 days

Other Meds:

Current Illness:

ID: 1502318
Sex: M
Age: 78
State: GA

Vax Date: 02/10/2021
Onset Date: 07/08/2021
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: Individual hospitalized for COVID-19 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1502319
Sex: M
Age: 36
State: OH

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:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: The patient fainted after receiving the vaccination. He stated he had fainted before when given other vaccines, stated he was beginning to feel lightheaded and decided to lie down. For a couple of seconds he was unresponsive but then recovered.

Other Meds:

Current Illness:

ID: 1502320
Sex: F
Age: 56
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: vaccine given after being refrigerated more than 30 days

Other Meds:

Current Illness:

ID: 1502321
Sex: M
Age: 23
State: OH

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 known drug allergies

Symptom List: Nausea

Symptoms: Patient passed out as he attempted to stand roughly 15 minutes after receiving his first dose of the Pfizer COVID vaccination. Patient hit his head on a door as he fell. Patient was given water and allowed to lie down for several minutes until he felt able to sit. Patient was then monitored until a family member could pick him up. Estimated greater than 30 minutes.

Other Meds: Ibuprofen loratadine

Current Illness: no known illnesses

ID: 1502322
Sex: M
Age: 42
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: vaccine given after being refrigerated more than 30 days

Other Meds:

Current Illness:

ID: 1502323
Sex: F
Age: 34
State: MN

Vax Date: 06/22/2021
Onset Date: 06/24/2021
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: Left calf abnormal leg pain on the back. Not going away. Urgent care didn?t see any signs of thrombosis, but the pain won?t go away.

Other Meds: No

Current Illness: None

ID: 1502324
Sex: M
Age: 52
State:

Vax Date: 05/17/2021
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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: vaccine given after being refrigerated more than 30 days

Other Meds:

Current Illness:

ID: 1502325
Sex: F
Age: 42
State: LA

Vax Date: 03/17/2021
Onset Date: 03/23/2021
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: sulfa, allergens to outdoors, such as pollen, and some foods.

Symptom List: Tremor

Symptoms: March 17: 9am Covid vaccine: not immediate reaction. Got home, got a rash. Took Allegra to control reaction. got very tired, slept all day. No fever, no coughing, pain in arm where shot was given. Started on Torprol XL, and aspirin, as palpitations got stronger and hard to control heartrate. Gastro Issues, stated on baking soda for abdominal pains. March 23: Gastro issues with intense abdominal pains (visited Dr., but never associated to Covid shot). Started gastro meds. March 29: Dr./Gastro. Clinic, ultrasound. April 6th: asthma attack; visited walking in emergency clinic, started prednisone. April 15: fatigue, dizziness, lack of concentration, easily tired, lack of energy, 'drunk feeling started'. visited general physician: Orthopedic Doctor (Dr.), ENT (Dr.), Eye doctor, dentist and waiting on appointment with neurologist late September. Still fighting dizziness on and off,, memory loss, facial pains, intense headaches, exhaustion for no reason.

Other Meds: allegra 180mg, vitamin gummies, Zinc chewable, fiber chewable, valium or tizanidine as needed at night.

Current Illness: Neck pain

ID: 1502326
Sex: F
Age: 25
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: Erythema, Pruritus

Symptoms: vaccine given after being refrigerated more than 30 days

Other Meds:

Current Illness:

ID: 1502327
Sex: M
Age: 68
State: FL

Vax Date: 01/21/2021
Onset Date: 01/21/2021
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: Penicillin

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

Symptoms: Hot and flush in face and neck, weakness in body, blood pressure went up.

Other Meds: Lipitor, Benecar, and multi-vitamins

Current Illness:

ID: 1502328
Sex: F
Age: 23
State: TX

Vax Date: 07/09/2021
Onset Date: 07/10/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: numbness to left arm and pain to left arm

Other Meds: none

Current Illness: none

ID: 1502329
Sex: F
Age: 60
State: TN

Vax Date: 06/05/2021
Onset Date: 06/06/2021
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: Knee pain 10+, flu symptoms, body hurt all over - unable to really describe it other than I hurt all over and it's indescribable. Spoke to internist and orthopedic doctor once I felt better

Other Meds: I've had an inflammatory reaction tot he pneumonia vaccine where it attacked by knee that was inflamed and prior to a knee replacement. I woke up overnight to both knees in pain - scale 10+, had flu like symptoms during the day Sunday, 6/6

Current Illness: Just gotten over an asthmatic and bladder event in the last few weeks.

ID: 1502330
Sex: M
Age: 36
State:

Vax Date: 05/17/2021
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:

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

Symptoms: vaccine given after being refrigerated more than 30 days

Other Meds:

Current Illness:

ID: 1502331
Sex: F
Age: 61
State: MI

Vax Date: 03/30/2021
Onset Date: 03/31/2021
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: Eggs Penecillin Erythromycin Sulfa

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

Symptoms: Dramatic increase in severity of existing tinnitus.

Other Meds: Prolia Injection low-dose aspirin Zyrtec Vit. D Chorella/spirulina

Current Illness:

ID: 1502332
Sex: M
Age: 11
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: After receiving both the tdap and MCV4, patient stated he felt light headed, dizzy, and was getting warm. Patient ended up lying down on the table bed in the vaccination room for about three minutes and drank some cool water. After lying down and drinking some water, patient stated he was feeling better and did not feel light headed or dizzy.

Other Meds:

Current Illness:

ID: 1502333
Sex: F
Age: 19
State: MA

Vax Date: 04/08/2021
Onset Date:
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: NKA

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

Symptoms: No Periods since receiving the Covid Vaccine - Moderna #1 given 4/8/21 and Moderna #2 given 5/7/21.

Other Meds: unknown

Current Illness: none

ID: 1502334
Sex: F
Age: 29
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: vaccine given after being refrigerated more than 30 days

Other Meds:

Current Illness:

ID: 1502335
Sex: M
Age: 76
State: NC

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: unknown

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

Symptoms: Patient had received a dose of Janssen COVID vaccine in March 2021. Patient stated in clinic today that he had not received COVID vaccine in the past. He noted an incorrect birth date on his consent form. When registration entered him into the system, they did not realize that he had received a dose of Janssen COVID vaccine in March 2021, and he was vaccinated with a dose of Pfizer COVID vaccine. Registration subsequently realized that patient had received the March dose of Janssen vaccine

Other Meds: unknown

Current Illness: unknown

ID: 1502336
Sex: F
Age: 75
State: FL

Vax Date: 03/24/2021
Onset Date: 04/29/2021
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: norvasc, fioricet, sulfa

Symptom List: Vomiting

Symptoms: blood pressure rose to 200/110 with accompanying severe dizziness, difficulty walking, burning pain in arms, pt was taken to emergency department and admitted for observation.

Other Meds: metoprolol, cranberry pills, macrodantin, glipizide, doxazosin, beta carotene, omeprazol, eliquis

Current Illness: polymyagia rheumatica in remission, diabetes, hypertension, a-fib

ID: 1502337
Sex: F
Age: 42
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: vaccine given after being refrigerated more than 30 days

Other Meds:

Current Illness:

ID: 1502338
Sex: F
Age: 52
State:

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: no known allergies

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

Symptoms: At approximately 1625, patient reported a tingling sensation in the lips. Patient denied itchiness, rashes, hives, swelling of lips/tongue, difficulty breathing, and difficulty swallowing. Patient given water. Patient able to drink water. Patient reported similar reaction to first dose. Patient reported following up with primary care provider regarding first dose reaction. Patient stated "my doctor said it was okay to get the second shot". Patient reported no known allergies. Patient reported history of hypertension and current medications include metoprolol and amlodipine for hypertension. Patient offered intramuscular diphenhydramine. Patient agreed to intramuscular diphenhydramine. At 1627, RN assessed patient vital signs: 179/103 mmHg, pulse 70 beats/minute, and SpO2 97%. At 1634, RN administered 50 mg/1 ml intramuscular diphenhydramine in patient's right deltoid. Patient advised to wait for 30 minutes for further observation. At 1639, RN assessed patient vital signs: blood pressure 160/105 mmHg, pulse 69 beats/minute and SpO2 98%. At 1645, EMT assessed patient vitals signs: blood pressure 162/92 mmHg, pulse 64 beats/minute, and SpO2 96%. Patient reported feeling less tingling in the lips. At 1648, patient reported the tingling in the lips felt "very faint". At 1651, EMT assessed patient vital signs: blood pressure 150/92 mmHg, pulse 65 beats/minute, and SpO2 96%. At 1700, lead nurse assessed patient. Patient stated "the tingling is completely gone". Patient denied swelling of lips/tongue, difficulty swallowing, and difficulty breathing. Patient denied drowsiness and reported she can drive herself home. Lead nurse educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider, and to sign up on v-safe. At approximately 1703, patient left facility with unlabored respirations and steady gait.

Other Meds: metropolol and amlodipine for hypertension

Current Illness: none reported

ID: 1502339
Sex: M
Age: 45
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
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: vaccine given after being refrigerated more than 30 days

Other Meds:

Current Illness:

ID: 1502340
Sex: F
Age: 41
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Allergic to latex, nuts, fish, shellfish, bees

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

Symptoms: Swelling in lymph nodes and arm. Very lethargic, bad headache, tired, whole body aches

Other Meds: Zrytec, singular, levothyroxine, gabapentin

Current Illness: None

ID: 1502341
Sex: M
Age: 15
State: WI

Vax Date: 07/19/2021
Onset Date: 07/23/2021
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: NKDA

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

Symptoms: Per MD Note: "Acute throat and upper chest pain this AM. At approximatley 0300, he woke up with severe 10/10 chest pain. The pain is sharp and he points to the midline between his collarbones. He went to an ED and received a GI cocktail and famotidine, which did not provide much benefit. He had an elevated troponin to 2.13, EKG without evidence of pericarditis. He was given 0.5 mg Ativan and 15 mg IV Toradol. Workup notable for CXR (wnl), EKG (wnl), CRP (2.2), ESR (29), proBNP (62 wnl). Lipase (wnl), Lithium 0.8 (0.6-1.2 mmol/L). CMP 142/3.9/106/27. BUN 12, Cr 0.75. Dexi 120. Upon arrival to our ED, he reports 1/10 chest pain. He denies any SOB, difficulty breathing, palpations, abdominal pain, nausea, vomiting, or diarrhea. He received his second Pfizer COVID-19 vaccination on 7/19 and has had low grade fever (Tmax 100.5F), myalgias, tiredness, and headache since then. He reports that his chest feels slightly tight, but denies any SOB. Assessment: Patient is a 15 y.o. male presenting with acute onset of chest pain and elevated troponin. Workup has been extensive and including BNP, repeat troponin, EKG, CXR, and echocardiogram. He does not show evidence of severe myocarditis or pericarditis. Assessment by cardiology suggested that mild myocarditdis in the setting of recent COVID-19 vaccination and acute heart strain/troponin leak in the setting of acute pain"

Other Meds: Lithium, Depakote, Guanfacine, Wellbutrin, Desmopressin, Zyrtec

Current Illness: None known

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm