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: 1509963
Sex: F
Age: 48
State: ID

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt had no adverse reaction. Shot was just given on day 14 and not 24 or higher.

Other Meds:

Current Illness:

ID: 1509964
Sex: F
Age: 16
State: IL

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/28/2021
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: NONE

Symptom List: Anxiety, Dyspnoea

Symptoms: She became ridged and pupils dilated and had some involuntary movements of arms and legs lasted about 8 sec. Client then regained conciseness . She states she was light headed and felt like she passed out and woke up. Client monitored for 30 minutes and then was released to go home. PCP notified.

Other Meds:

Current Illness:

ID: 1509965
Sex: F
Age: 55
State: TX

Vax Date: 12/29/2020
Onset Date: 01/10/2021
Rec V Date: 07/28/2021
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: 103 fever, headache muscle ache

Other Meds: cynthroid, somora, zynax, sambirpern

Current Illness: none

ID: 1509966
Sex: M
Age: 60
State: WI

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 07/28/2021
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: Patient marked on consent form that he had NOT received any vaccinations in the past 28 days, so 1st dose of Pfizer Covid19 vaccine was administered. WI DHS caught that the patient had received Johnson and Johnson vaccine 07/16/2021, and received Moderna Covid19 vaccine 07/21/2021. So this Pfizer dose is being inputted as an error of incorrect 2nd dose given - incorrect mRNA Covid19 vaccine product administered for second dose in 2-dose series.

Other Meds:

Current Illness:

ID: 1509967
Sex: F
Age: 25
State:

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/28/2021
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: PFizer vaccine was administered after being discovered that the vaccines were kept in the freezer for 11 days longer than the two week standard time. Patient was notified and given the option for additional dose.

Other Meds:

Current Illness:

ID: 1509968
Sex: M
Age: 35
State: UT

Vax Date: 04/16/2021
Onset Date: 05/26/2021
Rec V Date: 07/28/2021
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: I did not have anything as far as getting the shot but the second day of getting the shot I felt extreme fever, shaking in the bones and I did not go to work. I felt in extreme fever stage. Hot and cold. My body could not tell what was going on. Weeks later in May and June I was sick, and it lasted for a month and that was a lot of sinus infections, not having as good as taste I always had, lost of smell. I went to the doctor when both my ears were infected since I could not hear with either of them. They prescribed amoxicillin for 10 days because I had 2 ears infections. I still have coughing, nasal problems, half my smell is gone. I feel like I have a lingering cold. The first month I was not coughing at all, and when I cough I get a dry cough sometimes.

Other Meds: None

Current Illness: None

ID: 1509969
Sex: F
Age: 42
State: NY

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 07/28/2021
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: After receiving the pfizer vaccine pt c/o dizziness , then slow to respond to questions pt later was unable to state her name and where she was, rapid response called; Pt taken to the ED.

Other Meds:

Current Illness:

ID: 1509970
Sex: F
Age: 43
State: CO

Vax Date: 07/02/2021
Onset Date: 07/03/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Onset of nausea, vomiting (~6 episodes) & related symptoms of vertigo began about 0600h on 7/3. Presented to ED for eval/treat. Basic workup done - no abnormal labs noted. Given ondansetron & meclizine in ED and symptoms decreased enough for patient to agree to be discharged to home. Later in the morning on 7/3, patient began experiencing fever & chills (did not take her own temp), which resolved by evening.

Other Meds:

Current Illness:

ID: 1509971
Sex: F
Age: 74
State: FL

Vax Date: 02/15/2021
Onset Date: 04/01/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: sudden onset April 2021 headache pressure in head ringing in ears - constant worse when lying down dizziness BP very high medication increased then very low - all medication stopped 7/5/21

Other Meds: Breo Aspirin Pantoprazole oxybutynin venlafaxine meloxicam

Current Illness:

ID: 1509972
Sex: F
Age: 47
State:

Vax Date: 07/22/2021
Onset Date: 07/24/2021
Rec V Date: 07/28/2021
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: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Tachycardia, profuse sweating, lightheaded, dizziness, aggressive heart palpitations, Shortness of breath

Other Meds: lisinopril/hctz, savella, topiramate

Current Illness: N/A

ID: 1509973
Sex: F
Age: 71
State: GA

Vax Date: 05/25/2021
Onset Date: 07/23/2021
Rec V Date: 07/28/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient hospitalized due to COVID-19. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1509974
Sex: F
Age: 27
State: LA

Vax Date: 07/25/2021
Onset Date: 07/28/2021
Rec V Date: 07/28/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Symptoms began at 12:30AM Symptoms began as itchy, inflamed hands and feet Next swelling of lips began When seated on the toilet, began to sweat uncontrollably as itchy and inflammation increase Called for partner to check in on me at this time. Tried to get into the bathtub to help with itching but was unable to due to sudden urge to use restroom. Had one bowel movement after returning to toilet Proceeded to continue to sweat and ears began to ring. Vision became blurred, seeing purple spots. Speech was slurred and limbs were heavy and weak. Could think clearly but unable to do simple tasks such as grasp a cup of water without effort. Vision completely blackout at this point. I did not faint and still able to communicate but could not see anything other than blackness. This happened twice between 10 minute span. Once I was able to lie down, Vision and hearing cleared. Chills began then and itching continued. I was wrapped in three blankets unable to stop chills and shakes. Eventually I was able to relax and stop the chills and fall back to sleep at 3AM. It is now 2:05PM and I am experiencing some itching, fatigue, and cramping

Other Meds: Green tea extract, beets chewable, prescription adderall 10mg x 2 day, prozac 40 MG 1 x day

Current Illness: None

ID: 1509975
Sex: F
Age: 76
State: WA

Vax Date: 06/13/2021
Onset Date: 06/21/2021
Rec V Date: 07/28/2021
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: ASSESSMENT AND PLAN: 1. Palpitations (Primary) Assessment & Plan: Next step would be to take 1/2 dose metoprolol for any Bp <100/70 but pt doesn't want to do that at this time. Will cont asprin prophylaxis and will check tsh given concurrent fatigue. Will call with results. If normal thyroid, will f/u in 6 months or sooner should condition worsen Orders: - TSH, Reflex Free T4; Future - aspirin 81 mg EC tablet; Take 1 tablet by mouth Daily. Dispense: 90 tablet; Refill: 3 2. Essential hypertension Assessment & Plan: Well controlled at present. Limited by palpitations t hat are controlled by metoprolol but when controlled with metoprolol also occasionally cause some low bp and fatigue of unknown etiology. Will cont for now but may need to decrease metoprolol to 1/2 dose for any Bp <100/70 inf uture. Orders: - metoprolol tartrate (LOPRESSOR) 25 mg tablet; Take 1 tablet by mouth 2 times daily. Dispense: 180 tablet; Refill: 3 3. Fatigue after COVID-19 vaccination Comments: suspect much of fatigue is related to covid 19 vaccination. will monitor 4. Gastroesophageal reflux disease without esophagitis - omeprazole (PRILOSEC) 20 mg capsule; Take 1 capsule by mouth Daily 1 tablet before breakfast . Dispense: 90 capsule; Refill: 2 5. Seborrhea Comments: refilled chronic medications Orders: - desonide (DESOWEN) 0.05 % lotion; Apply 1 Application topically Daily as needed (itch) Apply once daily to prevent ear seborrhea. . Dispense: 59 mL; Refill: 3 - triamcinolone (KENALOG) 0.1% lotion; Apply small amount to affected area(s) two to four times daily as needed: avoid face and groin areas. Dispense: 60 mL; Refill: 3

Other Meds:

Current Illness:

ID: 1509976
Sex: M
Age: 53
State: CA

Vax Date: 04/23/2021
Onset Date: 05/05/2021
Rec V Date: 07/28/2021
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: I had mostly nausea and diarrhea. It keep happening so I went to my doctor. They told me to take over-the-counter medicine for it.

Other Meds:

Current Illness:

ID: 1509977
Sex: F
Age: 43
State: NY

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: I got shot, spoke with pharmacist who injected for about 3 min, they didn?t behave me sit and wait 15min like my husband did (different location) this morning. I started to leave store and immediately had metallic taste & my head felt different. I knew something was off! The taste is still there, my head is achy but everything else is fine.

Other Meds: None

Current Illness: Ended 5th IVF cycle on 7/16/21 (day of retrieval)

ID: 1509978
Sex: F
Age: 48
State: CA

Vax Date: 07/19/2021
Onset Date: 07/20/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, amoxicillin, Sensitivity to dairy and gluten

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

Symptoms: For the second shot, it was night sweats, dizziness, brain fog, and just disorientation. Then hot flashes between 1pm- 5pm the next day. THEN I have had nonstop dizziness, disorientation, and some nausea that might be tied to low blood pressure that started right after the 2nd Vax

Other Meds: I am taking hydrocortisone, NO thyroid and Low Dose Naltrexone (LDN). Vitamin include B-12, multivitamin, Calcium, magnesium , zinc,

Current Illness:

ID: 1509979
Sex: F
Age: 25
State:

Vax Date: 07/16/2021
Onset Date: 07/16/2021
Rec V Date: 07/28/2021
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: PFizer vaccine was administered after being discovered that the vaccines were kept in the freezer for 11 days longer than the two week standard time. Patient was notified and given the option for additional dose.

Other Meds:

Current Illness:

ID: 1509980
Sex: F
Age: 52
State: NE

Vax Date: 01/22/2021
Onset Date: 07/19/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin, Penicillin, Bactrim, Biaxin, Doxycycline

Symptom List: Ear pain, Hypoaesthesia

Symptoms: On July 19, 2021 about 05:30PM I was driving home and I had severe chest pain, on the right side of my heart. Once I got home I felt awful even after the pain stopped, I was diaphoretic. I went to work the next day and called a nurse. She suggested I go to the ER since I had chest pain. At the ER, they started an IV, did EKG, did a portable chest x-ray and gave me aspirin. I was sent home from the ER that day.

Other Meds: Metformin, Benadryl 50mg, Calcium supplement, Cranberry supplement, Vit D 1000/U, baby aspirin 80mg, Krill Oil, Cinnamon supplement

Current Illness: none

ID: 1509981
Sex: F
Age: 37
State: MI

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I admisitered the Varicella vaccine via IM injection. This vaccine is to be administered via SQ. Client had no symptoms at time of vaccine or for 15 mins after. Called client 24 hours later, she states only some soreness when the injection site is touched. She denies any other adverse effects.

Other Meds: none

Current Illness: none

ID: 1509982
Sex: M
Age: 69
State: TN

Vax Date: 02/16/2021
Onset Date: 03/02/2021
Rec V Date: 07/28/2021
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: Penicillin-rash as a baby

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

Symptoms: About 2 weeks after first COVID-19 vaccine, patient states he had trouble breathing and called 911. He states he was diagnosed with multiple blood clots at the hospital. He doesn't recall exact dates, states the difficulty breathing started at 2am. Was taken to on .

Other Meds: Miralax PRN; Pantoprazole; Another acid reducer

Current Illness: None reported

Date Died: 07/21/2021

ID: 1509983
Sex: M
Age: 76
State: MI

Vax Date: 05/29/2021
Onset Date: 06/01/2021
Rec V Date: 07/28/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None known allergies

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

Symptoms: The patient received the Janssen vaccine on 5-29-21 and had previously well controlled asthma. The patient presented to ED on 6-1-21, 6-13-21, 6-28-21, and 7-19-21 with acute asthma exacerbation. On 7-21-21 the patient was admitted into the ED and later ICU with cardiac arrest related to asthma acerbation and pronounced deceased on 7-25-21. Symptoms: - Wheezing -Shortness of breath - Onset following the day after vaccine administration Treatments: - Albuterol/ipratropium nebulizers - Prednisone -Albuterol inhaler

Other Meds: Amlodipine Budesonide-fomoterol Montelukast Albuterol

Current Illness: None

ID: 1509984
Sex: F
Age: 33
State: CA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 07/28/2021
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: Unevaluable event

Symptoms: Body aches slight fever fatigue and chest tightness.

Other Meds: Vitamin and fish oil and vitamin D

Current Illness: None

ID: 1509985
Sex: F
Age: 41
State: IA

Vax Date: 03/23/2021
Onset Date: 04/23/2021
Rec V Date: 07/28/2021
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: Penicillin

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

Symptoms: I was monitored at the clinic because my anxiety increased my BP. I was released after 30 more minutes. I took my hydroxyzine when I went home, and then planned to take it across the day (Up to 3 a day). At 3PM, I started to feel my left side inner mouth feel swollen and my jaw area, cheek, left side became numb and remained that way for 2 weeks. Went to ER that night at 4PM, ER Dr. said "bells palsy like" symptoms that would go away in time. Consulted with primary and told him of my concerns before getting second vax, he recommended I proceeds with second Vax.

Other Meds: Hydroxizine 25mg as needed for anxiety - did not take it the morning of first vax, Losartan100mg /HCTZ 25mg,

Current Illness: none

ID: 1509986
Sex: F
Age: 43
State: ME

Vax Date: 01/26/2021
Onset Date: 03/24/2021
Rec V Date: 07/28/2021
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: I am allergic to Celebrex.

Symptom List: Injection site pain, Pain

Symptoms: I experienced chest tightness and numbness (trigeminal myalgia). I had heart palpitations (blood pressure went up and heart resting rate was high as well). I scheduled a virtual appointment with my doctor for the following week since I could not reach her initially while I was at my campsite. She referred me for Thyroid testing. I was referred to a Endocrinologist who did not feel that my Thyroid function was off enough to put me on medication and she referred me to a Surgeon because I have a Thyroid Nodule just to rule out that it's not my Thyroid.; however because of my chest tightness did repeat tests for a month Heart rate and blood pressure are still off and my normal doctor put me on metoprolol to take every day. I was also prescribe gabapentin to take whenever I have numbness and nerve pain.

Other Meds: I took my allergy medications - Singular, Zyrtec, and Flonase.

Current Illness: No

ID: 1509987
Sex: M
Age: 40
State: GA

Vax Date: 07/24/2021
Onset Date: 07/25/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient developed new-onset hypertension the day after immunization that has persisted for the past 4 days. Patient not having chest pain, shortness of breath, or palpitations. Patient does endorse forceful heartbeat.

Other Meds:

Current Illness:

ID: 1509988
Sex: F
Age: 18
State:

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 07/28/2021
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: Pfizer vaccine was administered after being discovered that the vaccines were kept in the freezer for 11 days longer than the two week standard time. Patient was notified and given the option for additional dose.

Other Meds:

Current Illness:

ID: 1509989
Sex: F
Age: 73
State: CA

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/28/2021
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: Food Dye Pain killers many food allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient complained of many complications her main concern was her pulse was dropping low to a 50. Her blood pressure was dropping at a high rate. She complain of fatigue and headaches and feeling really dizzy.

Other Meds: Slow release 200mg Cynthoid 3 50 Micrograms inhaler Patient has other medications that she could not get the name of gummy Vitamins

Current Illness:

ID: 1509991
Sex: M
Age: 21
State: CA

Vax Date: 06/04/2021
Onset Date: 06/18/2021
Rec V Date: 07/28/2021
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: Dose 2 given 14 days.

Other Meds:

Current Illness:

ID: 1509992
Sex: M
Age: 38
State: OH

Vax Date: 04/22/2021
Onset Date: 05/17/2021
Rec V Date: 07/28/2021
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: Eggs, Erythromycin

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

Symptoms: Since the second injection I've lost the ability to speak. Along with quite a lot of pain in my throat. As I'm not a doctor I couldn't say if it is vaccine related, but one thing followed the other.

Other Meds: none

Current Illness:

ID: 1509993
Sex: M
Age: 17
State:

Vax Date: 07/16/2021
Onset Date: 07/16/2021
Rec V Date: 07/28/2021
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: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time. Patient notified and given the option for an additional dose.

Other Meds:

Current Illness:

ID: 1509994
Sex: U
Age: 74
State: MI

Vax Date: 01/28/2021
Onset Date: 02/02/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies: Bentyl

Symptom List: Injection site pain

Symptoms: Hearing loss in left ear a few days after first vaccine Right ear was affect after second vaccine on 2/18/2021 which was profound. My physician ordered prednisone ear drops and ordered a CT scan. Then referred me to ENT. Was placed on Prednisone for 2 weeks for sudden profound hearing loss.

Other Meds: Synthroid .88

Current Illness: None

ID: 1509995
Sex: F
Age: 17
State: PA

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/28/2021
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: Patient received vaccine at roughly 2:40 pm on 7/28/21. Was advised to stay at location for 15 minutes prior to leaving . Patient was shopping in store and fainted . Found patient lying on floor with her mother by her side . Patient was alert but shaken . Patient said she had hit her head and scraped her leg. patient was put into a chair and given some juice and an ice pack for back of neck . After about 10 to 15 minutes patient said she felt well enough to walk and was taken home by her mother .

Other Meds: UNKNOWN

Current Illness: NO

ID: 1509996
Sex: F
Age: 40
State: GA

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/28/2021
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: Penicillin

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

Symptoms: Chest pain, shortness of breath and sweating

Other Meds: Thyroid medicine, blood pressure and Celexa

Current Illness:

ID: 1509997
Sex: M
Age: 78
State: NJ

Vax Date: 02/01/2021
Onset Date: 03/05/2021
Rec V Date: 07/28/2021
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

Symptom List: Tremor

Symptoms: Severe and constant fatigue. Joint pain extreme. As well as muscle pain

Other Meds:

Current Illness:

ID: 1509998
Sex: F
Age: 59
State: MA

Vax Date: 04/20/2021
Onset Date: 04/27/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Erratic heartbeat, palpitations, atrial fib, ventricular tachycardia.

Other Meds: Metoprolol; singulair

Current Illness: Hypertrophic cardiomyopathy

ID: 1509999
Sex: F
Age: 57
State: OK

Vax Date: 07/23/2021
Onset Date: 07/26/2021
Rec V Date: 07/28/2021
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 Chicken Eggs

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

Symptoms: Patient reported muscle spasms

Other Meds: aripiprazole albuterol inhaler PRN Zyrtec Synthroid ASA Asmanex Singulair pravastatin metformin lisinopril

Current Illness: n/a

ID: 1510000
Sex: F
Age: 66
State: VA

Vax Date: 02/03/2021
Onset Date: 02/08/2021
Rec V Date: 07/28/2021
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: Zofran

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

Symptoms: Began as itchy red rash, painful to touch, increasingly warm and swollen, increasing in size. Went to urgent care on 3rd day and was told to use Benadryl and cortisone cream. Began to fade 2/13 and gone on 2/15

Other Meds: Woman's One a Day Multi-Vitamin Vitamin C Simvastatin (20 mg 3 days/week) Risedronate Sodium (35 mg once/week)

Current Illness: None

ID: 1510001
Sex: M
Age: 64
State: AZ

Vax Date: 04/14/2021
Onset Date: 07/18/2021
Rec V Date: 07/28/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On 07/18/2021 late that night my right knee swollen rapidly, about 1:30am called EMS, Xrays indicated fluid, Blood testing said my INR 7.1, the DR took my off Warphrine and bed rest. I was in the hospital for 6 days.

Other Meds: I am taking Warfrin, Synthroid, Lumotragine, Partonic, triCore, Aldectom, alpurinal, Coregg, Lasetics, Cevelamer, Crestor, metalazone, Pramafixal, baby aspirin, Gabapentin, Lunesta, Adavan, Retesabine, Potassium chloride, Seroquel, Lantis

Current Illness: none

ID: 1510002
Sex: F
Age: 63
State: CA

Vax Date: 01/21/2021
Onset Date: 02/06/2021
Rec V Date: 07/28/2021
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: Mildly allergic to dairy and egg whites (Blood test results)

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

Symptoms: I was woken up by a severe headache in the area behind my left ear. I went to brush my teeth and then looked in the mirror and saw my face and that the toothpaste could not stay in my mouth. The entire left side of my face had fallen about an inch. I could tell because my eyebrows were not even. The headache continued for several days but not as severe as the initial event. I could not use the muscles on the left side of my face at all. Initially, I was afraid to go to the hospital because of the level of COVID in my area but I did take pictures throughout the several weeks of my recovery.

Other Meds: Losartan Potassium-Hetz 12.5 Mg Amlodipine Besylate 10 Mg Aller-Flex

Current Illness: None

ID: 1510003
Sex: F
Age: 91
State: GA

Vax Date: 02/25/2021
Onset Date: 07/21/2021
Rec V Date: 07/28/2021
Hospital: Y

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:

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

Symptoms: Patient hospitalized due to COVID-19. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1510004
Sex: F
Age: 57
State: CA

Vax Date: 04/23/2021
Onset Date: 04/25/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies: Celebrex,

Symptom List: Pain in extremity

Symptoms: After receiving the vaccine I had the occasional sore arm and was experiencing chills for the first 3 days. Later on throughout the month I started to experience heart palpitations. I mentioned them to my PCP and he advised me to use a heart monitoring system until they could find out the reason why I was experiencing them out of nowhere. Also I have an appointment coming up to check out what is going on with my hip. I have been experiencing hip pain ever since receiving my 2nd dose of the vaccine. They are sending me to an orthopedic after they did an xray and seen how it was slowly deteriorating.

Other Meds: Benzaprine 10mg 1 xday, Vitamin C 100mg 1 xday, Vitamin D

Current Illness:

ID: 1510005
Sex: M
Age: 58
State:

Vax Date: 07/02/2021
Onset Date: 07/28/2021
Rec V Date: 07/28/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: dehydration with acute kidney injury, melanotic stool that is hematest positive

Other Meds:

Current Illness:

ID: 1510006
Sex: F
Age: 19
State: CA

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/28/2021
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: NO

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

Symptoms: Pt became nauseous and vomited minutes after receiving vaccine. Pt was given cold compress and water. VS were taken and WNL. Pt was allowed to rest until she felt better. No further adverse reaction was noted. Pt was advised to seek medical treatment if symptoms worsen over the course of time.

Other Meds: Zoloft, Zyertec

Current Illness:

ID: 1510007
Sex: F
Age: 47
State: TN

Vax Date: 07/25/2021
Onset Date: 07/25/2021
Rec V Date: 07/28/2021
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 single dose of Johnson & Johnson on 3/23/21. When asked if patient had ever received Covid-19 shot previously, patient stated "no". Patient also marked "no" on the first question of the consent form that asks "Have you ever received a Covid-19 vaccine? If so, which one?"

Other Meds: Unknown

Current Illness: Unknown

ID: 1510008
Sex: F
Age: 38
State: WA

Vax Date: 01/23/2021
Onset Date: 07/17/2021
Rec V Date: 07/28/2021
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: no

Symptom List: Vomiting

Symptoms: I woke up that Saturday - sore throat, cough, congestion a lot of fatigue - lasted four days. That following Thursday I saw DR. (who is a PA in my office) - pain in my ribs when I coughed - he thought it might be a pulled muscle and he gave me muscle relaxers. I took over the counter Day quill and nigh quill and Mucinex. By last weekend, I woke up and felt much better.

Other Meds: Depo shot for Birth control; Levothyroxine Thyroid Medication; Trazadone

Current Illness: no

ID: 1510009
Sex: F
Age: 71
State: NY

Vax Date: 04/11/2021
Onset Date: 04/13/2021
Rec V Date: 07/28/2021
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: no

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient reported that on 04/13 she had extremely joint pains... inside of arms hand and knees, Right hand is numb when she wakes up

Other Meds: Armour Anloditone Desylate Atyclodir Citalotram Biotin Magnesium Vitamin D3 Vitamin C Osteo Tacaplex B

Current Illness: no

ID: 1510010
Sex: F
Age: 13
State: MO

Vax Date: 07/08/2021
Onset Date: 07/08/2021
Rec V Date: 07/28/2021
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: shellfish, tree nut, peanut, mold

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

Symptoms: acute onset of cough, chest tightness and shortness of breath starting 3 hours after vaccination. Presented to urgent care facility. Took albuterol every 4 hours which improved symptoms. Developed body aches, nasal congestion in the following days.

Other Meds: Symbicort, Prozac

Current Illness:

ID: 1510011
Sex: M
Age: 13
State: GA

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 07/28/2021
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: Denies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Severe hypotension, sweating, unresponsive, lethargic, "lightheaded"

Other Meds: denies

Current Illness: Denies

ID: 1510012
Sex: F
Age: 51
State: ME

Vax Date: 02/03/2021
Onset Date: 02/24/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, macrobid, augmentin, some blue dyes

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

Symptoms: About 3 weeks after 2nd vaccine started having hypertension with multiple PVC?s. EKG showed a iv?s with every heartbeat. This would last for a day or 5 min. Would go in and out of abnormal rhrhm

Other Meds: Spironolactone. Levothyroxine. Vitamin d

Current Illness: High blood pressure. Hypothyroidism, chronic bladder spasms

ID: 1510013
Sex: M
Age: 58
State: IL

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

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

Lab Data:

Allergies:

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

Symptoms: patient reported that he first had flu like symptoms and his injection site looked like it may have had bruising. He then said after flu symptoms faded away he kept noticing his injection site first looked like a pea sized bruising it then kept increasing in size and is now about the size of Ping-Pong ball. He said its painful if he lays on it otherwise does not hurt but still keeps increasing in size with time and is not shrinking.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm