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: 1578421
Sex: M
Age: 57
State: TX

Vax Date: 03/27/2021
Onset Date: 07/24/2021
Rec V Date: 08/17/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Admit for COVID pneumonia. Treated w/ steroids, lovenox, plavix, Rocephin. Awaiting SNF placement at time of review 7/29.Patient continued to improve during the hospital stay, he is currently on room air but his D-dimer is elevated, so he started on Lovenox b.i.d. and transitioned to Eliquis at the time of discharge. Overall patient is stable from the respiratory point of view, he denies any major shortness of breath or chest pain. Patient will be discharged on supportive care medications including Decadron, Eliquis, antibiotics and continued on the rest of the medications.

Other Meds:

Current Illness:

ID: 1578422
Sex: F
Age: 58
State: MN

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

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

Lab Data:

Allergies: NONE

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever of 104 for 2 days (normal temperature is 96 degrees F) Severe fatigue, muscle aches, chills Nausea

Other Meds: NONE

Current Illness: NONE

ID: 1578423
Sex: F
Age: 49
State: AR

Vax Date: 08/05/2021
Onset Date: 08/16/2021
Rec V Date: 08/17/2021
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: Percocet - n/v

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

Symptoms: Body aches / fatigue x 1.5 days Itching over arms/legs started about 9 days after injection (8/16/21)

Other Meds: Voltaren / zoloft / buspar/ Requip / Trazadone / protonix / Lipitor/ gabapentin / melatonin

Current Illness: Body aches / fatigue (next day) and pain in arm (x2 days after)

ID: 1578424
Sex: F
Age: 49
State: TX

Vax Date: 04/28/2021
Onset Date: 07/24/2021
Rec V Date: 08/17/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Admitted for COVID and sepsis 2/2 ? acute cystits. Vaccine completed in Apr 2021. No focal covid symptoms. Rocephin, doxy, lovenox, vanc. Not requiring O2. The case was discussed with infectious disease on the day of discharge. She is discharged today in improved condition. Notably she did have headache during the admission which was evaluated with CT scan that showed no acute pathology and which was characteristic of the patient's historic migraines. On the day of discharge he also noted a knot under like a bruise on her left abdomen. She noted a history of abscesses in the past. Lesion was palpated while tender was not exquisitely so.

Other Meds:

Current Illness:

ID: 1578425
Sex: F
Age: 53
State:

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 08/17/2021
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 drugs.

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

Symptoms: Swollen lymph nodes, chest pains, dizziness, faint feeling, heart rate elevated, itchy skin, headache, nausea, sweating.

Other Meds: None.

Current Illness: None.

ID: 1578426
Sex: F
Age: 73
State: TX

Vax Date: 02/20/2021
Onset Date: 06/14/2021
Rec V Date: 08/17/2021
Hospital: Y

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: Admit 6/14. Vaccine 1/26, 2/20. H/O COPD, Type II DM, CAD, HTN. Admit for SOB. CXR showed COVID PNA. Treated with abx, steroid, remdesivir, Vit C and supplemental O2. Requested to be DC'd. DC'd to SNF on 2L O2.

Other Meds:

Current Illness:

ID: 1578427
Sex: M
Age: 57
State: VA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/17/2021
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: pt stated none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient received a 3rd dose too but did not meet criteria of being immunocompromised. Second Pfizer vaccine was given 3/25/2021. He stated was given second doses at 5 months and he wanted to get his now as well did not disclose this to the vaccinator until after the fact.

Other Meds: none noted

Current Illness: none

ID: 1578428
Sex: F
Age: 89
State: TX

Vax Date: 03/30/2021
Onset Date: 07/14/2021
Rec V Date: 08/17/2021
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: Pharyngeal swelling

Symptoms: Admit for Pna. COVID not diagnosed until 2 days after admit. After dx, treated with O2, steroids, remdesivir, tociluzimab, rocephin and azithro. Declined intubation, palliative onboard early. Deteriorated over hospital course and discharged to inpatient hospice service.

Other Meds:

Current Illness:

ID: 1578429
Sex: M
Age: 65
State: NV

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/17/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: About 5 minutes after administration, patient felt dizzy and lethargic. He stated no difficulty breathing but another 5 minutes elapsed before patient stated maybe some slight difficulty breathing. Paramedics were called and he opted to be taken in.

Other Meds: unknown

Current Illness:

ID: 1578430
Sex: M
Age: 73
State: TX

Vax Date: 04/06/2021
Onset Date: 07/22/2021
Rec V Date: 08/17/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Admitted for COVID pneumonia. Vaccine completed in Apr 2021. Treated w/ O2, rocephin, zithromax, steroids, plavix. He had been given his COVID vaccine given a few months earlier so was not given convalescent plasma. His symptoms improved and once he was stable arrangements made for him to be discharged to rehab

Other Meds:

Current Illness:

ID: 1578431
Sex: F
Age: 56
State: FL

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: Claritin D Amoxicillin Crab Shrimp Cantaloupe Kiwi

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

Symptoms: Hives, bright red color all over body face and extremities, facial swelling, Chest and throat tightness, difficulty taking deep breath, Treated with Epi pen, Benadryl 50 mgs x3, Pepcid. Required Benadryl for wo additional days

Other Meds: Norvasc Synthroid Protonix Vit D Multi Vit Zoloft

Current Illness: NA

ID: 1578432
Sex: F
Age: 53
State: TX

Vax Date: 05/27/2021
Onset Date: 07/21/2021
Rec V Date: 08/17/2021
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: Admit for COVID pneumonia w/ poss bacterial superimposed infection. Treated w/ O2, Vit-c, Vit-D, zinc, steroids, rocephin, doxy, warfarin, plasma. Discharged home.

Other Meds:

Current Illness:

ID: 1578433
Sex: F
Age: 73
State: TX

Vax Date: 02/06/2021
Onset Date: 07/20/2021
Rec V Date: 08/17/2021
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: Admit for COVID Pneumonia. Fully vaccinated "four months ago". Treated w/ IV abx, remdesivir, steroids, O2, lovenox, lasix, tocilizumab and plasma. Intubated 7/28. Also w/ acute cystitis. Patient remains on full mechanical ventilated support in prone positioning. Still admitted at time of review 7/29.

Other Meds:

Current Illness:

ID: 1578434
Sex: M
Age: 67
State: GA

Vax Date: 03/03/2021
Onset Date: 04/07/2021
Rec V Date: 08/17/2021
Hospital: Y

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: Admitted with pneumonia on April 6, 2021 and discharged home on April 13, 2021. Page 7 of medical records indicated tested negative by PCR on April 7 but record indicates a positive test on April 7. Also had cardiomegaly with with left ventricular ejection fraction of 15% (calculated 19%), and mild enlargement of the left and right atrium and left and right ventricle. Regarding his valves, the right coronary cusp of his aortic valve is mildly calcified. He has no atrial stenosis and trivial atrial regurgitation, moderate to severe mitral and tricuspid regurgitation, and mild pulmonary regurgitation. He has a history of cholecystectomy. Also has left bundle branch block. He has dilated cardiomyopathy with reduced ejection fraction. Followed up with cardiology department on 6/9, 6/16, and 7/1 regarding his medications.

Other Meds:

Current Illness:

ID: 1578435
Sex: F
Age: 94
State: TX

Vax Date: 06/24/2021
Onset Date: 07/14/2021
Rec V Date: 08/17/2021
Hospital: Y

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: Admit for COVID pneumonia. Vaccine completed June 24th. Treated w/ O2, steroids, zinc, vit-c, home dose of eliquis. Discharged with home O2.

Other Meds:

Current Illness:

ID: 1578436
Sex: F
Age: 30
State: CA

Vax Date: 07/26/2021
Onset Date: 07/26/2021
Rec V Date: 08/17/2021
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: All over body hives a few hours after injection. Hives haven?t gone away and I have been on OTC antihistamines with little to no improvement. I have hair loss and tightness in chest/throat.

Other Meds: Prenatal vitamins

Current Illness: None

Date Died: 07/23/2021

ID: 1578437
Sex: F
Age:
State: FL

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

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

Symptoms: admission to hospital with COVID symptoms that resulted in death

Other Meds:

Current Illness:

ID: 1578438
Sex: F
Age: 52
State: MN

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: Advil, Trazodone

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received COVID vaccine #1 on 4/9/2021. She received Moderna. We administered COVID vaccine #2 on 8/16/2021- Pfizer. Patient did not have any adverse reactions to the vaccine.

Other Meds: Adderral SR, Omeprazole, Venlafaxine ER

Current Illness: NA

ID: 1578439
Sex: M
Age: 17
State: WA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient was not in approved age range at time of vaccine (under 18 years old). Patient reported no adverse effects from the vaccination.

Other Meds:

Current Illness:

ID: 1578440
Sex: M
Age: 82
State: TX

Vax Date: 02/26/2021
Onset Date: 07/14/2021
Rec V Date: 08/17/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Admit for COVID and AKI. Vaccine completed Feb 2021. Treated w/ steroids, O2, vit-c, vit-D, zinc, Rocephin, cefepime, Vanc, no remdesivir d/t AKI. Still admitted at time of review 7/29; condition deteriorating to septic shock.

Other Meds:

Current Illness:

ID: 1578442
Sex: M
Age: 31
State: IL

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 08/17/2021
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: Penicillin; aspirin; TYLENOL; seafood; shellfish; pollen; grasses

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

Symptoms: Received shot and as soon as I was given the shot, my throat started closing. They shot me with an epipen twice and told me to take my inhaler. I also took Benadryl. They also gave me 50mg steroid for a week. I am also on oxygen; Loss of memory.

Other Meds:

Current Illness:

ID: 1578443
Sex: F
Age: 25
State: CT

Vax Date: 02/08/2021
Onset Date: 06/16/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin and blue food coloring

Symptom List: Unevaluable event

Symptoms: Was taking Macrobid at time of Moderna injection in Feb. 4 months later, I needed to take Macrobid again and started getting dermatographia and general hives 4 days after I finished the course. No idea if Moderna or Macrobid are related but no other medication or life style change has occurred. Dermatographia/hives are very itchy and require 3 doses of Zyrtec to not itch. They started on June 17th and have yet to go away, so about 2.5 months of hives.

Other Meds: Was taking Macrobid for a UTI at time of vaccination

Current Illness: Had a UTI

ID: 1578444
Sex: F
Age: 38
State: MA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/17/2021
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: Many: mold, pollen, animals, eggs, shrimp, adjuvant preservatives

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

Symptoms: Nausea, lightheaded, dizziness, brain fog, neck pain, mild tongue tingling

Other Meds: none

Current Illness: none

ID: 1578445
Sex: F
Age: 37
State: LA

Vax Date: 12/29/2020
Onset Date: 01/01/2021
Rec V Date: 08/17/2021
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: Flare reactions to dairy products

Symptom List: Injection site pain, Pain

Symptoms: 12/31/2020- chest pain 1/1/2021- Tingling in face. Benadryl then eased. 1/2/2021- Tingling on lips. Chills. Benadryl then ceased 1/3/2021- Chills 1/4/2021- Tingling on lips. Puritis to lips and face. Benadryl then ceased 1/6/2021- Feeling that something was in the back of the throat. 1/9/2021- Feeling of something in throat. Throat tingling. Benadryl then ceased. 1/10/2021- Sensation of the tongue being burnt. Benadryl then ceased. Feelings of burnt tongue/sensation in the back of the throat lasted until approx 1/18/2021 with periods of this occurring presently.

Other Meds: Multivitamins Vitamin D Zyrtec

Current Illness: NA

ID: 1578446
Sex: F
Age: 52
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs Adhesives Latex

Symptom List: Injection site pain, Menorrhagia

Symptoms: adhesive capsulitis, both arms, worsening over time, in physical therapy as of 08/01/2021 (reporting date). Injection site approximately 4 inches below the shoulder joint. (Injection was not given in bursa.)

Other Meds: Lithium carbonate 150mg Vyvance 40mg Levothyroxin 137mcg Aripiprazole 10mg Liothyronine 7.5mcg Bupropion HCL XL 450mg Doxepin 100mg to 200mg Trazodone 100mg Vagifem 10mcg 2xweek Linzess 29mcg

Current Illness:

ID: 1578447
Sex: F
Age: 0
State: CA

Vax Date: 08/01/2021
Onset Date: 08/16/2021
Rec V Date: 08/17/2021
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: Penicllin and sulfa

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

Symptoms: Numbness in center of left hand minutes after injection, pain in elbow of left arm 24 hours after injection. Swollen underarm lymph node on left arm about 6 to 8 inches of swelling about 36 hours after injection. Sore arm and shoulder after injection for 36 hours after injection was given on left side.

Other Meds: Wellbutrin xl 300mg wellbutrin 150mg buspar 15mg Vitamin c 100mg Vitamin d 50mg Zinc 25mg Glycerin 25mg

Current Illness: None

ID: 1578448
Sex: M
Age: 70
State: OH

Vax Date: 08/15/2021
Onset Date: 08/17/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt showed his arm which was red and warm to the touch in a 2inch by 2inch area. Pt stated it started earlier today. He will watch for progression of state

Other Meds:

Current Illness:

ID: 1578449
Sex: F
Age: 63
State: MI

Vax Date: 04/21/2021
Onset Date: 06/03/2021
Rec V Date: 08/17/2021
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

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Sometime late May around the 31st, I was having severe upper left abdominal pain that radiated to my back.

Other Meds: Lisinopril; simvastatin

Current Illness: None

ID: 1578450
Sex: M
Age: 42
State: HI

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/17/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: 5 minutes after giving JJ vaccine. Patient came to counter and said he needed to lie down bc he was feeling faint. I instructed him to lie down and by the time I got to him he had fainted. He was out for a few seconds. He remained lying down and felt dizzy. But was uninjured.

Other Meds:

Current Illness:

ID: 1578451
Sex: M
Age: 30
State: OR

Vax Date: 08/08/2021
Onset Date: 08/12/2021
Rec V Date: 08/17/2021
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: Bloody stools and diarrhea

Other Meds: None

Current Illness: Hemorrhoids

ID: 1578452
Sex: F
Age: 13
State: CA

Vax Date: 08/09/2021
Onset Date: 08/10/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: nkda

Symptom List: Injection site pain

Symptoms: Vomiting 08/10, headaches started 08/11, landed in the ER 08/13 at around 12:30am, treated and released for headaches and nausea. By Sat 08/14 around 9pm we are back at the ER for the headaches, vomiting and now rapid heart beat (in the 150's). During these days ibuprofen and acetaminophen weren't working. She did take Zofran for the nausea on 08/11 and 08/13. Hospital gave her fluids and meds through the IV that helped everything except rapid heart beat.

Other Meds: oral contraceptives for menstral cramps

Current Illness: none

ID: 1578453
Sex: F
Age: 57
State: WI

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received dose 1 of Pfizer at 1300, at 1315 she reported she was starting to itch on her right arm and leg. She was brought back and vital signs were obtained. BP: 125/82, P 76, O2 97%, Resp: 18. At 1330 she was administered 50mg Oral Benadryl per protocol. She was monitored for 30 minutes past medication administration. She was feeling better and left at 1405.

Other Meds:

Current Illness:

ID: 1578454
Sex: F
Age: 25
State: TX

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/17/2021
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: extreme body aches, fever, chills and migraine.

Other Meds: none

Current Illness: none

ID: 1578455
Sex: F
Age: 62
State: CA

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 08/17/2021
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

Symptom List: Tremor

Symptoms: High fever.

Other Meds: No

Current Illness: No

ID: 1578456
Sex: F
Age: 58
State: TN

Vax Date: 04/01/2021
Onset Date: 08/12/2021
Rec V Date: 08/17/2021
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: Cipro (anaphylaxis) Lyrica (anaphylaxis) Neurontin (anaphylaxis) Septra (anaphylaxis) sulfa drugs (Anaphylactic reaction) tetanus toxoid (anaphylaxis) mirtazapine Darvocet-N 100 (abd pain) Latex (rash, itching) Tape (blisters, rash) codeine (Nausea)

Symptom List: Erythema, Pruritus

Symptoms: patient is a 58 y old female with h/o HTN , dyslipidemia , hypothyroidism , Dm2, CKD 3 , chronic liver disease secondary to NASH among others who currently is established with hospice and is a DNR refers that for the last couple of days has been bedbound and weak . Refers that is unable to get out of bed . Also describes subjective fevers and worsening sob . Refers that husband has similiar symptoms suggestive of covid 19 . Refers having 2 doses of covid 19 vaccine - Pfizer back in April 2021 . Due to worsening weakness came to er . seems that initially was requiring 02 non rebreather with pulse ox 89 % . At time of exam patient is not febrile , not having cough and is currently on 6 liters 02 per nc . Patient is a poor historian and doesnt know what meds she takes though says that took water pills this am . Refers that regarding code status wants to have some things done if able to be kept alive but doesnt want to prolong her life either. On admission her cbc reveals no leukocytosis . Has lymphopenia . Patient has evidence of hyponatremia and AKI with creatinine 1.7 probably reflective of use of bumex and spironolactone at home . CXR reveals b/l infiltrates consistent with possible pneumonia . ER has requested admission for eval and treatment of covid 19 . Patient at this time is not tachypneic and is not coughing actively . Is requiring 02 and is at risk for progression and worsening disease.

Other Meds: Medications taking at time of hospitalization: allopurinol 100 mg oral tablet, 100 mg/ 1 tab(s), Oral, Daily Bumex, 1 mg, Oral, BID, Not taking: Has not taken in a while Colace, 200 mg, Oral, Daily at Bedtime Dexilant 30 mg oral delaye

Current Illness: Unknown

ID: 1578457
Sex: F
Age: 48
State: PA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 08/17/2021
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: 10 minutes after receiving vaccine in left upper arm she developed right arm pain, right leg tingling, lightheadedness, and bilateral hand swelling. Patient to ED, when arrived symptoms improved, reporting very mild lightheadedness and feeling very anxious. Pt observed of over 1 hour with vital signs stable and discharged to home.

Other Meds:

Current Illness:

ID: 1578458
Sex: F
Age: 62
State: UT

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 08/17/2021
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: HYDROCODONE, PEANUTS, CASHEW, CHOCOLATE AND TUNA FISH.

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

Symptoms: I had fatigue and tiredness and headache and i got covid in may.

Other Meds: THYROID MEDICINE; LEBOTRINE; VITAMIN C; VITAMIN D VITAMIN A K2; AND CALCIUM AND MAGNESIUM.

Current Illness: None

ID: 1578459
Sex: F
Age: 17
State: FL

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/17/2021
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: Client denies any allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 7:15PM patient was accompanied by her aunt/guardian. Client?s aunt/guardian completed and signed the COVID-19 consent form. Client was given a Pfizer COVID-19 vaccine (lot #EW0168 expiration date 8/31/2021) in the right deltoid by RN. 7:25PM Client c/o feeling ?dizzy? and ?hot?. Client was noted leaning forward in the chair. Client denied any chest pain or difficulty swallowing or difficult respirations. 7:27PM client B/P was 80/50; pulse 76 strong and regular; client c/o increased dizziness and feeling ?shaky? with an increase in diaphoresis was noted. Client was placed in a supine position with feet elevated. 7:30PM 911 call was made by another RN and observation of client continued with no change in condition. 7:37PM Paramedics arrived: Paramedics ran an EKG strip and did a PO2 which was unremarkable. B/P by Paramedics 96/60. Paramedics continued to observe client and did a repeat B/P. 7:41PM Client reports feeling better. Paramedics helped client to a sitting position. Client sitting B/P 104/64 and blood sugar of 50 (done by Paramedics). Paramedics administered and oral glucose liquid to client. 7:46PM Repeat blood sugar 67 and standing B/P 134/85. Paramedics recommend client?s aunt follow-up with client?s doctor on client?s hypoglycemia. Client told Paramedics she is a dancer and she (client) had an episode of feeling ?dizzy? and ?shaky? last week. Client also reports she ate ?2 hotdogs? prior to coming for COVID 19 vaccine and additionally denies missing meals. RN

Other Meds: Client denies taking any medications or supplements.

Current Illness: Client denies any illnesses or prior reactions to vaccinations

ID: 1578460
Sex: M
Age: 50
State: GA

Vax Date: 01/06/2021
Onset Date: 07/21/2021
Rec V Date: 08/17/2021
Hospital: Y

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: Patient hospitalized due to COVID-19. Patient is fully vaccinated. Patient in ICU.

Other Meds:

Current Illness:

ID: 1578462
Sex: M
Age: 71
State: WI

Vax Date: 04/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Suspected Coronavirus (Covid-19) Pt has been sick for a few days. He states that he was going to get tested for COVID today but had a near syncopal episode while getting ready this morning. Pt states that he has not been eating due to not feeling well. ? Weakness ? Fever 9 Weeks To 74 Years ? Cough HPI 71-year-old male presents for evaluation of fever and nonproductive cough. Patient reports that symptoms started 2 days ago. He states that he has been feeling progressively weak over the past 48 hours and was going to follow-up with his doctor today but had a near syncopal episode while getting ready. He states that he did not have any associated chest pain or shortness of breath. He denies any abdominal pain.

Other Meds:

Current Illness:

ID: 1578464
Sex: F
Age: 50
State: CA

Vax Date: 05/10/2021
Onset Date: 05/24/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin Amoxicillin

Symptom List: Pain in extremity

Symptoms: My first Moderna COVID vaccine was on 4/12/2021. Around 4/19/2021, I developed mild stiffness behind my knees and calves that resolved in a few days. My 2nd Moderna COVID vaccine was on 5/10/2021. Around 5/17/2021, I again developed mild stiffness in the back of my knees and calves, which resolved in a few days. Around 5/24/2021, I began to feel a burning sensation in my knees and in my elbows, initially mostly at night, usually after lying in bed for about an hour, and the burning sensation would persist throughout the night, making it difficult to sleep. It initially went away during the day, but after a few days, the burning sensation spread to other joints and began persisting at all times of the day and night. By 6/2/2021, the burning sensation was affecting the following areas of my body, often moving around and affecting different areas at different times: elbows, knees, hips, shoulders, shoulder blades, fingers, toes, ribs, and internal organs. The burning sensation in my joints and body continued throughout the month of June. I do not have health insurance, so I did not seek medical treatment until 6/26/2021 when I went to a medical facility. There they did blood tests and a urine test. The tests came back normal, showing negative Rheumatoid factor and negative ANA, as well as ruled out any infection. They gave me a shot of Toradol and a shot of Solumedrol, and prescribed 40 mg of Prednisone a day for 3 days, Naproxen, and Methocarbamol each twice daily for 7 days. The steroids helped the most, and over time the burning sensations have decreased, though still occur in a milder form sporadically, but other symptoms began shortly after I went to urgent care. These include muscle weakness, fatigue, brain fog, slight changes to my vision, painful spasms behind my ears, tingling and burning sensations on my skull, mild burning sensation in the skin near the various joints that I experienced burning in, stiffness in my jaw, elbow, and knee joints, pelvis, and needing to wear a brace on my right elbow sometimes due to pain (my right arm is the arm I received the vaccine in because I am left handed). Even today, three months after my 2nd vaccine, I am still dealing with mild symptoms, mostly pain and stiffness in my elbow and knee joints, jaw, and occasional muscle weakness throughout my body. I do not feel as well as I did before receiving the vaccine. It has greatly affected my ability to function in my life, especially from late May through the end of July, and I am still recovering.

Other Meds: None

Current Illness: None

ID: 1578465
Sex: M
Age: 18
State: TN

Vax Date: 06/10/2021
Onset Date: 06/11/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Patient experiences throbbing headache, body aches and nausea. CT head is within normal limits. Patient is treated with IV fluids, IV acetaminophen and ondansetron.

Other Meds: none

Current Illness: none

ID: 1578466
Sex: M
Age: 70
State: GA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 08/17/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: The Moderna Vaccine vial 039B21A had been stored in the refrigerator, at 39 degrees Fahrenheit, for 33 to 34 day. This is 3 or 4 days longer than the recommended storage time for thawed Moderna Vaccine. The patient experienced no known adverse reactions.

Other Meds:

Current Illness:

ID: 1578467
Sex: F
Age: 48
State: GA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/17/2021
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: vaccine was given at 20 days instead of 28 due to error in grits and system not catching early fill.

Other Meds:

Current Illness:

ID: 1578468
Sex: M
Age: 17
State: PA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 08/17/2021
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:

Symptom List: Vomiting

Symptoms: Patient stated feeling well right after vaccination, while ambulating to observation area he fainted and fell to the ground. Vital signs stable, he had not eaten yet and was given food. Left vaccination area with parent without further issues. He did receive 2nd vaccine dose on 05/21/2021 without incident.

Other Meds:

Current Illness:

ID: 1578469
Sex: M
Age: 19
State: NC

Vax Date: 08/09/2021
Onset Date: 08/11/2021
Rec V Date: 08/17/2021
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: Paroxysmal SVT x 24 hours. Exertional dyspnea. Dehydration.

Other Meds: OTC MVI and Flonase

Current Illness: None

ID: 1578470
Sex: M
Age: 63
State: TX

Vax Date: 02/25/2021
Onset Date: 03/04/2021
Rec V Date: 08/17/2021
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: penicillin

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

Symptoms: Double vision and droopy eyelids

Other Meds: titus pectin, curcumin, vit d, resveratrol, low dose aspirin and melatonin

Current Illness: no

ID: 1578471
Sex: F
Age: 65
State: GA

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 08/17/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: The Moderna Vaccine vial 039B21A had been stored in the refrigerator, at 39 degrees Fahrenheit, for 33 to 34 day. This is 3 or 4 days longer than the recommended storage time for thawed Moderna Vaccine. The patient experienced no known adverse reactions.

Other Meds:

Current Illness:

ID: 1578472
Sex: F
Age: 53
State: PA

Vax Date: 01/29/2021
Onset Date: 05/01/2021
Rec V Date: 08/17/2021
Hospital:

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

Lab Data:

Allergies: adverse reactions to antibiotics - headache, vomitting

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

Symptoms: Starting feeling very foggy about 2 months after vaccine. Also started having random skin rashes on shoulders, neck, back and face. Also feeling hyper and exhausted at same time. Hot flashes.

Other Meds: Lexapro

Current Illness:

ID: 1578473
Sex: F
Age: 36
State: HI

Vax Date: 03/17/2021
Onset Date: 03/31/2021
Rec V Date: 08/17/2021
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: Grass, trees, weeds, chemical fragrance, cashews, beef, corn, black rubber chemical, gold

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

Symptoms: Severe pain and inflammation in joints that moves throughout joints and lasts up to a week

Other Meds: Escitalopram

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm