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: 1522823
Sex: F
Age: 49
State: LA

Vax Date: 07/24/2021
Onset Date: 07/28/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Day 1 symptoms major arm pain tiredness Day 2 symptoms major arm pain at injection site, headache, body aches and extreme tiredness Day 5 symptoms flare up of bladder pain and back pain from Interstitial Cystitis I am on Day 11 after first injection and still experiencing bladder issues

Other Meds: Tramadil, Oxybutin, Ambien, blood pressure medication, estradiol, vitamin d, vitamin b, tynol

Current Illness:

ID: 1522824
Sex: F
Age: 50
State: PA

Vax Date: 05/27/2021
Onset Date: 05/28/2021
Rec V Date: 08/03/2021
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: dandelions, cats and dogs

Symptom List: Anxiety, Dyspnoea

Symptoms: swelling in legs and feet migraine headaches jaw pain

Other Meds: none

Current Illness: none

ID: 1522825
Sex: M
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 08/03/2021
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: none

Other Meds: Aspirin Losartan Atorvastatin

Current Illness: none

ID: 1522826
Sex: M
Age: 28
State:

Vax Date: 05/05/2021
Onset Date: 05/10/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: noticeable heart palpitations, never had them before in my life (that I could feel) until after vaccine

Other Meds: none

Current Illness: none

ID: 1522827
Sex: M
Age: 37
State: KY

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

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

Lab Data:

Allergies:

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

Symptoms: Tested positive for COVID on 08/2/2021 had an exposure at work and is having some mild symptoms.

Other Meds:

Current Illness:

ID: 1522828
Sex: F
Age: 54
State: CT

Vax Date: 01/29/2021
Onset Date: 04/13/2021
Rec V Date: 08/03/2021
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: N/A

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

Symptoms: Confusion, even about every day tasks and headache. Was diagnosed with stroke with no reason.

Other Meds: N/A

Current Illness: hypertension (under control) Hypothyroidism (Medication was in use)

ID: 1522829
Sex: M
Age: 67
State: DE

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 08/03/2021
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: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Approxamately 10 to 12 hours after receiving 2nd Moderna Covid 19 vaccine, I awoke to breathing problems. I felt outof breath, and was breathing very heavy and labored for about 6 hours. I considered calling 911 but although I was breathing heavily and out of breath, I did not get any worse, I was able to breathe well enough to keep from panicing, never called 911 and recovered on my own. Then it quickly went away after about 6 hours and I was breathing normally. I went back to sleep. I have severe COPD, not on Oxygen yet. I only had a slight tiredness after the first dose, as did my wife . She had no reaction at all to second shot. She does not have any health problems.

Other Meds: Stiolto respimat

Current Illness: COPD

ID: 1522830
Sex: F
Age: 61
State: GA

Vax Date: 08/09/2019
Onset Date: 08/10/2019
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: Pt was diagnosed with cellulitis left upper extremity, adverse effect of vaccine, shingrix on 8/14/2019

Other Meds: Vascepa, levothyroxine, lisinopril-hctz, pantoprazole, rosuvastatin.

Current Illness: None

ID: 1522831
Sex: F
Age: 22
State: TX

Vax Date: 03/29/2021
Onset Date: 05/05/2021
Rec V Date: 08/03/2021
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: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Around the 5th of May, 2021, Pt felt a numbness sensation in her right hand that radiate it up her arm. 1 week later, the numbness presented in her left hand as well following by a tingling. The numbness and tingling wrapped around her chest making it difficult to breath. Pt was taken to the hospital and went into the ER. They misdiagnosed her with a Pulmonary Embolism. Pt started to feel excruciating neck pain which cause an inability to sleep during this time. The doctors decided to do an MRI scan of her cervical spine. The doctors saw that she had lesions on her spine. The treatment in the hospital was blood thinners for the misdiagnosed

Other Meds: Women's Multi-vitamins

Current Illness: None

ID: 1522832
Sex: M
Age: 17
State:

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 08/03/2021
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: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time. Patient notified and given the option for an additional dose.

Other Meds:

Current Illness:

ID: 1522833
Sex: F
Age: 42
State: FL

Vax Date: 05/19/2021
Onset Date: 05/27/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: Food Sensitivity: Gluten and Casen

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

Symptoms: Rash, joint pain, waves of nausea. All come and go.

Other Meds: Multivitamin

Current Illness: N/A

ID: 1522834
Sex: M
Age: 62
State: WV

Vax Date: 03/04/2021
Onset Date: 03/11/2021
Rec V Date: 08/03/2021
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: Sulfa antibiotics cause a rash.

Symptom List: Rash, Urticaria

Symptoms: Shoulder and neck pain on the right. Ulcerative colitis started to flare. The second shot was not as bad. The arm was not as bad. He thinks the first shot was in the joint.

Other Meds: Asacol, Tamsulosin,

Current Illness: Ulcerative colitis, Enlarged prostate.

ID: 1522835
Sex: F
Age: 71
State: CT

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: Lamasil

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

Symptoms: Patient stated that about an hour after vaccination her neck and jaw started to swell, and 20 minutes later her face went numb. Patient also stated that she had a metallic taste in her mouth. Patient also stated that her tongue stayed numb for 24-36 hours. Patient didn't go visit doctor.

Other Meds: NONE

Current Illness: NONE

ID: 1522836
Sex: M
Age: 32
State:

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 08/03/2021
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: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time. Patient notified and given the option for an additional dose.

Other Meds:

Current Illness:

ID: 1522837
Sex: F
Age: 11
State: WI

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: This is not an adverse event, but rather an inappropriately administered vaccine. The patient's parent filled out the consent form and gave the incorrect date of birth, making the patient 12 years old. The vaccine was administered to on 7/26. On 8/2, the pharmacy team received an email from corporate stating the Immunization Registry had reached out regarding a potentially inappropriately administered vaccine based on the patient's age. Upon inspection of the consent form, the pharmacist on duty (not the pharmacist filling out this report) stated the consent form indicated the wrong DOB, as was entered into the computer prescription processing system. The managing pharmacist returned the next day and changed the patient date of birth to what was reported by the registry and attempted an insurance search using the computer prescription processing tool, which provided said patient's insurance information, indicating to the pharmacist that the date of birth is actually. This makes the patient ineligible to receive the Pfizer COVID-19 vaccine per the EUA. There have been no adverse events reported. The patient was unable to be notified or contacted regarding any adverse events as no phone number was provided/procured at the visit.

Other Meds: unknown

Current Illness: none

ID: 1522838
Sex: F
Age: 66
State: WI

Vax Date: 04/26/2021
Onset Date: 05/01/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: It started with severe pain in my back, and I went to the doctor, and she told me I should go to physical therapy for 3 weeks which did not do anything. Then I went to the chiropractor for a couple of weeks with no improvement and tomorrow I am going to see a spine specialist. I can hardly walk, and I am still in pain. I had an MRI done and they said some discs are bulging and there is degenerative disc disease. I am taking Ibuprofen, Gabapentin and Tylenol.

Other Meds: High blood pressure medication; cholesterol medication; magnesium; zinc; vitamin D; probiotics

Current Illness: None

ID: 1522839
Sex: F
Age: 50
State: FL

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/03/2021
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: Compazine

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

Symptoms: Pt. states that after receiving the 2nd dose of Phizer 08/03/2021, started to experience body aches and developing a rash throughout the chest. Rash is noticeably hot to the touch with welps forming. Primary notified but has yet to reach out to Pt. Still continuing to experience the fatigue with body aches.

Other Meds: N/A

Current Illness: N/A

ID: 1522840
Sex: F
Age: 49
State: MN

Vax Date: 12/22/2020
Onset Date: 08/02/2021
Rec V Date: 08/03/2021
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: Exposure

Other Meds:

Current Illness:

ID: 1522841
Sex: F
Age: 39
State: NC

Vax Date: 03/11/2021
Onset Date: 05/25/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: Latex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Developed symptoms of hypothyroidism in the weeks following the vaccine including increased weight gain, fatigue, extremity edema, fatigue, palpitations. Primary care provider ordered lab work in May 2021. Initial thyroid labs came back slightly elevated. Provider directed increased rest and decrease of stress and repeat labs in 2 months. Repeat of labs in July 2021 showed further increase in thyroid labs and antibodies indicative of Hashimoto's Disease. Patient had no previous record of abnormal thyroid labs or symptoms.

Other Meds: Vyvanse, Vitamin B12

Current Illness:

ID: 1522842
Sex: M
Age: 55
State: PA

Vax Date: 02/09/2021
Onset Date: 02/13/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: penicillin

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

Symptoms: parsonage turner syndrome - muscle pain , joint pain , nerve pain , and skin dumbness.

Other Meds: STOPPED TAKING TWO DAYS BEFORE .. meloxicam started back taking after vaccination and also Claritin

Current Illness: no

ID: 1522843
Sex: M
Age: 32
State: SD

Vax Date: 07/22/2021
Onset Date: 07/29/2021
Rec V Date: 08/03/2021
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: Numbness randomly on left side of body. Paresthesia under left side of chin, left leg, left arm, and left side of body. Have not seen doctor.

Other Meds: 600mg/day N-Acetyl Cysteine (Nac), 1000mg/day Cod Liver Oil, 180mg Resveratrol Complex, Multivitamin Gummy, 565mg/day Hawthorn Berry, 800mg Quercetin, 165mg Bromelain, 435mg Gotu Kola. Taken for 3 months+ some daily some irregularly. Discon

Current Illness: none

ID: 1522844
Sex: M
Age: 31
State: TX

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Extreme burning from injection site along with ache shortly after injection. Difficulty moving arm without strong pain. Though extreme pain has mostly subsided while standing. Burning pain lingering and very noticeable when arm is lifted upward or in differing positions. Sometimes burning pain can be felt at rest. Pain is centralized to injection site and travels to the back of left arm around upper shoulder area. Sometimes numbness can be felt and travels through arm to index finger. Extreme pain less noticeable after about 4 weeks 7/15/21. Burning, aching and numbness emits from injection area. No injuries have occurred sense receiving injection and no other health issues have been noticed. Burning, aching and periodic numbness still continues as of 8/03/21

Other Meds: St Johns Wort, Gingko, GABA

Current Illness:

ID: 1522845
Sex: F
Age: 55
State: IL

Vax Date: 08/01/2019
Onset Date: 08/04/2019
Rec V Date: 08/03/2021
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: Patient came to the Immunization clinic and told me that she had left sided facial droop 3 days after receiving her shingles 2nd dose and was treated in the Emergency Room. Patient wanted me to submit this report. She would know all details since this happened about 2 years ago

Other Meds:

Current Illness:

ID: 1522846
Sex: F
Age: 38
State:

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 08/03/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time. Patient notified and given the option for an additional dose.

Other Meds:

Current Illness:

ID: 1522847
Sex: F
Age: 75
State: TN

Vax Date: 01/02/2021
Onset Date: 03/29/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs, clindimyacin, dexilant, augmenting, macrodantin, lansoprazole

Symptom List: Injection site pain, Menorrhagia

Symptoms: 3/31/21 sore throat, low grade fever, cough, post nasal drip, achy, neg. strep, neg Covid. Lasted for 6 weeks despite 3 rounds of antibiotics and 1 round of steroids given by pulmonologist.

Other Meds: Risperidone 0.25; Losartan 50mg; Levothyroxine 50mcg.; Simvastatin 10 mg.; Omeprazole 40 mg; Allegra 180 mg; estrace vaginal cream; Fluticasone Propionate nasal spray; COQ10 100mg; Calcium +D; vit D3 5000iu; Multi Omega 3-6-9 (flax, borage,

Current Illness: None

ID: 1522848
Sex: F
Age: 51
State: OR

Vax Date: 08/01/2021
Onset Date: 08/01/2021
Rec V Date: 08/03/2021
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: Pt received 1st dose Pfizer covid vaccine on 8/1/2021. on VAR form pt misspelled her name which was not caught until after vaccine was administered. on chart/Alert iis review- pt has received Moderna Covid vaccine on 1/15/2021 and 2/16/2021 completing her series.

Other Meds:

Current Illness:

ID: 1522849
Sex: M
Age: 34
State: AR

Vax Date: 12/22/2020
Onset Date: 05/24/2021
Rec V Date: 08/03/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Discovered leucopenia (WBC 2.8) during beginning of May 2021 on routine labs (normal WBC counts before). Developed zoster rash on 5/23/21, started oral valcyclovir, started to have fever from 5/24/21, went to ER, diagnosed with Varicella Zoster meningitis with a PCR from spinal fluid through LP on 5/24/21. Switched to IV Acyclovir. Discharged on 5/26/21 with outpatient IV acyclovir. Still have leucopenia as of July. But i clinically recovered from infection. Awaiting hematology evaluation for leucopenia.

Other Meds: Occassional B12

Current Illness: None

ID: 1522850
Sex: M
Age: 16
State: MI

Vax Date: 07/29/2021
Onset Date: 07/30/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient woke up the following morning after receiving his 2nd Men B on 7/29/21 , on 7/30/21 with dizziness, headache, body aches, weakness, nausea and vomiting. Was taken to the ED and given Zofran. Went home, slept given Tylenol alternating with Advil and drank fluids. 7/31/21 felt weak and tired and went to work that afternoon. 8/1/21 he work up with neck and chest soreness and went to work. On 8/2/21 he felt fine.

Other Meds: PRN- Melatonin and Excedrin

Current Illness: none

ID: 1522851
Sex: M
Age: 59
State: KS

Vax Date: 04/27/2021
Onset Date: 05/01/2021
Rec V Date: 08/03/2021
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: no known allergies

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

Symptoms: about 2 weeks after receiving 2nd dose of Pfizer COVID vaccine, started noticing memory loss, dropping things, sleeping pattern is off, mood swings, headaches, cough for about last 3 weeks (mid-july), can't get anything done. Received 2 doses of Pfizer COVID vaccine: 4/6/2021 lot #EN6206, 4/27/2021 lot #EW0170 Advised to contact Med clinic (phone number given) for check-up; patient stated he does not have a doctor. Also advised to call 911 or go to ER if trouble breathing, or other life threatening issues.

Other Meds: none

Current Illness: none

ID: 1522852
Sex: F
Age: 53
State: AZ

Vax Date: 07/05/2021
Onset Date: 07/11/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: Penicillin and latex

Symptom List: Nausea

Symptoms: Tongue burning and enflamed taste buds. The imflammation moves to different locations on the tongue. No sense of taste on the front portion of the tongue. Very sensitive to different spices and salt. Was given prednisone but didn't help. There doesn't seem to be any improvement. Tip of tongue looks chopped up.

Other Meds: Mulitvitamin and omega fish oils

Current Illness: None

ID: 1522853
Sex: F
Age: 63
State: MN

Vax Date: 03/18/2021
Onset Date: 07/28/2021
Rec V Date: 08/03/2021
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: reports symptoms starting on 7/28/2021

Other Meds:

Current Illness:

ID: 1522854
Sex: M
Age: 57
State: PA

Vax Date: 01/21/2021
Onset Date: 07/26/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Fever or Chills Cough Fatigue Muscle or body aches Headache Sore throat Congestion or running nose

Other Meds: ascorbic acid (VITAMIN C ORAL) atorvastatin (LIPITOR) 10 mg tablet cyanocobalamin, vitamin B-12, (VITAMIN B-12 ORAL) KRILL OIL ORAL lisinopriL (ZESTRIL) 10 mg tablet

Current Illness:

ID: 1522855
Sex: F
Age: 38
State:

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 08/03/2021
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: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time. Patient notified and given the option for an additional dose.

Other Meds:

Current Illness:

ID: 1522856
Sex: F
Age: 36
State: SC

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/03/2021
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: CT dye

Symptom List: Tremor

Symptoms: Patient was given 1st dose of Pfizer covid vaccine at approximately 950am by RN. Patient notified RN that her mouth was starting to itch and she felt like she may pass out. RN administered 50mg of oral diphenhydramine hcl at 955am. Vitals: BP 125/79, HR 96, O2 98% Patient's face began to redden in a splotchy pattern. RN called 911 at 10am. At 10:01am began began coughing and her alertness started to decline. I administered 1 dose of Adrenalin 1mg/ml 0.3mg in her right outer thigh per protocol. 10:03am Vitals: BP 122/75, HR 89, O2 98% 10:04am Patient stated the itching in her mouth was improving. 10:07am Vitals: BP 122/78, HR 80, O2 97% 10:10am Vitals: BP 104/74, HR 78, O2 97% Patient stated that the itching was continuing to improve. She was also able to tell me the day of the week and her weekend plans with clarity. 10:15am RN called 911 again; Vitals: BP 114/75, HR 84, O2 96% 10:17am Patient states all symptoms have resolved. 10:20am Vitals: BP 117/74, HR 87, O2 98% EMS arrived at 10:21am and took over care of the patient. Patient was to be transported to the ED. Meds given: 2 capsules of Diphenhydramine Hcl 25mg, Lot 202451 Exp 8/2023 NDC 0904-5306-61 Adrenalin 1mg/mL 0.3mg IM x1, Lot 342523 Exp 10/2021 NDC 42023-159-01

Other Meds:

Current Illness:

ID: 1522857
Sex: M
Age: 59
State:

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 08/03/2021
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: Patient experienced side effects after both of his Moderna vaccines. Side effects included flu-like symptoms and lethargic.

Other Meds:

Current Illness:

ID: 1522858
Sex: M
Age: 16
State: PR

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/03/2021
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: Patient is not allergic to anything

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

Symptoms: 16 year old male patient oriented time, place, space reports feeling dizzy in the observation area after 12 minutes after administration of the first PFIZER vaccine, he presented with paleness of the face and upper extremities. Paramedic proceeds to take him to a stretcher to take vital signs with Dx: 101, BP 80/60, P: 88, Sat: 99%. Doctor is called and proceeds to indicate that the patient should drink juice since he did not have breakfast. Mom arrives with juice at 9:59am, Patient looks better. 10:16am patient reports feeling better. Retake vitals 15 minutes later. BP: 80/60, educates mother about the importance of breakfast before receiving second dose of PFIZER and discusses with the nursing staff about the symptoms he presented in his first dose.

Other Meds: patient does not take medications

Current Illness: Patient does not suffer from diseases

ID: 1522859
Sex: F
Age: 36
State: MO

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: NONE

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

Symptoms: Per patient, she broke out in a cold sweat and felt faint about 20 seconds after the shot. She also reports that her head and arms felt very heavy, and had trouble seeing. The staff gave her water and she was eventually okay to leave.

Other Meds: NA

Current Illness: NA

ID: 1522860
Sex: F
Age: 64
State: CA

Vax Date: 04/21/2021
Onset Date: 07/15/2021
Rec V Date: 08/03/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: After the 2nd dose vaccine, I felt really sick and could not work. I had flu like symptoms, very tired, headache, low grade fever, body aches and chills. It took 2-3 days for these symptoms to resolve. On 7/15/2021, I woke up unable to walk or speak. My husband called 911. I was taken to the hospital. They ran multiple tests and did a surgical procedure called thrombectomy to remove the clot. The procedure was successful. I was in the ICU for 1 night and discharged the following day. I was discharged with a diagnosed of stroke to follow up with neurologist and cardiologist and prescription for low dose aspirin and Lipitor. The cause of the stroke is of unknown nature since I do not have any risk factors or chronic medical conditions.

Other Meds: None

Current Illness: None

ID: 1522861
Sex: M
Age: 60
State: PA

Vax Date: 01/15/2021
Onset Date: 07/28/2021
Rec V Date: 08/03/2021
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: Contrast [Iodinated Contrast Media]Rash

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

Symptoms: Chief Complaint Patient presents with ? Cough ? Sinus Problem facial pain, PND, sneezing, watery eyes x 3 days. OTC Tylenol and Benadryl. HPI Patient is a 61 y.o. M presenting today for evaluation of sinus symptoms x 3-4 days. He states that he is having nasal congestion, sinus pain/pressure, rhinorrhea, cough, watery eyes. No fevers, V/D, ear pain, sore throat. He has been taking Tylenol and benadryl. No sick contacts. No hx of COVID-19, but he is fully vaccinated. No hx of asthma or COPD. Nonsmoker.

Other Meds: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler ALPRAZolam (XANAX) 0.5 mg tablet amoxicillin-pot clavulanate (AUGMENTIN) 875-125 mg per tablet BYSTOLIC 5 mg tablet desvenlafaxine (PRISTIQ) 100 mg 24 hr tablet diphenoxylate-atrop

Current Illness:

ID: 1522862
Sex: F
Age: 30
State: OR

Vax Date: 05/28/2021
Onset Date: 08/03/2021
Rec V Date: 08/03/2021
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: None

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

Symptoms: July 1st had a week of spotting. Then had a really heavy painful menstrual cycle at the end of July. Typically, my cycles are predictable and it rack them via an app. Now, 8/1 same pattern. Spotting and cramping. This is completely unusual and there have been no other major changes aside from the vaccine.

Other Meds: None

Current Illness: None

ID: 1522863
Sex: F
Age: 20
State: PA

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/03/2021
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: Dizziness after administration, patient stayed seated until feeling passed

Other Meds:

Current Illness:

ID: 1522864
Sex: M
Age: 16
State: MN

Vax Date: 03/20/2021
Onset Date: 08/02/2021
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: asymptomatic

Other Meds:

Current Illness:

ID: 1522865
Sex: F
Age: 52
State: UT

Vax Date: 04/15/2021
Onset Date: 06/24/2021
Rec V Date: 08/03/2021
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: I was fully vaxxed, I started coughing am June 24, I was in bed for 3 days, no fever no runny nose, persistent cough and a really bad headache. After a week I could function, I went to urgent care on 27th and they did a rapid test for covid 19 came back negative. And I lost taste and smell on the 29th,

Other Meds:

Current Illness:

ID: 1522866
Sex: F
Age: 18
State: PA

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/03/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Patient felt dizzy, fainted, then came to and felt dizzy and nausea

Other Meds:

Current Illness:

ID: 1522867
Sex: M
Age: 18
State: AL

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/03/2021
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: The patient felt like he was going to pass out approximately 1 minute after the vaccine was given. He experienced a brief period of vasovagal syncope. After about a minute he was aware and feeling better. A physician examined him and took his vital signs. After about 5 minutes he was feeling normal.

Other Meds:

Current Illness:

ID: 1522868
Sex: F
Age: 38
State: PA

Vax Date: 01/21/2021
Onset Date: 07/29/2021
Rec V Date: 08/03/2021
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: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Visit Diagnoses Contact with and (suspected) exposure to covid-19 URI, acute

Other Meds: acetaminophen (TYLENOL) 500 mg tablet ascorbic acid, vitamin C, (VITAMIN C) 125 mg tablet,chewable cholecalciferol, vitamin D3, (VITAMIN D3) 10 mcg (400 unit) capsule fexofenadine (ALLEGRA) 60 mg tablet multivitamin 400 mcg tablet

Current Illness:

ID: 1522869
Sex: F
Age: 84
State: NH

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 08/03/2021
Hospital: Y

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: NA

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

Symptoms: The day after 2 nd Pfizer Vaccine our mother was exhausted and slept straight for 12 hours. After that her episodes of complete insomnia and heart palpitation started. We have reported regularly to the doctor that she is not sleeping. Our mother was unbale to sleep for even one hour a day. Heart palpitations continue. Eventually on April 27th we took her to emergency room. We have reported in Hospital emergency room that her troubles with sleeping and heart palpitations stared after 2nd vaccine but they refused to record it or ask any questions about the vents that led us to emergency room visit.

Other Meds: Levothyroxine Sodium

Current Illness: MS

ID: 1522870
Sex: M
Age: 72
State:

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 08/03/2021
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: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time. Patient notified and given the option for an additional dose.

Other Meds:

Current Illness:

ID: 1522871
Sex: F
Age: 45
State: VA

Vax Date: 12/22/2020
Onset Date: 12/01/2020
Rec V Date: 08/03/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Injections: 12/22/2020 & 01/08/2021; Immediately after both vaccinations: extreme right side headache; arm pain, right; jaw soreness (similar to TMJ), right; hip pain, right; shoulder pain, right. alternated acetaminophen and ibuprofen with not relief for at least 12 hours. Heating pad used at site with no relief for 12 hours. Rash on abdomen to groin & back to buttocks began less than one week of injection and lasted until May 2021. no other changes with medications, laundry detergent, location.

Other Meds: Multi-vitamin, probiotic

Current Illness: NONE

ID: 1522872
Sex: M
Age: 87
State: MN

Vax Date: 05/17/2021
Onset Date: 08/02/2021
Rec V Date: 08/03/2021
Hospital: Y

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: POSITIVE COVID TEST 8/2/21

Other Meds: chlorthalidone (HYGROTON) 25 mg oral tablet Sig: Take 0.5 tablets (12.5 mg) by mouth once daily. fluticasone (FLONASE) 50 mcg/actuation nasal spray Sig: Instill 1 spray into EACH nare twice a day. metoprolol tartrate (LOPRESSOR) 25 mg ora

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm