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: 1583124
Sex: F
Age: 35
State: MI

Vax Date: 07/28/2021
Onset Date: 07/30/2021
Rec V Date: 08/18/2021
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: None. I am sensitive to gluten and dairy at times.

Symptom List: Dysphagia, Epiglottitis

Symptoms: Two days after my initial shot, I noticed I had a sore spot on my right collar bone. I felt it and it was a swollen lymph node. Over the next few days it got smaller and was eventually gone within that next week. During this time I also felt soreness under both my armpits as if I had swollen lymph nodes there as we. All was gone about a week after these all appeared.

Other Meds: None taking the day of the vaccination however I am on prenatal vitamins because I had a baby in early July.

Current Illness: None

ID: 1583125
Sex: F
Age: 55
State: PA

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 08/18/2021
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: Cephalexin Pork Sulfa Methotrexate Adalimumab Aspirin

Symptom List: Anxiety, Dyspnoea

Symptoms: Call reason call to ans svc. Spoke with pt who shares that she received the COVID vaccine yesterday and starting yesterday with hives on the left side of her chest. This is the only area with the "bumps" . Denies any dyspnea neg n/v. Declining to go to the hospital but is aware at the slightest inkling any distress she is to call 911 so that she be evaluated in the ER. For now, she will continue taking benadryl. Will notify staff so that a report can be placed in the VAERS system.

Other Meds: Advair diskus 250 mcg/-50 mcg 1 puff bid Albuterol for nebulization 3 ml 4 times daily as needed Amlodipine 10 mg 1 tab daily Atenolol 25 mg 1 tab daily Atorvastatin 40 mg 1 tab daily Calcium 500 + D 500 1 tab twice daily CellCept 500 mg 2

Current Illness: Rheumatoid arthritis Systemic Lupus Erythematosis COPD Low back pain Hyperlipidemia Right upper quadrant pain Pain in right hip Right lower quadrant pain Prediabetes Disorder of thyroid

ID: 1583126
Sex: F
Age: 53
State: NY

Vax Date: 08/12/2021
Onset Date: 08/13/2021
Rec V Date: 08/18/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

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

Symptoms: Employee received first dose of COVID19 vaccine on 8/12/2021. Employee states that on 8/13/2021 at about 7:00 am, she started having severe headache, numbness from her left shoulder to her left foot and lower back pain of which she took Tylenol but it did not help her. She then took Advil and felt a little better.

Other Meds: none

Current Illness: no

ID: 1583127
Sex: M
Age: 56
State: MD

Vax Date: 06/17/2021
Onset Date: 08/02/2021
Rec V Date: 08/18/2021
Hospital:

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: Tinnitus

Other Meds: Tresiba, Novalog

Current Illness:

ID: 1583128
Sex: F
Age: 12
State: OH

Vax Date: 08/13/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: 8/16/21 around 12pm rash appeared on face 8/17/21 8am rash began to blister and continued to spread 8/18/21 went to doctor to have evaluated. Doctor unable to provide any other medical diagnosis other than reaction to vaccine. Prescribe skin antibiotics to treat blisters as they pop. Follow in week if not heeling or improved

Other Meds: None

Current Illness: None

ID: 1583129
Sex: F
Age: 22
State: PA

Vax Date: 04/10/2021
Onset Date: 08/02/2021
Rec V Date: 08/18/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: sore throat and cough.

Other Meds: norethindrone-e.estradioL-iron (JUNEL FE 1/20, 28,) 1 mg-20 mcg (21)/75 mg (7) per tablet

Current Illness:

ID: 1583130
Sex: F
Age: 57
State: TX

Vax Date: 05/01/2021
Onset Date: 06/16/2021
Rec V Date: 08/18/2021
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: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I started having extreme itchiness after mosquito bites. It itched so bad I dug into my skin to try and get it out. It was red and swollen. Sometime after that my fact started having unusual break outs that are also itchy and red and swollen. I am still having the face breakouts and I am getting read on my cheeks after I shower. Went to a dermatologist and she thinks it might be rosacea. I took prednisone and it helped but now that I['m not on the prednisone it is coming back. I also took an oral medication, Imervectan and waiting on a topical cream, hoping that will help.

Other Meds: Bioidentical Hormones: Estrodial, Progestrone, Testosterone

Current Illness: Have had diarrhea on and off since March 2020. And started having pre-hypertension around early 2020 or late 2019.

ID: 1583131
Sex: M
Age: 63
State: IL

Vax Date: 06/10/2021
Onset Date: 06/15/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: My vision has "dulled". My eye jelly has detached from the retina. My arm is sore and painful at the point of injection

Other Meds: none

Current Illness: none

ID: 1583132
Sex: F
Age: 60
State: MD

Vax Date: 05/01/2021
Onset Date: 05/02/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: Ronacade; Cipril; Calandimizen; Sulpha; infib.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I had an irritated cough and chills.

Other Meds: Levothyroxine; PTN; Iron Infusion; Faloxiacid; Vitamin D2; Thyroxine; Vitamin A; vitamin B; calcium B and E; Pain Medication

Current Illness: none

ID: 1583134
Sex: F
Age: 21
State: NC

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
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: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Rash began on the left arm and spread to the right arm hours later. The next day the rash spread to my legs and neck.

Other Meds: Setraline Lo Estrin Fe Multivitamin

Current Illness: N/A

ID: 1583135
Sex: F
Age: 41
State: OK

Vax Date: 03/15/2021
Onset Date: 04/12/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: Pertussis vaccine

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

Symptoms: I started feeling a tingling/shooting pain going from my elbow up to my shoulder/underarm and down to my hand. I've never felt this before. It is still happening. It happens several times a day. The only time I haven't noticed it happen is when I'm lying in bed.

Other Meds: Synthroid Adderall Multi-vitamin

Current Illness: None

ID: 1583136
Sex: M
Age: 72
State: GA

Vax Date: 02/01/2021
Onset Date: 07/12/2021
Rec V Date: 08/18/2021
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: Pt was hospitalized at for COVID-19 from 07/13/2021-08/05/2021. Updated symptoms and pre-existing medical conditions per medical records. Pt experienced shortness of breath, fever and cough. Pt has hypertension, dyslipidemia, COPD, hypothyroidism, and dementia. Per medical records, family found out that one of the pt's visiting granddaughters was found to be positive for COVID-19, so the family brought the pt to the hospital for further management. Per medical records, pt was seen and examined on day of discharge in stable condition and transferred to Hospital.

Other Meds:

Current Illness:

ID: 1583137
Sex: M
Age: 64
State: CA

Vax Date: 02/09/2021
Onset Date: 03/16/2021
Rec V Date: 08/18/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: March 2021, I found swollen lymph nodes near left armpit (vaccine site), June 2021, Diagnosed Lymph Cancer,- B-CELL lymphoma From July 2021, I am under chemotherapy.

Other Meds:

Current Illness:

ID: 1583138
Sex: F
Age: 43
State:

Vax Date: 08/14/2021
Onset Date: 08/17/2021
Rec V Date: 08/18/2021
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: rapid heart beat, soreness, headache, dizzyness, hangover feeling, high blood pressure.

Other Meds: albuterol

Current Illness:

ID: 1583139
Sex: F
Age: 48
State: PA

Vax Date: 04/13/2021
Onset Date: 08/05/2021
Rec V Date: 08/18/2021
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: Penicillin LatexRash

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

Symptoms: Loss of taste and smell, runny nose, diarrhea, and PND

Other Meds: cetirizine (ZyrTEC) 10 mg tablet fluticasone propionate (FLONASE ALLERGY RELIEF NASL) levonorgestreL-ethinyl estrad (LARISSIA) 0.1-20 mg-mcg per tablet mv-min-C-glutamin-lysine-hb124 (AIRBORNE, LYSINE HCL,) 1,000-50 mg tablet, effervescent

Current Illness:

ID: 1583140
Sex: F
Age: 49
State: MS

Vax Date: 04/01/2021
Onset Date: 04/09/2021
Rec V Date: 08/18/2021
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:

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

Symptoms: Stroke

Other Meds:

Current Illness:

ID: 1583141
Sex: F
Age: 47
State: PA

Vax Date: 08/16/2021
Onset Date: 08/17/2021
Rec V Date: 08/18/2021
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: codeine

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

Symptoms: 1st day after vaccination had runny nose and sore throat and congestion 2nd day after vaccination (today) has as rash and hives all over her face and neck and arm. She is also SOB and gasping on and off.

Other Meds: unknown

Current Illness: none

ID: 1583142
Sex: F
Age: 42
State: WI

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
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: Immediate sensation of itchiness around site at left deltoid. Within minutes itchiness extended to arm, into neck area, then into other arm, then extended down into legs. With 10-20 minutes itchiness extended to trunk area, and to back of neck and head at about 40 minute mark. No redness or swelling noted anywhere. Vital Signs: Pulse Ox 99% room air, blood pressure 144/83, heart rate 70. Denied shortness of breath. Denied difficulty breathing.

Other Meds:

Current Illness:

ID: 1583143
Sex: F
Age: 69
State: NC

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: Maybe latex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Nausea, vomiting, muscle and joint aches/pain, chills, fever, diarrhea, headache, arm soreness Started approximately 4:00PM ON 8-16-2021 and ended by midnight 8-17-2021. Treated with ibuprofen and Tylenol.

Other Meds: Calcium, D3, zinc, multivitamin, Lexapro, Omeprazole

Current Illness: None

ID: 1583144
Sex: F
Age: 33
State: FL

Vax Date: 07/27/2021
Onset Date: 07/28/2021
Rec V Date: 08/18/2021
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: Patient said she has been having pain and numbness in the injection site arm on and off since receiving dose 1. She has not sought out medical care. She received dose 2 on 8/17/21 and indicated on the VAR form that she had no previous reaction to immunizations. She said she has only normal tenderness from dose 2. She got both shots in the same arm and didn't report the side effects from dose 1 prior to receiving dose 2.

Other Meds:

Current Illness:

ID: 1583145
Sex: M
Age: 38
State: PA

Vax Date: 04/15/2021
Onset Date: 08/06/2021
Rec V Date: 08/18/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: increased risk of exposure to COVID-19 virus Generalized body aches Fatigue, unspecified type

Other Meds: NONE

Current Illness:

ID: 1583146
Sex: F
Age: 56
State: CA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
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: Moderna COVID-19 vaccine# 1 in series administered. A 56-year-old female completed a 30-minute observation period with the following signs and symptoms of an adverse reaction: Pseudo seizure. Action(s) taken: Epinephrine administered. Allergy to COVID-19 vaccine documented in allergies activity. Patient advised to discuss second dose considerations with a clinician.

Other Meds: Topiramate; Gabapentin, Prazosin, Sertraline, Bupropion

Current Illness:

ID: 1583147
Sex: F
Age: 51
State: CT

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 08/18/2021
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: Sulpha Drugs

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

Symptoms: I had a fever around 101 and extreme fatigue an body aches.

Other Meds: Costyenx

Current Illness: none

ID: 1583148
Sex: F
Age: 55
State: OH

Vax Date: 08/15/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
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: SULFA ALLERGY ONLY

Symptom List: Injection site pain, Pain

Symptoms: rash next day with itching. still getting bigger. took Zyrtec and recommended to take tylenol. pt has a call into pcp.

Other Meds: IBUPROFEN, ZYRTEC-D, MULTIVITAMIN

Current Illness: SEASONAL ALLERGY, FUNGAL INFECTION

ID: 1583149
Sex: M
Age: 17
State: PA

Vax Date: 04/16/2021
Onset Date: 08/02/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Dx Nasal Congestion ? Sore Throat ? loss of senses ? Shortness of Breath ? Cough ? Headache

Other Meds: NONE

Current Illness:

ID: 1583150
Sex: F
Age: 26
State: MD

Vax Date: 04/22/2021
Onset Date: 06/06/2021
Rec V Date: 08/18/2021
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: n/a

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

Symptoms: chronic idiopathic urticaria

Other Meds: n/a

Current Illness: n/a

ID: 1583151
Sex: M
Age: 76
State: FL

Vax Date: 04/10/2021
Onset Date: 08/14/2021
Rec V Date: 08/18/2021
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: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Full vaccinated Covid-19 case. General weakness, and fatigue

Other Meds: Lipitor 80mg, Felodipine 10mg, Sotalol 80mg, Citalopram 20mg, Losartan 50mg, Xanax 0.5mg, Hydralazine 50mg, Omeprazole 20mg, Ticagrelor 90mg, Xarelto 20mg, Metformin 500mg,

Current Illness:

ID: 1583152
Sex: M
Age: 77
State: NY

Vax Date: 07/30/2021
Onset Date: 08/15/2021
Rec V Date: 08/18/2021
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: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt presented with URI infectious symptoms for 5 days starting on 08/10/21 after receiving Moderna vaccine, pt went into cardiac arrest on 08/15/21, 5 days after symptom onset.

Other Meds: unknown

Current Illness: HTN, hyperlipidemia, diabetes

ID: 1583153
Sex: M
Age: 64
State: TX

Vax Date: 02/28/2021
Onset Date: 04/15/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: None.

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

Symptoms: Shortness of breath, chest tightness, heart palpitations, elevated heart rate and blood pressure, referred to a cardiologist. Was diagnosed with a pulmonary embolism with several blood clots in lungs. Currently on Eliquis 5mg twice a day.

Other Meds: Valsartan 320 mg, Triamterene-Hctz 37.5 25mg, Rosuvastatin 10mg, Levocetirizine 5mg 1 tablet per day.

Current Illness: None.

ID: 1583154
Sex: F
Age: 18
State: TX

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/18/2021
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: Nausea

Symptoms: pt stated lt arm began to be numb after injection.

Other Meds:

Current Illness:

ID: 1583155
Sex: F
Age: 67
State: GA

Vax Date: 02/23/2021
Onset Date: 07/22/2021
Rec V Date: 08/18/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient is a 67 y.o. female with multiple medical comorbidities was admitted for management of COVID-19 pneumonia and acute hypoxic respiratory failure and discharged Yesterday 7/28 , With ABX and steroids And 1 L oxygen upon discharge . Pt comes back this noon to ER stating her stats Overnight with 1 lts O2 was down to 86 . Pt did not try to increase The O2 flow . C/o low O2 sats when getting up and moving around (84-88%) Pt also with c/o worsening dyspnea Hospital Course: (Please include treatment given and significant findings) 67-year-old female with history of hypertension, type 2 diabetes, hypothyroidism asthma was recently hospitalized for COVID pneumonia and was discharged on monitor oxygen. She presented back to ER on 08/02 with complaint of low oxygen saturation at home. She was started on broad-spectrum antibiotics and steroids. Pulmonary was consulted and recommendations were followed. 2D echo shows normal EF. Patient improved clinically during hospital stay. She is currently requiring 2 liters oxygen. Symptoms started on 07/20. She was advised to follow-up with primary care provider and Pulmonary on an outpatient basis. Outpatient sleep study recommended. The remainder of the patient's medical problems were chronic and stable without any further intervention this admission. The patient will continue the current treatments and medications. Patient was clinically and hemodynamically stable at discharge. Patient was seen and examined at bedside earlier today. She denied any complains. Physical Exam: Temp: [98 ?F (36.7 ?C)-98.3 ?F (36.8 ?C)] 98 ?F (36.7 ?C) Heart Rate: [54-80] 74 Resp: [16-18] 18 BP: (115-185)/(71-109) 158/109 GEN: No acute distress CV: Regular rate and rhythm, No murmurs appreciated PULM: Clear to ausculation anteriorly, No rales or wheezing ABD: Bowel sounds normoactive, Soft, Not tender, Not distended SKIN: No rashes appreciated NEURO:No focal deficits

Other Meds:

Current Illness:

ID: 1583156
Sex: M
Age: 38
State: NM

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 08/18/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: The evening after getting vaccinated I experience extreme fever, chills, and body aches. I hardly ever get sick and that was the ONLY and the worst reaction I have ever had to any medical treatment. My symptoms were so bad I almost went to the emergency room that night, but was too weak to get out of bed. A week later I ended up going to the doctor for the reaction I had due to the vaccination. I still was experiencing weird bodily sensations and aches. My physician recommend that I report my reactions to VAERS.

Other Meds: n/a

Current Illness: None

ID: 1583157
Sex: F
Age: 75
State: MN

Vax Date: 02/24/2021
Onset Date: 08/10/2021
Rec V Date: 08/18/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: patient brought to ED for multitude of symptoms not feeling well for approx 2 weeks, maybe 1 week prior for Covid like s/s.

Other Meds:

Current Illness:

ID: 1583158
Sex: F
Age: 29
State: AR

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
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 given

Symptom List: Tremor

Symptoms: The patient's Vaccination Record Card was filled out with Moderna as the first dose give on 7-28-21. The patient came and asked for Moderna which was given. Upon billing for the vaccine, it was discovered that the first dose was billed and recorded to system as Pfizer. I am still not completely sure there is an error but the patient was sure that the she had asked for the Pfizer vaccine to be given. She asked for Moderna by name when she came in for her shot. I feel that this Pfizer was given for the first dose and the Moderna was given in error due to the card and patient request.

Other Meds: unknown

Current Illness: none given

ID: 1583159
Sex: F
Age: 4
State: CT

Vax Date: 10/01/2020
Onset Date: 10/01/2020
Rec V Date: 08/18/2021
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: Erythema, Pruritus

Symptoms: Rash with raised bumps at site of injection

Other Meds: Vitamin D supplements

Current Illness: No

ID: 1583160
Sex: F
Age:
State: CA

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 08/18/2021
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: fever, headache, body aches, chills

Other Meds:

Current Illness: autoimmune....lupus

ID: 1583161
Sex: F
Age: 69
State: NC

Vax Date: 07/19/2021
Onset Date: 07/19/2021
Rec V Date: 08/18/2021
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: Latex maybe

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

Symptoms: Chills, muscle/joint aches/pains, fever, nausea, headache, and injection arm red, itching patch below injection site about 3? x 4? Took ibuprofen

Other Meds: Calcium, D3, zinc?, multivitamin, Lexapro, omeprazole

Current Illness: None

ID: 1583162
Sex: F
Age: 36
State: NV

Vax Date: 02/08/2021
Onset Date: 03/01/2021
Rec V Date: 08/18/2021
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: All -cillins (suspected due to clinical reaction), shrimp, latex

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Abnormal vaginal bleeding and severe cramping, began on 3/1/2021, outside of overall regular and predictable cycle. Approximately 1 tennis ball size amount of blood clots and light bleeding after. 4x severe cramps, like labor contractions, just prior to passing blood clots. Suspected possible miscarriage in not yet detected pregnancy. Family member and on call medical assistant for patient's PCP encouraged ER visit on 3/2/2021. First vaccine administration was done on 1/11/2021 Moderna Lot number 011L20A.

Other Meds: Multivitamins, Kesimpta, no changes.

Current Illness: None

ID: 1583163
Sex: M
Age: 22
State: MA

Vax Date: 08/09/2021
Onset Date: 08/10/2021
Rec V Date: 08/18/2021
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: None

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

Symptoms: Sever muscle spasms the night after vaccination. Continued muscle spasms in the abdominal area.

Other Meds: None

Current Illness: None

ID: 1583164
Sex: M
Age: 51
State: FL

Vax Date: 01/23/2021
Onset Date: 07/07/2021
Rec V Date: 08/18/2021
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: Topical antibiotics containing neomycin

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

Symptoms: Experienced myalgia/arthralgia, mild fever, sinus congestion and cough on 7/7/21, tested with Abbott BinaxNOW rapid antigen COVID test on 7/9/21, test was positive, progressively became more symptomatic including fatigue, loss of smell and taste, difficulty breathing. Had 2 subsequent positive rapid antigen tests, finally tested negative on day 14 after symptoms started (7/21/21).

Other Meds: Famotidine 20 mg qhs; Fluticasone nasal spray

Current Illness: n/a

ID: 1583165
Sex: F
Age: 64
State: PA

Vax Date: 04/19/2021
Onset Date: 08/01/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Pain in extremity

Symptoms: runny nose, headache and fatigue.

Other Meds: carboxymethylcellulose sodium (THERATEARS) 0.25 % drops ergocalciferol (VITAMIN D2) 1,250 mcg (50,000 unit) capsule estradioL (ESTRACE) 0.01 % (0.1 mg/gram) vaginal cream fexofenadine (ALLEGRA) 180 mg tablet montelukast (SINGULAIR) 10 mg ta

Current Illness:

ID: 1583166
Sex: F
Age: 29
State: MD

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: Seasonal Allergies

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

Symptoms: A few minutes after I got the first dose my fingers started to get tingly. I did not feel good, and people asked me if I was alright because I was pale. My heart rate was very high. I was observed for longer and my heart rate came back down. During the whole day I was still having palpitations for a minute or two at a time. It continued for about a week and my doctor advised that since it was intermittent and short lived it was OK. I had the second dose and I just felt feverish for one day and a headache for a couple of days.

Other Meds: Adderall PRN, Escitalopram 10mg/daily; Trazadone; Topamax; Humira; Flonase; Claritin; Vitamin C; Vitamin B

Current Illness:

ID: 1583167
Sex: M
Age: 57
State: WA

Vax Date: 02/04/2021
Onset Date: 08/18/2021
Rec V Date: 08/18/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: loud ringing in right ear

Other Meds: multi vitamin, D3, fish oil,

Current Illness: none

ID: 1583168
Sex: M
Age: 15
State: TX

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/18/2021
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: pt stated his lt arm felt heavy.

Other Meds:

Current Illness:

ID: 1583169
Sex: F
Age: 95
State: FL

Vax Date: 01/15/2021
Onset Date: 08/16/2021
Rec V Date: 08/18/2021
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: Statins

Symptom List: Vomiting

Symptoms: The patient presents with COVID positive. ED Nurse states pt is from Care Center and was tested for COVID on 8/9/2021 and had an X-ray that showed COVID pneumonia but it wasn't confirmed. Nurse states pt was sent so COVID pneumonia can be r/o and pt can get medically cleared back to facility. She states the pt is 93% on room air, and pt has no complaints at this time. HPI limited to pt's history of dementia. The course/duration of symptoms is constant. The degree at present is none. Risk factors consist of hypertension, diabetes mellitus and age. Patient was still admitted at time the form was submitted.

Other Meds: Colace, Omega 3, Gabapentin, Lisinopril, Zinc, Loratadine, Metformin, Levothyroxine, Labetalol, Losrtan, Amlodipine, Tylenol ASA

Current Illness: Unknown

ID: 1583170
Sex: F
Age: 14
State:

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 08/18/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Nausea, ice packs, laid on a cot

Other Meds:

Current Illness:

ID: 1583171
Sex: M
Age: 16
State:

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/18/2021
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: Syncope after dose 1, assisted to stretch, allowed to rest, patient's father refused further evaluation

Other Meds:

Current Illness:

ID: 1583172
Sex: M
Age: 65
State: PA

Vax Date: 04/19/2021
Onset Date: 07/29/2021
Rec V Date: 08/18/2021
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: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Dx Fever Generalized Body Aches Chills Myalgia Diarrhea, unspecified type Exposure to SARS-associated coronavirus

Other Meds: aspirin 81 mg chewable tablet atorvastatin (LIPITOR) 20 mg tablet cholecalciferol, vitamin D3, 25 mcg (1,000 unit) tablet cyclobenzaprine (FLEXERIL) 5 mg tablet(Expired) omeprazole (PriLOSEC) 20 mg capsule tadalafiL (CIALIS) 5 mg tablet zin

Current Illness:

ID: 1583173
Sex: F
Age: 51
State: FL

Vax Date: 05/07/2021
Onset Date: 08/14/2021
Rec V Date: 08/18/2021
Hospital: Y

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

Lab Data:

Allergies: Hydrocodone

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

Symptoms: Shortness of breath, Dizziness, Chest tightness, Fatigue, General weakness and Fever. Fully vaccinated Covid-19 case

Other Meds: Multivitamin 1 tab, Tramadol 50mg

Current Illness:

ID: 1583174
Sex: F
Age: 36
State: CA

Vax Date: 04/29/2021
Onset Date: 05/04/2021
Rec V Date: 08/18/2021
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: none

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

Symptoms: Neurological problems: - muscles twitches - restless leg syndrome - myoclonus - ear pumping - muscle weakness in hands and legs - restlessness in upper back - blurred vision

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm