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: 1536062
Sex: M
Age: 38
State: MI

Vax Date: 01/07/2021
Onset Date: 01/19/2021
Rec V Date: 08/09/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pancreatitis Severely high triglycerides

Other Meds: None

Current Illness:

ID: 1536063
Sex: F
Age: 47
State: WI

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

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccine was drawn up in syringe on Friday 8/6, but administered Monday 8/9. No adverse outcomes at this time. Awaiting manufacturer's guidance on if need to repeat dose.

Other Meds:

Current Illness:

ID: 1536064
Sex: F
Age: 36
State: AR

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/09/2021
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: Pertusses vaccine Morphine Sulpha Dawn dish detergent

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

Symptoms: 11 by 8 centimeter red whelp at injection site, fever, chills, burning sensation in skin, body aches, severe headache consistently since the vaccination

Other Meds: Zyrtec Flonase

Current Illness: None

ID: 1536065
Sex: F
Age: 29
State:

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: R-sided arm and leg numbness and tingling for 1 week

Other Meds: N/A

Current Illness: N/A

ID: 1536066
Sex: M
Age: 62
State: MT

Vax Date: 03/25/2021
Onset Date: 08/02/2021
Rec V Date: 08/09/2021
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: niacin, bee venom, adhesive

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

Symptoms: Covid infection after vaccination

Other Meds: asa, vit d, gabapentin, lisinopril, metformin, multi-vit, Fibercon, Crestor, hytrin

Current Illness:

ID: 1536067
Sex: F
Age: 50
State: OR

Vax Date: 08/04/2021
Onset Date: 08/04/2021
Rec V Date: 08/09/2021
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: Per Alert, patient already recieved 2 Pfizer vaccines/doses. First dose on 12/23/20, second dose on 1/15/21 and on 8/04/21 she received a 3rd dose.

Other Meds:

Current Illness:

ID: 1536068
Sex: F
Age: 30
State: CA

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/09/2021
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: Body aches, back aches, join pain beginning 9 hours after shot. Severe chills, nausea, vomiting. Migraine and fever.

Other Meds:

Current Illness:

ID: 1536069
Sex: F
Age: 51
State: OR

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: Shellfish

Symptom List: Pharyngeal swelling

Symptoms: Early in then, I developed a horrible migraine and then experienced uncontrollable vomiting. I couldn't keep anything down, even water, and became dehydrated. I was stranded due to a massive ice storm so I spoke to my healthcare professional by phone, we decided to wait until the 48-hour mark, and then if my symptoms were not improved, I would head to the ER for fluids. Please note, due to other circumstances, I have never had another vaccine other than the tetanus shot.

Other Meds: None

Current Illness: None

ID: 1536070
Sex: M
Age: 61
State: WI

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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 drawn up in syringe on Friday 8/6, but administered Monday 8/9. No adverse outcomes at this time. Awaiting manufacturer's guidance on if need to repeat dose.

Other Meds:

Current Illness:

ID: 1536071
Sex: M
Age: 12
State: GA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 08/09/2021
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's father filled out paperwork with incorrect date of birth of June 23, 2009 to make him eligible to receive the vaccine. When they came in for second dose and we were searching for GRITS to see the first dose we realized this and when questioned about it the father admitted what he'd done. So patient received first COVID vaccine at age 11.

Other Meds:

Current Illness:

ID: 1536072
Sex: M
Age: 11
State: CA

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 08/09/2021
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: Vaccine given to outside of recommended age. Patient was age 11 at time of vaccination. No adverse events

Other Meds:

Current Illness:

ID: 1536073
Sex: F
Age: 58
State: GA

Vax Date: 03/26/2021
Onset Date: 07/24/2021
Rec V Date: 08/09/2021
Hospital: Y

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: Patient hospitalized due to COVID-19. Patient is fully vaccinated. On supplemental O2, Rocephin, azithromycin, Decadron, Remdesivir, Lovenox

Other Meds:

Current Illness:

ID: 1536074
Sex: M
Age: 66
State: CA

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: Seasonal allergies

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

Symptoms: Eight hours after my vaccine I experienced a left sore arm. Then few days later I started with a fever, muscle aches, headaches, runny nose, muscle pain, anorexia, nausea, vomiting, diarrhea, cough congestion, head congestion which lasted few weeks. I was seen at clinic and I do not recall the name of doctor I saw. I have no symptoms today.

Other Meds: None

Current Illness: None

ID: 1536075
Sex: F
Age: 58
State: CO

Vax Date: 04/26/2021
Onset Date: 05/03/2021
Rec V Date: 08/09/2021
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: no

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

Symptoms: next day had flu like symptoms a few days later starting getting a red irritation on her face which had started slowly spreading also it burn and itches

Other Meds: vit a, fish oil

Current Illness: no

ID: 1536076
Sex: F
Age: 33
State: GA

Vax Date: 07/27/2021
Onset Date: 08/04/2021
Rec V Date: 08/09/2021
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: Cefdinir

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

Symptoms: Dull pain and slight swelling at the injection site. Red, itchy, circular rash around the injection site approximately 13 days post injection.

Other Meds:

Current Illness:

Date Died: 08/06/2021

ID: 1536077
Sex: F
Age: 58
State: TN

Vax Date: 03/01/2021
Onset Date: 08/02/2021
Rec V Date: 08/09/2021
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: iodinated radiocontrast dyes

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

Symptoms: death

Other Meds: Benzonatate 200 mg TID for cough, furosemide 20 mg q day, glipizide 5 mg BID, metformin1000 mg BID, pantoprazole 40 mg q day, spirinolactone 50 mg q day

Current Illness:

ID: 1536078
Sex: M
Age: 76
State: KY

Vax Date: 02/25/2021
Onset Date: 06/14/2021
Rec V Date: 08/09/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Approximately 2 months after having vaccination my father started having episodes of weakness and fatigue which he never had before, but he blamed on ?low blood sugar?. These episodes culminated at the local park where he was walking his dog when he became weak and unsteady and began slurring his speech. He got home and returned to base line that night, but the next morning woke up very confused, unable to effectively use phone to contact me, depth perception and coordination issues and fait and balance dysfunction. He was taken to medical crnter ER where he was found to have had a stroke and was in afib with RVR which the doctors had significant difficulty getting under control, returning multiple times over course of 6 day hospital stay. He had diagnosis of afib, but had never had any issues once placed on beta blocker and aspirin treatment 7 years prior with f/u with his cardiologist just before vaccination initiated.

Other Meds: Sotalol ASA 81 mg

Current Illness:

ID: 1536079
Sex: M
Age: 71
State: MI

Vax Date: 02/12/2021
Onset Date: 08/02/2021
Rec V Date: 08/09/2021
Hospital: Y

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

Lab Data:

Allergies: None Known

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient presented to emergency department on 8/3/2021 following a syncopal episode at home. He was experiencing shortness of breath for approximately 1 week and was found to be COVID-19 positive on 8/2/2021 prior to his presentation. During admission, he was asymptomatic for COVID-19 and was not treated for infection. He was discharged on 8/5/2021.

Other Meds: atorvastatin (LIPITOR) 80 MG tablet carbamide peroxide (DEBROX) 6.5 % otic solution furosemide (LASIX) 40 MG tablet lisinopril (PRINIVIL) 5 MG tablet metoprolol tartrate (LOPRESSOR) 50 MG tablet venlafaxine (EFFEXOR XR) 75 MG XR capsule war

Current Illness: None known

ID: 1536080
Sex: M
Age: 59
State:

Vax Date: 07/27/2021
Onset Date: 07/27/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: moldic

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I am having a hard time breathing, everything smells and taste funny. And having a hard time catching my breath. Also I am really weak feeling, I feel very nauseous and cant throw up

Other Meds: yes his normal medication

Current Illness: no

ID: 1536081
Sex: M
Age: 48
State: WI

Vax Date: 07/28/2021
Onset Date:
Rec V Date: 08/09/2021
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: Client presented to Health Department for a Pfizer COVID-19 vaccine - client documented he had not received a prior COVID-19 vaccine on the consent form. Pfizer vaccine was provided. While documenting the vaccination into the writer found documentation that client had received a Janssen COVID-19 vaccine (Lot 0434A21A) on 4/7/21 at the Pharmacy. Pharmacy contacted and verified client had received the Janssen vaccine 4/7/21. Client did not respond to voice messages left. Letter sent to his address.+ No negative outcome reported by client.

Other Meds:

Current Illness:

ID: 1536082
Sex: M
Age: 27
State: CO

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/09/2021
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: No known/reported

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

Symptoms: Patient has history of anxiety and panic attacks. He was very nervous to get the vaccine and debated for about 15 minutes in clinic whether to get it that day or not. He agreed to get it, he felt fine prior to and during the vaccination process. He walked from the clinic room to the waiting room after the immunization was given and within a minute he came back into the clinic and said his chest felt tight/burning, his throat was burning, felt light headed, dry heaving. We did his vitals which were stable and within normal limits except BP was 160s/80s, his O2 was within normal limits. Provider asked if he wanted to be evaluated by EMS and he said yes, called 911. EMS did EKG that was negative. After about 30-45 minutes patient felt better. EMS did a driving test on patient to make sure he was safe to drive home. Patient independently walked out of clinic. No medications were given.

Other Meds: Anti anxiety medications

Current Illness: none

ID: 1536083
Sex: F
Age: 51
State: AR

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

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

Lab Data:

Allergies: Sulfa

Symptom List: Unevaluable event

Symptoms: Vaccine #2 Thursday Aug 5th, 3:10pm Friday August 6th: Fever 100.5, chills, aches, headache, fatigue. Sunday August 8th, 2:30om: Sudden onset dizziness/lightheadedness, weakness in extremities. Feeling like I'm going to pass out off and on for the rest of the day. Monday August 8th: slight feeling of dizziness/lightheadedness, not as severe as Sunday, but still feel off.

Other Meds: D3 5000IU B12 1000mcg

Current Illness: None

ID: 1536084
Sex: M
Age: 60
State: AR

Vax Date: 07/26/2021
Onset Date: 08/03/2021
Rec V Date: 08/09/2021
Hospital: Y

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Hopsitalization--patient now fully vaccinated with Janssen

Other Meds: unknown

Current Illness: unknown

ID: 1536085
Sex: F
Age: 69
State: OK

Vax Date: 12/31/2020
Onset Date: 01/15/2021
Rec V Date: 08/09/2021
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: Clindamycin

Symptom List: Injection site pain, Pain

Symptoms: Sudden onset of shortness of breath While going for my daily 2 mile walk I experienced SOB that required me to stop and rest several times, This is still occurring to this date. I have had an ablation, lung scans and xrays with nothing found. No respiratory relief post ablation. I wondered if it could be related to the vaccine.

Other Meds: Eloquis, Metoporal/ Pravastin, Levothyroxine, Prilosec, Zinc

Current Illness: None

ID: 1536086
Sex: M
Age: 62
State: NY

Vax Date: 03/24/2021
Onset Date: 07/27/2021
Rec V Date: 08/09/2021
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: hospitalized with covid19 pneumonia

Other Meds:

Current Illness:

ID: 1536087
Sex: F
Age: 60
State:

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 08/09/2021
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: dose given 7 days past BUD for refrigerated Moderna vaccine.

Other Meds:

Current Illness:

ID: 1536088
Sex: F
Age: 17
State: FL

Vax Date: 07/02/2021
Onset Date: 07/04/2021
Rec V Date: 08/09/2021
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: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Watery/Loose stools since first vaccine on 7/2/2021. Two water stools daily.

Other Meds: N/A

Current Illness: N/A

ID: 1536089
Sex: F
Age: 47
State:

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: None.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Knot on arm is turning black at injection site, night sweats, nauseous, throat closed- could not breathe, weak, chills, vomiting, fainted.

Other Meds: None.

Current Illness:

ID: 1536090
Sex: F
Age: 62
State: CO

Vax Date: 03/08/2021
Onset Date: 04/22/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Occasional phantom cigarette smell

Other Meds: Calcium Vitamin D3 Levothyroxine Pravastatin Multivitamin

Current Illness: None

ID: 1536091
Sex: M
Age: 51
State: TX

Vax Date: 03/25/2021
Onset Date: 03/28/2021
Rec V Date: 08/09/2021
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: Most concerning was the Shortness of Breath, lasting 5 days. Also cough, runny nose, congestion, post nasal drip, but no fever.

Other Meds: Tamsulosin HCL

Current Illness: none

ID: 1536092
Sex: F
Age: 42
State: KY

Vax Date: 07/30/2021
Onset Date: 08/03/2021
Rec V Date: 08/09/2021
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: Injection site pain

Symptoms: Four days after the shot, I woke up with a burning sensation under my eye with some redness. The next day I woke up and it was very red. The third day I work up with some minor swelling and tiny blisters. The following day my under eye was swollen, very red, and irritated. The blisters were crusty but not scabbed. I went to Urgent care and the provider there thought it was Shingles but wasn?t sure. Directed me to the ER because they have an Ophthalmologist on staff. The ER doctor confirmed it was shingles and it had not spread to my eye. The doctor also thought I had a skin infection also and that was causing the swelling. I was sent home with antiviral medication and also and antibiotic.

Other Meds: Metoprolol 50mg, Vitamin B complex, Vitamin D

Current Illness: None

ID: 1536093
Sex: F
Age: 51
State: CA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: Oral steroids

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

Symptoms: Pins and needles sensations, numbness in back of legs and face, swollen face, vomiting, lasted around 3 weeks, broke in hives in the back of the leg, pin needles in arm left hand

Other Meds: None

Current Illness: Osteoporosis; COPD

ID: 1536094
Sex: F
Age: 14
State: KY

Vax Date: 08/05/2021
Onset Date: 08/06/2021
Rec V Date: 08/09/2021
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: NKDA

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

Symptoms: My daughter has developed pain that starts in her neck and goes to her right chest when she breathes deeply or swallows. It has not improved after 4 days post vaccine.

Other Meds: None

Current Illness: None

ID: 1536095
Sex: F
Age: 18
State: OH

Vax Date: 01/14/2021
Onset Date: 03/01/2021
Rec V Date: 08/09/2021
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: Milk/dairy

Symptom List: Tremor

Symptoms: Moderna COVID?19 Vaccine EUA

Other Meds: NA

Current Illness: NA

ID: 1536096
Sex: M
Age: 59
State: CA

Vax Date: 04/06/2021
Onset Date: 07/14/2021
Rec V Date: 08/09/2021
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: None known

Symptom List: Erythema, Pruritus

Symptoms: Multi-lobe pulmonary embolism. Only symptom was shortness of breath doing household chores. I had a nearly identical event nine years prior. Reported to ER. CT scan with contrast confirmed diagnosis. Started on Eliquis anticoagulation. Ultrasound of legs showed non-occlusive clot in posterior tibial vein in right calf. Stayed overnight in hospital. Released the next day. This event is likely not related to the Covid vaccine, but I reported this to V-Safe, and they called back and asked me to fill out this form.

Other Meds: Lexapro, Nexium, simvastatin, multivitamin, fish oil

Current Illness: No

ID: 1536097
Sex: F
Age: 27
State: FL

Vax Date: 06/21/2021
Onset Date: 08/04/2021
Rec V Date: 08/09/2021
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: I received vaccine on 6/21. I got my period right before July 4th. It is now August 9th and I have not gotten my period for August. My period is never late and I took a pregnancy test and am not pregnant.

Other Meds: N/a

Current Illness: n/a

ID: 1536098
Sex: M
Age: 20
State: CA

Vax Date: 01/27/2021
Onset Date: 03/20/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: I experienced extreme pain in my left arm 03/20/2010 and could not lift it (spanned a period of 10-days and still comes and goes randomly). I went to the ER and the doctor explained that possibly the clinician struck a nerve while administering the 2nd dose of the vaccine. I was asked a series of questions and directed to move my arms in different directions so they could properly diagnose me. Once I left the ER and arrived home the pain was gone.

Other Meds: No

Current Illness: No

ID: 1536099
Sex: F
Age: 29
State: MO

Vax Date: 08/04/2021
Onset Date: 08/05/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Myalgias day after vaccine- mostly resolved but ongoing neck pain and headaches. NO visual or neurologic symptoms. Taking aspirin products.

Other Meds: none

Current Illness: none

ID: 1536100
Sex: F
Age: 36
State: WI

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/09/2021
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: N/A

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

Symptoms: Sore arm; headache; interrupted sleep; exhaustion; brain fog.

Other Meds: Multivitamin

Current Illness: N/A

ID: 1536101
Sex: F
Age: 84
State: AR

Vax Date: 03/08/2021
Onset Date: 08/06/2021
Rec V Date: 08/09/2021
Hospital: Y

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Hospitalization with covid after being fully vaccinated

Other Meds: unknown

Current Illness: unknown

ID: 1536103
Sex: F
Age: 19
State:

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Dose given 7 days past BUD for refrigerated Moderna vaccine.

Other Meds:

Current Illness:

ID: 1536104
Sex: M
Age: 79
State:

Vax Date: 03/03/2021
Onset Date: 08/06/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Covid + and diagnosed on 8/6/21

Other Meds:

Current Illness:

ID: 1536105
Sex: F
Age: 55
State: NJ

Vax Date: 01/25/2021
Onset Date: 02/01/2021
Rec V Date: 08/09/2021
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: iodine

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

Symptoms: about a week later at night- slight ringing in my ears, my doctor E and T specialist - hearing test. Its now worst. bad chills started 3 weeks after the vaccine. it lasted 36 hrs.

Other Meds: none

Current Illness: no

ID: 1536106
Sex: F
Age: 36
State: TX

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

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

Lab Data:

Allergies: None

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

Symptoms: Fever, headache, ache , whole busy heard. Generalized lymph node on left side of my neck

Other Meds: Allergies

Current Illness: None

ID: 1536107
Sex: F
Age: 71
State: AL

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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: Latex ,Sulfur ,lidocaine ,Iron injections

Symptom List: Vomiting

Symptoms: 10 minutes after moderna vaccine IM injection in left deltoid Pt has SOB with tachycardia of 150 and BP 181/125. Given 50 mg Benadryl, and 60 mg solumedrol and transported via EMS to ER. No hives, no wheezes, no angioedema.

Other Meds: atenolol 25mg

Current Illness: Breast CA right breast

ID: 1536108
Sex: M
Age: 13
State: TX

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Client had dizziness and light headed became clamy, Was laid on cot for 30 min with blood pressure checked.

Other Meds: one

Current Illness: None

ID: 1536109
Sex: F
Age: 44
State: CA

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/09/2021
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: Amoxicillin, sulfa, tetracycline, methyldopa, fentanyl, several severe outdoor and food allergies.

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

Symptoms: 8/6/2021: 1400 - excessive sleepiness, general malaise, and dry mouth 1800 - severe headache, chills, fever above 100, muscle soreness, and skin tenderness 2230 - severe headache worsened as did chills and fever and I became nauseous, all other symptoms remain from start 8/7/2021: 0100 - symptoms remained the same and caused wakefulness due to extreme discomfort 0530 - 2145 all symptoms listed above remain and I'm too weak to get out of bed. Fever also worsened throughout the day, reaching 103.6. Nausea is so severe that I am unable to eat or drink anything. 2230 - I tried to eat something and discovered that I lost my sense of taste. All other symptoms remain as well. Fever down to 100.2 8/8/2021: 0615 - 2200 - Severe headache, severe nausea remain. No fever since 0130. New symptom of vertigo. It's not just dizziness. The house appears to be sideways and my equilibrium is off. If I remain still while lying down than symptoms ease. 8/9/2021: 0545 - Vertigo remains and it appears as though other symptoms have subsided.

Other Meds: none

Current Illness: none

ID: 1536110
Sex: M
Age: 22
State: PA

Vax Date: 04/28/2021
Onset Date: 06/15/2021
Rec V Date: 08/09/2021
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: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: The adverse event was a sore throat that hurt when swallowing, I got swabbed for covid and bacterial infection so my PCD thought it was a viral infection but wasn't sure what. it lasted for about five days and that was it. I took ibuprofen and then it just went away after a few days on it's own. I had went to the doctor on June 18, 2021.

Other Meds: Daily Vitamin D

Current Illness: N/A

ID: 1536111
Sex: M
Age: 20
State:

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 08/09/2021
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: Dose given 7 days after BUD for refrigerated Moderna vaccine

Other Meds:

Current Illness:

ID: 1536112
Sex: F
Age: 50
State: VA

Vax Date: 01/04/2021
Onset Date: 01/18/2021
Rec V Date: 08/09/2021
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: Mobic- hives Mefloquin- intolerance due to psych side effects

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

Symptoms: Weeks after noted muscle tenderness. Have sore/tender places to touch all over my body. No better and no worse since noting these. No joint involvement. I don't feel the pain until the spot is touched and then the pain is much more than the touch that triggered it and it will slowly resolve over time. Tried scheduled Tylenol without help. Can't take consistent NSAIDS due to causing stomach pains. Have had steroid shots, due to other issue, in my shoulder and the steroid didn't help.

Other Meds: Toprol XL, Lexapro, Magnesium oxide, Zyrtec

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm