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: 1525991
Sex: F
Age: 47
State: TN

Vax Date: 05/01/2021
Onset Date: 05/23/2021
Rec V Date: 08/04/2021
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: Levaquin Codiene Mustard

Symptom List: Dysphagia, Epiglottitis

Symptoms: I can't remember most of the time lines

Other Meds: Lisinopril, Estradiol, Propanolol, B-12, Protonics,

Current Illness: None

ID: 1525992
Sex: M
Age: 53
State: WA

Vax Date: 07/16/2021
Onset Date: 07/21/2021
Rec V Date: 08/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: moderate localized shoulder pain at injection site after 2nd dose of moderna covid vaccine

Other Meds:

Current Illness:

ID: 1525993
Sex: F
Age: 46
State: MD

Vax Date: 01/11/2021
Onset Date: 08/01/2021
Rec V Date: 08/04/2021
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: COVID positive after vaccination

Other Meds:

Current Illness:

ID: 1525994
Sex: M
Age: 81
State: FL

Vax Date: 02/02/2021
Onset Date: 02/09/2021
Rec V Date: 08/04/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The patient started experiencing pain in his neck 7 days after vaccination and within 48 hours he lost all mobility. He was taken to the emergency room and found to have a spontaneous hemorrhage with cord compression in the cervical cord. patient was hospitalized at the Clinic for 10 days and then transferred to rehab facility for week. He had a syncopal episode while in rehab and was readmitted into the clinic. He was stabilized and then later discharged in to another rehab for 5-6 weeks. Patient is still ongoing with physical therapy and occupational therapy. He was initially quadriplegic, but has regained mobility in his upper extremities and is progressing with mobility in his lower extremities.

Other Meds: aspirin 81 mg oral delayed release tablet, 81 mg= 1 tab, PO, HS atorvastatin 10 mg oral tablet, 10 mg= 1 tab, PO, Daily, 3 refills benazepril 40 mg oral tablet, 40 mg= 1 tab, PO, BID, 1 refills carvedilol 12.5 mg oral tablet, 12.5 mg= 1 tab

Current Illness: None

ID: 1525995
Sex: M
Age: 24
State: AL

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 08/04/2021
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: A few minutes after vaccine administration, patient was sitting in waiting area and lost consciousness. He fell out of his chair. He regained consciousness quickly but was lightheaded and pale. EMS was called and checked him, he was cleared to leave and drive home after approximately 20 minutes.

Other Meds:

Current Illness:

ID: 1525996
Sex: M
Age: 33
State: NC

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/04/2021
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 stated or listed on agency

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

Symptoms: Within 10-15 minutes patient fainted and woke up with no other issues. Breathing was normal throughout this time period. Some sweating.

Other Meds: none stated or listed on agency

Current Illness: none stated or listed on agency

ID: 1525997
Sex: M
Age: 67
State: FL

Vax Date: 01/28/2021
Onset Date: 04/28/2021
Rec V Date: 08/04/2021
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: No

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: On 01/28/2021, the day of my vaccination I had smooth skin on my upper arm. By the late part of April I noticed a bump going on under my skin, and my first thought I remember that's where I had my injection. On 04/28/20 went to my dermatologist, and it was biopsied. The biopsy results: squamous cell carcinoma. On 06/14/2021, they removed the growth, about the size of quarter and deep to make sure they removed any cancer that was there.

Other Meds: Omeprazole; atorvastatin; tadalafil; pramipexole; B-12; TheraLith supplement

Current Illness: No

ID: 1525999
Sex: F
Age: 62
State: WI

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

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Severe brain fog for nearly 3 weeks.

Other Meds: mult vitamin, vit d, vit b12, omega Levotyroxine 75 mcg 1 per day 6 times a week

Current Illness:

ID: 1526000
Sex: M
Age: 75
State: NC

Vax Date: 02/04/2021
Onset Date: 07/24/2021
Rec V Date: 08/04/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: No Symptoms Unknown

Other Meds:

Current Illness:

ID: 1526001
Sex: M
Age: 52
State: TX

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: patient stated Excessive bleeding right after injection

Other Meds: N/A

Current Illness: N/A

ID: 1526002
Sex: F
Age: 75
State: AZ

Vax Date: 02/24/2021
Onset Date: 03/08/2021
Rec V Date: 08/04/2021
Hospital: Y

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

Lab Data:

Allergies: I am allergic to beta blockers, ace inhibitors and to clonidine. I also have a mild allergy to peanuts and I'm allergic to bee stings.

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

Symptoms: After I received the first dose, I went into A-fib. I was hospitalized for one night. After receiving the second dose, I was hospitalized for 6 days, for A-fib as well. I do have a history of A-fib, but I have not had an episode in over a year. After the first dose, a week later I went into A-fib. I ended up going into rapid A-fib, while waiting for my doctor and the insurance company. It made me feel weak, dizzy and a little nauseous. He took me in and they admitted me into the hospital. The outcome after the first dose, they did a cardio aversion. They monitored me for the night and discharged me the next day. The aversion worked and I went back into sinus rhythm. After my second dose, I went into A-fib again. I called Dr. and he took me off of multaq and changed me to amiodarone 400mg twice daily for 1-2 weeks. The day I went into the hospital, I started to have chest pain. The pain wasn't severe, but it made me stop what I was doing and stand still. I was seen by the cardiologist and I was admitted. The cardiologist wanted to keep me for monitoring. They did a cardio aversion, but it didn't work. I was receiving IV diltiazem treatment plus my amiodarone. They did a cardio aversion following the medical treatment and it worked. I went back into sinus rhythm.

Other Meds: I was taking losartan 50mg daily, levothyroxine .75mg daily, Isosorbide mononitrate 30mg daily, Eliquis 5mg twice daily, magnesium 250mg daily, multaq 400mg twice daily, atorvastatin 40mg once per day, Furosemide 40 mg daily, potassium chlo

Current Illness: I was not experiencing any illness at that time.

ID: 1526003
Sex: M
Age: 23
State: NC

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 08/04/2021
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: Patient fainted about 10 minutes after dose was given

Other Meds: NONE

Current Illness: NONE

ID: 1526004
Sex: M
Age: 40
State: CA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 08/04/2021
Hospital:

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

Lab Data:

Allergies: Possible: Bacterim

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

Symptoms: 20-40 minutes after injection; tightness in chest, similar feeling as asthma attack; however, no wheezing. Lasted about 5 hours.

Other Meds: Allegra; Sudafed PE; Flonase; Centrum Complete Multi Vitamin

Current Illness: Herniated disks in T and C spine

ID: 1526005
Sex: M
Age: 74
State: MI

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Very tired, general muscle pain, fever, sensitive skin, back pain, headache, weakness

Other Meds: Crestor, zetia, 81mg aspirin, coq 10, krill oil, multi vitamin, protonix

Current Illness: None

ID: 1526006
Sex: M
Age: 45
State: VT

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 08/04/2021
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: Increase in migraine intensity and frequency almost immediately after the injection. Soon thereafter an increase in vertigo episodes that have yet to decrease. Balance has also been bad and not gotten much better.

Other Meds: topiramate, naproxen sodium, omeprazol, montukelaast, cetirizine, hydroxyzine

Current Illness: None

ID: 1526007
Sex: F
Age: 57
State: GA

Vax Date: 04/06/2021
Onset Date: 07/20/2021
Rec V Date: 08/04/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Acute hypoxic respiratory failure secondary to Covid pneumonia; Continue Decadron -total 10 days, completed 5 days of remdesivir, cxray showed -Patchy basilar reticular lung opacities consistent with atypical infection.Empiric antibiotic with IV Rocephin and Zithromax Antitussives /mucolytic's for cough BD,Supplemental oxygen-she has qualified for home oxygen, Supportive care including incentive spirometry prone positioning as tolerated

Other Meds:

Current Illness:

ID: 1526008
Sex: F
Age: 38
State: TX

Vax Date: 07/30/2021
Onset Date: 07/31/2021
Rec V Date: 08/04/2021
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: Sulfa drugs

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

Symptoms: The morning after taking first injection I started my menstrual cycle which was 9 days early. I never start even a day early. I also had a heavy nose bleed on that day after my first vaccination.

Other Meds: None

Current Illness: None

ID: 1526009
Sex: F
Age: 62
State: NY

Vax Date: 07/20/2021
Onset Date: 07/22/2021
Rec V Date: 08/04/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt. had redness, warmth and soreness at the injection site on 07/23/2021. Dr. prescribed her kepflex 500mg BID for 5 day course, pt. didnt started that medication and went to ED on 07/24/2021, the dr.'s at ED gave her Doxycycline 100mg BID and pt. started taking that and visited the clinic back on 07/27/2021, on examination the redness was lighter in color but it spreded a little bit more.

Other Meds: Amitiza, Synthyroid, simvastatin, myrbetriq

Current Illness:

ID: 1526010
Sex: F
Age: 40
State: MO

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 08/04/2021
Hospital:

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

Lab Data:

Allergies: patient stated: cephalexin, mango, feather, amoxil, demerol, azithromycin, promethazine, coconut, raseberry, sux, latex, ibuprofen, tylenol, darvocet-n 10

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient self montored at home

Other Meds:

Current Illness:

ID: 1526011
Sex: F
Age: 18
State: WI

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/04/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Patient complained of numbness down left arm to hand

Other Meds: unknown

Current Illness: unknown

ID: 1526012
Sex: F
Age: 65
State: CA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 08/04/2021
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: Compazine, Demerol

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

Symptoms: I have a past medical history, about 2 years ago, I had an auto accident and had whiplash in my neck. With treatment, the pain went away and had completed resolved. My neck pain started with the 1st dose of the Pfizer (lot # EK5730 IM LA). This pain continued and I went and got my 2nd dose. The pain continued to bother me. I did take meloxicam and tramadol, which helped to relieve the pain but the pain will still return. I went to a chiropractor in 2/2021, but the pain never went away. I tried getting a massage, taking other medications like my Celebrex which really did not help. I finally decided to take my Meloxicam 1 pill daily for 1 week and rested my neck by refraining from putting any strain or stretching on my neck. This definitely improved my pain and symptoms. I finally got to see my PCP, the pain had significantly improved and I was given a prescription for Meloxicam and Tramadol. I still have intermittent pain in the back of my head. I haven't fully recovered.

Other Meds: Meloxicam, Tramadol

Current Illness: None

ID: 1526013
Sex: F
Age:
State: CA

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

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

Lab Data:

Allergies: Merthiolate

Symptom List: Unevaluable event

Symptoms: After my first dose, and two weeks after I experienced erythema nodosum in both lower extremities. I apply a steroid cream daily. To this day I still have the erythema nodosum in both lower extremities. I do not have lot# to provide.

Other Meds: Crestor

Current Illness: No

ID: 1526015
Sex: M
Age: 52
State: CA

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/04/2021
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: Pt states some allergies in the past, denies anaphylaxis or epi-pen use

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

Symptoms: Patient received dose of Janssen at 4:37pm, apx 20 minutes later (he was on 15 min observation but was waiting on family member with 30 minute observation) pt states ?swelling in my left tonsil? pointing to left throat. RN Assessment does not note any swelling in airway or respiratory distress. Pt states this sometimes happens with seasonal allergies but this ?feels different.? Pt with continued observation, stable, talking with family, states feels ?the same? 10 minutes later, no visible distress, drinking water, speaking clearly/coherently. Pt asks to go outside to take mask off as pt states he rarely wears mask for extended period of time. RN accompanies pt outside where he states ?swelling is better? but now feels dizzy. RN takes vitals: 154/90 left arm, manual, 97%RA, RR18, clear lung sounds bilaterally, HR 70. Pt states dizziness resolved but now feels ?swelling? again, same as before, not worse, states ?just a little bit? swollen. RN does not note any visible airway compromise, pt denies CP, SOB, swallowing difficulty, appears comfortable but anxious. No hives on chest, back, pt ambulating freely around vaccination site. Patient offered EMS ride and safely of further medical evaluation. Education provided on delayed allergic reaction. Patient declines, stays on site until 5:31, signs AMA form and leaves with family. No distress on leaving, pt drinking water and speaking clearly, education provided on calling 911. Patient and family verbalize understanding.

Other Meds: unknown

Current Illness: unknown

ID: 1526016
Sex: F
Age: 47
State: CA

Vax Date: 07/27/2021
Onset Date: 07/29/2021
Rec V Date: 08/04/2021
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: Augmentim, sulfa

Symptom List: Injection site pain, Pain

Symptoms: 2 days after vaccine, Stiff neck left side, sevier pain from left neck to shoulder down to arm. Unbearable pain that keeps me up at night. Went to ER on Saturday.

Other Meds: Vitamin c,zinc, d3,multi vitamin

Current Illness: allergy issues

ID: 1526017
Sex: F
Age: 61
State: NY

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 08/04/2021
Hospital:

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

Lab Data:

Allergies: no known allergies

Symptom List: Injection site pain, Menorrhagia

Symptoms: As soon as I pulled the needle out of her arm, she began to fall forward as she had passed out. I tried to catch her but she hit her head on a cabinet and I lowered her to the ground. 911 was called immediately. She regained consciousness in about 10 seconds. She had a small amount of blood coming out of her left nostril and was bleeding from her head. EMT's evaluated her and found an abrasion on the top of her head. After they evaluated her, they got her on her feet and then sitting down on a bench. Her blood pressure was 158/85. They deemed it unnecessary to go to the hospital. She sat for at least another 15 minutes. She had no dizziness or lightheadedness. The only symptom she had was pain at the abrasion site. She was released with her husband. Her husband had told me that she has an extreme anxiety of needles.

Other Meds: unknown

Current Illness: unknown

ID: 1526018
Sex: F
Age: 45
State:

Vax Date: 03/06/2021
Onset Date: 07/28/2021
Rec V Date: 08/04/2021
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: Breakthrough symptomatic COVID19 infection

Other Meds:

Current Illness:

ID: 1526019
Sex: F
Age: 47
State: OR

Vax Date: 04/04/2021
Onset Date: 04/06/2021
Rec V Date: 08/04/2021
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: Tramadol, insect stings

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Heart rate went up to 120-130 while sitting down. I got dizzy. I went to and was sent to the Emergency . They did an EKG and some blood work. After about an hour my heart rate went back down and I was fine.

Other Meds: Implanon, Metoprolol, Estrodial, Venaflaxine, Zrytec, Flonase, multi vitamin

Current Illness: none

ID: 1526020
Sex: M
Age: 31
State: GA

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

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

Lab Data:

Allergies: Codeine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I woke up my joints was stiff, felt very tired, experienced a headache. I tried to bend my left leg couldn't felt like knee was locked in place. I have been experiencing intermittent knee pain in my left leg that has gotten worse over time.

Other Meds: Anti Inflammatory; Gabapentin

Current Illness: No

ID: 1526021
Sex: F
Age: 58
State: MT

Vax Date: 01/13/2021
Onset Date: 07/20/2021
Rec V Date: 08/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Tested positive for COVID after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1526022
Sex: F
Age: 32
State: NY

Vax Date: 05/07/2021
Onset Date: 05/13/2021
Rec V Date: 08/04/2021
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 was associate with hives

Symptom List: Nausea

Symptoms: painful lump in L armpit

Other Meds: none

Current Illness: none

ID: 1526023
Sex: F
Age: 65
State: NV

Vax Date: 02/27/2021
Onset Date: 03/01/2021
Rec V Date: 08/04/2021
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: Pain in left arm

Other Meds: motrin 600 MG

Current Illness: No illness at time of vaccination

ID: 1526024
Sex: M
Age: 53
State: MI

Vax Date: 04/06/2021
Onset Date: 08/04/2021
Rec V Date: 08/04/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: blurry vision in both eyes for about 15 minutes and headache similar to day after i had shot April 7th where i had blurry vision in one eye and headache

Other Meds: Lisiniprol(?) for blood pressure

Current Illness: none

ID: 1526025
Sex: M
Age: 42
State: IL

Vax Date: 01/26/2021
Onset Date: 02/20/2021
Rec V Date: 08/04/2021
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: none

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

Symptoms: I GOT SHINGLES,

Other Meds: depression and lotaxine, alpazorine,

Current Illness: none

Date Died: 07/29/2021

ID: 1526026
Sex: M
Age: 70
State: MI

Vax Date: 04/01/2021
Onset Date: 04/23/2021
Rec V Date: 08/04/2021
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: Azithromycin--rash (mild) Ciprofloxacin--lightheadedness/confusion (moderate to severe) Codeine--dizziness Hydralazine-dizziness, moderate Nitrile gloves

Symptom List: Tremor

Symptoms: Pulmonary Embolism 7/20 presented to ED with right sided pain which he had for about 2 weeks. Denies any hx of trauma. Did admit to moving furniture but did not recall an injury. D/C'd with chest wall pain and given Ultram 50mg 1 tab q 4hrs qty= 7. on 7/26 he presented to ED with symptoms of PE and was dx'd with acute PE He was declared deceased on 7/29/21

Other Meds: Amlodipine 2.5 mg Daily Aspirin 81mg Daily Atorvastatin 20mg Daily Metformin 500mg Twice a day Tamsulosin 0.4mg Daily Tolterodine ER 4mg ER Daily in the evenings

Current Illness: BPH HTN Hypercholesterolemia Lipoma long head of biceps rupture neoplasm of bladder OSA PAD Type 2 DM without complication muscle pain hemospermia hydroureter somatic dysfunction of sacroiliac joint

ID: 1526027
Sex: F
Age: 54
State: TX

Vax Date: 07/26/2021
Onset Date: 07/30/2021
Rec V Date: 08/04/2021
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: Buspar

Symptom List: Erythema, Pruritus

Symptoms: started out as rash then spread to all over the body, looks like shingles, hives and reg. rash. Body Aches and feels like pulled muscles in chest, tingling left arm and sore neck

Other Meds: Synthroid

Current Illness: none

ID: 1526029
Sex: M
Age: 32
State: PA

Vax Date: 04/23/2021
Onset Date: 07/03/2021
Rec V Date: 08/04/2021
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: Succinylcholine Augmentin

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

Symptoms: I have suffered with abdominal bloating, I had pain at the beginning but not much pain with it my stomach is just distended. My stomach feels crampy on and off. I saw my PCP and she ordered an abdominal X-Ray and results came back normal.

Other Meds: Levothyroxin (50mcg 1xday) Atenolol (25mg tabs 1xday) Famotidine (20mg 2xday) Daily Fiber (1xday)

Current Illness: NA

ID: 1526030
Sex: F
Age: 79
State: MI

Vax Date: 03/29/2021
Onset Date: 04/12/2021
Rec V Date: 08/04/2021
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: Patient stated that two weeks after vaccination she noticed these white splashes like someone had threw hot water on her. Patient stated that she has these patches all over her body and the spots are turning light and it seems that she is loosing color petition.

Other Meds: Hydrcloside Adolophine Womens Vitamin

Current Illness:

ID: 1526031
Sex: M
Age: 70
State: CT

Vax Date: 01/21/2021
Onset Date: 02/01/2021
Rec V Date: 08/04/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Increase in resting heart rate from the 60?s per minute to 100+. First aware of this 2/1/2021. Persisted until May, 2021. Extra heart beats began in January and persisted until new RX, Metoprolol, started June 9, 2021

Other Meds: Sertraline, losartan, cialis, clonzapam

Current Illness: Covid 19 11/15/2020 Tested positive on 11/16 and 11/17

ID: 1526032
Sex: F
Age: 54
State: PA

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 08/04/2021
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: The patient complained of intense arm pain after receiving her second dose of the Pfizer COVID-19 vaccine lot #ER8735 in her left deltoid on April 10th, 2021. The patient returned to the pharmacy after the clinic to inform the pharmacist of said pain. a nurse from school, and a pharmacist from the Pharmacy, assessed the patient. It was confirmed the needle was inserted two finger lengths below the shoulder, and 90 degrees into the deltoid muscle. She was advised to ice her arm and take tylenol which she stated she did on 4/11/2021. She visited her doctor on 7/27/2021 for the continuing arm pain. The patient has an ultrasound scheduled for 8/10/2021.

Other Meds: The patient stated she is not taking any medications on 8/4/2021. This pharmacy does not dispense her medications so we cannot confirm/deny this.

Current Illness: The patient stated she does not have any current illnesses on 8/4/2021.

ID: 1526033
Sex: M
Age: 49
State: PA

Vax Date: 03/19/2021
Onset Date: 04/07/2021
Rec V Date: 08/04/2021
Hospital: Y

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: No allergies to medications/foods. Allergic to dust, seasonal allergies.

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

Symptoms: Myocarditis: The patient presented to the emergency department with pleuritic, positional, non-radiating, non-exertional, chest pain and an elevated blood pressure reading at home. Labs were notable for elevated ESR, CRP, as well as elevated troponins which increased and then trended back down (0.076 -- > 0.109 -- > 0.105 -- > 0.088). EKG was negative for acute ischemic changes. The patient was admitted to the hospital. TTE was notable for LVEF 61% with normal RV function without significant valvular disease and no pericardial effusion. Cardiac MRI was notable for myocardial edema and inflammation with findings overall consistent with acute myocarditis without pericarditis. Patient was initially treated with prednisone 40 mg daily. Cardiology was consulted who recommended stopping the increased prednisone. Etiology of myocarditis remained unclear; given onset after second Pfizer mRNA vaccine, it was considered whether it might be a reaction to the vaccine. The patient was recommended to avoid NSAIDS, extensive exercise, and alcohol, follow-up with outpatient Cardiology. The patient has now been seen in follow up - his chest pain has resolved, blood pressure normalized, and repeat cardiac MRI shows stable to improved myocarditis (6/3/21 cardiac MRI read: "1. Overall, compared to prior CMR from 4/12/21, the findings are similar. The pattern and extent of LGE is unchanged. 2. Normal left ventricular size and function. Moderate concentric hypertrophy, with the thickest segment measuring 18mm at the mid inferoseptum. Diffuse midmyocardial LGE with mildly elevated myocardial T2 suggestive of mild inflammation. The differential for these findings include 1) resolving myocarditis in the setting of a preexisting nonischemic cardiomyopathy, most likely underlying hypertrophic cardiomyopathy, 2) amyloidosis given the diffuse pattern of delayed enhancement and moderate hypertrophy (although the pattern of LGE and lack of atrial enlargement is unusual), and 3) resolving myocarditis in the context of underlying hypertensive cardiomyopathy. 3. Normal right ventricular size and function.")

Other Meds: albuterol, eplerenone, latanoprost eye drops, levocetirizine, mycophenolate mofetil, pravastatin, predniSONE, propranolol, tacrolimus

Current Illness: No active illnesses at the time of vaccination/up to one month prior.

ID: 1526034
Sex: M
Age: 58
State: FL

Vax Date: 04/09/2021
Onset Date: 04/19/2021
Rec V Date: 08/04/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: Pt. states that after receiving the 1st dose of J&J 04/09/2021, started experiencing uncontrollable hiccups lasting 24/48hrs at a time 04/19/2021. Treated by Primary but no results of subsiding. Weakness, uncontrollable hand shaking, and nausea. Stress test recommended appt. not set. Still continuing to experience symptoms.

Other Meds: N/A

Current Illness: N/A

ID: 1526035
Sex: M
Age: 68
State: ID

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 08/04/2021
Hospital: Y

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

Lab Data:

Allergies: Ampicillin, Erythromycin, PCN, SULFA

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

Symptoms: Pt received Moderna shoot #2 2/11/21. Reports that on 2/12/21 Pt began experiencing chest pain and dyspnea. 911 was called, PT was transported to local Hospital and treated with DX of MI followed by stent placement.

Other Meds: Unknown

Current Illness: Unknown

Date Died:

ID: 1526036
Sex: F
Age: 73
State: KY

Vax Date: 03/24/2021
Onset Date: 07/27/2021
Rec V Date: 08/04/2021
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: codeine, penicillins, tetanus toxoids

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

Symptoms: Presented to ED on 7/27/21 with shortness of breath and non-productive cough. POC PCR positive on 7/27/21. Previous recent hospitalization 7/7-7/11 for acute metabolic encephalopathy, acute kidney injury, theophylline toxicity. Palliative care in place. Died 8/3/21 Hospitalized 8 days at Health care

Other Meds: oxygen, albuterol, dexamethasone, doxycycline, famotidine, mer

Current Illness: COVID-19 pneumonia,sepsis, respiratory acidosis, met. encephal

ID: 1526037
Sex: M
Age: 51
State: AK

Vax Date: 03/12/2021
Onset Date: 08/02/2021
Rec V Date: 08/04/2021
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: NKA

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

Symptoms: SARS-COV 19 Infection. Cough, congestion, runny nose, Diarrhea, Loss of taste, loss of smell, sore throat, fatigue, chills, muscle aches.

Other Meds: NONE.

Current Illness: NONE

ID: 1526038
Sex: F
Age: 33
State: NY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Vomiting

Symptoms: Within a minute of administering the vaccine. The patient fainted. She was conscious within a minute of fainting but was visibly confused. Her vital signs were normal and was able to speak and answer questions about her breathing and pain. EMT was on site within 5-10 mins of the incident and took her to the emergency room. She is currently home resting.

Other Meds: None

Current Illness: None

ID: 1526039
Sex: M
Age: 28
State: MT

Vax Date: 01/11/2021
Onset Date: 07/21/2021
Rec V Date: 08/04/2021
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: Tested positive for COVID after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1526040
Sex: M
Age: 50
State: TX

Vax Date: 04/30/2021
Onset Date: 05/02/2021
Rec V Date: 08/04/2021
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: SHELLFISH ALLERGY

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

Symptoms: CRANIUM ACHE; RIGHT EYE; RIGHT SHOULDER PAIN; CHEST PAIN HEAD SPASM

Other Meds: AMALOTIVIDE; METOPROLOL; AMLODIVINE; METFORMIN

Current Illness: NONE

ID: 1526041
Sex: M
Age: 31
State: GA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 08/04/2021
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: Codeine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: My joints was more stiff this time my left elbow almost locked up.The severe pain in my left elbow lasted around 2 days. I also exp headache and fatigue. I'm still exp intermittent pain in my left elbow.

Other Meds: Anti Inflammatory, Gabapentin

Current Illness: No

ID: 1526042
Sex: M
Age: 73
State: CO

Vax Date: 03/05/2021
Onset Date: 03/15/2021
Rec V Date: 08/04/2021
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: The day after the injection, the injection site became swollen and painful and the right shoulder ached. This fully resolved the next day. 10 days later, the right shoulder suddenly became swollen and painful and I could not raise my arm above my shoulder. It was difficult to sleep because of the pain. Within 2 weeks, the pain subsided but I was still unable to raise my right arm. A picture of my back showed the right shoulder blade appeared detached from the back (picture available upon request.) I visited the doctor on April 2 who ordered Xray? CT? of the shoulder but could find nothing specific to explain the incident. covid vaccine? unrelated? The movement of my right shoulder is improving slowly.

Other Meds: Ibuprofen

Current Illness:

ID: 1526043
Sex: F
Age: 35
State: PA

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 08/04/2021
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: None

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

Symptoms: Starting heavy vaginal bleeding approximately 1 hour post dose administration.

Other Meds: Valtrex 500 mg Clariton Prenatal vitamin Omega 3

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm