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: 1528838
Sex: F
Age: 46
State: WA

Vax Date: 03/31/2021
Onset Date: 06/01/2021
Rec V Date: 08/05/2021
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: Alopecia, extreme hair loss. Hair started coming out in clumps and has continued for the last 2 months. I have lost 2/3 or more of my hair. Balding spots and diffuse loss all over. Blood tests were done and nothing was observed to be causing hair loss.

Other Meds: Multi vitamin

Current Illness:

ID: 1528840
Sex: F
Age: 13
State: WA

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 08/05/2021
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: cows milk

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient started fainting a few minutes after getting vaccine. started having jerking/seizure like movements. after she came out of that, patient said she had chest pain and 911 was called. was stable until paramedics came and paramedics took her with them to hospital

Other Meds: unknown

Current Illness: none reported

Date Died: 06/27/2021

ID: 1528841
Sex: M
Age: 79
State: TN

Vax Date: 03/31/2021
Onset Date: 06/27/2021
Rec V Date: 08/05/2021
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-19 BREAKTHROUGH CASE THAT EXPIRED APPROXIMATELY THREE MONTHS AFTER COMPLETING VACCINATION SERIES.

Other Meds:

Current Illness:

ID: 1528842
Sex: M
Age: 50
State: OR

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 08/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Person completed their COVID-19 vaccine series with the Moderna vaccine. Person came in and received a 3rd dose of the Moderna.

Other Meds:

Current Illness:

ID: 1528843
Sex: F
Age: 39
State: NC

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 08/05/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: 12 hours after vaccine I had body aches, rapid heart rate and a headache for 3 to 4 days after vaccine

Other Meds: none

Current Illness: none

ID: 1528844
Sex: M
Age: 46
State: NJ

Vax Date: 05/20/2021
Onset Date: 06/01/2021
Rec V Date: 08/05/2021
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: Patient presented with blisters in mouth. He visited oral surgeon who prescribed amoxicillin. Blisters continued to spread throughout the body. He visited our office and a biopsy was done which resulted in the diagnosis of Pemphigus Vulgaris. He was treated with high dose oral steroids, topical steroids and referred to Heme Onc for an infusion of Rituximab

Other Meds: NONE

Current Illness: NONE

ID: 1528845
Sex: F
Age: 11
State: MN

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 08/05/2021
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: Parent provided date of birth on vaccine administration/consent form for both girls (they are twins) as 7/22/09, making them 12 years old. When vaccination data was submitted to state IIS, it was discovered that their actual DOB was 9/22/09 making them 11 years and 10 months old.

Other Meds:

Current Illness:

ID: 1528846
Sex: F
Age: 62
State: FL

Vax Date: 02/02/2021
Onset Date: 05/15/2021
Rec V Date: 08/05/2021
Hospital:

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

Lab Data:

Allergies: Seasonal allergies to grass and pollen, Bactrim, Avelox, Augmentin, and ALL artificial sweeteners

Symptom List: Pharyngeal swelling

Symptoms: I have had cramping in my legs, feet, and abdomen and diarrhea with urgency about 4-5 times a day.

Other Meds: Synthroid, Gabapentin, Toprol XL, Protonix, Crestor, Lisinopril, Zanaflex, Welchol, 81mg Aspirin, Biotin, D3, Magnesium (2000mg/day), High Potency Fish Oil, Petadolex, Zinc, Glumetza, Sudafed and Ala-Hist IR

Current Illness: None

ID: 1528847
Sex: F
Age: 52
State: MO

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/05/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Vaccine was predrawn into syringes and these were administered after the 6 hour expiration time limit

Other Meds:

Current Illness:

ID: 1528848
Sex: F
Age: 44
State: NC

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 08/05/2021
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: Patient administered Pfizer vaccine after receiving the J&J vaccine on 4/11/2021. This incident was first identified when the Pfizer vaccine dose was entered in system. Patient did not inform pharmacy of any adverse events.

Other Meds:

Current Illness:

ID: 1528849
Sex: M
Age: 64
State: TX

Vax Date: 01/22/2021
Onset Date: 02/04/2021
Rec V Date: 08/05/2021
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: codeine

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

Symptoms: The patient awakened on 02/04/2021 confused and disoriented. Didn't know where or who he was and was taken to the hospital by ambulance and evaluated and admitted. BP by EMS was 220 systolic. He was diagnosed with hypertensive encephalopathy, but I suspect it may have been a Transient Global Amnesia.

Other Meds: none

Current Illness: none

ID: 1528850
Sex: F
Age: 16
State: OR

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 08/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Person received their first dose of Moderna by another provider. We used the off label guidance from CDC to complete the series even though they were under approved age.

Other Meds:

Current Illness:

ID: 1528851
Sex: F
Age: 27
State: TN

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 08/05/2021
Hospital:

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

Lab Data:

Allergies: Latex

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

Symptoms: Redness, flushed, SOB occurred instantly after receiving injection to L arm. Benadryl was given immediately. L shoulder area above injection site remained reddened throughout the night. Upon rising 3/10/21, noted painful rash/whelped/raised areas (approximately 6 different blotched areas of blister like rashes to L shoulder/Lneck/Lshoulder blade area). Went to urgent care clinic approx 2 days after injection r/t pain/irritation/burning in L shoulder/neck area. PO steroids were administered and cream for site. After 5 days of PO steroids, rash did not burn/sting anymore but Blisters/raised areas never went away after this. Area is currently still there and flares up at times causing irritation and itching.

Other Meds: Lo-Estrin

Current Illness: N/A

Date Died: 07/29/2021

ID: 1528852
Sex: F
Age: 74
State: TN

Vax Date: 03/03/2021
Onset Date: 07/29/2021
Rec V Date: 08/05/2021
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: COVID -19 BREAKTHROUGH CASE THAT EXPIRED FOUR MONTHS AFTER COMPLETING COVID VACCINATION SERIES.

Other Meds:

Current Illness:

ID: 1528853
Sex: M
Age: 11
State: OR

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 08/05/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Parent/guardian lied about the child's age on both the first and second dose. Child was not approved per the guidance.

Other Meds:

Current Illness:

ID: 1528854
Sex: F
Age: 60
State: MO

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/05/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Vaccine was predrawn into syringes and given after the 6 hour time limit

Other Meds:

Current Illness:

ID: 1528855
Sex: F
Age: 48
State: MD

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 08/05/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: none

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

Symptoms: 2 days after the 2nd dose, I noticed a rash below the injection site. The rash was splotchy and a long band. A few days later, it turned into hives. It was itchy and tender. It resolved on its own over the next several weeks but the pain lingered. The pain was sore and tender and a knot would form. This continued for a few months. I had an ultrasound of my neck and everything is normal. I also had an x-ray of my cervical neck and x-ray came back normal. Starting in June/ July, the pain radiated from near the injection site and down to elbow and up to the shoulder. Now, its has continued down to my wrist and up to my neck. On a scale of 1 to 10, the pain is a 6-7 when in motion or in use. I have now limited use with my left arm. I am currently in physical therapy to try to regain use of my arm. I was prescribed a muscle relaxer cyclobenzaprine.

Other Meds: Famotidine, Lyrica, multivitamins

Current Illness: none

ID: 1528856
Sex: M
Age: 17
State: MA

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient presented to the pharmacy with a DOB of 8/1/2003, which would have made him 18 the day of administration, to receive his COVID-19 vaccine. After vaccination we were able to determine via his insurance plan that the patient had falsified his DOB to receive a the vaccine.

Other Meds:

Current Illness:

ID: 1528857
Sex: F
Age: 56
State: GA

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 08/05/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient report that the first day of the vaccine she was fine.. Next day she had leg champs couldnt walk or sleep... had to place her legs above her heart to get comfort...

Other Meds: Cyclobenzaprine 10mg Lyrica 100mg Tizanidine Hydrochloride 4mg Lyrica 150mg Viavepam 5mg Tramadol 50mg Robaxin 750mg Trazodone Hydrochloride 100mg Methylprednisolome 4mg Liyrica 100mg Methocarbol 500 mg Tramadol 50mg Hydroxyzine 50mg Hyd

Current Illness: no

ID: 1528858
Sex: F
Age: 46
State: IL

Vax Date: 05/27/2021
Onset Date: 08/03/2021
Rec V Date: 08/05/2021
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: Pt presented to the ED on 8/3/21 with shortness of breath and cough. She states that her symptoms started about 10 days prior to admission. Pt reports having a positive COVID test through pharmacy, but the exact date is unknown. Pt was tested in the ED which confirmed that patient was COVID positive. In the ED, pt was satting 88% on room air, so pt was placed on 3L O2 and admitted for COVID treatment (remdesivir and dexamethasone). Pt completed her Moderna vaccinations (4/29 and 5/27) PTA. She is also on Gilenya for MS.

Other Meds:

Current Illness:

ID: 1528860
Sex: F
Age: 71
State: MD

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 08/05/2021
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: Sulfa Amoxicillin Cipro

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

Symptoms: 4/13/21- Uncontrolled runny nose, headache, left arm swelling,severe reaction ie. redness, left shoulder to forearm including pain. 4/14/21 - Headache ongoing, fatigue, nose dripping, began coughing with productive sputum which continues to date. Developed chest pain, left arm pain and back pain. Shortness of breath. July 2021, diag: Nodules in left lung and possible cardiac problems. No significient problems prior to 4/13/21. Pending lung surgery to remove nodules.

Other Meds: Glipizide Spironolactone

Current Illness: N/A

ID: 1528861
Sex: F
Age: 67
State:

Vax Date: 08/04/2021
Onset Date: 08/05/2021
Rec V Date: 08/05/2021
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: At 2 AM patient woke up and her neuropathy was much worse, and symptoms are still present today at 1 PM.

Other Meds:

Current Illness:

ID: 1528862
Sex: F
Age: 39
State: MN

Vax Date: 07/19/2021
Onset Date: 07/21/2021
Rec V Date: 08/05/2021
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: Celiac Disease

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

Symptoms: Hives, Day 3, 5 spots; Day 4, expanded to 25 spots

Other Meds: oral contraceptive

Current Illness: n/a

ID: 1528863
Sex: F
Age: 11
State: CA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 08/05/2021
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: 11 y/o pt received first dose 1 of Pfizer vaccine. Pt was observed. No rxn noted.

Other Meds:

Current Illness:

Date Died: 08/04/2021

ID: 1528864
Sex: M
Age: 97
State: MI

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Came to EC for CHF was put on hospice during admission

Other Meds: Amlodipine, ecotrin, tenormin, apresoline, hydrodiulil, coumadin, zocor

Current Illness:

ID: 1528865
Sex: F
Age: 18
State: SC

Vax Date: 07/26/2021
Onset Date: 08/03/2021
Rec V Date: 08/05/2021
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: After directly receiving the shot, I was very achey and weak. Exactly a week after I received my vaccine, I developed a UTI. This is unusual since I have not had one since I was young. I am unable to complete daily tasks without being extremely exhausted and my body hurting. I struggle walking for long periods of time.

Other Meds: Rae Rebalance Vitamins

Current Illness:

ID: 1528866
Sex: F
Age: 59
State: KS

Vax Date: 07/29/2021
Onset Date: 08/05/2021
Rec V Date: 08/05/2021
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: PT HAS NOT BEEN SEEN SINCE THE DATE OF VACCINATION.

Other Meds: PT DID NOT DISCLOSE THAT SHE HAD PREVIOUSLY RECEIVED A MODERNA COVID-19 VACCINE IN MARCH OF 2021 AND WAS GIVEN A JANSSEN COVID-19 VACCINE ON STATED DATE. KDHE IMMUNIZATION DEPARTMENT WAS NOTIFIED.

Current Illness:

ID: 1528867
Sex: M
Age: 19
State: VA

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

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

Lab Data:

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Soon after administering the vaccine the patient stated the the shot hurt. He began to feel nauseated and he stated his hearing was "funny like an echo". and he vomited twice. His pulse was 65 BPM's. and his breathing was normal. An ice pack was placed on the back of his neck. After about 10 minutes he began to feel better. He remained in the pharmacy for an additional 30 minutes after he began to feel better. After the 30 minutes he left and was feeling better. He was accompanied by his father the whole time.

Other Meds: Unknown

Current Illness: Unknown

ID: 1528868
Sex: F
Age: 36
State: TX

Vax Date: 07/23/2021
Onset Date: 07/25/2021
Rec V Date: 08/05/2021
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 known

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

Symptoms: Shot was given on 23rd (Friday), and by the 25th (Sunday), she woke up with a rash that encircled the vaccine point reaching all the around her shoulder area (the vaccine point was clear about a 1/2 inch in diameter). The rash was red, patchy, raised and itchy, and she applied the cream. It felt better and was less raised and less itchy. The rash stayed, but she thought it would resolve. For a couple of days, it stayed red but was less itchy. For 2-3 days, the rash seemed to be getting better, so she stopped applying the cream. Then the rash got re-inflammed, itchy, raised hot, etc about day day 7. So she applied the cream again on day 7 and 8. She stopped, thinking it would resolve, but it began to spread on her bicep area. She came to the pharmacy to show me. I said she should apply hydrocortisone 1% and a cold compress. We filled out this report * will monitor.

Other Meds: Patient has not maintenance meds; patient applied a product containing betamethasone, gentamycin, and clotrimazole and was using daily. She also took aleve the day after her immunization.

Current Illness: Just pain at injection site after getting shot; no other conditions or illnesses noted.

ID: 1528869
Sex: F
Age: 49
State: MT

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

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

Lab Data:

Allergies: Codein

Symptom List: Nausea

Symptoms: 1st sx was pain when inhaling back of lungs, 02 sats 94-98%, elevated BP, feeling SOB when prone

Other Meds: Omeprazole, Lisinopril, Cyclobenzaprine, MVI, Motrin, Zyrtec

Current Illness: Change in BP 4 days prior

ID: 1528870
Sex: F
Age: 33
State: NY

Vax Date: 07/17/2021
Onset Date: 07/21/2021
Rec V Date: 08/05/2021
Hospital:

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

Lab Data:

Allergies: Modal Fabric, strawberries, dust

Symptom List: Injection site pain

Symptoms: Numbness in tops of feet that spread up into calves. Tingling, numbness and burning. Doesn't limit movement. Just caused irritation and worry.

Other Meds:

Current Illness: Allergic reactions to modal fabric

ID: 1528871
Sex: F
Age: 35
State: GA

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

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

Lab Data:

Allergies: eggs

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

Symptoms: Face and throat swelling, sore/tingling throat, skin redness (mostly face, neck and chest). Took 2 Benadryl, face/throat swelling and redness subsided within 8 hours.

Other Meds:

Current Illness:

ID: 1528872
Sex: M
Age: 51
State:

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/05/2021
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: Patient came in feeling nervous and decided to receive his first Pfizer Covid19 shot. The shot was administered with no issues about 15 minutes later when checking on the patient he stated he felt groggy/spacey. I asked him if he has eaten today which he had. He is not diabetic and has been drinking >>1 gallon of water per day for the past month. I asked him if he would allow me to check his blood pressure, he had a pressure of 145/100 and pulse of 145. He stated that is abnormal for him as he has had multiple brain aneurysm and is on medication to keep his pressure and pulse low. I asked him to try to relax for 5 minutes before repeating the test which resulted in a bp of 168/100 and hr of 145 at this point I offered to take him to the ER and he said he is in a condition he is comfortable driving himself.

Other Meds:

Current Illness:

ID: 1528873
Sex: F
Age: 50
State: IL

Vax Date: 01/29/2021
Onset Date: 02/12/2021
Rec V Date: 08/05/2021
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: Seasonal Allergies

Symptom List: Tremor

Symptoms: 2-3 weeks after the vaccination had ringing in head, headache for two weeks, fatigue, did feel like self as in energy level and anxiety. Called GP and saw ENT office ear noise and thought hearing test. Results were okay.

Other Meds: Multi- Vitamin; Calcium; Iron; Vitamin D; Vitamin B

Current Illness: No

Date Died: 01/24/2021

ID: 1528874
Sex: M
Age: 83
State: VA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 08/05/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient went to the medical center for appointment with primary care for blood work and to receive the COVID-19 vaccine. When he returned home with his wife, he started feeling bad. He took a nap and woke up with sweat and chills. Patient's wife attempted to call his PCP and the Medical Center with no success and transported patient to the local Emergency Department. There it was discovered he had a fever and he was admitted for possible urinary tract infection. Overnight, while in his room he became agitated and had a sense of impending doom. Per his wife, he grabbed his chest and turned blue, falling to the bed. A code blue was called and CPR was performed. He was intubated and put on some sedation. He was transferred to the ICU. After a couple days of a poor prognosis he was put on comfort care or hospice. He passed away on January 24, 2021

Other Meds: Dopamine, Atorvastatin, Aspirin, Atenolol

Current Illness: Urinary Tract Infection

ID: 1528875
Sex: F
Age: 18
State: MI

Vax Date: 06/29/2021
Onset Date: 06/30/2021
Rec V Date: 08/05/2021
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: N/A

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

Symptoms: Pt.'s mother states that after receiving the 1st dose of the Phizer 06/29/2021, started experiencing symptoms 06/30/2021 of elevated pulse rate, chills, tiredness, fatigue, and eye lid swelling still continuing. Lymphoids swollen, sore throat, headaches, and still continuing. Primary visit -8/05/2021 diagnosed with EBV, recommendation for rest.

Other Meds: N/A

Current Illness: N/A

ID: 1528876
Sex: F
Age: 46
State: CO

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/05/2021
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: doxycycline hyclate, clyndomycin latex capsule, latex, bee sting, wasp sting, shellfish

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

Symptoms: loss of taste after 10 minutes, headache, nausea, vomiting 2 to 3 hours after injection. Conditions persisted more than 24 hours

Other Meds: fluticasone 50 mcg, buproprion 150 mg, linzess 72 mcg, pantoprazole 40 mg, mesalamine 1.2 gm, lisinopril 20 mg, vitamin d3 5,000 iu, albuterol ,083% 25x3ml, zirtek, aspirin 81 mg, enercy, antacid 750 mg

Current Illness: N/A

ID: 1528877
Sex: M
Age: 38
State: TX

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 08/05/2021
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: On 8/4/21: Patient reported and confirmed never having previously received any COVID-19 vaccine; Pfizer vaccine administered; ImmTrac2 findings show that patient received dose 1 of Moderna vaccine on 02/20/2021.

Other Meds:

Current Illness:

ID: 1528878
Sex: F
Age: 63
State: HI

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 08/05/2021
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, corn,

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

Symptoms: Headache, dizziness, tongue feeling numb for weeks. Following the shot, my thought process was diminished for months.

Other Meds: Synthroid, Duloxatine, Zyrtec daily, 81 mg aspirin

Current Illness: None

ID: 1528879
Sex: M
Age: 16
State: CO

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 08/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Given to patient at age 16

Other Meds:

Current Illness:

Date Died: 08/04/2021

ID: 1528880
Sex: M
Age: 61
State:

Vax Date: 03/01/2021
Onset Date: 08/02/2021
Rec V Date: 08/05/2021
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: Pain in extremity

Symptoms: death I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) J18.9 - Pneumonia due to infectious organism, unspecified laterality, unspecified part of lung

Other Meds:

Current Illness:

ID: 1528881
Sex: F
Age: 44
State: NY

Vax Date: 08/02/2021
Onset Date: 08/04/2021
Rec V Date: 08/05/2021
Hospital:

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

Lab Data:

Allergies: None known

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

Symptoms: After 2nd vaccine shot I had what I read were normal side effects such as soreness and aches, especially on left side of upper body. Then 2 days later I got a bad rash on my back and on my left side that was itchy and kind of painful. It continues?

Other Meds: N/A

Current Illness: None

ID: 1528882
Sex: F
Age: 38
State: MA

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 08/05/2021
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: I have agitation and flu like symptoms to morphine, i get headaches and flu like symptoms from ibuprofen, i have severe chemical allergies to scents like febreeze and bounce (migraines and contact dermatitis)

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

Symptoms: Maybe a half hour after my first moderna shot, i got ringing in my ears, and i wondered if it was from the vaccine, and started to feel very worried, but it went away after maybe an hour. After my second shot, it came back and it is worse and never goes away completely, and it gets worse if i am upset, or of course at night, though sometimes i do not percieve it, it always comes back. It is not like my normal tinnitus, it doesnt sound the same, it is more metalllic sounding , not a single tone like normal tinnitus, it is like a metallic chorus of ringing. and it comes with a sort of light buzzing dizzy feeling. it is very upsetting. Still here after 2 months, i deeply hope it goes away. I checked the none of the above box, but i honestly dont know if this is permanent damage. If it is, as a musician, flute maker, and audio engineer that would be very bad for me.

Other Meds: I take one edible to get to sleep every night, thats it

Current Illness: no

ID: 1528883
Sex: F
Age: 15
State: OH

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/05/2021
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: cefdinir (hives)

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

Symptoms: About 5 minutes after vaccine was administered patient felt dizzy and nauseated and proceeded to vomit. Once an ice pack was applied to back of neck symptoms subsided over the next 5 to 10 minutes and patient returned home.

Other Meds: None

Current Illness: none

ID: 1528884
Sex: F
Age: 17
State: NY

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/05/2021
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: No

Symptom List: Vomiting

Symptoms: Client administered 2nd dose of Moderna at age 17 because 1st dose already given & as per CDC guidance, the 2nd dose can be administered.

Other Meds: Unknown

Current Illness: Unknown

ID: 1528885
Sex: F
Age: 58
State: NH

Vax Date: 03/20/2021
Onset Date: 03/28/2021
Rec V Date: 08/05/2021
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: Gluten (celiac) Nystatin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I have maintained good health since my Sjogrens diagnosis in Feb 2019. I used to take pain/muscle relaxants for the pain but I've been able to control any discomfort via diet and exercise. After the vaccine, the pain came forth with a vengence. The medications did not help. Increased exercise did not help. Fatigue continued to increase over three months. Last week, the pain has finally started to decline and I think I'm getting back to my old self. Still more tired than the norm but the pain has gone. I think the vaccine through my body into a "flare".

Other Meds: Estradiol Levothyroxine Metformin Iron Colace Vitamin C

Current Illness: Sjogrens, Hashimotos, pre-diabetic, celiac

ID: 1528886
Sex: F
Age: 23
State: NY

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 08/05/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Hives all over arms, legs, neck, back, and chest for a couple of hours. The hives started at 9:00 PM, about 4 hours after receiving the vaccine, and were gone when the patient woke up the next morning.

Other Meds: None

Current Illness: None

ID: 1528887
Sex: M
Age: 68
State: TX

Vax Date: 03/12/2021
Onset Date: 08/03/2021
Rec V Date: 08/05/2021
Hospital: Y

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: NO KNOW ALLERGIES

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient in ER w/difficulty breathing and cough. Onset was 08/02/2021. The symptoms are worsening during course. Fever, SOB, dizziness, muscle pain and nausea.

Other Meds: UNKNOWN

Current Illness: NO KNOWN ILLNESSES

ID: 1528888
Sex: F
Age: 17
State: CO

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 08/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Given at 17 years old.

Other Meds:

Current Illness:

Date Died: 08/04/2021

ID: 1528889
Sex: M
Age: 84
State:

Vax Date: 02/27/2021
Onset Date: 07/30/2021
Rec V Date: 08/05/2021
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: death - Multifocal pneumonia

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm