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: 1513625
Sex: M
Age: 23
State: TN

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

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient passed out in the chair (in the waiting room), while waiting the 15 minutes. He leaned over in the chair and his girlfriend noticed. He came to quite quickly. He was pale and sweating. He felt nauseated but never vomited. He stated he hadn't eaten in over 6 hours. He had been working outside in the heat and hadn't had much water, so those may have been contributing factors. He stayed in the waiting area for 30 minutes and felt completely fine when he left the store.

Other Meds: Unknown

Current Illness: None

ID: 1513626
Sex: F
Age: 31
State: TX

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: Pertusis Vaccine

Symptom List: Anxiety, Dyspnoea

Symptoms: I had stroke like symptoms and a major migraine for over a week. This was followed by the heaviest most painful period of my life. I got pregnant the same month and miscarried. I ended up getting covid anyway in July.

Other Meds: Lamictal, Prozac, Adderal, Hailey, Claritin

Current Illness:

ID: 1513627
Sex: M
Age: 86
State: FL

Vax Date: 07/29/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient came to pharmacy requesting a COVID vaccine, Pfizer, Moderna, whatever we had. Patient was given Moderna. Hours later daughter calls and states that father had received Pfizer when the vaccine was first available to the public back in January and had received both doses. Stated that father suffers from memory problems.

Other Meds:

Current Illness:

ID: 1513628
Sex: F
Age: 60
State: CA

Vax Date: 03/12/2021
Onset Date: 03/15/2021
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Tinitus--Ear ringing in both ears.

Other Meds: Amlodipine 5 mg/day, Estrogen patch .06 mg/week, Progesterone 100 mg/day.

Current Illness: Noneha. I also had hearing checked a few months prior before vaccine and no ringing.

ID: 1513629
Sex: M
Age: 26
State: OH

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none known

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

Symptoms: Patient fainted after about 5 to 10 minutes never stopped breathing emt checked patient out and he left of his own accord stating he was fine now

Other Meds: none known

Current Illness: none known

ID: 1513631
Sex: M
Age: 83
State: PR

Vax Date: 01/01/2021
Onset Date: 06/12/2021
Rec V Date: 07/29/2021
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: Vertigo, dizziness

Other Meds: Atorvastatin calcium 20 mg once daily, Finasteride 5 mg 1 daily prostate, Metformin 500 2 times per day, Losartan 25 mg twice, Levocetirzi allergy 5 mg, Tamsulosin one at night daily .4 mg.

Current Illness: None

ID: 1513632
Sex: F
Age: 18
State:

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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513633
Sex: F
Age: 52
State: CA

Vax Date: 03/16/2021
Onset Date: 04/06/2021
Rec V Date: 07/29/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin Codeine

Symptom List: Pharyngeal swelling

Symptoms: Cerebellar Stroke- 06/23/2021

Other Meds: Amour Thyroid 60 mg Maxalt 10mg Progesterone 200mg Evamist

Current Illness:

ID: 1513634
Sex: M
Age: 50
State: HI

Vax Date: 06/02/2021
Onset Date: 07/26/2021
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: Positive COVID PCR test on 7/28/21. Patient with tactile fever, body aches, chills, cough, nasal congestion, runny nose, fatigue.

Other Meds: none

Current Illness: none

ID: 1513635
Sex: F
Age: 23
State:

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513636
Sex: F
Age: 77
State: LA

Vax Date: 07/26/2021
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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: Pt received first dose on Monday 7/26/21 and returned to pharmacy on Thursday 7/29/21 reporting she had a sore throat the night she got her vaccine. She now has redness/red-like and warm-to-the-touch circular appearance about 3 inches below her injection site (may be cellulitis). Pt denied she did not have other symptoms like throat swelling, itching, lip swelling, etc. She will take benadryl and ibuprofen to reduce the redness/inflammation. She will also keep the area clean by washing with warm water and soap. She was advised to contact MD if she does not see it going away or symptoms persist or new symptoms occur.

Other Meds: N/A

Current Illness: N/A

ID: 1513637
Sex: M
Age: 57
State: TX

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: I have never had Tinnitus. My ears started ringing after my first Phizer Covid vaccine which was administered on 3/12/21. The ringing in my ears worsened 24 hrs after receiving my second dose of the Phizer Covid vaccine on 7/26/21.

Other Meds: Famotidine - for gerd

Current Illness: none

ID: 1513638
Sex: M
Age: 45
State:

Vax Date: 07/13/2021
Onset Date: 07/13/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513639
Sex: F
Age: 37
State: ME

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

Lab Data:

Allergies:

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

Symptoms: Patient was given the Covid 19 Pfizer shot. Per protocol she was in the waiting room for the 15 minutes but was not feeling well. Conscious but was feeling light headed and dizzy. Came over and mentioned about her condition and wanted her vitals to be checked, brought her back to the immunization room and took her blood pressure was around 140/90 was high and requested me to call 911. Had an intern stay in the room with her had the EMT take a look and they brought her to the ER. At the hospital she felt more dizzy light headed and weak and started noticing tinglyness and tightening of the throat at that time they started her on prednisolone and Benadryl, after which she started feeling better and normal. Had her under observation till 5 pm and let her go home. Did prescribe her to take Benadryl for the next two days. Was not able to contact her yesterday. But did speak to her to find out about her condition, which she is feeling much better. She did notice similar symptoms in the morning so she did take Benadryl. Did contact her doctor listed on VAR form and updated them. The ER also requested the patient to contact the CDC for further information.

Other Meds:

Current Illness:

ID: 1513640
Sex: M
Age: 31
State: MA

Vax Date: 07/26/2021
Onset Date: 07/26/2021
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: nkda

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

Symptoms: Patient came to pharmacy after scheduling a COVID-19 first dose online. His paperwork was prepared, the vaccine drawn up, vaccine given, and patient observed for 15 minutes. The vaccine was billed later that evening and rejected though insurance. The rejection read, "MANUFACTURER DIFFERENT THAN INITAL DOSE". I looked him up on MIIS and he received the Janssen vaccine on 4/5/21 at a Pharmacy. I reviewed his form and he responded no to question #2 regarding "Have you ever received a dose of COVID-19 vaccine?" and did not mark any of the mentioned vaccines. I called him and he admitted to having received that dose. I informed him that currently there are not guidelines to become revaccinated after having completed a prior COVID-19 vaccine series. He said he must have been misinformed. He says he feels fine. there was no adverse event but was advised to report unwarranted vaccine

Other Meds: unknown

Current Illness: unknown

ID: 1513641
Sex: F
Age: 68
State: CA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
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: Penicillin Clindamycin contrast dye

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

Symptoms: 5 minutes after receiving the vaccine, I had a severe flushing throughout my body and my throat began to swell. My blood pressure spiked and I got nauseous and felt like I was going to pass out. I immediately took 2 benedryl tablets and went to the ER to get Prednisone. It lasted throughout the night and seemed to be better in the morning. However, I continued to have allergic reactions daily, for the next 3 weeks. I believe I then caught Covid 19 from the ER. I got monoclonal antibodies treatment and my case of Covid did not require hospitalization. I now have Long Covid, and have for the last 5 months. I have not developed MCAS

Other Meds: Levothyroxine 88 mcg tablet, pravastatin 20 MG Daily Vitamin Vitamin C

Current Illness:

ID: 1513642
Sex: M
Age: 88
State: PA

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

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

Symptoms: Patient stated that they did not receive any previous COVID-19 vaccinations. Moderna vaccine was administered. Patient's insurance kicked back because they did receive both doses before.

Other Meds:

Current Illness:

ID: 1513643
Sex: F
Age: 48
State: OH

Vax Date: 07/29/2021
Onset Date: 07/29/2021
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: NKA per the administration form

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient called and asked if we had the Pfizer vaccine in stock, and my tech confirmed that we do. She explained if they are the first of the day, they will need to wait 30 minutes for it to come to room temperature. Patient showed up around 6PM and asked for the Pfizer vaccine. We told her we had it in stock and it was ready to go from previous vaccines in the day. We gave her the form to fill out and asked if she has filled her prior. She has filled a prescription recently so we didn't need to get her license or insurance card. As she was filling out her administration form, she asked about a bug bite on her face and wondered if she can get the vaccine today. I told her it would be fine. The gentleman that was with her (I am assuming the husband) asked if I could look at it and make a recommendation on her to treat it. She stated she took a dose of Benadryl already. I told her to use the Benadryl and to contact the MD for a steroid. She agreed to call in the morning since it is after hours and probably no one is in the office at this time. She completed her paperwork and we sent her into the vaccination room. When I walked in to the consultation room, I asked verbally if she had any other of the vaccines and if this is in fact her first COVID vaccine. She verbally stated yes this is the first and she didn't have one anywhere else. I proceed to ask if she has any questions about this vaccine and to inform her on the procedure about seeing her back in 3 weeks. I vaccinate her and she bleeds. As I am stopping her arm from bleeding and cleaning up the area, she states something along the lines of "I hope I don't have any issues like I did with the J and J shot." I said what, you already had a vaccine and she said ?Yes I had the J and J back in March or April and since the delta variant is out, I am afraid of getting it so I came to get the Pfizer today?. I said you told me you didn't have any other vaccines and now you are saying you did. She confirmed again. I told her I needed to fill out an incident report for my corporate and she said "It's okay don't fill out the report." I stated no I like my job and I am going to fill out the report. I also told her that corporate may be contacting her about this. I stated that I'm not sure what she will experience with getting this after the J and J vaccine, and that we will not be giving her another dose. I put on note on her file here.

Other Meds: Ambien 10mg daily at bedtime, Benadryl for bug bite on face OTC

Current Illness: Patient had a bug bite on her face

ID: 1513644
Sex: F
Age: 57
State: OK

Vax Date: 04/12/2021
Onset Date: 04/16/2021
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: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: joint inflammation, will not go away. Dr gave steroids which relieved pain, but returned after course of steroids. Still hurts 4 months later.

Other Meds: N/A

Current Illness: N/A

ID: 1513645
Sex: F
Age: 82
State: CA

Vax Date: 03/06/2021
Onset Date: 03/10/2021
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: on anticoagulation wtih xarelto for a fib started having rectal bleeding 1 wk after moderna #1 2/6/21 then again 1 wk after moderna #2 3/6/21. pt has continued to have intermittent bleeding since 2nd vaccine

Other Meds:

Current Illness:

ID: 1513646
Sex: M
Age: 13
State: CA

Vax Date: 06/29/2021
Onset Date: 06/30/2021
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: None

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

Symptoms: Pt and mom report that after first Covid vaccine 6-29-21, pt's ears hurt and he was sensitive to noise. That improved over days. He got 2nd vaccine 7-23-21 and has had some mild bilateral ear pain on and off since then. Normal ear exam 7-29-21

Other Meds: Flonase and cetirizine for allergies (does not take consistently)

Current Illness: None

ID: 1513647
Sex: M
Age: 44
State: FL

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

Lab Data:

Allergies: Penicillin

Symptom List: Unevaluable event

Symptoms: Significant Tinnitus like I've never experienced. Extremely loud and very concerning. Sounds like a deafening number of cicadas. The sound can be masked by external sounds at times but when it would otherwise be quiet the ringing becomes overwhelming.

Other Meds: None

Current Illness: None

ID: 1513648
Sex: M
Age: 52
State: TX

Vax Date: 07/26/2021
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: LA

Lab Data:

Allergies: NKA

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

Symptoms: Moderate pain and swelling in left armpit, probably swollen lymph nodes

Other Meds: None

Current Illness: Epididymitus

ID: 1513649
Sex: M
Age: 70
State: HI

Vax Date: 04/16/2021
Onset Date: 07/24/2021
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: none

Symptom List: Injection site pain, Pain

Symptoms: COVID PCR positive on 7/28/21. patient with runny nose and fatigue

Other Meds: Metformin, atorvastatin, lisinopril, sildenafil

Current Illness: none

ID: 1513650
Sex: F
Age: 13
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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Injection site pain, Menorrhagia

Symptoms: PATIENT WAS NERVOUS ABOUT THE SHOT. AFTER THE VACCINE WAS ADMINISTERED, SHE WAS TOLD TO WAIT AROUND FOR 15 MINUTES. APPROXIMATELY 2-5 MINUTES AFTER, THE PHARMACY STAFF HEARD A THUD AND SAW SHE SLUMPED DOWN ON OUR CHAIR. THE PATIENT CLAIMED SHE IS DIZZY, NAUSEOUS, BLURRY VISION, AND MUFFLED SOUNDS. PARAMEDICS WERE CALLED AND CAME TO CHECK HER VITALS. THE PARAMEDICS CONCLUDE THAT SHE IS FINE TO GO HOME AND REST. PHARMACIST FOLLOW UP WITH THE PATIENT'S MOTHER 4 HOURS LATER AND WAS TOLD PATIENT IS FINE.

Other Meds: N/A

Current Illness: N/A

ID: 1513651
Sex: U
Age: 41
State:

Vax Date: 07/06/2021
Onset Date: 07/06/2021
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: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513652
Sex: F
Age: 54
State: FL

Vax Date: 05/11/2021
Onset Date: 05/11/2021
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: LA

Lab Data:

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Since the injection I've been running a low grade fever ranging from 99.4 to 100 still to this day. I was having troubles with my eyes, seeing laser lights and all the cars at night looked like a blue object coming at me. My Thumbs have been swollen, inflamed and hurting for two months now. (EYES)= I've had to use steroid eye drops for four weeks and then have Glycerin Stick inserted into both eyes because the doctor told me my eyes were to dry and inflamed, and she could not do the eye test while my eyes were like that. Since, I have had my eyes check and read for new glasses and contacts. The Eye Doctor did tell me that she was convinced my symptoms where do to the Vaccine. (Fever and Thumbs)= Doctor ordered blood work on 6/15/2021 to check for infection because my fever would not go back to normal. Results came back with Elevated Cholesterol Levels and Elevated Liver Enzymes. *(Which is not normal for me since I've been a Plant Base Eater for two years now.* A second full blood work was ordered for Auto Immune Disorder on 6/25/2021 and results where Normal. On 7/16/2021 I went to the doctor because my Thumbs ached badly. I was given a injection of steroids and anti inflammatory and sent for X-Rays that same day. Results came back , no inflamation. Which is funny because my thumbs swell up and ache constanly. Please be advised that on 7/09/2021 I personally spoke to someone on the Moderna Hot Line and told them about my symptoms since the vaccination.

Other Meds: B12,D3,Organic SF Immunity up,Immune24+ (Nature Bounty)

Current Illness: None

ID: 1513653
Sex: F
Age: 14
State: LA

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: RA

Lab Data:

Allergies: n/a

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt fainted on mother's arm after a few minutes of receiving vaccine. She fainted approximately 30 seconds - 1 minute. When she woke up, she was pale and weak. BP was taken, and it was below normal. She drank water and ate skittles to boost her sugar and get BP back up. She was informed to sit for another 30 mins with her mother to make sure she was okay. She also had a fan blowing cool air on her to help her feel better. After waiting over 30 mins and retaking her BP, pt felt better enough to leave with her mother. Mother was advised to watch her daughter for the remainder of the day, and for the pt to eat a hearty meal before returning for her second covid imz.

Other Meds: N/a

Current Illness: n/a

ID: 1513654
Sex: M
Age: 17
State: MN

Vax Date: 07/23/2021
Onset Date: 07/23/2021
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: Amoxicillin

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

Symptoms: About 8 - 9 hours after first vaccine dose, started to develop sores on his mouth, primarily on his tongue. Sore continued to increase each day. Saw Dr. on 7/26/21 and she encouraged us to report on this site. As of today, 7/29/21, sores contine to increase. Most on tongue plus a couple on inside of lower lip. Also gums are sore, slightly swollen and red.

Other Meds: None

Current Illness: None

ID: 1513655
Sex: F
Age: 13
State:

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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513656
Sex: F
Age: 19
State: CA

Vax Date: 04/25/2021
Onset Date: 05/03/2021
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: No known allergies

Symptom List: Injection site pain

Symptoms: 19 Y female referred for L face tingling/numbness after COVID first vaccine dose 7 days prior-- >symptoms resolved but MRI showed lesions suspicious for MS. Per chart: -5/7/21 visit with pcp: L face numbness 1 week after first dose COVID vaccine (Pfizer, administered outside on 4/25/21). Day of visit also with L sided headache, pressure. Noted to be under lot of stress with finals at school. -5/10/21 email to pcp that tingling gone on L face but "left side of my face and mouth are fully numb and I'm experiencing some discomfort swallowing and talking." -5/11/21 PCP TAV: L upper and lower facial tingling resolved but "c/o numbness of her left upper cheek and lower face, left side of her tongue, inside of her left side of cheek. Drooling when she drinks liquids intermittently since 5/3/21. Denies choking."-- >MRI brain with contrast recommended but done w/o contrast. MRI showed T2/flair lesions suspicious for MS. Onset of tingling and numbness L side of face, scalp about May 2, one week after first COVID-19 Pfizer vaccine given. 1/2 tongue on L numb and some numbness feeling in throat. No actually trouble swallowing but some discomfort swallowing. Because can't feel mouth/face/tongue well food sometimes dribbles from L mouth. Had some drooling pool L side of mouth when lying on L side. Symptoms slowly progressed over about 1.5 weeks and then have not gotten better but haven't worsened. No limb symptoms or visual symptoms. No weakness. No Bowel or bladder control issues -Had decreased L upper and lower along with L mid and lateral scalp sensation, reflexes 3 knees but symmetrical, one repetitive beat with R forced ankle DF. -non-con MRI brain 5/14/21: L brachium pontis and bilateral supratentorial PV white matter, deep white matter and R internal capsule anterior limb lesions "suspicious for multiple sclerosis." -- >given oral dexamethasone 5/25. 19 yo woman with demyelinating attack 5/2021 approximately 1 week after receiving first COVID Pfizer vaccine. MRI brain with supratentorial demyelinating lesions and L brachium pontis lesion and f/u with gad and spinal MRIs w/o additional lesions and no enhancement (but MRI brain with contrast done about 6 weeks after attack onset).

Other Meds: JUNEL FE 1/20 1-20 MG-MCG TABS ATOMOXETINE HCL 10 MG CAPS FLUOXETINE HCL 10 MG CAPS

Current Illness:

ID: 1513657
Sex: F
Age: 44
State: MN

Vax Date: 07/01/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Per immunization and confirmed by patient today, she had received J&J vaccine on 4/1/21 and should not have received the first shot of Moderna on 7/1/21. Pt was given 1st Moderna vaccine in error. Pt was told today that she could not receive 2nd dose without further clarification by CDC guidelines.

Other Meds:

Current Illness:

ID: 1513658
Sex: F
Age: 16
State:

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

Lab Data:

Allergies:

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

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513659
Sex: M
Age: 14
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NO KNOWN DRUG ALLERGIES, FOOD ALLERGIES OR OTHER PRODUCT

Symptom List: Tremor

Symptoms: Patient was alert but disoriented, difficulty breathing, speaking in between breathes, chest tightness, dizziness, and nausea 5 minutes after receiving the Pfizer Covid 19 Vaccine. 911 was called & paramedics arrived at the scene about 10 minutes from onset of patients symptoms. Patient was taken into Paramedics care and transported to the hospital.

Other Meds: NO MEDICATIONS BEING TAKEN

Current Illness: NO KNOWN ILLNESSES AT TIME OF VACCINATION

ID: 1513660
Sex: F
Age: 31
State:

Vax Date: 07/13/2021
Onset Date: 07/13/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513661
Sex: F
Age: 52
State: AZ

Vax Date: 12/29/2020
Onset Date: 12/29/2020
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: None

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

Symptoms: facial numbing, tingling which began 20 min after shot second dose, same response that did not dissipate after second dose many additional sx appeared over next 2 -3 months which included erratic BP, pain and tingling in legs, dizziness, body weakness

Other Meds: Ambien Ritalin

Current Illness: None

ID: 1513662
Sex: M
Age: 75
State: MA

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

Lab Data:

Allergies: None known

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

Symptoms: Pt was given a vaccine that had expired on 6-2-2021. No side effects occurred for pt. Offered to revaccinate pt and he is going to discuss with his doctor first.

Other Meds: Atorvastatin, bisoprolol, escitalopram, metformin, triamterene/hctz, verapamil

Current Illness: None known

ID: 1513663
Sex: F
Age: 32
State: AZ

Vax Date: 07/27/2021
Onset Date: 07/29/2021
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: No

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Allergic reaction broke out in hives on my back then hours later had a swollen lip reaction this has never happened to me before prior to the vaccination

Other Meds: PTU Thyroid

Current Illness: None

ID: 1513664
Sex: F
Age: 88
State:

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

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

Symptoms: Given after the beyond-use-dating due to the vaccine being stored improperly.

Other Meds:

Current Illness:

ID: 1513665
Sex: M
Age: 53
State:

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

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

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513666
Sex: M
Age: 29
State:

Vax Date: 07/05/2021
Onset Date: 07/05/2021
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: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513667
Sex: F
Age: 13
State: CA

Vax Date: 07/29/2021
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: Olive pollen

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

Symptoms: Patient reported to clinic 1+ hour post vaccination with complaints of itchiness and swelling to face. Patient denied any discomfort of the throat or tongue. Vital signs were within normal limits. Consulted with Pediatric Dr. who consented the administration of a 25 mg oral capsule of Benadryl. Patient began to feel slight discomfort swallowing. Oxygen levels remained within normal limits. Consulted with Dr. and per his assessment patient stable and no need for further intervention. Patient was observed for a total of 30 minutes following administration of medication. After 30 minutes patient reported that her symptoms were resolved.

Other Meds: Kids multivitamin and Vitamin D and C

Current Illness: No

ID: 1513668
Sex: M
Age: 24
State:

Vax Date: 07/13/2021
Onset Date: 07/13/2021
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:

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

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513669
Sex: M
Age: 14
State: PR

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: allergic to lentil

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

Symptoms: 14 year old patient refers to EMT feeling dizzy 20 minutes after second Pfizer dose. The EMT proceed by taking him to observation area to measure his vital signs: 70/40 mmHg b/P, P-59 beats/minute Oxygen98% and DXT 135mg/DL. Patient is instructed to lay down on table with feet elevated (trendelenburg position) for the return of the volume in his blood. He is in observation for 15 minutes. At 4:57 his vitals are taken again: 80/50 mmHg B/P, P-70 beats/minute and Oxygen 99%. At 5:15pm he is discharge with stable condition by Doctor.

Other Meds:

Current Illness:

ID: 1513670
Sex: F
Age: 41
State:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513671
Sex: F
Age: 34
State: AZ

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 07/29/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: SIRVA. Unable to move arm for months. Shooting pain in arm. Saw a chiropractor, PT, received MRI to confirm SIRVA.

Other Meds: Levothyroxine, Necon (birth control)

Current Illness: None

ID: 1513672
Sex: F
Age: 37
State: OR

Vax Date: 07/26/2021
Onset Date: 07/26/2021
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: Sulfa- get hives

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

Symptoms: Around 8:30 pm on 7/26 my heart began racing and my chest felt tight. I then started getting a fever which was 101 so I took two Advil. About an hour passes by and I recheck my temperature and it?s 103. So I take two Tylenol. By 11:30 that night my temperature reaches 104.7. I take a like warm bath to try and get my temperature down and I start throwing up. I go and lay in bed trying not to move because I was so sick. I wake up around 2 am take more Tylenol because my temp was over 103. The next morning I continue to have a fever but stays between 101-103 with both alternating Advil and Tylenol. My fever finally lowers to 100-101 mid afternoon. I call my doctors office and let them know my symptoms to which they say are normal. 7/28 fever breaks mid afternoon. I am very weak and fatigued. Chest still feels tight. 7/29 still very weak fatigued and light headed when standing.

Other Meds: Naratripitan and Apri

Current Illness: None

ID: 1513673
Sex: F
Age: 24
State: GA

Vax Date: 02/12/2021
Onset Date: 02/24/2021
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: N/a

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Chest pains, high blood pressure, high heart rate, shortness of breath, constant headache got sent straight to the ER from work. Now I?m seeing a cardiologist and neurologist.

Other Meds: Wellbutrin 300 mg

Current Illness: None

ID: 1513674
Sex: F
Age: 60
State:

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

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

Symptoms: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

ID: 1513675
Sex: M
Age: 38
State:

Vax Date: 07/05/2021
Onset Date: 07/05/2021
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: given after the beyond-use-dating due to the vaccine being stored improperly

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm