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: 1531871
Sex: M
Age: 30
State: TX

Vax Date: 08/03/2021
Onset Date: 08/04/2021
Rec V Date: 08/06/2021
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: Doxycycline

Symptom List: Dysphagia, Epiglottitis

Symptoms: Cramps in the ribs, diarrhea, watery eyes, nausea, headache, chest pain.

Other Meds: Clanazepam, lexapro

Current Illness: Myofacil release

ID: 1531873
Sex: F
Age: 55
State: CO

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 08/06/2021
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: nka

Symptom List: Anxiety, Dyspnoea

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 37 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531874
Sex: F
Age: 17
State: VA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 08/06/2021
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: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1531875
Sex: M
Age: 25
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531876
Sex: F
Age: 39
State: MS

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 08/06/2021
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: Patient received the second dose of COVID shot and passed out about 5 minutes following administration. Patient regained consciousness within 30 seconds and then felt nauseous. Paramedics were called but patient refused to be taken to ER via ambulance. Checked in with patient's husband that afternoon and he said she was feeling fine.

Other Meds:

Current Illness:

ID: 1531877
Sex: M
Age: 37
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: NKA

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

Symptoms: On internal audit, we discovered a patient received a vaccination held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: Unknown

Current Illness: Unknown

ID: 1531878
Sex: F
Age: 29
State: MN

Vax Date: 07/18/2021
Onset Date: 07/19/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The day after receiving the vaccine I experienced nausea. Following 2 days or so extreme muscle pain at injection site. Roughly 8 days after vaccine I experienced extreme migraines, muscle pain, numbness, etc. I felt like I was having a stroke. Slowly symptoms have gotten better however I still experience muscle pain/weakness. I have not gone to the doctors for these symptoms as they have slowly gotten better however it is concerning that I was completely normal and then following the vaccine I have had all of this muscle pain/weakness/numbness.

Other Meds: N/A

Current Illness: N/A

ID: 1531879
Sex: F
Age: 84
State: CA

Vax Date: 01/23/2021
Onset Date: 03/04/2021
Rec V Date: 08/06/2021
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: Latent RA became active and I have ongoing pain, swelling and hand issues a month or so after second Pfizer shot

Other Meds: none

Current Illness: none

ID: 1531880
Sex: M
Age: 30
State: IA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 08/06/2021
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: the patient received the wrong COVID 19 vaccine. He should have received a 2nd dose of Pfizer but received a Moderna.

Other Meds:

Current Illness:

ID: 1531881
Sex: M
Age: 55
State: AZ

Vax Date: 02/02/2021
Onset Date: 04/12/2021
Rec V Date: 08/06/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: codeine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Around 4/12/2021 I began I started realizing my left leg was throbbing, but I was linking it to my torn hip muscle, my doctor stated it could have been from my back. The pain was unbearable so I went to the ER on 4/30/2021, they did an ultra sound and found that I had a blood clot in my leg which was causing the pain. I was admitted over night at the Hospital and went home on 5/1/2021. I went to my PCP for follow up and again I went for a follow up ultra sound last week and it showed that I still have the blood clot. I was given Eliquis. The pain that was in my leg is gone, but I continue to have swelling and a tingling sensation in my leg.

Other Meds: Multi-vitamin, probiotic

Current Illness: torn hip muscle

ID: 1531882
Sex: F
Age: 17
State: VA

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 08/06/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1531883
Sex: F
Age: 42
State: HI

Vax Date: 05/19/2021
Onset Date: 07/26/2021
Rec V Date: 08/06/2021
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: contracted Covid

Other Meds:

Current Illness:

ID: 1531884
Sex: M
Age:
State: NY

Vax Date: 01/30/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: 90yo M hx COPD, pulmonary fibrosis with chronic hypoxic respiratory failure on O2 4L NC cont, prednisone dep 10mg daily, GERD, OA, HLD, BPH, aortic stenosis,, otherwise active (ambulates without walker, learned to ski at age 65) with previous exposure to COVID19 on 7/7/2021 (son in law also admitted to hospital currently with COVID19), who presented to hospital with fever, cough, sob, diarrhea on 7/19/2021 and had SARSCOV2 nasopharyngeal swab positive at that time but was tolerating his home O2 need at 4L NC and opted to be discharged to home presented back to hospital today (7/24/2021) with worsening shortness of breath and hypoxia into 70s despite 4L NC while at rest occurring last evening. Patient required 12L High flow nasal NC respiratory support. Patient complete a 5 day course of Remdesivir and a 10 day course of Decadron. Patient was able to be discharge a week after admission on his baseline O2 requirements.

Other Meds:

Current Illness:

ID: 1531885
Sex: M
Age: 17
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: nka

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

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531886
Sex: M
Age: 20
State: AR

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/06/2021
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: Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Headache-Medium, Systemic: Visual Changes/Disturbances-Mild, Additional Details: Conciousness regained immediately upon lower extremity elevation. Fell from seated, left temporal contusion. Applied ice, notified EMT/firefighter father. No PCP, directed to nearby Urgent Care, notified urgent care of his arrival. Will follow up further

Other Meds:

Current Illness:

ID: 1531887
Sex: F
Age: 12
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531888
Sex: F
Age: 49
State: TX

Vax Date: 07/26/2021
Onset Date: 07/27/2021
Rec V Date: 08/06/2021
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: Ampecillin

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

Symptoms: Unusual menstrual bleeding, hypersensitivity to sound, significant increase in neuropathy

Other Meds: Multi-vitamin

Current Illness:

ID: 1531889
Sex: M
Age: 74
State: WA

Vax Date: 02/04/2021
Onset Date: 02/09/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: PENICILLIN

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Blisters on hand, Burn blister, felt like skin was on fire.

Other Meds: MULTI VITAMIN

Current Illness: NONE

ID: 1531890
Sex: F
Age: 15
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531891
Sex: F
Age: 32
State: IL

Vax Date: 07/11/2021
Onset Date: 08/06/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: Minocycline - RASH

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

Symptoms: 32 y.o. female with no significant PMH presenting with chest pain, lightheadedness, dyspnea on exertion.. Patient reports that a month ago she started experiencing a headache around the time of her first COVID vaccination (~7/11/21). She then visited her doctor Wednesday 07/28. She was started on fioricet for headache treatment. She got her last dose of the vaccination, Sunday 08/01, and on Monday (8/2/21) started to experience facial numbness, left arm and hand numbness. She went to hospital and was diagnosed with Bell's Palsy and started on prednisone. The next day she started to have chest pain. She described the chest pain as a pressure, as if someone was sitting on her chest, substernal in location without any radiation or alleviating/exacerbating factors. The chest pain persisted over the next two days which prompted her to come to the ER on 8/5/21. In addition to the chest pain she endorses significant lightheadedness. She stated that it happens whenever she gets up to move, example going to the bathroom). No syncopal events. She denies any nausea, vomiting, melena, BRBPR, or hematemesis. She is on her menstrual cycle currently and says that she is not having heavier vaginal bleeding. Also having shortness of breath which is mild at rest but also worsened with exertion. Lastly did started to notice spontaneous bruising on her arms over the past two weeks without clear trauma. Denies fevers, chills, dysuria, urinary urgency, cough, abdominal pain, diarrhea, rashes. She is undergoing diagnosis with a presumptive diagnosis of Microangiopathic hemolytic anemia likely 2/2 to TTP, with PLASMIC score of 6.

Other Meds: Butalbital-acetaminophen- caffeine PRN Ibuprofen PRN Desogestrel-ethinyl estradiol

Current Illness: Trichomonas - Moxifloxacin & Flagyl prescription for 5 days (6/16-20)

ID: 1531892
Sex: F
Age: 12
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: nka

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

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531893
Sex: F
Age: 17
State: IL

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 08/06/2021
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: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1531894
Sex: F
Age: 40
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: nka

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

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531895
Sex: F
Age: 39
State: MI

Vax Date: 08/05/2021
Onset Date: 08/06/2021
Rec V Date: 08/06/2021
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: tramadol, morphine, acetaminophen, azithromycin

Symptom List: Injection site pain, Pain

Symptoms: Patient developed right eye pain and blurred vision. Symptoms improved with dexamethasone 10 mg IV x1. Current working diagnosis is optic neuritis. Follow up with ophthalmologist is planned.

Other Meds: pantoprazole 40 mg po bid, cetirizine 10 mg po daily, Vitamin D3 25 mcg po daily

Current Illness: GERD,

ID: 1531896
Sex: F
Age: 22
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Injection site pain, Menorrhagia

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531897
Sex: F
Age: 17
State: VA

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 08/06/2021
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: Error: Patient Too Young for Vaccine Administered-

Other Meds:

Current Illness:

ID: 1531898
Sex: F
Age: 49
State: FL

Vax Date: 07/30/2021
Onset Date: 08/05/2021
Rec V Date: 08/06/2021
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: RASH UP THE RIGHT KNECK TO THE RIGHT SIDE OF FACE AND MOVING TO THE FOREHEAD. BELIEVED TO BE SHINGLE REACTION.

Other Meds:

Current Illness:

ID: 1531899
Sex: F
Age: 43
State: OH

Vax Date: 05/28/2021
Onset Date: 06/03/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: penicillin, amoxicillin,

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Arrhythmia (uneven heartbeat), chest pressure, chest pain

Other Meds: Metoprolol

Current Illness: N/A

ID: 1531900
Sex: F
Age: 41
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: nka

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

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531901
Sex: F
Age: 16
State: NC

Vax Date: 07/28/2021
Onset Date: 07/31/2021
Rec V Date: 08/06/2021
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: Patient awoke that morning with slurred speech , right side of face drooping, tongue feels tingly, right arm feels heavy. Face felt heavy and when drinking fluid it ran out of her mouth,. Mother took her to Urgent Care and they diagnosed her with Bell's Palsy.

Other Meds: none

Current Illness: none

ID: 1531902
Sex: M
Age: 96
State: NY

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

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: 97-year-old male with a past medical history of CKD 3, PVD, hypertension, diabetes not on medication, CHF, hypertension who is a resident of an assisted living facility. He then felt the room was spinning he returned back to his bed and sat down on the edge of the bed and slid off and fell to the floor and could not get up. He did not hit his head and he did not have any loss of consciousness. Chest x-ray showed no acute abnormality. Found to be COVID + , but did not have any respiratory symptoms. Required 1.5L for a few hours (saturation was 98% so I question if he even needed it). He was given Decadron x 10 days.

Other Meds:

Current Illness:

ID: 1531903
Sex: F
Age: 26
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: On internal audit, we discovered a patient received a vaccination held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: Unknown

Current Illness: Unknown

ID: 1531904
Sex: M
Age: 19
State: MA

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/06/2021
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: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Tinnitus-Mild

Other Meds:

Current Illness:

ID: 1531905
Sex: F
Age: 13
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: nka

Symptom List: Tremor

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531906
Sex: M
Age: 72
State: OH

Vax Date: 03/23/2021
Onset Date: 08/05/2021
Rec V Date: 08/06/2021
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: No known allergies

Symptom List: Erythema, Pruritus

Symptoms: Direct admit from free standing ED for positive COVID test, fatigue, decreased PO intake. SpO2 91% on room air

Other Meds: unknown

Current Illness:

ID: 1531907
Sex: M
Age: 60
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: nka

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

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531908
Sex: F
Age: 39
State: TX

Vax Date: 07/14/2021
Onset Date: 07/16/2021
Rec V Date: 08/06/2021
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: Ongoing insomnia, can only sleep an hour at a time with OTC sleep meds, get jolted to wake up constantly

Other Meds: None

Current Illness: None

ID: 1531909
Sex: F
Age: 42
State: AZ

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/06/2021
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: Patient was inadvertently given Pfizer dose #2 seven day early. Dose #1 was administered 7/16/21 and dose #2 on 7/30/21. Patient waited in observation for the recommended 15 minutes; no adverse events reported.

Other Meds:

Current Illness:

ID: 1531910
Sex: F
Age: 14
State: NY

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/06/2021
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: NKDA

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

Symptoms: 12 y/o presents for covid vaccine(pfizer dose 1) accommanied by 18 y/o brother with verbal consent from parent patient, after receiving the Pfizer injection seemed to be in no apparent distress upon standing from the exam bed she demonstarted no synptoms of dizzinesxs or being light headed in observation area after 15 minutes of receiving the vaccine we noticed she appeared to be sleepiung but when aroused she seemed ome what larthagic and complained of a headache while observing her gait she appeared to be unsteady BP was taken at 124/75 Pulse 85 res 16 lungs were clear bilaterally and denies any respiratory distress no rashes present no flushing or swelling of the face denies pruritus denies swelling of tongue or mouth and no skin rashes noted because she still seemed some what lethargic and unstaedy with her gait EMS was contacted and patient was transported to hospital Mother was called and agreed that patient be screened at ED

Other Meds: Denies

Current Illness: Denies

ID: 1531911
Sex: M
Age: 58
State: AZ

Vax Date: 03/15/2021
Onset Date: 08/05/2021
Rec V Date: 08/06/2021
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: No Known Allergies

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

Symptoms: After being full vaccination with Moderna this patient tested positive for COVID-19 on 8/5/2021.

Other Meds: Unknown

Current Illness: Unknown

ID: 1531912
Sex: F
Age: 13
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Pain in extremity

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531913
Sex: F
Age: 12
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: nka

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

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531915
Sex: M
Age: 51
State: SD

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/06/2021
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: Patient is currently incarcerated at Detention center. patient states he needs a covid shot, he is requesting to get J &J. PHN gave covid-19 vaccine. When PHN went back to her facility to chart she noticed patient already recieved a J&J vaccine on 6/4/2021.

Other Meds: NA

Current Illness: NO

ID: 1531916
Sex: M
Age: 12
State:

Vax Date: 06/16/2021
Onset Date: 07/30/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: U07.1 - COVID-19

Other Meds:

Current Illness:

ID: 1531917
Sex: M
Age: 13
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: nka

Symptom List: Vomiting

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531918
Sex: F
Age: 73
State: AZ

Vax Date: 06/11/2021
Onset Date: 06/16/2021
Rec V Date: 08/06/2021
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: sulfa erythromycin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Huge auto immune response creating severe disabling psoriasis

Other Meds: sertraline 200mg./day; Losartan 100mg/.day;;zinc 50mgday; Omega 3 fish oil 2000mg. /2xday; B12 500mg/ 2x day; C 1000mg/day; D3 5000iu/day; Rainbow light advanced enzyme/2xday; red yeast rice 2400mg/day/ milk thistle extract 150mg/day; cinn

Current Illness: discoid lupus

ID: 1531919
Sex: M
Age: 14
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
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: nka

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

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531920
Sex: M
Age: 52
State: NC

Vax Date: 01/26/2021
Onset Date: 07/11/2021
Rec V Date: 08/06/2021
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: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Two things happened at same time: Gout (never had before); A bad ear infection - that was treated with one kind of antibiotic drop and then it was flushed out and then a different drop with an oral Augmentin - which resolved it pretty much in a week. Not treatment for Gout except Ibuprofen.

Other Meds: Losartan; amlodipine; HCTZ; omeprazole; melatonin; baby aspirin

Current Illness: No

ID: 1531921
Sex: F
Age: 15
State: CO

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/06/2021
Hospital:

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

Lab Data:

Allergies: nka

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

Symptoms: On internal audit, we discovered that a patient received a vaccination that was not expired but was held at refrigeration temperature for 38 days. Appropriate steps were taken to notify the state and are coordinating efforts to notify patients to repeat vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1531922
Sex: M
Age: 76
State: GA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 08/06/2021
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: Penicillin

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

Symptoms: After vaccination I had severe soreness in my arm, going down my arm and up to my shoulder.

Other Meds: Yes, daily medications

Current Illness: No

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm