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: 1519123
Sex: F
Age: 64
State: KS

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 08/01/2021
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: A couple of hours after receiving the Pfizer-BioNTech Covid-19 Vaccine EUA in my upper left arm muscle, that muscle starting aching and the pain increased so that I chose to take Tylenol ExStrength for the next 24 hours (every 6 hours). I also used an ice pack and heating pad alternately several times. My overnight sleep was interrupted because of the pain. On a scale of 1 to 10, with 10 being the worst pain ever, I would rate this pain a 7.5. It lasted for 2 and 1/2 days then subsided. The more disconcerting side effect is the brain-zapping episodes. This sensation began 3 days after the Vaccine shot: 7/10/2021. I sensed a vertigo-like sensation while standing still and erect and simply looking from one thing to another- not fast; just moving my eyes. It is a combination of visual vertigo and an electric pulse sensation in my brain only lasting for 1 to 2 seconds. That's why I describe it as a brain zap. This happens 3 - 4 times a day. It has lessened and only happens every few days now. Then I did get positional vertigo for 2 weeks. It's finally going away. It is mild and didn't need doctor attention.

Other Meds: levothyroxine 75mcg daily. One-A-Day multi-vitamin for 50+, Vitamin D3, Calcium/Magnesium, Glucosamine Sulfate, daily.

Current Illness: none

ID: 1519124
Sex: M
Age: 28
State: TX

Vax Date: 12/19/2020
Onset Date: 12/19/2020
Rec V Date: 08/01/2021
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: Penicillin(rash)

Symptom List: Anxiety, Dyspnoea

Symptoms: hyper-Irritability for 3hrs 6hrs after administration

Other Meds: Dextroamphetamine salts 20mg TID

Current Illness: none

ID: 1519125
Sex: F
Age: 78
State:

Vax Date: 06/30/2021
Onset Date: 07/02/2021
Rec V Date: 08/01/2021
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: nil

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

Symptoms: I feel itch here and there, on my legs, arms or neck and swell a little if i scratch. I applied ointment then disappear, but new spots come out again till now. It does not drive me crazy but annoying and worried. I thought it would disappear but lasted this long, so, I am reporting now.

Other Meds: nil

Current Illness: nil

ID: 1519126
Sex: F
Age: 31
State: GA

Vax Date: 04/14/2021
Onset Date: 04/21/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Polen

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Severe fatigue

Other Meds: Levothyroxyn; Sertralin; Vitamin D; Calcium; Iron; Vitamin C; Fexofenadin; Fish Oil; Glucosamin Sulfate; Multivitamin

Current Illness: Hypothyroidism; Depression; Anxiety; Asthma

ID: 1519127
Sex: U
Age: 34
State: TX

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: Penicillin Envega (non-generic) , anything with respredone, resperidal, or any derivative thereof, milk

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

Symptoms: Dysphoria, delusional thoughts, paranoia, signs from god.

Other Meds: Adderal Lamotrogine Clanazipam

Current Illness: Cold like symptoms, coughing, congestion, fatigue, low appetite, headache. (I think contributed by the transition from the air conditions while in treatment facility to the air quality in transitional center

ID: 1519128
Sex: F
Age: 37
State: MD

Vax Date: 07/28/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: Nose bleeds, and out of cycle menstruation.

Other Meds: None

Current Illness: None

ID: 1519129
Sex: M
Age: 31
State: NY

Vax Date: 06/29/2021
Onset Date: 06/30/2021
Rec V Date: 08/01/2021
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: Pain behind the eyes (eye ache) started the day after the injection following a night of intense fever and chills. Ibuprofen is not very effective in reducing pain. Eye ache reduces with rest, but no long term improvement after 1 month.

Other Meds: Dietary supplement

Current Illness:

ID: 1519130
Sex: M
Age: 12
State: SD

Vax Date: 05/18/2021
Onset Date: 05/23/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Walnuts, Pecans, sesame, environmental

Symptom List: Pharyngeal swelling

Symptoms: His heart rate went up repeatedly while resting (laying down) to 100- 115 several days after the vaccination.

Other Meds: D3, Folic Acid

Current Illness: None

ID: 1519131
Sex: F
Age: 44
State: CA

Vax Date: 06/10/2021
Onset Date: 06/18/2021
Rec V Date: 08/01/2021
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: Tinnitus got worse, hair thinning/breaking, more fatigue, extreme brain fog, red spots and blisters on toes, and skin rashes.

Other Meds: Cymbalta

Current Illness: Fatigue, brain fog, tinnitus, and gastrointestinal problems.

ID: 1519132
Sex: F
Age: 41
State: TX

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/01/2021
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: She was anxious before getting the shot @ 1615. Appears anxiety attack after shot. Denied shortness of breath, headaches and dizziness. At 1630 heart rate 116 bpm. Offered ice pack and cold water. At 1637 heart rate 87 bpm. OR Sat 99%. Stated feeling better. At 1645 Went home with stable conditions.

Other Meds:

Current Illness:

ID: 1519133
Sex: M
Age: 63
State: MI

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: COVID Vaccine

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

Symptoms: Within 6 hours of receiving the second vaccine, I had a severe allergic reaction. Fever of 101 degrees, cold sweats, headache, sore muscles, joint pain, and fatigue. Pain so severe I was in bed for a week. These symptoms have lasted 3 months. My immune system is overreacting and causing auto-inflammation. There is a dysfunction within my immune system that has triggered my body to mount a chronic inflammatory attack against itself.

Other Meds: Excedrin, Amlodipine Besylate 5mg

Current Illness: None

ID: 1519135
Sex: F
Age: 33
State: NJ

Vax Date: 07/28/2021
Onset Date: 07/28/2021
Rec V Date: 08/01/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: N/a

Symptom List: Rash, Urticaria

Symptoms: Shortly after the second shot I had terrible body pain and chills. Later that night stabbing pain vomiting and diarrhea. I waited one more day the pain as unbearable and when to the hospital and appendix had to be removed.

Other Meds:

Current Illness: N/a

ID: 1519136
Sex: F
Age: 61
State: CA

Vax Date: 07/30/2021
Onset Date: 07/31/2021
Rec V Date: 08/01/2021
Hospital:

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

Lab Data:

Allergies: Topical anesthetic

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

Symptoms: Red, itchy and painful rash in both sides of neck and injection site arm area

Other Meds: None

Current Illness: None

ID: 1519137
Sex: F
Age: 72
State:

Vax Date: 01/19/2021
Onset Date: 07/30/2021
Rec V Date: 08/01/2021
Hospital: Y

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: Acute CHF, pleural effusion, atrial flutter and NSTEMI

Other Meds:

Current Illness:

ID: 1519138
Sex: M
Age: 84
State:

Vax Date: 03/06/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
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: Acute respiratory failure, pleural effusion (1.5L removed), heart failure, new onset atrial fibrillation, normal WBC (no sepsis), echo 2 weeks prior to event showed normal LV function with EF of 60%

Other Meds:

Current Illness:

ID: 1519139
Sex: M
Age: 61
State: DC

Vax Date: 07/14/2021
Onset Date: 07/22/2021
Rec V Date: 08/02/2021
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: none

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

Symptoms: On Day 10-11 after the vaccination, my husband started developing tingling in his legs and arms with increased numbness and weakness in his leg muscles. He had a hard time breathing. He was admitted to the ER at Hospital. He is diagnosed with Guillian Barre Syndrome. His arms and legs are near paralyzed. He has been in the ICU for 6 days and is on a respirator

Other Meds: Rosuvastatin, Amlodipine

Current Illness: none

ID: 1519140
Sex: F
Age: 60
State:

Vax Date: 03/24/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
Hospital: Y

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: Non traumatic subarachnoid hemorrhage requiring IR coiling and embolization, no HTN history

Other Meds:

Current Illness:

ID: 1519141
Sex: M
Age: 13
State: GA

Vax Date: 07/27/2021
Onset Date: 08/01/2021
Rec V Date: 08/02/2021
Hospital:

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

Lab Data:

Allergies: Patient is at low risk for long QT intervals.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient has epilepsy but has not had a seizure in 6 weeks. Today, 5 days after his second dose of Pfizer vaccine he had 3 seizures. Pt. was taken to the local ER and after the nurse spoke with pt. neurologist, the doctors felt the seizures were caused by the 2nd dose. He has been pale, irritable and generally unwell looking. The neurologist felt that due to the immune response from the vaccine and the fact that pt. has been feeling crummy these past 5 days, that it lowered his seizure threshold.

Other Meds: Too many to list here. My son suffers from multiple co- morbidities as well as lung scarring from Covid last November and suffering from a collapsed lung in May-June where he required a ventilator and was admitted to hospital PICU.

Current Illness: Chronic pulmonary issues; right lung volume is diminished, and severe OSA. Patient requires oxygen at night.

ID: 1519142
Sex: F
Age: 29
State: CA

Vax Date: 07/29/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
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: Onset of localized pain at injection site, approximately 48 hours after the injection accompanied by a raise red bump at the injection site.

Other Meds: None

Current Illness: None

ID: 1519143
Sex: M
Age: 63
State:

Vax Date: 03/09/2021
Onset Date: 07/25/2021
Rec V Date: 08/02/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: bilateral hand weakness, progressive generalized neurological weakness, paresthesias and sepsis

Other Meds:

Current Illness: osteomyelitis

ID: 1519144
Sex: F
Age: 55
State: AL

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
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 per patient

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

Symptoms: AFTER THE PATIENT HAD BEEN SITTING IN THE WAITING AREA ABOUT 8-10 MINUTES I LOOKED UP FROM DRAWING MORE VACCINES TO DISCOVER THE PATIENT'S HUSBAND HOLDING THE PATIENT WHO WAS SLUMPED IN HER CHAIR. WHEN HE SAW ME LOOKING HE WAVED HIS HAND AND SAID SHE'S OK , SHE'S FINE. I DROPPED WHAT I WAS DOING AND WENT OUT TO CHECK ON HER. HE STATED SHE DOES THIS ANYTIME SHE GETS A SHOT AND SAID SHE'D BE OK IN A MINUTE. I ASKED IF HE WANTED ME TO CALL AN AMBULANCE TO CHECK HER OUT. HE SAID NO, YOU JUST HAVE TO GIVE HER A MINUTE. HE STATED HE'D BEEN THROUGH THIS WITH HER MANY TIMES BEFORE. I GOT HIM A DAMP PAPER TOWEL AND AND CARD TO FAN HER WITH, SINCE SHE WAS SWEATY. THE PATIENT PERKED UP IN A FEW MINUTES. SHE SAID SHE FELT OK AND I THEN HAD MY TECHNICIAN TAKE HER SOME WATER. I FOLLOWED UP WITH THE PATIENT THE FOLLOWING DAY AND SHE STATED SHE WAS DOING FINE BUT THAT THE VACCINE HAD KIND OF "ZAPPED" HER. SHE STATED SHE HAD A COUPLE OF THE EXPECTED SIDE EFFECTS HEADACHE AND FATIGUE.

Other Meds: none per patient

Current Illness: none per patient

Date Died: 01/01/2001

ID: 1519145
Sex: M
Age: 0
State: CO

Vax Date: 12/27/2000
Onset Date: 01/01/2001
Rec V Date: 08/02/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Unevaluable event

Symptoms: I was living with my friend and I had my first baby, She got me in touch with a doctor's office near by. He signed his name M.D. I had only been to his office that one time, I think. My son's 3 month shots appointment. It was December 27, 2000. He got all four of his injections and everything was okay. 3 days later on January 01, 2001, our neighbor friend tried to pick him up to play because it was still m orning, and she stated that he was hard. Patient had passed away. I did not see any signs. I always had these feelings of what if he had a reaction to his shots. I never went back to that doctor again. Patient was born by c-section because i was in labor then the umbilical cord started going around his neck. He was fine right after delivery. He was 3 days late. He was a good happy baby, no medical concerns. No pregnancy issues. I was told that it was SIDS.

Other Meds: Nothing was ever prescribed or any medical conditions.

Current Illness: No

ID: 1519148
Sex: F
Age: 26
State: TN

Vax Date: 07/24/2021
Onset Date: 08/01/2021
Rec V Date: 08/02/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Breaking out in hives in a circle around the area that I received the shot. Arm very red and itchy

Other Meds:

Current Illness:

ID: 1519149
Sex: F
Age: 38
State: CA

Vax Date: 07/30/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
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: Shortness of breath and tightness in chest. Feels like a heart palpitations. Anxiety.

Other Meds: None

Current Illness: None

ID: 1519150
Sex: F
Age: 21
State: TX

Vax Date: 05/24/2021
Onset Date: 07/30/2021
Rec V Date: 08/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Heart rate increase to 110 bpm, low pressure, tiredness

Other Meds:

Current Illness:

ID: 1519151
Sex: F
Age: 43
State: CA

Vax Date: 04/25/2021
Onset Date: 05/23/2021
Rec V Date: 08/02/2021
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: Penicillin

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

Symptoms: Stopped getting my period. Spotted for 8 days in early june ans then nothing beyond that. Not menopausal.

Other Meds: Spironolactone 50 mg

Current Illness: None

ID: 1519152
Sex: M
Age: 23
State: MD

Vax Date: 07/30/2021
Onset Date: 07/01/2021
Rec V Date: 08/02/2021
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: Fever of 103 degrees, soaked in sweat, heart palpitations

Other Meds:

Current Illness:

ID: 1519153
Sex: F
Age: 54
State: NY

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 08/02/2021
Hospital:

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

Lab Data:

Allergies: Penicillin: not immediate anaphylactic reaction but delayed reaction after about 7 days of taking it.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: SYMPTOMS FROM VACCINE: Heart Palpitations, Neck Pain, eventually feeling a lump in neck; pain also in the lumbar spine. Arthritic symptoms. Neck lump and pain wouldn't go away so had an MRI in July which came back with multiple demyelinating foci of brain and demyelinating of par of the cervical spine. Now have tingling in hand foot face eyebrow on right side. FYI: Second dose was on 03/29/21 at about 9:30 am symptoms got exponentially worse

Other Meds: Adderal SYMPTOMS FROM VACCINE: Heart Palpitations, Neck Pain, eventually feeling a lump in neck; pain also in the lumbar spine. Arthritic symptoms. Neck lump and pain wouldn't go away so had an MRI in July which came back with multiple

Current Illness: None

ID: 1519155
Sex: M
Age: 41
State: CA

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 08/02/2021
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: None

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

Symptoms: Headache

Other Meds: None

Current Illness: None

ID: 1519157
Sex: F
Age: 52
State: GA

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
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

Symptom List: Nausea

Symptoms: Nausea, dizziness, vomiting

Other Meds: Rosuvastatin calcium 5mg

Current Illness: None

ID: 1519158
Sex: M
Age: 36
State: TX

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
Hospital:

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

Lab Data:

Allergies: Cold sweats from Tramadol. No other known issues.

Symptom List: Injection site pain

Symptoms: After a few hours the roof of my mouth became sore and I got a strange taste. Seems to be best described as metallic. It's also not a lack of taste but it does impair my ability to taste things. It's generally unpleasant. It's occurring 24/7 at this point.

Other Meds: Clonazapam .5mg-.75mg daily,Trazodone 100mg nightly,Metoprolol for mild high blood pressure and anxiety symptoms.

Current Illness: None

ID: 1519159
Sex: F
Age: 34
State: MN

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 08/02/2021
Hospital:

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

Lab Data:

Allergies: amoxicillin

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

Symptoms: Severe nausea, vomiting, diarrhea, malaise, body aches, fever

Other Meds: albuterol

Current Illness: none

ID: 1519160
Sex: F
Age: 39
State: NY

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/02/2021
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: Approximately 2 hours after receiving vaccine patient described delayed urticaria occurred on numerous areas on the body. Including stomach, hands , feet, arms, legs, and thighs.

Other Meds:

Current Illness:

ID: 1519163
Sex: M
Age: 83
State: VA

Vax Date: 03/01/2021
Onset Date: 07/01/2021
Rec V Date: 08/02/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: severe covid with hypoxia and hospitalization

Other Meds:

Current Illness:

ID: 1519164
Sex: M
Age: 47
State: CA

Vax Date: 06/23/2021
Onset Date: 07/05/2021
Rec V Date: 08/02/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Have been having asthma type wheezing noises and limited lung capacity since having the vaccine. I haven't had anything like that since i was a kid 40 years ago or so

Other Meds: Aciphex, vitamin c, k2/d3, multi vitamin, b12, E, potassium, licorice root

Current Illness: None

ID: 1519238
Sex: M
Age:
State: PR

Vax Date:
Onset Date: 06/30/2021
Rec V Date: 08/02/2021
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:

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

Symptoms: RED STAIN ON THE RIGHT SIDE OF BODY BELOW ARMPIT AND MORE RED STAINS AROUND IT; ITCHING; This spontaneous report received from a patient concerned a 59 year old male. The patient's height, and weight were not reported. The patient's past medical history included panic attacks, right knee surgery total replacement, obstruction in colon, colostomy placed and removed, 2 right shoulder surgeries, and 27 operations in total, and concurrent conditions included hypertension, arthritis, disabled, penicillin allergy, latex allergy, non-smoker, social alcohol user, and spasms, and other pre-existing medical conditions included the patient had no history of drug abuse or illicit drug usage. The patient experienced drug allergy when treated with acetylsalicylic acid for drug used for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1816022, expiry: UNKNOWN) dose was not reported, administered on 30-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-JUN-2021, the subject experienced itching. On 07-JUL-2021, the subject experienced red stain on the right side of body below armpit and more red stains around it. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from itching on JUL-2021, and had not recovered from red stain on the right side of body below armpit and more red stains around it. This report was non-serious.

Other Meds:

Current Illness: Arthritis; Disability; Hypertension; Latex allergy; Non-smoker; Penicillin allergy; Social alcohol drinker (I sometimes drink wine socially or when i am very anxious); Spasms

ID: 1519249
Sex: F
Age: 16
State: KY

Vax Date: 03/15/2021
Onset Date: 04/12/2021
Rec V Date: 08/02/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Erythema Nodosum on lower legs; This spontaneous report as received from a consumer (also reported as a other health professional, conflicting information) via Pfizer refers to a non-pregnant 16-year-old not patient. No information regarding the patient's pertinent medical history, drug reactions or allergies was provided. Concomitant therapies included doxycycline and "muslin birth control". On 15-MAR-2021, the patient was vaccinated with the first dose of varicella virus vaccine live (manufacturer unknown) in the left arm (exact dose, route of administration, lot # and expiration date were not reported) for prophylaxis. On 27-MAR-2021, the patient was vaccinated with the first dose of (PFIZER BIONTECH COVID-19 VACCINE) in the left arm (exact dose, route of administration, lot # and expiration date were not reported) for prophylaxis. On 12-APR-2021, the patient experienced erythema nodosum on lower legs. Treatment included "elevating legs prior to vaccination". On 06-MAY-2021, she had a rapid nasal COVID-19 test and it was negative. The outcome of erythema nodosum was reported as not recovered/not resolved. The causality assessment between the event and the suspect vaccines was not provided.

Other Meds: DOXYCYCLINE

Current Illness: Prophylaxis

ID: 1519261
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/02/2021
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: a sore arm with the first shot.; This case was reported by a consumer via interactive digital media and described the occurrence of pain in arm in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. Co-suspect products included COVID-19 VACCINE (COVID 19 VACCINE) for prophylaxis and COVID-19 VACCINE (COVID 19 VACCINE) for prophylaxis. On an unknown date, the patient received the 1st dose of Shingles vaccine, the 1st dose of COVID 19 VACCINE and the 2nd dose of COVID 19 VACCINE. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced pain in arm. On an unknown date, the outcome of the pain in arm was recovered/resolved. It was unknown if the reporter considered the pain in arm to be related to Shingles vaccine. Additional details were provided as follows: This case was reported by the patient himself. The age at vaccination was not reported. The patient stated that his/her arm hurt after two Covid shots and the first shingles shot, and he/she did not feel really any symptoms other than a sore arm with the first shingles shot. The patient reported that everyone's symptoms might vary or might not be symptomatic at all. It was unknown if the reporter considered the pain in arm to be related to COVID 19 vaccine and COVID 19 vaccine. The follow-up would not possible as no contact details were available. For tolerance of second dose, refer case 2021AMR160238.; Sender's Comments: GLAXOSMITHKLINE-US2021AMR161077:Invalid case GLAXOSMITHKLINE-US2021AMR160238:same reporter

Other Meds:

Current Illness:

ID: 1519265
Sex: F
Age: 59
State: CA

Vax Date: 07/28/2021
Onset Date: 07/29/2021
Rec V Date: 08/02/2021
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: shrimp (sometime severe) codeine talwin vicodin

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

Symptoms: Within approx 11 hours of vaccine woke with severe chills, fever of 103?. This soon progressed to severe body aches, neck & shoulder pain, overall muscle weakness, loss of appetite, zaps of pain at left base of head. Overall felt like a severe flu. Half doses of Ibuprofen & Excedrin had little effect easing symptoms. but reduced fever to 100-101?. iSlept 10.5 hours and stayed in bed 24 hours - too weak to assume activities. After 48 hours took half of Tylenol (250mg). Fever and body aches immediately responded. Had incident of vertigo. Have foggy brain, feeling dusconnected. Began to smell metal (phantom). By 72 hours most symptoms resolve except for general weakness, joint pain, feeling disconnected and groggy, fatigued.

Other Meds: metoprolol hydrochlorothiazide synthroid fish oil vitamin D3 zinc vitamin C multi-vitamin magnesium

Current Illness: gout

ID: 1519266
Sex: F
Age: 17
State: FL

Vax Date: 07/25/2021
Onset Date: 07/26/2021
Rec V Date: 08/02/2021
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: Amoxicillin

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

Symptoms: Fever, chills, runny nose, cough, loss of smell

Other Meds: Seamoss gel

Current Illness: None

ID: 1519267
Sex: F
Age: 15
State: MD

Vax Date: 07/10/2021
Onset Date: 07/29/2021
Rec V Date: 08/02/2021
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: Pain in extremity

Symptoms: Acute onset chest pain, increased work of breathing and hypoxia requiring BiPAP. CT scan with bilateral ground glass opacities of unclear etiology

Other Meds: Acetazolamide; Iron Supplement

Current Illness: Diagnosed with idiopathic intracranial hypertension 1 month prior (07/02/2021)

ID: 1519268
Sex: F
Age: 44
State: WA

Vax Date: 06/01/2021
Onset Date: 07/28/2021
Rec V Date: 08/02/2021
Hospital:

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

Lab Data:

Allergies: Aspirin, lisinopril

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

Symptoms: Vax fog, joint pain, nasal congestion, ear infection right ear, cough, fever, red itchy painful bumps, sore throat

Other Meds: Oxycodone 5mg/Ibuprofen 400mg.

Current Illness: None

ID: 1519269
Sex: F
Age: 39
State: SC

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 08/02/2021
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: Painful hard knot at injection site that has not dissipated after 21 weeks

Other Meds: Hydrochlorothiazide Tylenol

Current Illness:

ID: 1519270
Sex: M
Age: 19
State: GA

Vax Date: 07/26/2021
Onset Date: 08/01/2021
Rec V Date: 08/02/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Patient developed a large, red splotch on at the injection side. The red site is about the size of a deck of cards. On researching it appears to be "Covid Arm". It doesn't itch, but is warm to the touch and swollen and red. His lymph nodes in his arm pit and neck are also swollen. Redness came up on day 7 after 1st dose.

Other Meds: none

Current Illness: none

ID: 1519271
Sex: M
Age: 40
State: MA

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/02/2021
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: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: shortly after receiving vaccine, pt had blurred vison,sweating,nausea,clammy feeling,dizzinesss, felt like about to throw up, felt like passing out, tingling in the arm where vaccine administered. gave pt bottle of water, wet paper towels on neck. after sitting for about 30 minutes, he felt better and was able to go home. he was not driving, had another person with him.

Other Meds:

Current Illness:

ID: 1519272
Sex: M
Age: 40
State: NC

Vax Date: 07/29/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Patient said she is experiencing covid arm and it is very swollen

Other Meds:

Current Illness:

ID: 1519273
Sex: F
Age: 64
State: MO

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: patient explained before vaccination that she normally faints after vaccines. shortly after shot patient felt very lightheaded and very breifly fainted though unconfirmed if she was fully unconcious. patient was advised to sit on floor in fetle position and given water where she recovered fully shortly afterwards with no further complications.

Other Meds:

Current Illness:

ID: 1519274
Sex: F
Age: 54
State: PA

Vax Date: 07/29/2021
Onset Date: 07/31/2021
Rec V Date: 08/02/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: cellulitis-Medium, Error: Infection / Cellulitis (diagnosed by MD)-, Additional Details: patient came into pharmacy,indicating she was getting an antibiotic for cellulitis in left arm where covid shot was given. she said alcohol pad must not have worked

Other Meds:

Current Illness:

ID: 1519275
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/02/2021
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: IGM POSITIVE, IGG NEGATIVE; This spontaneous report received from a patient via a company representative via social media (Facebook) concerned a patient of unspecified age and sex, race and ethnic origin. Initial information was processed with additional information received from Central complaint vigilance on 29-JUL-2021. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown).5 ml,1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, four months later the patient had IgM positive, IgG negative. Laboratory data (dates unspecified) included: IgG (NR: not provided) Negative, and IgM (NR: not provided) positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of IgM positive, IgG negative was not reported. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20210761815 This report was associated with product quality complaint: 90000187621; Sender's Comments: V0: 20210760356-COVID-19 VACCINE AD26.COV2.S- IgM positive, IgG negative. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS

Other Meds:

Current Illness:

ID: 1519276
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/02/2021
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: BABIES BEING BORN WITH ISSUES AFTER MOTHERS RECEIVE VACCINE; DRUG EXPOSURE IN UTERO; This spontaneous pregnancy report received from a consumer concerned multiple patients. The patient's height and weight were not reported. No past medical history or concurrent conditions were reported. The patient's parent received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch/lot number. No concomitant medications were reported. On an unspecified date, the subject experienced babies being born with issues after mothers receive vaccine, and drug exposure in utero. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from drug exposure in utero, and the outcome of babies being born with issues after mothers receive vaccine was not reported. This report was non-serious. This parent/child case is linked to 20210760501.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm