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: 1510220
Sex: F
Age: 50
State: OR

Vax Date: 04/20/2021
Onset Date: 04/21/2021
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: shingly vaccine

Symptom List: Dysphagia, Epiglottitis

Symptoms: For two day, I did not feel good. I had body aches. I felt sick to my stomach. I felt like I was going to vomit. I also had a slight fever. I went to the doctor about it. They gave me nausea pills.

Other Meds:

Current Illness:

ID: 1510221
Sex: M
Age: 20
State:

Vax Date: 07/01/2021
Onset Date: 07/17/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever, no treatment

Other Meds:

Current Illness:

ID: 1510223
Sex: F
Age: 38
State: CA

Vax Date: 02/17/2021
Onset Date: 02/17/2021
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: Birch related fruit and vegetables

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

Symptoms: Intense radiating lower back and leg pain for 1 week. Increasing numbness over weeks in left foot and leg. Left with extreme numbness in left toes and foot.

Other Meds: T4, progesterone

Current Illness:

ID: 1510224
Sex: F
Age: 35
State: NJ

Vax Date: 01/06/2021
Onset Date: 01/07/2021
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: tingling down left arm, headache, diarrhea. body aches

Other Meds:

Current Illness:

ID: 1510225
Sex: F
Age: 58
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: Patient became sweaty, pale and very dizzy. We measured her BP and it seemed very low but later after 10 minutes it went back up again. We called 911 and medics came to take her to the hospital.

Other Meds: Not known

Current Illness: Not known

ID: 1510226
Sex: F
Age: 62
State: WA

Vax Date: 04/06/2021
Onset Date: 04/07/2021
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: Sulphur; Cestin; Ceclor; Biaxin; Neurontin; Vicodin

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

Symptoms: I experienced soreness and a extremely large bruise, itching and a rash. I took a picture of it and sent it to my doctor the next and was placed on Zinc along with Claritin. During meeting, she asked that I meet with her again if the hives (rash) did not go away within a week along with the bruise; however, the soreness lasted a bit longer. She told me that my Mast Cell Disease reacted to the vaccine but not to be concerned with it unless my breathing was erratic. After a month to six weeks it subsided.

Other Meds: Synthroi; Cytomel; Azelastine HCL; Singulair; Klonopin; Adderall; Phosphatidylserine; SynovX; HistaRelief 60; Vitamin K-2; D-3 Astaxanthin; Methylated B; Ultimate Cell Energy 120; Alamaxcr; Acetyl-L-Carnitine; Pantetheine; Pure Omega 3; Tot

Current Illness: No

ID: 1510227
Sex: M
Age: 49
State: MO

Vax Date: 04/30/2021
Onset Date: 05/03/2021
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: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I received my 2nd Moderna Covid-19 vaccine shot on April 30,2021. On May 3, 2021 I had pretty bad disequilibrium hit me for the first time in my life. It happened after driving a semi/ tractor trailer for over 30 constant miles at highway speeds. It felt like the truck was tilting over and sliding across the road. Of course this sensation happening during a rain storm made matters worse. I didn't know what was going on. I pulled over and collected myself and started back out. The symptoms would come up ever so often and I would pull over if it got bad. I went between thinking the steering on the truck was coming apart or it was me.I spent the next couple weeks taking days off, trying to rest and see if that helped. I would do short delivery runs in the truck and nothing would happen. But once I would do a load that was over 30 minutes of constant highway speed and I changed lanes of went around a curve, that feeling of tilting would come back. I changed trucks just to see if it was my assigned truck or not. Nope, it's me. I've been through vestibular therapy since my trip to an ENT doctor almost a couple weeks after this first started. The ENT diagnosed me with left peripheral vestibulopathy and otolith dysfunction. They didn't disagree with me drawing a line between the vaccines and my condition. They actually said there's been an uptick in patients since around March 2021. This is about the same time the ramping up of vaccinations started. The ENT doctor didn't discourage my linkage either and said that things would become more clear with data.

Other Meds: Alive -Men's 1 a Day vitamin

Current Illness: none

ID: 1510228
Sex: M
Age: 11
State: CA

Vax Date: 07/27/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient's mom wrote that patient was "14" but the DOB written on form makes the patient only 11yo. The patient is underage and therefore the vaccination was not given in accordance to the approved EUA guidelines.

Other Meds:

Current Illness:

ID: 1510229
Sex: M
Age: 33
State:

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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Syncopal episode 5 minutes after vaccine administration. Patient was monitored and fully recovered within 10 minutes.

Other Meds:

Current Illness:

ID: 1510230
Sex: M
Age: 64
State: FL

Vax Date: 03/25/2021
Onset Date: 07/12/2021
Rec V Date: 07/28/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: morphine (anaphylaxis)

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient reported as breakthrough infection requiring hospitalization. Received dose #1 of Pfizer on 3/4/21 and dose #2 on 3/25/21. Patient hospitalized from 7/12-7/15. Below is copied from discharge summary: Pt is a 64 y/o M with pmHx of Afib on eliquis, HTN, chronic HFpEF, anxiety/depression, chronic pain who presented with c/o generalized weakness x 2 days after having an exposure to COVID-19 from a family member. He also reported fever and chills with reported temperature of 102F. He completed COVID vaccine back in March. He tried tylenol with mild improvement. He denied chest pain, cough, SOB, n/v/d, loss of smell, LE edema, orthopnea. He was found to be meeting sepsis criteria in the setting of COVID 19. CXR showed bilateral hazy pulmonary opacities and left sided pleural effusion. Initial vitals showed sinus bradycardia and home amiodarone and coreg were held. He was not requiring oxygen on admit. He was admitted for further management. Procalcitonin was elevated at 0.33 and pt was started on azithromycin and ceftriaxone for possible superimposed bacterial PNA. On 7/14, pt was found to be hypoxic and required 3L of oxygen and was started on Dexamethasone. An echo was done showing mild concentric LVH, EF 50-55%, moderately enlarged RV. He did receive a few doses of IV lasix while inpatient. His home coreg and amiodarone were resumed. He was seen by PT/OT who recommended HH services which was ordered. He was feeling well on 7/15 and back on room air. He passed a walking desaturation study. He had completed 4 days of azithromycin and ceftriaxone and was discharged with Augmentin to complete a 5 day course.

Other Meds: albuterol (ProAir HFA) 108 (90 Base) MCG/ACT Inhalation Aerosol Solution as needed. ALPRAZolam (XANAX) 2 MG Tablet Take by mouth nightly at bedtime as needed for sleep. amiodarone (PACERONE) 200 MG Tablet Take by mouth daily.

Current Illness:

ID: 1510231
Sex: F
Age: 42
State: AZ

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

Lab Data:

Allergies: Sulpha drugs

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

Symptoms: Immediately after shot, tip of tongue was numb. After an hour or two, I also noticed tingling in right foot and hand. Next day, (today) I have tingling in top of both hands, up right forearm, tops of both feet, up to both shins and on my face - mostly right side of face and onto lips.

Other Meds:

Current Illness:

ID: 1510232
Sex: F
Age: 55
State: WA

Vax Date: 03/18/2021
Onset Date: 07/27/2021
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: seafood, clindaymcin

Symptom List: Rash, Urticaria

Symptoms: break thru covid case after completing covid vaccine series

Other Meds: Montelukast, albuterol, famotidine

Current Illness:

ID: 1510233
Sex: M
Age: 63
State: ID

Vax Date: 06/23/2021
Onset Date: 07/14/2021
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: hydrocodone, metoprolol, coreg, prednisone

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

Symptoms: 3 OCCURENCES OF V. FIB FROM WHICH HIS IMPLANT SAVED HIM. HE HAS ALSO HAD SIGNIFICANT WATER RETENTION

Other Meds: allopurinol, Eliquis, gabapentin, furosemide, potassium

Current Illness:

ID: 1510234
Sex: M
Age: 14
State: IL

Vax Date: 07/20/2021
Onset Date: 07/20/2021
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: none

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

Symptoms: Syncope approx 15 minutes after vaccine administration. Brief LOC and no sequelae.

Other Meds: none

Current Illness: none

ID: 1510235
Sex: F
Age: 74
State: CA

Vax Date: 06/09/2021
Onset Date: 06/19/2021
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: None

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

Symptoms: Developed Guillain-Barre Syndrome. Was hospitalized for one week and underwent IVIG, then transferred to a rehabilitation center for four weeks to undergo rehab and caretaking. Is recently home after five weeks and is learning how to adapt at home with her limited walking ability.

Other Meds: Metformin, Glipizide, Isosorbide, Rosuvastatin, Omeprazole, Clopidogrel, Lisinopril, Levothyroxine, Atenolol, baby aspirin, magnesium oxide, Citrical calcium, Vitamin D

Current Illness: None

ID: 1510236
Sex: F
Age: 44
State: IN

Vax Date: 06/26/2021
Onset Date: 07/01/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: My shoulder remained in pain as the usual Covid Vaccine reactions. From Day 5 and beyond my arm was extra soar, started losing sensation in my left hand and forearm. Sleeping became unbearable after 10 days. I was unable to tend to normal daily thing slike cooking, dressing myself, shampoo, putting on sunscreen (by that time I was on vacation in Florida). It did not get better. My arm hurt, shoulder, forearm hand, weakness and pins and needs in my hand as well. I booked a doctors appointment for July 16.

Other Meds: None

Current Illness: None

ID: 1510237
Sex: F
Age: 63
State: WA

Vax Date: 07/28/2021
Onset Date: 07/28/2021
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: Tetracycline - reaction is bumps on tongue

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

Symptoms: Approximately 5 minutes after receiving vaccination patient reported feeling tightness on the left side of her jaw, then it spread to back of neck and up the face to below her eye. Patient reported no difficulty breathing and no movement issues (no drooping in face or arms), reported it felt like her lymph node was swelling when she palpated the area, reported she felt like her face was puffy. Patient declined ice pack, emergency services. Patient waited in pharmacy area and was observed for 30 minutes, then decided she wanted to get up and walk around. Patient reported her left foot felt numb upon standing up but that she has experienced that before with her herniated disc. Patient again declined emergency services. Patient reported pain in lymph node improved but still felt tightness in jaw, face, and neck. Patient chose to walk around store for a little bit, then returned to pharmacy to inform pharmacist she felt okay and wanted to leave.

Other Meds: Losartan 25mg , Goldenseal

Current Illness: Shingles (recovered approximately 1 month prior) Congestion

ID: 1510238
Sex: F
Age: 43
State: NH

Vax Date: 04/28/2021
Onset Date: 05/19/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I began my my menstrual period at the usual time following my vaccine and it has not stopped. I have been experiencing moderate to heavy bleeding most days for 2 months. Prior to the vaccine, I had a normal cycle.

Other Meds:

Current Illness:

ID: 1510239
Sex: M
Age: 49
State: WA

Vax Date: 03/25/2021
Onset Date: 07/26/2021
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: tested positive for covid19 after completing the vaccine series

Other Meds: metformin, glipizide

Current Illness:

ID: 1510240
Sex: F
Age: 24
State: LA

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

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

Lab Data:

Allergies: none

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

Symptoms: Hives on face, neck, and top of chest, still present on 7/28/2021

Other Meds: multivitamin

Current Illness: none

ID: 1510241
Sex: F
Age: 11
State: ID

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

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

Symptoms: covid vaccine administered to unauthorized age group- age 11 instead of 12. Unable to reach patient or parents at phone number provided. Patient's form was filled with incorrect date of birth, indicating that she was 12. Patient also verbally confirmed she was 12 years old. Outside medical records indicate otherwise.

Other Meds: unknown

Current Illness: unknown

ID: 1510242
Sex: M
Age: 17
State: OH

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Patient passed out in the chair within seconds of receiving the first dose of the Pfizer covid vaccine. I steadied him in the chair until he came back to, approx 20-30 seconds. When he awoke he said he felt nauseous, hot and sweaty. I provided him with a water and had him stay seated until he felt he could stand up, approx 10 minutes. He then left with his father, who was with him the entire time.

Other Meds:

Current Illness:

ID: 1510243
Sex: F
Age: 35
State: CA

Vax Date: 01/26/2021
Onset Date: 04/22/2021
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: no

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

Symptoms: April - Kidney stones - Hospital, ER visit - Kidney stones End of May or May 15th, 2021 - Have been diagnosed with a sarcoma in my liver since then. It was found incidentally - at hospital they did a biopsy. My lymph nodes - I have had two scans - my left side axilla has been inflamed. It's the side that I was vaccinated on - it's been seven months and it's still enlarged. The other side is normal

Other Meds: Huber ring

Current Illness: no

ID: 1510244
Sex: M
Age: 14
State: NY

Vax Date: 07/09/2021
Onset Date: 07/19/2021
Rec V Date: 07/28/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: Concern for a possible post-vaccine MIS-C-like inflammatory reaction Symptoms at presentation included intermittent fever and hives-like rash x 5 days, conjunctivitis x 1 day, and lip erythema x 1 day.

Other Meds: none

Current Illness: none

ID: 1510245
Sex: M
Age: 63
State: CO

Vax Date: 04/08/2021
Onset Date: 06/11/2021
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: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: Developed Gall Bladder failure along with decreased liver function

Other Meds: Atorvastatin 40mg ? 1per day Valsartan/ HCTZ 320/25 mg ? ? per day Allegra 24 hour Vitamin D Proair-HFA inhaler as needed

Current Illness: None

ID: 1510246
Sex: F
Age: 78
State: CA

Vax Date: 01/21/2021
Onset Date: 02/01/2021
Rec V Date: 07/28/2021
Hospital: Y

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: Nine days after the first dose of the vaccine on 02/01/2021 during the night I had a severe headache and I lost consciousness. I was taken to the hospital and I had had a stroke. I was hospitalized for four days and transferred to rehab on 02/05/2021 where I remained for 21 days. I was discharged from rehab on 02/26/2021. I also had in home therapy and continued to receive physical therapy until recently. I received the second dose of the vaccine in the hospital on 02/11/2021.

Other Meds: Calcium chewable vitamin.

Current Illness:

ID: 1510247
Sex: F
Age: 29
State: NH

Vax Date: 07/28/2021
Onset Date: 07/28/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Before the shot the patient was very nervous. 5 Minutes later she lost consciousness in her chair but quickly recovered, with dizziness, tunnel vision, sweating, shivering, nausea, weakness. She got better with resting her head down by her knees, had some water, then stood up to go to the bathroom due to nausea, but didn't make it and vomited 2 times. After resting on the floor with pharmacist supervision for about 20 minutes she began to feel better. I called her boyfriend who came to pick her up. She did not want the ambulance.

Other Meds:

Current Illness: panic disorder

ID: 1510248
Sex: F
Age: 48
State: WI

Vax Date: 07/05/2021
Onset Date: 07/05/2021
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: Mixed Series for COVID vaccine. Patient received Pfizer for her first shot on 4/6/21 and received Moderna for her 2nd shot on 7/5/21.

Other Meds:

Current Illness:

ID: 1510249
Sex: F
Age: 56
State: VA

Vax Date: 01/01/2021
Onset Date: 02/05/2021
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:

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

Symptoms: Extreme fatigue, months later atrial tachycardia, sob, diziness, fainting episodes

Other Meds:

Current Illness:

ID: 1510250
Sex: M
Age: 4
State: CA

Vax Date: 06/04/2019
Onset Date: 06/04/2019
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: None known at this time

Symptom List: Nausea

Symptoms: He had severe swelling in arm at injection site. Red, hot to the touch. He became tired and run down within hours of vaccination. Doctor said if it got any worse then to come in but some swelling was normal. He had exczema appear on his inner elbows, and it comes and goes ever since.

Other Meds: Tylenol

Current Illness: No

ID: 1510251
Sex: F
Age: 69
State: KY

Vax Date: 03/17/2021
Onset Date: 07/27/2021
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: Injection site pain

Symptoms: Tested positive for COVID on 07/27/2021 does not have any symptoms but was exposed to COVID. Is in a Rehab center and 3 of the employee had tested positive.

Other Meds:

Current Illness:

ID: 1510252
Sex: F
Age: 36
State: IN

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: bee stings, mushrooms

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

Symptoms: lips started feeling tingle and numb and couldn't catch breath, heart racing and tightness in chest

Other Meds: zoloft, prenatal vit

Current Illness: no

ID: 1510253
Sex: M
Age: 73
State: WA

Vax Date: 02/24/2021
Onset Date: 07/20/2021
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: unknown

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

Symptoms: tested positive for covid19 after completing vaccine series

Other Meds: unknown

Current Illness:

ID: 1510254
Sex: F
Age:
State: CA

Vax Date: 06/23/2021
Onset Date: 06/27/2021
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 Tetanus vaccine

Symptom List: Tremor

Symptoms: sore throat, fluid/congestion in back of throat suddenly filled lungs, pain in chest, dry cough, lost voice, tired. By day 6 oafter these symptoms were getting worse. I went to urgent care, was given breathing treatment, Z-Pack, Steriods (Prednisone), Cough syrup. I did improve but not completely, I continue to have chest pain, cough and congestion and feel run down and tired.

Other Meds: Asthma control inhalors

Current Illness: None

ID: 1510255
Sex: F
Age: 24
State:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Localized itching at injection site for about 5 mins

Other Meds:

Current Illness:

ID: 1510256
Sex: M
Age: 57
State: CA

Vax Date: 04/10/2021
Onset Date: 04/30/2021
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: non

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

Symptoms: No treatment has been done. I have a tingling on my right arm on each of my thumb and unable to grab or type normal. I inform by doctor. He stated just keep doing exercise on my finger, but it no strength

Other Meds:

Current Illness: none

ID: 1510257
Sex: F
Age: 70
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Flonase, Maxide

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

Symptoms: Per , she has a new bruise on her right shoulder and varicose veins in a small series on her right leg. Patient claims that this bruise and the varicose veins were not there before. She noticed this around 1400 and reported it to me at 1433 over email. I then filled in this form with her over the phone.

Other Meds: Losartan 50mg

Current Illness: None

ID: 1510258
Sex: F
Age: 45
State: MI

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PATIENT SAYS SHE EXPIERENCED NAUSEA AND VOMITING, EXTREME FATIGUE, CHEST PAIN, JOINT PAIN AND SWELLING SO MUCH THAT SHE COULD BARELY WALK AND A BIG KNOT/SWELLING AT THE INJECTION SITE. SYMPTOMS STARTED THE EVENING AFTER RECEIVING THE VACCINE, BUT BECAME SO SEVERE AFTER 2 DAYS SHE WENT TO THE EMERGENCY ROOM. SHE SAID THEY GAVE HER IV FLUID BECAUSE SHE WAS SO DEHYDRATED AND MEDICATION FOR NAUSEA. THE DOCTOR DID NOTICE THE INJECTION SITE ALSO. SHE IS DOING BETTER NOW, BUT STILL HAS SOME LINGERING FATIGUE AND JOINT PAIN.

Other Meds:

Current Illness:

ID: 1510259
Sex: F
Age: 15
State:

Vax Date: 06/03/2021
Onset Date: 06/04/2021
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: None

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

Symptoms: My child experienced dizziness and fainted within 24 hours of receiving the covid19 vaccine. That night, she experienced chills, fever and muscle aches. By the following morning (about 36 hours post vaccine), she was back to normal. No problems since then.

Other Meds: None

Current Illness: None

ID: 1510260
Sex: F
Age: 56
State:

Vax Date: 03/10/2021
Onset Date: 07/26/2021
Rec V Date: 07/28/2021
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:

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

Symptoms: sore throat, malaise

Other Meds:

Current Illness:

ID: 1510261
Sex: F
Age: 38
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: PATIENT WAS GIVEN JJ VACCINE , SHE WAS VERY AFRAID OF THE NEEDLE. SHORTLY AFTER THE VACCINE PATIENT FAINTED IN THE WAITING AREA AFTER VACCINE. PATIENT WAS GIVEN WATER, JUICE AND WAS FANNED FOR RELIEF. PATIENT STARTED FAINTING AGAIN AND AT THAT POINT THE AMBULANCE WAS CALLED. PATIENTS VITALS WERE ALL LOW INCLUDING BLOOD PRESSURE, BLOOD SUGAR AND HEART RATE. PATIENT WAS TAKEN TO THE HOSPITAL FOR FURTHER EVALUATION.

Other Meds:

Current Illness:

ID: 1510262
Sex: M
Age: 68
State: CA

Vax Date: 07/22/2021
Onset Date: 07/23/2021
Rec V Date: 07/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt requested to receive COVID vaccine. Phizer first dose was given as recommended. The next day when staff was inputting data in computer for insurance, it was denied because pt had already received Johnson and Johnson vaccine at another facility on April 11, 2021. Staff called insurance to verify and then called patient to verify. They both stated, yes patient had previously received the J&J COVID vaccine. Patient was told he could not receive the second dose of Pfizer. Patient did not notify Rite Aid staff nor immunizer that he had previously received the J&J vaccine.

Other Meds:

Current Illness:

ID: 1510263
Sex: F
Age: 33
State: OR

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

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

Symptoms: AFTER THE VACCINE PATIENT REQUESTED TO STAY SEATED, SHE WAS DIZZY AND PASSED OUT AND FEL FOR A BRIEF MOMENT.

Other Meds: N/A

Current Illness: N/A

ID: 1510264
Sex: F
Age: 78
State:

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 07/28/2021
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: - stye on left eye - uncontrollable diarrhea - diagnosed with lymphocytic colitis - shortness of breath - blood in urine - hematuria

Other Meds:

Current Illness:

ID: 1510265
Sex: M
Age: 39
State:

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Vomiting

Symptoms: Facial paralysis 8 days ago, right side of the face.

Other Meds: None

Current Illness: None

ID: 1510266
Sex: M
Age: 1
State: CA

Vax Date: 11/30/2017
Onset Date: 12/01/2017
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: None known at this time.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Broke out in a full body rash, made another appointment and doctor said rash was not related to the vaccine and prescribed antibiotics. Speech regression, hyper sensitivity, sensitive to lights and sound. He started eating paint chips.

Other Meds: No

Current Illness: No

ID: 1510267
Sex: F
Age: 32
State: CO

Vax Date: 04/24/2021
Onset Date: 06/14/2021
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: asprin

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

Symptoms: I got pregnant about 2 weeks after recieving the 2nd dose of my vaccine. About 6 weeks later , I started bleeding. I saw my Dr. they tested the HCG levels. The fetus was measuring 5 weeks even though I was 8 weeks.

Other Meds: Propranool, vit c and Magnisum

Current Illness:

Date Died: 07/14/2021

ID: 1510268
Sex: F
Age: 28
State: TX

Vax Date: 07/06/2021
Onset Date: 07/07/2021
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: nkda

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient died.

Other Meds: sprintec ocp. xanax prn 1 mg.

Current Illness: none known

ID: 1510269
Sex: F
Age: 36
State: MA

Vax Date: 01/21/2021
Onset Date: 03/04/2021
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: finned fish - salmon, tuna

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

Symptoms: I started having very painful low back - around my SI joints on both sides. And then back would spasm around my whole lower back and I couldn't walk. It happened three weekends - and I was down for the count on Saturday and Sunday in the March and April timeframe. Worse symptoms in April. I sought care with PCP and saw a physical therapist - I did about 10 sessions - and she thought I might be hyper mobile and told me it might be hEDS . ended up seeking care with a genetic team who diagnosed me with hyper mobile EDS. Now once a week, I get a massage: myofascial release to help me to not have spasms so that I can't walk about once a week. I moved all my exercise into the water - it's easier on my joints. I go to PT and massage and I have referrals to see other specialists - to check out things that are correlated with EDS. I will go to cardiology for sleep evaluation and will be checked out for Dysautonomia - It's a chronic issue that needs symptom managed.

Other Meds: Methotrexate - 8 pills once a week; Cymbalta - 60 mg a day; Allegra -once a day; Vit D - 5000 IU per day; Magnesium -500 mg per day; Singulair; Flonase and Symbicort

Current Illness: no

ID: 1510270
Sex: F
Age: 68
State: WI

Vax Date: 03/29/2021
Onset Date: 05/21/2021
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: RA

Lab Data:

Allergies: Penicillin; Amoxicillin; Atropines; PolyTrim.

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

Symptoms: 05/21/2021, couldn't sleep, severe abdominal pain, self-diagnosed as shingles, I had noticed a rash earlier in the day. On Monday, 05/24/2021, I had a video visit with the doctor. The doctor said given the condition of the pustules he thought it probably started on 05/19/2021, he diagnosed it to be shingles. I was already taking CBD oil for it. And the doctor prescribed gabapentin. The shingles were pretty bad for 2 weeks on the 3rd week it subsided. On 06 /13/2021, at night my big toe was so painful I couldn't stand to have a sheet on it. On the 06/24/2021 I went to see a physician he put in the chart and said it was gout. He asked me a bunch of question about diet. He gave a uric acid blood test. The results were 4.7 value which he said was in a completely normal range. I received the results in a letter. The results it was inconsistent with gout and he said it was probably an immune reaction with gout- like features. He prescribed colchicine 0.6 mg, which is specific for gout and it worked pretty well.

Other Meds: High Dose Vitamin B; Multivitamin; B-vitamin; Vitamin E; Black Cohosh; Levothyroxine; Sumatriptan; Vitamin C.

Current Illness: No.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm