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: 1513408
Sex: F
Age: 52
State: NV

Vax Date: 07/08/2021
Onset Date: 07/09/2021
Rec V Date: 07/29/2021
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: tomatoes

Symptom List: Dysphagia, Epiglottitis

Symptoms: woke up on the 7/9 21 with jelled eyes that turned blood red . Difficulty breathing also black around the eyes. Severe headaches.

Other Meds: Gabapentin 600 mg , amlodipine 10mg fluticasone propionate nasal spray 60 mg albuterol ,topiramate 100 mg meloxicam 15 mg, cumvivent inhaler

Current Illness: no

ID: 1513409
Sex: F
Age: 30
State: CA

Vax Date: 07/20/2021
Onset Date: 07/21/2021
Rec V Date: 07/29/2021
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: Patient called hospital call center. Pt stated pt got 2nd covid vaccine Pfizer yesterday at her local pharmacy. Pt said pt feels left throat swelling, left eye and left collar bone swelling and pain(socre 7/10) when pt touches on left collar bone swelling area, body aches and sinus headache. Pt advised by to go to ED

Other Meds:

Current Illness:

ID: 1513410
Sex: F
Age: 19
State: CO

Vax Date: 04/26/2021
Onset Date: 04/29/2021
Rec V Date: 07/29/2021
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: fever followed by genital aphthous ulcers of the vulva

Other Meds: Seroquel, Mirena

Current Illness: none

ID: 1513411
Sex: F
Age: 51
State: MO

Vax Date: 02/22/2021
Onset Date: 02/27/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: Keflex-causes hives

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I developed a new and unexplained pain in my knees and elbows, feet, and hips. The pain feels like a stabbing knife into the area of pain. Most of the time it happens simultaneously with both knees and both elbows. Once it begins I get so bad I can barely stand or walk. I tried Bayer, Aleve, Aspercreme, Valteran, CBD, and vitamins. I went to a couple of doctors and they treated me with Prednisone and that has helped. If I try to go 3 days or more without the steroids I can not walk, get out of bed, work, walk, etc.

Other Meds: Cymbalta, Lyrica, Trazadone,

Current Illness: I was not ill near the time of the vaccination

ID: 1513412
Sex: F
Age: 49
State: WI

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: minocycline

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

Symptoms: hypertensive urgency/tachycardia 230/125 Pulse 135 and some chills. Hydration all night. symptoms lasted all night. By mid morning, b/p went down to 170/100 HR 99.

Other Meds: vitamin D3 Magnesium multivitamin

Current Illness: none

ID: 1513413
Sex: M
Age: 60
State:

Vax Date: 04/26/2021
Onset Date: 07/22/2021
Rec V Date: 07/29/2021
Hospital: Y

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:

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

Symptoms: COVID-19

Other Meds:

Current Illness:

ID: 1513414
Sex: F
Age: 47
State: PA

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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: NA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: PATIENT WANTED MODERNA,. INSTEAD PT RECEIVED jANSSEN

Other Meds: FLONASE

Current Illness: NA

ID: 1513416
Sex: F
Age: 66
State: GA

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: Penicillin; corn & wheat products ,lavender, most nuts

Symptom List: Pharyngeal swelling

Symptoms: Right after shot, before I left the Dr's office - headache; by the time I reached my car - headache, sweating, runny nose & eyes. The next day -rash on my right arm, chest. In days to follow still had rash, headsche. extremely weak, muscle aches, no strength or energy, lack of appetite.. To date - still extremely weak, muscle aches - w/xtreme muscle cramping w/muscles locking up, rash comes & goes, overall exhausted.

Other Meds: Amlodipine Besylate 10mg; Rosuvastatin 40mg; Lisinopril 5mg; Acetaminophen w.codeine #3; Glipizide ER 2.5mg; Daily - 1 a day multi vitamins (Energy); Claritin - chewable tablets;; fish oil; vitamin C; vitamin E; glucosamine & chondroitin;

Current Illness:

ID: 1513417
Sex: F
Age: 46
State: CA

Vax Date: 06/21/2021
Onset Date: 06/28/2021
Rec V Date: 07/29/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: One week after my first shot, I got my period and it was very heavy bleeding with clotting for days 2,3, 4 and some of 5. I had major back ache and the same thing but worse occurred one week after my second shot. I have bad periods but the last 3 years it?s gotten better where I don?t have to take Advil. I had to take advil for my last two periods which also gave me major Advil side affects such as pain in my spine into my neck and shoulders, sharp pains in my head and long lasting headache. Advil side effects went away after the second day I stopped taking it. I was taking 4 200mg pills a day 2 in the morning and 2 10-12 hours later. My period pains were extreme, worse I?ve felt in 3 years and I usually have bad pains and heavy bleeding but nothing like the two periods I experienced one week after each shot. I?m hoping my 3rd period isn?t going to like my last one because this was awful.

Other Meds: None

Current Illness: Diabetes 2, iron deficiency and auto immune disorder (unknown which)

ID: 1513418
Sex: F
Age: 63
State: WV

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 07/29/2021
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: allergies - molds; some smells; concentrated artificial lavender - breathing issues; artificial flavoring - watermelon artificial - in bubble gum and I had an anaphylactic reaction to it.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: That evening, body aches and by 09:30pm I had a fever of 102-103. I was hurting and I was fatigued. When I woke up the next morning, I=it hurt to move, breathe, or even sit. Every muscle and joint hurt. By 03:00 that afternoon, my fever went to 103.1. I had a horrible pounding headache, too, the whole time. I stayed in bed all the day. When I woke up the next morning after that, fever was gone. I was still aching - muscles of upper arm (bicep) and thighs, knees, hip, ankles, hands. They weren't hurting as much as they had the day before but still hurting. But the joint pain never went away - I have a flare up every two or three weeks when muscles hurt again, too. In my joints in my fingers, they stay swollen - like when I have an osteoarthritis flare up. Those joints have really never gone back down to size since then. They've stayed swollen. My feet have hurt the entire time. It literally hurts to walk some days - every muscles and joint in feet hurt. Knees and hips - those really hurt badly. I never had this achiness before. I had to have a reason for it before (achiness) - with hard work I do on the farm but now it's all the time of feeling achiness. I was taking three Ibuprofen three times a day. I had to stop that because I developed two ulcers. I have had to stop and take turmeric which doesn't help as well. Every day there is a continuing ache in my joints. The back of my hips - the lumber spine - hurts - it is always there....part of that is that I could have worn that out. I'm still hurting. I was told to take Naproxin when it gets really bad. I want the Ulcer to heal so I don't take that very often. I take a low dose aspirin and ginger capsule and the Turmeric currently.

Other Meds: Blood pressure medicine - Lisinopril; Intuniv; Zyrtec - seasonal allergies; Potassium - because Lisinopril washes that out. Women's multi-Vitamin - one day for 50+ age group; Vit C - 500 mg; Vit D - 3000 a day; Pro Air Inhaler - but when I

Current Illness: no

ID: 1513419
Sex: F
Age: 78
State:

Vax Date: 02/16/2021
Onset Date: 07/23/2021
Rec V Date: 07/29/2021
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: U07.1 - COVID-19

Other Meds:

Current Illness:

ID: 1513420
Sex: M
Age: 58
State: CA

Vax Date: 05/01/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
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: Pt stated pt got 1st covid vaccine Pfizer 5/1/2021 and pt got arm pain, neck pain and headache with nausea until 2nd covid vaccine scheduling. Noted no show of 2nd covid vaccine schedule on file. Pt said that pt still have neck pain when pt moves his neck side to side and headache with nausea at least a month. Noted pt has no emergency s/sx. Pt is educated covid vaccine side effects. Informed pt to call 911 or go to ED if pt experienced emergency s/sx. Pt scheduled 9:40am 7/21/2021 urgent care provider for consultation

Other Meds:

Current Illness:

ID: 1513421
Sex: F
Age: 32
State: PA

Vax Date: 07/16/2021
Onset Date: 07/23/2021
Rec V Date: 07/29/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: 7/20/21 right armpit became swolen and sore 7/21/21 Same effects 7/22/21 same soreness swelling goes down half way 7/23/21 right arm became swolen and sore along with armpit soreness and swelling same 7/24/21 right arm sore and swollen same, added large, red, itchy, hot circle around injection area. Less armpit soreness almost no armpit swelling. 7/25/21 same arm soreness, same swelling, same circle. No armpit soreness, no armpit swelling. 7/26/21 less arm swelling, less arm soreness, circle area is entirely itchy but not completely red. Only hot where red. Circle was blotchy top half, fully red on bottom half. 7/28/21 same with lesser red up top, still fully red on bottom. 7/29/21 same with lesser red up top, still fully red on bottom(about one inch left fully red at bottom) entire circle still itches -present

Other Meds: Albuterol inhaler 2 puffs/month

Current Illness: Neck injury, took cyclobenzaprine hci 10mg tab acts 1 per day ending 7/26/21

ID: 1513422
Sex: F
Age: 34
State: TX

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
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: Penicillin

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

Symptoms: Heart is racing since 2-3 minutes after receiving shot. It continues racing 48 hours after the shot.

Other Meds:

Current Illness:

ID: 1513423
Sex: M
Age: 66
State:

Vax Date: 04/05/2021
Onset Date: 07/20/2021
Rec V Date: 07/29/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: U07.1 - COVID-19

Other Meds:

Current Illness:

ID: 1513424
Sex: F
Age: 18
State: CO

Vax Date: 04/25/2021
Onset Date: 04/28/2021
Rec V Date: 07/29/2021
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: Amoxicillin

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

Symptoms: Fever followed by Genital aphthous ulcers on the vulva

Other Meds: Albuterol

Current Illness: no

ID: 1513425
Sex: F
Age: 49
State: NY

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/29/2021
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: none

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

Symptoms: Burning sensation at injection spot that won't go away. LIghteaded, dizzy, almost fainting. Slurred speech, feels like head is spinning, exhaustion.

Other Meds: none

Current Illness: asthma, copd

ID: 1513426
Sex: F
Age: 18
State: IL

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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: Patient has P.O.T.S. Patient was driving and had a episode and blacked out. Patient had a high fever.

Other Meds: Midrodrine Prilozec

Current Illness:

ID: 1513427
Sex: F
Age: 60
State: NE

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: morphine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: been sick since I recieved the 1st dose nausa, worst migranes, blacking out, have more sick days then not

Other Meds: Venlafxine 150mg Chlordiazepoxide 25mg Ezetimibe 10mg ( 1 time a day all of them ) 81mg asprin, multi vitiamin for women, vit D ,B Complex

Current Illness: none

ID: 1513428
Sex: F
Age: 42
State: CA

Vax Date: 07/27/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt c/o bodyache,headache and feeling lowe grade fever but did not check temp. Pt concerned its due to possible s/e of covid 19 vaccine Pfizer that she got on 07/27/21. Pt speech clear, comfortable. AO X3. Also denies emergency sx at this time. Advised to monitor her sx but pt requested f/u MD appt for these mentioned concerns .

Other Meds:

Current Illness:

ID: 1513429
Sex: M
Age: 20
State: OR

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 07/29/2021
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:

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

Symptoms: Pt received 1st MODERNA covid vaccine at another pharmacy. Pt requested to get 2nd Pfizer covid vaccine at our pharmacy. RPH did not catch the different type of vaccine and administered Pfizer vaccine to pt.

Other Meds:

Current Illness:

ID: 1513430
Sex: F
Age: 15
State: MT

Vax Date: 06/23/2021
Onset Date: 07/18/2021
Rec V Date: 07/29/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Unevaluable event

Symptoms: Presented with right arm redness and swelling. Ultrasound evaluation reveal DVT. Underwent heparinization and thrombolysis. Underwent post thrombolysis venogram. Patient is a 15 year old previously healthy female with unprovoked thrombosis located in right upper extremity, per the Admission Note specifically at the right distal subclavian through axillary vein as well as a DVT in the basilic and proximal brachial vein. Associated symptom was sensation of pressure on right arm "like blood pressure" cuff. Duration as of admission of these symptoms and presumably underlying clot was three days with onset of these symptoms was Sunday 7/18/2021. Timing was cyclical with discomfort in the arm worse in the morning than in the evening. Context of this thrombosis was healthy female who does not smoke, does not use hormonal contraception, is not active in sports where upper body workouts are emphasized, and was not injured.

Other Meds: none

Current Illness: none

ID: 1513431
Sex: F
Age: 79
State:

Vax Date: 07/20/2021
Onset Date: 07/25/2021
Rec V Date: 07/29/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC)

Other Meds:

Current Illness:

ID: 1513432
Sex: F
Age: 65
State: CA

Vax Date: 06/28/2021
Onset Date: 06/30/2021
Rec V Date: 07/29/2021
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: Cipro, Bactrim, Augmentin (antibiotics)

Symptom List: Injection site pain, Pain

Symptoms: Loud ringing in the right ear lasted all night starting at 7 pm June 30, 2021 until the next morning around 9am. Had a hearing test and results showed sudden hearing loss in that right ear. Another episode occured on Friday July 2, 2021 . It started 7pm lasted all night until 9am next morning. The following week I experienced 4 episodes of vertigo on July6. JUly 7, July 10, and July 12, 2021. Each episode lasted any where from 1 and half hours to 5 hours. The Vertigo episode on July 10th required a trip to the ER at the Hospital because I almost passed out.

Other Meds: Omeprazole 20mg, Vitamins B2, B12, D, C, calcium

Current Illness: none

ID: 1513433
Sex: F
Age: 15
State: CO

Vax Date: 05/17/2021
Onset Date: 05/20/2021
Rec V Date: 07/29/2021
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: Fever followed by Genital aphthous ulcers of the vulva

Other Meds: none

Current Illness: none

ID: 1513435
Sex: M
Age: 93
State: CA

Vax Date: 03/01/2021
Onset Date: 07/08/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received 2 doses of Moderna, last in March, at distribution site. In July came down with severe covid requiring admission and high flow oxygen in the ICU. Was discharged home after a week.

Other Meds:

Current Illness:

ID: 1513436
Sex: F
Age: 50
State:

Vax Date: 06/20/2021
Onset Date: 07/22/2021
Rec V Date: 07/29/2021
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: I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC)

Other Meds:

Current Illness:

ID: 1513437
Sex: F
Age: 65
State: FL

Vax Date: 07/20/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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: patient received shot on 7/20 on 7/29 patient reported rash and heat coming from injection site

Other Meds:

Current Illness:

ID: 1513438
Sex: F
Age: 75
State: CA

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PATIENT CHECKED "NO " ON NEVER RECEIVING A COVID 19 VACCINE ON CONSENT FORM. PATIENT WAS GIVEN A DOSE OF PFIZER VACCINE. HOWEVER, IT WAS LATER DISCOVERED WHEN TRYING TO BILL FOR THE SERVICE THAT PATIENT HAD ALREADY GOT MODERNA VACCINE.

Other Meds:

Current Illness:

ID: 1513439
Sex: F
Age: 73
State:

Vax Date: 05/15/2021
Onset Date: 07/09/2021
Rec V Date: 07/29/2021
Hospital: Y

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: I21.4 - NSTEMI (non-ST elevated myocardial infarction)

Other Meds:

Current Illness:

ID: 1513440
Sex: M
Age: 21
State:

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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: MINUTES AFTER RECEIVING COVID VACCINE PATIENT FAINTED. HE DID NOT HIT HIS HEAD. RESCUE WAS CALLED AND HE REGAINED CONSCIUOUSNESS MOMENTS AFTER FAINTING. WHEN RESCUE CAME PATIENT DENIED ANY FURTHER SERVIES AND STATED HE WAS FEELING BETTER AND LEFT THE PHARMACY.

Other Meds:

Current Illness:

ID: 1513441
Sex: F
Age: 13
State: CO

Vax Date: 06/07/2021
Onset Date: 06/10/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: peanuts, egg whites

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

Symptoms: fever followed by genital aphthous ulcers on vulva

Other Meds: none

Current Illness: none

ID: 1513442
Sex: M
Age: 70
State: WA

Vax Date: 04/28/2021
Onset Date: 05/09/2021
Rec V Date: 07/29/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Approximately 10 days after 1st dose, complaint about pain running from lower to upper inside of left leg. Second dose given on 5/19/21. On 5/21/21 had an ultrasound of left leg. Acute deep vein thrombosis found. On 5/22/21, complained of pain in back when breathing. Hospitalized overnight with acute pulmonary embolism.

Other Meds: Lisinopril, Lovastatin, Memantine, Metoprolol Succinate, Venafaxine XR, Vitamin C, Vitamin D3, Zinc Gluconate

Current Illness: None

ID: 1513443
Sex: F
Age: 21
State: WA

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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 and nuts

Symptom List: Tremor

Symptoms: During registration at , , informed that she might be pregnant and was not sure whether it was safe to get the Pfizer vaccine. explained to that she could still get the vaccine even if she was pregnant. But if she had any questions or concerns regarding the vaccine and her pregnancy, she should speak to her healthcare provider first. also told staff that was allergic to Penicillin and nuts. Staff explained to her that she could still get the vaccine, but she would have to sit for 30 minutes in the observation area so that staff could make sure she did not have any adverse reactions. decided to go forward with getting the vaccine. After getting the vaccine from , was directed to sit in the observation area for 30 minutes. During this time, , would periodically check on her to see how she was feeling, and each time said she felt fine. After her 30 minutes were over, told that she felt dizzy. asked if she could stay longer in the observation area as it was unsafe for her to stand up and walk. agreed. Staff offered her some candy and water to drink. After eating some candy, said she felt better. About 6 minutes later, said she was having trouble breathing and that it was getting worse. checked her oxygen level and it was 98. Staff explained to that her blood oxygen level was normal, but said she still couldn't breathe. tried to do some breathing exercises with her. called EMS at 1:50 p.m. and then went outside and waited for them to arrive. then told staff that she was having chest pain and that it hurt. Staff continued to monitor until EMS arrived at 2:07 p.m. They assessed and then transported her to Hospital at 2:20 p.m. to have her further

Other Meds: unknown

Current Illness: unknown

ID: 1513444
Sex: F
Age: 24
State:

Vax Date: 04/30/2021
Onset Date: 07/14/2021
Rec V Date: 07/29/2021
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: Erythema, Pruritus

Symptoms: O20.0 - Threatened abortion

Other Meds:

Current Illness:

ID: 1513445
Sex: M
Age: 54
State: SC

Vax Date: 01/26/2021
Onset Date: 05/21/2021
Rec V Date: 07/29/2021
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: Sulfa Bactrim Creator Latex Augmentin

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

Symptoms: Arm pain Swelling at injection site Diarrhea Nausea Joint pain

Other Meds: Benefiber Ozempic Humalog Tresiba Jardiance Omeprazole Lisinopril Coreg Flomax Hyomax Er Allegra Mobic Celexa Zocor Centrum Vitamin D Testosterone

Current Illness: None

ID: 1513447
Sex: F
Age: 29
State: TX

Vax Date: 07/19/2021
Onset Date: 07/23/2021
Rec V Date: 07/29/2021
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: Bactrim

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

Symptoms: Raised itchy rash occurred all over body.

Other Meds: Sertraline 25mg, Clindamycin

Current Illness: Mastitis

ID: 1513448
Sex: F
Age: 14
State: CO

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 07/29/2021
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: Amoxicillin, Augmentin, lidocaine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: fever followed by genital aphthous ulcers on vulva

Other Meds: Retin A cream

Current Illness: none

ID: 1513449
Sex: F
Age: 37
State: PA

Vax Date: 07/27/2021
Onset Date: 07/28/2021
Rec V Date: 07/29/2021
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: Just Gadolinium contrast media

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

Symptoms: "Moderna COVID19 Vaccine EUA" I rcvd vaccine around 7pm n about 12hrs after injection, 8/9 am, I started having terrible side effects. It reminded me of my symptoms when I had COVID back in February 2021. I was exhausted but couldnt sleep bc I had chills n a fever with the most awful body aches u can imagine. It really felt like days 4 n 5 of the actual virus! Totally dreading getting my 2nd dose now! Lol. But that only lasted until about 30 hrs after injection-around 12 am. The soreness in my arm started a few hours after injection but it was bearable and today its still sore but a lot better than yesterday. Just thought u should know in case it helps u understand this better!! Thanks for all u guys are doing!

Other Meds: Gabapentin, Zoloft, Ibuprofen

Current Illness: N/A

ID: 1513451
Sex: F
Age: 48
State: PA

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
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: Sulfa, PCN, Flagyl, bees

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

Symptoms: Palpitations, increased blood pressure, wheezing ,SOB within 5 minutes symptoms increase as time went on-tachycardia -epi pen administer after 15-20 mins after injection

Other Meds: Aspirin, women multivitamin, Simvastatin, Ambien, Prolisec

Current Illness: None

ID: 1513452
Sex: F
Age: 61
State: WA

Vax Date: 03/17/2021
Onset Date: 03/29/2021
Rec V Date: 07/29/2021
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: shingles, left torso treated with valacyclovir 7 days

Other Meds:

Current Illness:

ID: 1513453
Sex: M
Age: 66
State: CA

Vax Date: 07/23/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: pt had fever the following day after getting the shingrix vaccine, then 4 days later he felt pain on his right side, armpit, breast and back. He went to the dr and dr said he has shingles

Other Meds: n/a

Current Illness: n/a

ID: 1513617
Sex: F
Age: 67
State: WA

Vax Date: 07/24/2021
Onset Date: 07/25/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: Codeine, dairy, gluten, tomatoes

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

Symptoms: For Five Day Body Pain, severe headache, chills and fever, arm pit soreness, soreness down arm to wrist, nausea, redness on shoulder under injection spot that has grown larger and is hot.

Other Meds: Sertraline Levothyroxine Citalopram Fibro aid Brain Plus Pregnenolone Ginseng Pycnogenol Montelukast Progesterone melatonin Citracal levocetirizine Magnesium

Current Illness: None

ID: 1513618
Sex: M
Age: 32
State: WA

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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: no

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

Symptoms: After about 13 minutes, patient stated that he started to have blurry vision about 80% of it was gone, he felt nauseous, and starting to sweat a lot. Then patient threw up a little bit. After that we gave gave him some water and glucose tablets. Patient hasn't eaten all day either.

Other Meds: no

Current Illness: no

ID: 1513619
Sex: F
Age: 69
State: FL

Vax Date: 03/31/2021
Onset Date: 04/07/2021
Rec V Date: 07/29/2021
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: After the first shot mild fatigue from 2-3 day post vaccination, up to the second vaccination. After the second dose of the vaccine to the present time EXTEME FATIGUE AND DISSINESS ALL DAY LONG, along with a FOG FEELING IN THE HEAD ALL DAY LONG. tHIS IS going on up to today ,July 29, 2021, when will it get better ?

Other Meds: Predisone 5mg. OD., Imuran 50 mg. OD, synthroid 62.5 mcg. OD, Metoporol 25 B.I.D. Isosorbide ER.30 mg. Linsinopril 5Mg. BID, Memendine 7.5 mg. OD, Restasis drops for eyes bid.

Current Illness: Systemic Lupus Erythematosis since age 35-40 years of age Mild Hypertension

ID: 1513620
Sex: F
Age: 20
State: CA

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: nausea, weakness, dizziness, neuropathy

Other Meds: none

Current Illness: none

ID: 1513621
Sex: F
Age: 27
State: NC

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
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: Bactrim

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

Symptoms: 7/27/2021 @ 9:00pm broke out in hives, swollen lips & eyes, tight chest, short of breath. Took Benadryl for treatment. 7/28/2021 @ 10:30am broke out in hives. Took Benadryl for treatment. 7/29/2021 @ 03:00am broke out in hives. Took Benadryl. 7/29/2021 @ 12:30pm woke up with palpitations and shaking. No treatment. Called employee health to let them know to document my reactions. I was told by employee health @12:38pm to follow up with my PCP if this continues or worsens.

Other Meds: n/a

Current Illness: n/a

ID: 1513622
Sex: F
Age: 45
State: UT

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 07/29/2021
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: Tuberculosis skin test

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Seizure; Blurry vision

Other Meds: Vitamin D3; Divalaproex 500mg; Divalaproex 250mg ER; TraZODone 100 mg (1/2 tab) last night ; Potassium CL 10 mEq SR Tab (2 daily); CertaVite with Antioxidants multivit/Min/FA FeFum 0.4/18 mg Tab Ruab; Vitamin B-12 Cyanocobaiamin 1,000 mcq

Current Illness: Swelling in lower extremity and foot

ID: 1513623
Sex: F
Age: 59
State: WA

Vax Date: 07/26/2021
Onset Date: 07/27/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: metachlopramide, prochlorperazine, promethazine

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

Symptoms: Right knee severe pain, without swelling, reduced ROM, or systemic symptoms

Other Meds: amlodipine, aspirin, atorvastatin, carvedilol, cyclbenzaprine, insulin lantus & aspart, metformin, lisinopril, methadone, protonix

Current Illness:

ID: 1513624
Sex: F
Age: 69
State: FL

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 07/29/2021
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: Pt took BP after 15 observation period and BP was high 147. Did not inform staff, drove home and when arrived husband noticed her lips were blue and she also had chest tightness some time after. Patient did not seek medical attention and did not consult the pharmacy reported during 2nd shot consultation.

Other Meds: Vyvanse, Lamotrigine, Metoprolol

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm