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: 1529727
Sex: F
Age: 33
State: FL

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

Lab Data:

Allergies: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Approximately 3-4 minutes after vaccination the patient was seated and fainted and fell over. Her husband caught her so she did not hit the ground. She remained unconscious for approximately 3-4 minutes and appeared to be shaking/trembling. 1 dose of epinephrine (0.3mg/ml) was given into lateral left thigh and patient immediately regained consiousness. She exhibited confusion and has no memory of the event. She reported chest pain and severe nausea, without vomiting and extreme thirst. EMS arrived and checked the patient out with no remarkable findings. The patient was still experiencing chest pain and advised to go to the hospital for examination

Other Meds:

Current Illness:

ID: 1529728
Sex: M
Age: 25
State: GA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Immediate syncope: loss of consciousness for ~5 seconds. Consciousness regained but physically weak. After 5 seconds, lost consciousness again, and became unresponsive for several more seconds before regaining consciousness. This repeated for several minutes until he became unresponsive (eyes were open, occasionally moaning, and occasionally shaking with seizure-like motions) for 30 seconds. EMT called at 6-min mark (never arrived). Then consciousness regained, patient A&Ox3 but still weak. Patient's eyebrow was bleeding and reported pain as if struck, so possible head injury during first fainting, though unobserved by RPh who was present. Patient remained alert after this but weak. after ~40 mins, reported paresthesia in left arm, which resolved after 15 mins, but then reported paresthesia in left leg, which again resolved after 20 minutes. Patient refused emergency transport and departed for home at 8pm.

Other Meds: unknown

Current Illness: unknown

ID: 1529729
Sex: M
Age: 16
State: IL

Vax Date: 08/05/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no know allergies

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

Symptoms: Pt had a vasovagal reaction to his first dose of Pfizer covid vaccination. I had administered the dose and patient was waiting in the waiting area. I checked in on him a few minutes later and he stated he was sweating and "just didn't feel too good". He also stated he was having blurred/"seeing spots" vision. I had my tech come with me. I had the patient elevate his legs on another chair, applied a cold pack to his forehead and advised him to close his eyes. The patient's brother went to get his mom at this time. When his mom arrived patient started to feel better, I continued to hold the icepack and asked him to tell me when he felt he no longer needed it. After a few minutes he no longer needed the cold back and was feeling better. I had my technician watch the patient for another 15 minutes and patient's family was advised to help patient up and to walk with him to the car. I will be checking in on patient a little later today.

Other Meds: n/a

Current Illness: unknown

ID: 1529730
Sex: M
Age: 12
State: CA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: NONE

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient developed a stomach ache within a few seconds after administration. After a few seconds more he developed vasovagal syncope. He fell on the floor and had seizure like symptoms that last 5 seconds. Regained full consciousness. he was given water and gatorade and was back to normal within 5 to 10 minutes. Ambulance was called.

Other Meds: NA

Current Illness: NA

ID: 1529731
Sex: F
Age: 64
State: TX

Vax Date: 03/03/2021
Onset Date: 03/20/2021
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: shellfish and walnut allergy

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

Symptoms: ear fullness, ringing in ears, hearing loss

Other Meds: multivitamin

Current Illness: none

ID: 1529732
Sex: F
Age: 33
State:

Vax Date: 08/04/2021
Onset Date: 08/04/2021
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:

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

Symptoms: Breastfeeding newborn (10 days old). Stool was green & mucous-y for 24 hours following vaccine (~3-4 hour delayed onset from vaccine). Baby fussy and irritable when passing stool. Seemingly had more gas.

Other Meds:

Current Illness:

ID: 1529733
Sex: M
Age: 41
State: CO

Vax Date: 04/29/2021
Onset Date: 05/02/2021
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: None known.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 2nd dose administered on Thursday morning the 29th of April. Flu like symptoms felt Friday and Saturday. Recovering slightly on Sunday. Noted a very swollen lymph node on my left collar bone. Lost voice on Monday the 5th and remained hoarse through the week. I monitored the swollen lymph node. Made a clinic appointment when a 2nd node in the same area appeared. Area tender and uncomfortable. Severe fatigue and general "feeling icky." Headaches, body aches, sleeping all night, but not waking up rested. Appointment was on the 17th of May. Doctor agreed to monitor the issue as it was concerning and I was to come back in 3-4 weeks if symptoms did not subside. Was prescribe antibiotic for 10 days. Antibiotic appeared to have no effect. I scheduled another appointment for June 21st as symptoms were getting worse. Provided the following list of symptoms to doctor. Sinus pain/pressure, Ear Pain - sharp, Jaw/joint Pain, puffy swollen face, redness on face increasing, exhaustion - weakness/no strength to walk, headaches, throat stiff, occasional voice loss, full night sleep but waking up tired, swollen lymphnodes/ducts on collarbone AND now showing on jawline, crusty nose, week long cold sores in mouth, constant for 3 weeks, eye pain/twitching, shortness of breath and chest pain, sudden urge to sleep (mid sentence), random join/muscle pain in arms and feet/legs. Bloodwork showed no elevated white bloodcell count, but it did exhibit an elevated fatty liver. Concerned enough, doctor scheduled and Ultrasound. That did not occur until July 7th. Results were negative for anything concerning. As to how I'm still feeling, almost all of the symptoms listed above are all still around and its life changing. I have SHARP nerve pain showing up now. Sleep is tough, inner ears are very painful. Walking is difficult and its a challenge to do anything with family or work. If feels like a constant sinus/ear infection with body pain, but no infection can be found except the swollen nodes. I'm in pain, and all this started a couple days after my 2nd dose.

Other Meds: Daily multi-vitamin, 5000iu D3, 750mg krill oil, Phillips Colon Health Probiotic, occasional B.

Current Illness: none

ID: 1529734
Sex: F
Age: 67
State: CT

Vax Date: 05/15/2021
Onset Date: 05/16/2021
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: none

Symptom List: Pharyngeal swelling

Symptoms: My Rheumatoid Arthritis had been in remission for three years. After the first Pfizer shot I had joint pain all over my body, extreme fatigue. Three months later I am still have joint pain and fatigue.

Other Meds: 25 mg Seroquel, 50 mg Trazadone

Current Illness: Rheumatoid Arthritis

ID: 1529735
Sex: M
Age: 48
State: IA

Vax Date: 08/02/2021
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: NKDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The patient did not have any reactions. I administered the 1st dose of the Pfizer on 8/2/21. I will not administer the 2nd dose as directed by the IRIS representative. The patient receive the Janssen vaccine in May 2021. The patient was wanting MRNA coverage due to the outbreak of the Delta variant. I believe this was a very logical step for the patient to protect himself. I informed my staff that only one pfizer dose is to be given to Janssen patients if this arises again.

Other Meds: Nothing mentioned

Current Illness: Nothing

ID: 1529736
Sex: F
Age: 50
State: CA

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shrimp, Penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Instant tingling down my arm, headache, dizzy, blurred vision. Went home, tingling spread to legs and jaw. In the morning , my left side of body, arms and legs tingling and numb. Chest feels inflamed and hurts to take deep breaths. Indigestion, frequent urination, very thirsty nausea, intense dizziness. Sharp stabbing pains through the day in heart and stomach. Went to ER Was only given steroid inhaler

Other Meds: d3, zinc, C

Current Illness: none

ID: 1529737
Sex: F
Age: 64
State: OH

Vax Date: 07/28/2021
Onset Date: 07/29/2021
Rec V Date: 08/05/2021
Hospital:

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

Lab Data:

Allergies: guaifenesin-codeine, cipro

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

Symptoms: Patient had had poison ivy dermatitis diagnosed 7/19 and treated with prednisone taper. Rash was improving. 7/28 she received her vaccine, and the next day her poison ivy rash dramatically worsened.

Other Meds: prednisone 30 mg daily

Current Illness: poison ivy dermatitis diagnosed 7/19

ID: 1529738
Sex: M
Age: 69
State: IN

Vax Date: 02/06/2021
Onset Date: 04/10/2021
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: Recephan

Symptom List: Rash, Urticaria

Symptoms: Irregular heartbeat that I did not have prior to the vaccination

Other Meds: Ibuprofen

Current Illness: None

ID: 1529739
Sex: M
Age: 39
State: AL

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: none

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

Symptoms: About 5 minutes after administration of the vaccination, patient became nauseated and was coughing a little, and had to lie down. The patient's breathing was fine but he felt mostly nauseated which lasted for at least 30 minutes after he first told the staff he was nauseated. We monitored patient while lying down, got a fan to put on him and after about 5 minutes of lying down, the patient sat back up in chair at immunization table and put a fan at table for him, he asked for water and some crackers which we gave him and he did eat and drink. He texted his wife to come pick him up as we felt it may be unsafe for him to drive his 20 minute commute back home, his wife came approximately 40 - 45 minutes after his initial symptoms and by that time he was much better and walked out of the pharmacy area without assistance.

Other Meds: not available

Current Illness: none

ID: 1529740
Sex: F
Age: 63
State: FL

Vax Date: 03/01/2021
Onset Date: 08/05/2021
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: Developed sudden onset of osteoporosis, may require medication; patient to follow up with healthcare provider

Other Meds: Plaquenil

Current Illness:

ID: 1529741
Sex: F
Age: 56
State: FL

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: LA

Lab Data:

Allergies:

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

Symptoms: 4:00 pm lip numbness and part tone

Other Meds:

Current Illness: Lips numbness and part of the tongue

ID: 1529742
Sex: F
Age: 63
State: NM

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: codeine, etolodac

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

Symptoms: Patient is complaining of nausea and vomiting, not being able to keep food down. fever and chills.

Other Meds: n/a

Current Illness: n/a

ID: 1529743
Sex: F
Age: 28
State: NJ

Vax Date: 08/03/2021
Onset Date: 08/03/2021
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: Patient experienced rapid heart palpitations and difficulty breathing but shortly after she was able to breath. pharmacist called the ambulance , when paramedics came , they checked the patient vitals . her heart beat and blood pressure was slightly high but vitals came down after 15 minutes and when they checked her vitals for the third time. vitals were in normal ranges. patient was asked if she wants to go to the hospital but she refused . paramedics left after patient claimed that she is feeling okay. Minutes after paramedics left patient started to have a rapid heart beat again.so pharmacist called the ambulance for the second time and when they came patient was taking to the hospital.

Other Meds: None

Current Illness: None

ID: 1529744
Sex: F
Age: 12
State: IL

Vax Date: 08/02/2021
Onset Date: 08/02/2021
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: Cefzil

Symptom List: Ear pain, Hypoaesthesia

Symptoms: complained that both of her feet were numb to her ankles. She said that she could not feel when she touched her feet. She also stated it felt like she could not feel the floor when she walked. She said their was no tingling sensation. I looked at both feet and they were natural color, warm to touch and she had strong pulses in both feet. No weekness in either foot or leg. This sensation lasted until Thursday morning.

Other Meds: Zyrtec

Current Illness: None

ID: 1529745
Sex: F
Age: 20
State: TX

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Medication Error: Patient received Pfizer COVID-19 vaccine as second dose in series after receiving Moderna as her first dose. (Moderna 1st dose 6/22/21 date of administration, lot# 017B21A). No adverse event, signs or symptoms noted after vaccination administration.

Other Meds: none

Current Illness: none

ID: 1529746
Sex: F
Age: 11
State: MN

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

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

Lab Data:

Allergies:

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

Symptoms: Parent falsified the consent form to make patient appear older to be edible for vaccine.

Other Meds:

Current Illness:

ID: 1529747
Sex: F
Age: 21
State: GA

Vax Date: 08/05/2021
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: 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: Hives started about 5 minutes after immunization. Gave 50 mg of Benadryl and ice to apply to skin. No progression of symptoms. Stayed in store about 45 minutes total. Said she felt fine and left with person she came with. Said she wanted to take cool shower and he promised to watch for any other symptoms. Phone calls confirmed she is fine.

Other Meds: amlodipine

Current Illness: none

ID: 1529748
Sex: F
Age: 36
State: NY

Vax Date: 07/15/2021
Onset Date: 07/19/2021
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: Bactrim

Symptom List: Unevaluable event

Symptoms: Burning sensation in my chest where it radiates down to the left of my atm

Other Meds: None

Current Illness: None

ID: 1529749
Sex: F
Age: 32
State: FL

Vax Date: 07/31/2021
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: None

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

Symptoms: I have started to feel dizzy frequently and having vertigo. I have to lay down and close my eyes for a little to help. I feel as if I?m looking through glasses and my depth perception is off.

Other Meds: Escitalopram , Levothyroxine

Current Illness: None

ID: 1529750
Sex: M
Age: 61
State: IA

Vax Date: 08/02/2021
Onset Date: 08/05/2021
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: I was notified by the health department that the patient had already received a covid 19 vaccine of a different manufacturer on 4/9/21. The patient told us he had not gotten any type of covid 19 vaccine before. He was given the Janssen vaccine on 4/9/21.

Other Meds:

Current Illness:

ID: 1529751
Sex: F
Age: 36
State: TX

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patent had nausea, vomitting, shortness of breath, and dizziness ,,, adverse events occur a few minutes of getting shot. and adverse reaction lasted for 5 minutes. and after that she was feeling fine. And also patient said that adverse reaction may be due to low blood sugar.

Other Meds:

Current Illness:

ID: 1529752
Sex: M
Age: 31
State: TN

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: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: 6:26 PM. Approximately 5 minutes after receiving vaccine, pt's wife informed me that the pt had "passed out " while I was administering her vaccine. I went to waiting area, pt was conscious, very pale, upright , somewhat disoriented in waiting area chair. Wife stated that pt often faints after blood draws and many other medical procedures. Very shortly, the patient's color and mental status improved significantly. Pt denied any itching ,throat/tongue issues or difficulty breathing . Pt refused offer to call EMS. Pt was given something to drink and advised to sit in the waiting area for a minimum of 30 minutes after injection where he was closely monitored. Checked pt's BP at 1845 and it was 105/73 which pt stated was normal for him. Pt left pharmacy at 1853.

Other Meds: none

Current Illness: none

ID: 1529753
Sex: F
Age: 57
State: FL

Vax Date: 01/05/2021
Onset Date: 01/06/2021
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: latex, lunesta, percocet, pork, walnuts, plums, ambien,lexiscan,

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: inability to be able to walk due to severe pain, swelling on both legs,, inflamation in joins, tingilling on toes and fingers radiating to legs and arms inability to stand due to instability , neck glands inflamation, it required to have epi-pen at my side for 3 days

Other Meds: none

Current Illness: n/a

ID: 1529754
Sex: F
Age: 14
State: NM

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient is 14 years old and should have received the Pfizer vaccine but received the Moderna vaccine

Other Meds:

Current Illness:

ID: 1529755
Sex: F
Age: 67
State: NC

Vax Date: 03/15/2021
Onset Date: 05/06/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: I developed vertigo, with the first serious episode 5/6/2021. I do not know if it is vaccination related or not, but figured I should report to be on the safe side. I had several other serious episodes: 6/7/0221 6/10/2021 7/14/2021 Doing the maneuver under the treatment of a physical therapist has alleviated the dizziness, but I still experience it some three months after the first vertigo episode.

Other Meds: Omeprazole 20mg CBD oil 50mg multivitamin with iron

Current Illness: acid reflux osteoarthritis depression anxiety

ID: 1529756
Sex: M
Age: 12
State: CO

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: RA

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: 17:45/Vaccine administered , 17:50 patient became pale, diaphoretic, collapsed to ground, while being Assisted by medical staff. Vitals Stable: HR99, O2 94%, BP 130/77. Able to follow commands and answer questions. 18:05 Vitals Stable: HR83, O2 98%, BP 100/60 18:15 patient able to stand unassisted, vitals remained stable Walked independently to personal vehicle accompanied by mother.

Other Meds: None

Current Illness: None

ID: 1529757
Sex: F
Age: 59
State: AK

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

Lab Data:

Allergies: None known

Symptom List: Injection site pain

Symptoms: Feverish with chills and sweats. Every joint hurt when standing. Fatigue. Mild headache, deep in my head only. Extreme flu symptoms. Off and on frequent urination.

Other Meds: Hydrocodone 10mg

Current Illness: None

ID: 1529758
Sex: F
Age: 17
State: MD

Vax Date: 06/24/2021
Onset Date: 06/25/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: While screening the patient for the 2nd dose, she told me that she had trouble breathing around midnight the night that the 1st dose was administered. She said she was having anxiety and she thinks it might have been from that. Her father offered to take her to the hospital but she declined. She drank a lot of water and woke up fine the next morning. I deferred the 2nd dose until she consults with a physician. She currently has no PCP.

Other Meds:

Current Illness:

ID: 1529759
Sex: F
Age: 12
State: IN

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Headache, fatigue, chills, light heaednesss

Other Meds:

Current Illness:

ID: 1529760
Sex: F
Age: 17
State: MD

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: eggs

Symptom List: Tremor

Symptoms: Patient presented to clinic and registered as 18 y/o for Janssen vaccine. Patient presented school ID, stated she did not have her drivers license. I scanned ID in chart and verified all demographic information including DOB. Patient stated all information was correct and LPN staff, LPN who was in orientation with FT clinic staff LPN, Another LPN. They were both in the room with me from the start of the visit. Emergency Use Authorization and VAERS V-SAFE Fact Sheet reviewed with patient. Patient denied any questions. Patient reported allergy to eggs. Consulted with pharmacist, Matengy and Janssen Manufacturer hotline to ensure that vaccine does not contain egg products which it does not contain any egg products. This took about 40 mins to do these consultations and research. While I was doing the research the patient kept asking if we can hurry and get the vaccine so she can leave and go to work. LPN's nd I kept reassuring patient that I have to make sure of her safety with getting this vaccine by making sure it does not contain eggs and to be patient. Also, called mom who verified that patient's only allergy is to eggs. Mom said yes she's only allergic to eggs and that patient has done alot of research and she knows all the risks. Discussed with patient the risks of rare blood clots in her age group 18-50 years old. Patient said that she is well aware of the research as her mom is a dentist and all of her family have gotten the Janssen and she wants to get that one as well. She also stated that her PCP told her to come here and get the Janssen vaccine because they don't have it at the office. After all information discuseed LPN gave her the vaccine and LPN wrote the information on the covid vaccination card including her DOB and I sgned it. After getting the vaccine I gave the patient her visit summary and the card. As she was walking out the door to the observation area she looked at the card and said "Can you change this? I was born in 2003." I replied that is what you told us and that is what is in the system and she said I'm sorry it is 2003. So I changed the DOB in the system and it made her 17y/o, not 18. The Janssen vaccine is approved for 18 years and older. I immediately asked the patient to call her mom for me so that I can talk to her. She called mom I informed her that she was registered as 18 y/o and mom said "Oh that's okay. I don't mind that she got the vaccine. As long as she will get something saying she got the vaccine so that she can go to school." I explained to her that the vaccine is not approved for under 18 y/o. She said "I'm ok with that. I won't say anything. You can let whoever know so that if they want to put her in a trial or something I'm ok with that too." I told her I would be writing a safety report and I would let management know. Patient did not experience any adverse effects and left the clinic. LPN witnessed this conversation. I called SPM, who is covering for my manager today. SPM stated to complete a Patient Safety Event and VAERS report. Called collaborating MD Dr. and left a message to call me back.

Other Meds:

Current Illness: no

ID: 1529854
Sex: F
Age: 19
State: OR

Vax Date: 08/03/2021
Onset Date: 08/04/2021
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: cefuroxime

Symptom List: Erythema, Pruritus

Symptoms: 1d after Covid imm, reported fever to 104F at home, vomiting, fatigue, myalgias, 2d after imm presented to walk-in clinic describing above symptoms, ongoing vomiting, temp 99.0, mild tachycardia. Recommended supportive care

Other Meds: doxepin, aviane, levocetirizine, gabapentin, advair, albuterol, tizanidine, sumatriptan

Current Illness: migraines

ID: 1529855
Sex: F
Age: 51
State: FL

Vax Date: 05/01/2021
Onset Date: 07/29/2021
Rec V Date: 08/05/2021
Hospital: Y

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: Aspirin Ibuprofen Penicillin Sulfur Keflex Levaquin Prednisone Lamotrigine Bacitracin Neomycin

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

Symptoms: Pulmonary embolism

Other Meds: Multi vitamin Probiotic Vitamin D Spironolactone Omeprazole Linzess

Current Illness: None

ID: 1529856
Sex: M
Age: 58
State: IL

Vax Date: 04/15/2021
Onset Date: 04/17/2021
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: None

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

Symptoms: Small toes in my left foot remain swollen and numb. The small toes no longer move in the same way as on my right foot. The Metatarsal bones in both feet give me pain during the day and the night. I have tried Epsom Salt soaks and Ice Packs.

Other Meds: Just a Multi Vitamin.

Current Illness: None.

ID: 1529857
Sex: F
Age: 27
State: AL

Vax Date: 07/27/2021
Onset Date: 07/27/2021
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: Within 5 min of receiving vaccine, my blood pressure dropped and I started to black out. I experienced hot sweating and nausea. I threw up. After a few minutes, I began to feel better and regained color in my face. Overall, experience lasted about 5 -10 min. I was able to drive myself home after the fact.

Other Meds: Tylenol

Current Illness: Going through miscarriage

ID: 1529858
Sex: F
Age: 58
State: GA

Vax Date: 07/14/2021
Onset Date: 07/16/2021
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: Bananas and gluten

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

Symptoms: My left elbow, wrist and pinky finger was in extreme pain. My left middle finger swelled up and was painful. I was unable to make a fist for 2-1/2 was. Also my left outer knee was extremely painful and a week later my knee cap. My left ankle swelled and my left toes hurt. I started to form nods on my left pinky and middle finger. I was in such extreme pain I would scream especially at night. A week later my right fingers started to hurt and my right pinky swelled. I felt like I aged 30 years with rheumatoid arthritis. I was hiking 4 miles in the mountains and running upstairs until that shot. I didn?t have health insurance until Aug 1 and finally saw the doctor on Aug 3 and started steroids and pain meds. The steroids and the swelling went down and I FINALLY am starting to feel normal.

Other Meds: Multi-vitamin, fish oil, calcium, vitamin d3

Current Illness: Celiac disease

ID: 1529859
Sex: F
Age: 45
State: MA

Vax Date: 07/19/2021
Onset Date: 07/22/2021
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: None

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

Symptoms: From 72 hr post 1st dose, experienced severe joint pain in elbows and knees and moderate pain/stiffness in neck. Condition has remained steady for 3 weeks since the first dose. Impacting daily routine and work ability. Was informed that any side effects generally fade after 72 hrs but these symptoms have remained persistent. Taking extra strength Tylenol 500mg 2X daily.

Other Meds: None

Current Illness: None

ID: 1529860
Sex: F
Age: 15
State: TX

Vax Date: 07/02/2021
Onset Date: 07/02/2021
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: Unkown

Symptom List: Pain in extremity

Symptoms: Patient advertently received Moderna Vaccine that's not approved in their age group. Patient was counseled at different store to receive 2nd dose.

Other Meds: Unknown

Current Illness: Unknown

ID: 1529861
Sex: F
Age: 29
State: MN

Vax Date: 03/04/2021
Onset Date: 03/10/2021
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: gluten, dairy

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

Symptoms: 6 days after receiving the 1st dose of the Moderna vaccine I noticed a rectangular rash around my injection site. It was very itchy and resolved within 10 days of onset. Upon second dose of the vaccine I experienced a very heavy menstrual cycle a week after vaccination. This was my first post-partum cycle. It was heavy and resulted in hemorrhaging. Since that time I have been treated with tranexamic acid to manage bleeding. I am unsure if this experience is connected to the vaccine.

Other Meds: Calcium, prenatal, magnesium, Metamucil tab

Current Illness: n/a

ID: 1529862
Sex: M
Age: 60
State: MI

Vax Date: 05/20/2021
Onset Date: 07/12/2021
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: None

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

Symptoms: Pain at injection location went away within 1 week after dose 1 and 2. After a couple weeks I noticed elbow joint pain and muscle pain around elbow and motion ability was reduced without pain. This pain has continued to current date (8-5-2021) and at times has extended down arm toward wrist. There is no past history of pain in this area. This is all LH arm. No RH arm conditions. In addition, it seems to have started simultaneously to have a stiff sore neck off and on on the RH side of my neck and upper shoulder area. This seems to come and go. Again, there is no history of recurring pain like this. One more item I have noticed. Both of my knee caps have started randomly popping. This occurs maybe 3 to 5 times a week. There is no history of this being a repeating occurrence either.

Other Meds: Motrin, Tylenol

Current Illness: None

ID: 1529863
Sex: F
Age: 38
State: NV

Vax Date: 07/28/2021
Onset Date: 08/04/2021
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: Allergic to Gardasil vaccine.

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

Symptoms: "Moderna arm rash": hot and swollen red rash at the vaccine site. Fatigue.

Other Meds: Gummi women's multivitamin and iron capsules. Omeprazole 20mg

Current Illness: None.

ID: 1529864
Sex: M
Age: 34
State: AZ

Vax Date: 05/19/2021
Onset Date: 07/20/2021
Rec V Date: 08/05/2021
Hospital: Y

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: Tuesday July 20 I had a severe headache and loss of vision in my right eye. I thought it was a migraine. The two days that followed my headached got better but I still didn't feel right. On Friday the right side of my body started going numb. I went to the ER where they did a CT scan and an EKG. CT scan showed I had a stroke. They transferred me to another hospital where they did a MRI to confirm the stroke and did an echocardiogram to check my heart. Everything with my heart checked out perfectly fine, my blood pressure was good. They could find no reason for me to have a stroke at 34.

Other Meds: None

Current Illness: NOne

ID: 1529865
Sex: F
Age: 20
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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: no

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: patient with history of fainting during vaccine started passing out a few minutes after the shot and had jerk like/seizure like movements. pt eventually woke up and was fine. did not need to call 911

Other Meds: unknown

Current Illness: none stated

ID: 1529866
Sex: F
Age: 44
State:

Vax Date: 08/03/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Left supraclavicular swelling and left neck swelling with a lump. Tender to palpation, red, hot. Started one day after vaccination was given.

Other Meds: None

Current Illness: None

ID: 1529867
Sex: F
Age: 52
State: IA

Vax Date: 03/10/2021
Onset Date: 03/13/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Multiple DVT blood clots in leg above and below knee

Other Meds: Levothyroxine Colestipol Verapamil Fish oil Calcium Multi vitamin

Current Illness:

Date Died: 02/20/2021

ID: 1529868
Sex: U
Age: 63
State: MP

Vax Date: 02/15/2021
Onset Date: 02/18/2021
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: SUDDEN CARDIAC DEATH

Other Meds:

Current Illness:

ID: 1529869
Sex: F
Age: 65
State: IN

Vax Date: 07/22/2021
Onset Date: 07/23/2021
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: RA

Lab Data:

Allergies: Keflex, VASOTEC, PENICILLIN,NSAID

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

Symptoms: INJECTION SITE TENDER

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm