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: 1540519
Sex: M
Age: 74
State: FL

Vax Date: 07/30/2021
Onset Date: 07/31/2021
Rec V Date: 08/10/2021
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: No Known Allergens

Symptom List: Dysphagia, Epiglottitis

Symptoms: Loss of the ability to walk, could not control bowel or bladder function. Upper extremities worked and lower extremities did not work for 2 hours the day following vaccination. Took Tylenol for fever also following day.

Other Meds: Vit D Zinc MVI Eliquis 5mg BID Provastatin 40mg QD Gabapentin 100mg BID Losartan 150mg QD

Current Illness: None

ID: 1540520
Sex: F
Age: 60
State:

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/10/2021
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: Janssen vaccine administered at 10:15 AM. Patient complained of heavy tongue and "feeling funning back of the throat" after a minute or two of the vaccine. On or about 5 minutes after, patient continued to complain of heavy tongue and back of throat dry and "getting worse". Nurse Stat called then transferred to ED. Speech became slurred and had a fearful disposition stating her throat was getting worse. She also complained of feeling itchy.

Other Meds:

Current Illness:

ID: 1540521
Sex: M
Age: 54
State: VA

Vax Date: 07/19/2021
Onset Date: 07/21/2021
Rec V Date: 08/10/2021
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: NKDA

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

Symptoms: Patient arrived for second Pfizer dose on 8/9/21 and reported that he had experienced a rash following his first shot. Patient stated that the rash began "about a week after the vaccination" on his right arm near the injection site. He further stated that it looked like "mosquito bites' that were close together and red. He only experienced the rash on that arm. Patient stated that it resolved within 2-3 days after putting "a cream like Neosporin" on it.

Other Meds: Unknown

Current Illness: None listed

ID: 1540522
Sex: F
Age: 43
State: MN

Vax Date: 08/05/2021
Onset Date: 08/06/2021
Rec V Date: 08/10/2021
Hospital:

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

Lab Data:

Allergies: Pork and Latex

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 8/6: Fever of 101, Difficulty walking and holding head up. Severe muscle aches and pains. Muscles felt on fire with pain at times. Couldn't hold things in my hands like water to drink. Heart palpitations with feelings of dizziness lightheaded and feeling as if I was going to pass out, SOB. Took Tylenol and Ibuprofen rotation with water and broth. 8/7: Fever 100 Continued Tylenol and Ibuprofen with water. Same heart palpitations with SOB and muscle aches slightly improved, could walk without assitance. 8/8: No longer fever continued muscle aches and left arm markedly more swollen and weak than right. Heart palpitations with same feelings as above slightly less often 8/9: Migraine, muscle aches and Heart Palpitations no medications taken Will be contacting provider today to see if she wants me to do anything about the heart palpitations.

Other Meds: Wellbutrin, Liquid Vitamin B Complex, Hair, skin and Nails vitamin and a Calcium Chew

Current Illness: None

ID: 1540523
Sex: F
Age: 40
State: SD

Vax Date: 01/09/2021
Onset Date: 08/06/2021
Rec V Date: 08/10/2021
Hospital:

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

Lab Data:

Allergies: morphine, adhesives, chlorhexidine gluconate

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

Symptoms: 12/19/20 Pfizer covid vaccine 1/9/21 Pfizer covid vaccine 8/6/21 ill 8/8/21 + Covid PCR 8/17/21 potential to return to work

Other Meds: zinc, multi vitamin, Quercetin

Current Illness: no

ID: 1540524
Sex: F
Age: 39
State: WI

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/10/2021
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: Levofloxacin - Hives

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

Symptoms: Patient reported to PCP's office that within first 15 minutes she had bumps, redness and itching that occurred on her neck. Within the next couple of hours, she reported Numbness tingling of lips and tongue. Lips were swollen. No shortness of breath. Arm soreness next day. All other symptoms had resolved.

Other Meds: Calcium Aspartate 75 MG TABS 2 times daily. loratadine (CLARITIN) 10 MG tablet as needed. medroxyPROGESTERone (PROVERA) 10 MG tablet Take 1 tab daily for 10 days naproxen sodium (ANAPROX) 220 MG tablet Take 220 mg by mouth daily as needed.

Current Illness: None

ID: 1540525
Sex: F
Age: 38
State: VA

Vax Date: 08/07/2021
Onset Date: 08/09/2021
Rec V Date: 08/10/2021
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: minocycline ? pertussis

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Rash onset 56 hours post vaccination administration

Other Meds: none

Current Illness: none

ID: 1540526
Sex: F
Age: 55
State: WI

Vax Date: 01/15/2021
Onset Date: 05/01/2021
Rec V Date: 08/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Had COVID 19 08/2020. Symptoms were sinus congestion and post nasal drainage. Sense of smell and taste was only dulled. Following the vaccine- my sense of smell was gone and the tinnitus is constant in a waxing and waning intensity. Just this past month my sense of smell gives me brief light smells, then gone again.

Other Meds: lisinopril, metoprolol, Strattera, HCTZ, Crestor, famotidine, ASA, black cohosh,

Current Illness: Had COVID 19 08/2020. Symptoms were sinus congestion and post nasal drainage. Sense of smell and taste was only dulled. Following the vaccine- my sense of smell was gone and the tinnitus is constant in a waxing and waning intensity. Just this past month my sense of smell gives me brief light smells, then gone again.

ID: 1540527
Sex: M
Age: 60
State: VA

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/10/2021
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: There was no adverse reaction. Patient received the J&J vaccine on 03/20/21. On 08/05/21, he received Pfizer.

Other Meds:

Current Illness:

ID: 1540528
Sex: M
Age: 13
State: VA

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/10/2021
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: NONE

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient fainted in the waiting area approximately 5-10 minutes after administration. Did not lose consciousness. Patient did not sit in the chair in waiting room and mother reported that he had not eaten today.

Other Meds: NONE

Current Illness: NONE

ID: 1540529
Sex: M
Age: 36
State: NY

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

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

Lab Data:

Allergies: None

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

Symptoms: The arm was swollen for 2 full days, rapid heartbeat during the first night, body temperature up to 37.4 for 2 days, fatigue for 7 days, allergic reaction on the second day, headache for 3 days, a red rash appeared on the face on the second day (probably vasculitis), getting tired quickly.

Other Meds: Vitamin D, B

Current Illness: None

ID: 1540530
Sex: M
Age: 45
State: CA

Vax Date: 05/04/2021
Onset Date: 05/10/2021
Rec V Date: 08/10/2021
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: Vitiligo, white spots on hands, elbows, knees, wrist, and face.

Other Meds:

Current Illness:

ID: 1540531
Sex: M
Age: 46
State: TX

Vax Date: 05/31/2021
Onset Date: 06/01/2021
Rec V Date: 08/10/2021
Hospital:

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

Lab Data:

Allergies: Seafood

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

Symptoms: Sore shoulder for two days

Other Meds:

Current Illness:

ID: 1540532
Sex: F
Age: 40
State: NY

Vax Date: 02/02/2021
Onset Date: 04/01/2021
Rec V Date: 08/10/2021
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: On April 1, 2021 started to get a pain where her injection shot is and the pain went from her upper arm to her fingers. Left arm was weak and she couldn't move it was very swollen. Left arm is very numb all the time and it's painful for her to move it. In May went to the hospital and they gave her pain medicine naproxen and methocarbamol.

Other Meds: None

Current Illness:

ID: 1540533
Sex: F
Age: 63
State: NC

Vax Date: 02/05/2021
Onset Date: 02/08/2021
Rec V Date: 08/10/2021
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: I do not have any allergies.

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

Symptoms: Within a few days of receiving my injection, I started having pain under my left rib. I have to move very carefully because of the pain. I went to the health clinic and had a urinalysis. I was told that my amylase levels were high (pancreas). I was given a prescription for my UTI. The doctor told me to go see my PCP. I saw a resident at my PCP's office. The resident checked my amylase levels and they were a bit higher. He performed an x-ray and could not see anything wrong with my ribs. I am still experiencing the pain when I move a certain way, but no one knows what the pain is.

Other Meds: I was not taking any medications.

Current Illness: I was not experiencing any illness prior to vaccination.

ID: 1540534
Sex: M
Age: 14
State: NC

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/10/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Pt received vaccine and 13 minutes after began having seizure and fell to floor. Vitals were taken and ambulance called for transport to hospital

Other Meds: none

Current Illness: none

ID: 1540535
Sex: F
Age: 40
State: LA

Vax Date: 08/02/2021
Onset Date: 08/04/2021
Rec V Date: 08/10/2021
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: no

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

Symptoms: Inner right arm, arm pit, right breast outer most right side swole up and started looking lumpy. This lasted for three days. Appearance of extremely swollen lymph nodes. The arm was too swollen to have the arm placed by my side. Tender to the touch.

Other Meds: nizoral shampoo, taclonex

Current Illness: positive covid result 7/30/2021

ID: 1540536
Sex: F
Age: 61
State: KS

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received Pfizer for first dose and Moderna for second dose

Other Meds:

Current Illness:

ID: 1540537
Sex: M
Age:
State: CA

Vax Date: 08/09/2021
Onset Date: 08/10/2021
Rec V Date: 08/10/2021
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: Left side of chest in sever pain. Throat is burning, fever. Heart pain.

Other Meds: Zoloft

Current Illness: None

ID: 1540538
Sex: M
Age: 41
State: NV

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/10/2021
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: over 42 days 1st dose 03/18/21, 2nd dose 08/5/21

Other Meds:

Current Illness:

ID: 1540539
Sex: M
Age: 31
State: NV

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

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

Symptoms: Severe acid reflux triggering GERD/LPR symptoms including uvular ulcers and throat ulcers appearing after 36 hours. Seemingly low resting heart rate, around 60 bpm while resting and frequent dropping into high 40s late at night. Chest pain off and on

Other Meds: None regular-omeprazole infrequent

Current Illness: None confirmed - occasional light headed headedness

ID: 1540540
Sex: F
Age: 54
State: SD

Vax Date: 01/19/2021
Onset Date: 08/06/2021
Rec V Date: 08/10/2021
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: Unevaluable event

Symptoms: 12/21/20 Moderna Covid vaccine 1/19/21 Moderna Covid vaccine 8/6/21 ill 8/7/21 tested + Covid PCR test 8/17/21 potential to RTW

Other Meds: none

Current Illness: none

ID: 1540541
Sex: F
Age: 49
State: GA

Vax Date: 05/20/2021
Onset Date: 07/01/2021
Rec V Date: 08/10/2021
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: No

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

Symptoms: Changes in menstrual cycle. Cycle following 2nd vaccine lasted 10 days and was very heavy. Another cycle started 2 weeks after the first ended and was very light, stopped completely for about a day and then started back up for a couple of days.

Other Meds: Adderall 20 mg/day Prozac 40 mg/day Multivitamin

Current Illness: No

ID: 1540542
Sex: F
Age: 49
State: IA

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 08/10/2021
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: Codeine 06/11/2015 Nausea And Vomiting Erythromycin 06/11/2015 Nausea And Vomiting Percocet [oxycodone-acetaminophen] 06/11/2015 Nausea And Vomiting Propoxyphene 04/08/2009 Nausea And Vomiting Beef Allergy 06/11/2015 Other (See Comments)

Symptom List: Injection site pain, Pain

Symptoms: There was no adverse event. I was told to fill this out by Department of Public Health. This patient was given two doses of the Moderna brand vaccine in March and April of 2021. She had her antibodies drawn for COVID19 2 months later and they were negative. Due to the fact that patient is on IV immunosuppressive therapy for myasthenia gravis and had failed to develop antibodies, the doctor here ok'd her to have a second set of vaccinations. This was completed in July and August 2021. Patient is fine. No adverse reaction. Again, filling this out at the direction of Department of Public Health.

Other Meds: albuterol (VENTOLIN HFA) 108 (90 Base) MCG/ACT inhaler 1 Inhaler 3 2/23/2019 Sig: Inhale 1-2 puffs into the lungs every 4 (four) hours as needed for Wheezing. Route: Inhalation PRN Reason(s): Wheezing alendronate (FOSAMAX) 35 M

Current Illness: None

ID: 1540544
Sex: F
Age: 32
State: MO

Vax Date: 01/09/2021
Onset Date: 04/16/2021
Rec V Date: 08/10/2021
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: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: after the first shot on day 2 i broke out in whelps all over my body and had to leave work, i had a few stomach issues but nothing to be alarmed about. after the 2nd shot id say a month and a half after i broke out all over my body again at work and my throat started to close up and had to be taken by ambulance to the hospital. i continued to break out all over with the whelps for over a week and still have photos of this event. then i started having severe diarrhea that hasn't stopped. I've had a colonoscopy and taken numborus antibiotics to try and stop it but it hasn't. I was told by the dermatologist and the GI dr that alot of people that has had the shot are complaining about the same issues so i decided to finally report whats going on

Other Meds: buspirone 15 mg twice a day, alprazolam 1 mg 1 tablet in am, half a tablet at noon, and one tablet at bedtime, birthcontrol

Current Illness: none

ID: 1540545
Sex: M
Age: 24
State: NV

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 08/10/2021
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: over 42 days, 1st dose 04/27/21, 2nd dose 08/5/21

Other Meds:

Current Illness:

ID: 1540546
Sex: M
Age: 63
State: MN

Vax Date: 04/12/2021
Onset Date: 08/01/2021
Rec V Date: 08/10/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: This case meets vaccine breakthrough criteria review. SxS cough, intermittent fevers, myalgias, SOB, increased O2 needs, fatigue, diarrhea

Other Meds:

Current Illness:

Date Died: 08/08/2021

ID: 1540547
Sex: M
Age: 64
State: KY

Vax Date: 03/16/2021
Onset Date: 08/04/2021
Rec V Date: 08/10/2021
Hospital: Y

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 Died

Other Meds:

Current Illness:

ID: 1540548
Sex: F
Age: 71
State: FL

Vax Date: 01/08/2021
Onset Date: 07/30/2021
Rec V Date: 08/10/2021
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: Seasonal allergies, oats

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

Symptoms: Extreme fatigue, fever over 101, nausea, sore throat, muscle aches, headache

Other Meds: Plavix, low-dose aspirin, monthly infusions of Gammagard, Atorvastatin

Current Illness: None

ID: 1540549
Sex: F
Age: 58
State: TN

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/10/2021
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: Nausea

Symptoms: Reports receiving Pfizer vaccine 080621 at approx. 0900 and by 1600 was experiencing severe joint and muscle pain. Evaluated at ER and found to have low potassium level. Discharged home and by Saturday 080721 she was experiencing nausea, vomiting, and diarrhea which has continued through Tuesday 081021.

Other Meds: not known

Current Illness: not known

ID: 1540550
Sex: F
Age: 45
State: NC

Vax Date: 03/25/2021
Onset Date: 04/06/2021
Rec V Date: 08/10/2021
Hospital:

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

Lab Data:

Allergies: Cashel nuts

Symptom List: Injection site pain

Symptoms: Join pain ,left knee more painful and swollen than all other joins

Other Meds: Metformin ,glipixide,Atorvastatin,Ibuprofen, B12 supliments ,

Current Illness: Diabetes 2

ID: 1540551
Sex: F
Age: 86
State: TN

Vax Date: 03/03/2021
Onset Date: 08/09/2021
Rec V Date: 08/10/2021
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: NO KNOWN ALLERGIES

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

Symptoms: PATIENT PRESENTED TO MEDICAL CENTER ER ON 8/9/2021 WITH APPROXIMATELY 5-6 DAYS OF GENERAL ILLNESS TO INCLUDE NASAL CONGETSTION, COUGH PRODUCTIVE WITH WHITISH SPUTUM. SUBJECTIVE FEVERS AND CHILLS, GENERALIZED WEAKNESS AND DECREASE APPETITE, MULTIPLE SYNCOPAL EPISODES, SOME DIARRHEA. DENIES ANY KNOWN SICK CONTACTS OR RECENT TRAVEL. TOOK HOME COVID TEST REPORTED IT WAS POSITIVE. RETESTED AT HOSPITAL. COVID19 SARSCoV2 = DETECTED ON8/9/21

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1540552
Sex: F
Age: 71
State: GA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: 100? temp; headache; muscle aches; loss of energy; Balance off kilter; swollen and very sore site of injection; still swollen and arm muscle after 3 days.

Other Meds: Levothyroxine 100 1x day Glipizide 5 1x day Ozempic 0.5 1x wk Atorvastatin 40 1xday Niacin 500 flush free 1xday CoQ10 200 1xday PLAVIX 100 1xday Multivitamin Silver for women Magnesium 400 1xday Lisinopril 5 1xday D3 1000 1xday

Current Illness: None

ID: 1540553
Sex: F
Age: 17
State: FL

Vax Date: 07/20/2021
Onset Date: 07/23/2021
Rec V Date: 08/10/2021
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: No Allergies

Symptom List: Tremor

Symptoms: Started with a fever of 101 and tiredness on Friday night, had 2 TYLENOL, then at 3am Saturday started with great tremors, 102 fever after controlling the tremors. Had TYLENOL and after 30 minutes vomiting. All Sunday had a better time, then Tuesday sore throat that lasted 5 days.

Other Meds: No Medication

Current Illness: None

ID: 1540554
Sex: F
Age: 35
State: TX

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/10/2021
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: Erythema, Pruritus

Symptoms: P/T stated she need to throw up. ( symptom: nausea). 9:29 bag 3 cold packs to neck area. No vomiting, 02 Sat 99% BP 110/80 R20 T 96.6. 9:36 pt without nausea ,vomit or dizziness, no headache. 02 Sat 99% pulse 81 BP 100/80 R20 9::45 BP 110/78 P 86, R 86, R20, 02 Sat 100% Pt left with no symptoms at 10:16 a.m.

Other Meds: none

Current Illness: none

ID: 1540555
Sex: F
Age: 23
State: CA

Vax Date: 02/22/2021
Onset Date: 04/13/2021
Rec V Date: 08/10/2021
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:

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

Symptoms: Irregular Menstruation

Other Meds:

Current Illness:

ID: 1540556
Sex: F
Age: 29
State: IL

Vax Date: 07/30/2021
Onset Date: 08/06/2021
Rec V Date: 08/10/2021
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: seasonal allergies

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

Symptoms: On day one after an hour i felt little pain and irritation. Pain went away for a couple of days while taking Tylenol and Aleve. About 3days later a bumpy patch appeared on the vaccinated area, after that I felt very fatigue, and bump swelled bigger each day, arm felt very hot and numb. I had ice packs on the area and that seemed to help. The vaccinated area is still puffed up but has gone down after 3 days from puffing up.

Other Meds: no

Current Illness: yes a cold two weeks before

ID: 1540557
Sex: F
Age: 46
State: NY

Vax Date: 07/09/2021
Onset Date: 07/13/2021
Rec V Date: 08/10/2021
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: Splenda Tetracycline

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Intense hot flashes. The number of hot flashes I was getting reduced when I began my Levothyroxine medication. They were drastically reduced for 4 months. After my first shot they started three days later. They were more frequent and more intense. After my second shot, two days later, the frequency increased tremendously along with the intensity. I immediately sweat. I have close to 10 -15 a day now. My period also leveled out after my medication. My last period came two days after my first shot and it was 7 days long and light. I am now 13 days late. I am not pregnant. I have one ovary and no tubes.

Other Meds: 100 MCG Levothyroxine Ionic Zinc 50Mg Vitamin D3 25 mcg L-Lythine 500 mg B complex B12

Current Illness: No illness at time of vaccination or month prior

ID: 1540558
Sex: F
Age: 41
State:

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: diabetes, overpeeing, always thirsty, headache, upper abdominal pain, fatigue

Other Meds: metaproprolol

Current Illness:

ID: 1540559
Sex: F
Age: 43
State: UT

Vax Date: 07/29/2021
Onset Date: 07/30/2021
Rec V Date: 08/10/2021
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: N/A

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

Symptoms: Terrible dreams every night since receiving the vaccine, sleep disruption has been continuous, sleep paralysis the first couple day after vaccine, extreme arm aching and intense (entire arm into fingertips) for about 10 minutes after the shot

Other Meds: Omneprazole Aurovela

Current Illness: N/A

ID: 1540560
Sex: M
Age: 52
State: KY

Vax Date: 01/28/2021
Onset Date: 07/15/2021
Rec V Date: 08/10/2021
Hospital:

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

Lab Data:

Allergies: Medications

Symptom List: Pain in extremity

Symptoms: I contracted COVID 19 virus after being fully vaccinated.

Other Meds: Blood pressure medication

Current Illness: No

Date Died:

ID: 1540561
Sex: M
Age: 73
State: KY

Vax Date: 02/12/2021
Onset Date: 06/23/2021
Rec V Date: 08/10/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Acute respiratory Failure, Covid 19, COPD exacerbation, HTN, Sepsis, DN2, Atrial Fibrillation. Patient Died.

Other Meds:

Current Illness:

ID: 1540562
Sex: F
Age: 83
State: PA

Vax Date: 08/09/2021
Onset Date: 08/10/2021
Rec V Date: 08/10/2021
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: No known allergies

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

Symptoms: adverse events: this morning the patient woke up with swollen eyelids and swollen lips

Other Meds:

Current Illness:

ID: 1540563
Sex: M
Age: 52
State: TX

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/10/2021
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: No

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

Symptoms: Waited the 15 minutes for monitoring. Became wheezy when walking to truck. Did have cough immediately after vaccine was administered. Patient is asthmatic. Held for 30 additional minutes for monitoring with no symptoms. Lung sounds clear. No medications administered.

Other Meds: Lisinopril Albuterol Monolukast Statin

Current Illness: None

ID: 1540564
Sex: F
Age: 50
State: IA

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 08/10/2021
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: eosinophilic pneumonia with associated hypoxia, pneumothorax, and bilateral pulmonary emboli.

Other Meds: fluoxetine

Current Illness: none

ID: 1540565
Sex: F
Age: 69
State: NJ

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 08/10/2021
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: Cats; Mold; Environmental

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 12 hours after the vaccination, 01/29/2021, I woke up and I felt pain below my left eye and it was swollen. I had bubbles on my bottom eyelid or lip of my left eye, right along the edge. I still have a tiny scar on the bottom of my eyelid. A couple of weeks later, starting 02/03/2021, I had extreme abdominal pain, muscle and body aches and cramping, mostly at night, where I couldn't sleep. I felt like I had a wave of cold, metallic, or acid across my chest, I don't know how to describe it, because it's different from what I have ever felt before. I had a telehealth with Dr. on 02/18/2021, and she wanted me to see a gastroenterologist and she prescribed a proton pump inhibitor for 1 month. On 03/10/2021, I went to see the GI doctor. She prescribed doubling the PPI for 30 days and having an upper endoscopy. I followed up with the upper endoscopy on 05/24/2021, even though I was not having the GI problems anymore, the GI doctor wanted me to follow up.

Other Meds: Vitamin D-3; Allegra; Atorvastatin; Zoloft; Qzar redihaler; Famotidine.

Current Illness: No

ID: 1540566
Sex: F
Age: 39
State: MI

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

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

Lab Data:

Allergies:

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

Symptoms: Pt came in for first dose Covid vaccination. Due to allergy history pt was instructed to wait in observation area for 30 mins. Roughly 35 mins into observation time, pt reported feeling itchy and having a scratchy throat. Pt notified writer she took her own dose of 25mg of oral benadryl. Continued to monitor pt - pt reported no improvement but no worsening of symptoms. 30 min after dose of benadryl pt stated she did not want additional medication at this time. Pt stable. Pt instructed to follow up with PCP/allergist and knows to not come back to clinic if she thinks she needs additional medical attention.

Other Meds:

Current Illness:

ID: 1540567
Sex: M
Age: 35
State: AL

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/10/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: About 2 hour after receiving my second dose of the pfizer vaccine, I continued to do strenuous work outdoors in the hot evening. I began to feel very slight stabbing pain into the late evening. It was almost unnoticeable at first but continued throughout the night as I had trouble sleeping (I took approximately 800mg of ibuprofen at 2am that night). The next day I continued to do strenuous activity and by the afternoon I became fatigued by the vaccination and the sharp pain in the left side of my chest continued on and off until Monday afternoon and which by then the pain had moved towards the center of my chest. By Tuesday the stabbing sensation has stopped but the entire left side of my chest feels like a sore muscle.

Other Meds: none

Current Illness: none

ID: 1540568
Sex: F
Age: 57
State: ME

Vax Date: 08/03/2021
Onset Date: 08/07/2021
Rec V Date: 08/10/2021
Hospital:

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

Lab Data:

Allergies: sulfa antibiotics

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

Symptoms: patient had shingles like eruption to bilateral cheeks, lesions in various stages of blistering/scabbing, nerve like pain associated with them

Other Meds: none

Current Illness: none

ID: 1540569
Sex: F
Age: 80
State: CA

Vax Date: 07/15/2021
Onset Date: 07/15/2021
Rec V Date: 08/10/2021
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: Cashews, Black walnuts, Sulfa, Celebrex, Elderberry

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 07/15/2021, started experiencing symptoms that evening of a sore arm with pain radiating throughout the arm to hand. Experiencing HBP and edema in both feet. Still continuing, received 2nd dose of 08/05/2021. Primary contact recommendation of elevation for the edema in the feet.

Other Meds: Lisinopril, Coreg, Spiriva, Primadone, Lanfaprezone

Current Illness: N/A

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm