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: 0974285
Sex: F
Age: 28
State: CA

Vax Date: 01/13/2021
Onset Date: 01/21/2021
Rec V Date: 01/26/2021
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: Latex

Symptom List: Dysphagia, Epiglottitis

Symptoms: Localized swelling, redness, itching

Other Meds: Prenatal vitamins

Current Illness: None

ID: 0974286
Sex: F
Age: 45
State: NV

Vax Date: 01/17/2021
Onset Date: 01/24/2021
Rec V Date: 01/26/2021
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: 7 days later, large red hot spot appeared on upper arm where injection occurred. Muscles still very tender on upper arm where injection occurred. Slight swelling of upper arm.

Other Meds: Losartan 25 mg Wellbutrin XL 150 mg Crestor 25 mg zetia 10 mg over the counter: Ambien, Benedryl, Tylenol, Aleve

Current Illness: None

ID: 0974287
Sex: F
Age: 39
State: NY

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/26/2021
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: Penicillin

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

Symptoms: First vaccine on 12/30/20 almost immediately after receiving vaccine metallic taste in mouth, followed by itchy throat and felt throat slightly thighten took Benadryl and received relief Second dose on 1/20/21 took a Zyrtec per doctor?s instruction prior to receiving vaccine about 15 minutes after receiving second dose tongue numbness and weird taste in mouth now and developed itchy face, managed with Zyrtec although itchiness not resolved, taking Zyrtec every day since second dose, yesterday 1/25 in afternoon still medicated under Zyrtec face began to swell on left side of face, persistent itchy face, itchiness went down to other areas including neck, chest, bumps on left hand now on an oral steroid per my doctor

Other Meds: Lexi pro

Current Illness: None

ID: 0974288
Sex: F
Age: 25
State: MI

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: UNKNOWN

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Tingling in nose/lip

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 0974289
Sex: F
Age: 47
State: ME

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: Dust mites

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

Symptoms: Itchy swollen upper lip. Eyes watered and filled with fluid, itchy, sealed shut.

Other Meds: Lexapro, zyrtec, Flonase

Current Illness: None known

ID: 0974290
Sex: F
Age: 70
State: OR

Vax Date: 01/21/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
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: Hay fever

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

Symptoms: Nausea, vomiting, chills

Other Meds: None

Current Illness: None

ID: 0974291
Sex: F
Age: 58
State: KY

Vax Date: 01/24/2021
Onset Date: 01/24/2021
Rec V Date: 01/26/2021
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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: First fatigue, then headache, progressing to chills with fever up to 102 lasting approximately 24 hours, body/joint aches, deep cough, felt like I couldn't get a deep breath (shallow breathing)

Other Meds: hormone patch estrogen

Current Illness: None

ID: 0974292
Sex: F
Age: 79
State: NE

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 01/26/2021
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: ON 1/22/21 DEVELOPED REDNESS AT INJECTION SITE.

Other Meds:

Current Illness:

ID: 0974293
Sex: F
Age: 69
State: IN

Vax Date: 01/14/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: sulfa

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Not quite 2 weeks since my vaccination I developed a slight rash, redness and some swelling in my upper left arm. I think slightly below where I received the shot. Not sure if it had to do with vaccination. Just letting you know.

Other Meds: l-throxine\ lovastatin

Current Illness:

ID: 0974294
Sex: M
Age: 73
State: MI

Vax Date: 01/20/2021
Onset Date: 01/23/2021
Rec V Date: 01/26/2021
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: High doses of Motrin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Itchy large welts on back and side of right leg from buttocks to ankle. Took 50 mg of Benadryl and applied Afterbite to leg immediately. Most welts subsided within a few hours. Took another 50 mg of Benadryl Saturday night. Still have a few small areas of redness. Between the time of vaccination and outbreak, I did not eat anything new, no new clothes detergent, no changes.

Other Meds: Vitamin D

Current Illness: None

ID: 0974295
Sex: M
Age: 58
State: MN

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/26/2021
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 next day after getting the vaccine I had a doctors appointment and my TB test was abnormal which never happened. I am getting retested soon to get a final result

Other Meds: Opempreziol Hydrochlorothiazide Vitamin D

Current Illness: None

ID: 0974296
Sex: F
Age: 80
State: FL

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/26/2021
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: years ago, reaction to shellfish no reaction in last 20 years

Symptom List: Rash, Urticaria

Symptoms: Pfizer-BioTech COVID-19 Vaccine EUA Witihin 5 minutes, burning chest pain. Within less than 20 minutes BP measured at 203/185 and 15 minutes later 191/187. (normal for me is 128/65). Heart rate 130 (normal is 92) Lightheadedness. EMTs on site did EKG and subsequent BP checks. Recommended Emergency Room care, which I did. Aspirin given, blood work done (at 3 different times). 2 Additional EKGs done with no abnormalities noted.. BP and heart rate went down in approximately 2 hours, to 138/85 and 105, but not to normal status. Have been normalized since.

Other Meds: Levothyroxine 100 mg Pravastatin 20 mg Biotin 10000 mcg Vitamin B 12 1000mcg

Current Illness: none

ID: 0974297
Sex: F
Age: 68
State: MD

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/26/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Shoulder Injury Related to Vaccine Administration Signs and Symptoms: decreased ROM, persistent left shoulder pain, Positive Neer's and Hawkins tests Treatment: Left subacromial bursa corticosteroid injection on 01/22/2021.

Other Meds: calcium carbonate-vitamin D3 500 mg-200 unit per tablet cholecalciferol (VITAMIN D3) 400 unit Tab tablet, Take 2,000 Units by mouth fluticasone propion-salmeteroL (ADVAIR) 250-50 mcg/dose diskus inhaler, Inhale 2 puffs into the lungs. mult

Current Illness:

ID: 0974298
Sex: F
Age: 53
State: CO

Vax Date: 01/22/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
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: Pecan, walnuts, avocado, asparagus

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

Symptoms: Itching on the right knee and both legs below the knees. Swollen spot below right knee that itches. Right eye is swollen. I took allergy eye medicine , a 24 hour tablet of Allegra, and put Cortizone 10 on my legs below the knees. As of 1/26/2021 - the medicine has stopped the itching, but eye is still slightly swollen.

Other Meds: Bio-Identical Hormone Pellet, Progesterone

Current Illness: none

ID: 0974299
Sex: F
Age: 81
State: OH

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/26/2021
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: Sulfa and Codeine

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

Symptoms: Pt came into be evaluated for a possible reaction to covid vaccine that she received at senior center. Pt was experiencing left subzygomatic cheek swelling (quarter sized area), Pt denies difficulty breathing, denies ever having facial dermal fillers. Pt on low dose of prednisone that has been previously prescribed by HCP. Pt took Claritin D. Pt was told to take OTC Benadryl at Dr. Visit with other HCP.

Other Meds: Pt takes Vitamin D3 2,000 unit daily, B12 1,000 mcg daily, iron 325 mg daily, Folic Acid 800 mcg daily, Glucosamine daily, multi- vitamin Daily, zinc 50 mg daily, Melatonin 3 mg at HS, Flexiril 10 mg pt takes 5 mg daily (may take up to tid

Current Illness: none noted

ID: 0974300
Sex: F
Age: 51
State:

Vax Date: 01/20/2021
Onset Date: 01/23/2021
Rec V Date: 01/26/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: nausea, tiredness and cold

Other Meds:

Current Illness:

ID: 0974301
Sex: F
Age: 58
State: CA

Vax Date: 01/16/2021
Onset Date: 01/24/2021
Rec V Date: 01/26/2021
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: gluten sensitivity, seasonal allergies

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

Symptoms: After a week: itching at the injection site, rash, slight swelling

Other Meds: Standard Process Daily Vitamins (but not taken at least 5 days prior to the vaccine)

Current Illness: NA

ID: 0974302
Sex: F
Age: 56
State: GA

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: symptoms - headache and body aches

Other Meds: None

Current Illness: None

ID: 0974303
Sex: F
Age: 65
State: NY

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin Teyracycline

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Chills, bad headache, fever and muscle aches

Other Meds: Synthroid Ritalin Allopurinol

Current Illness: COVID

ID: 0974304
Sex: F
Age: 48
State: CA

Vax Date: 01/15/2021
Onset Date: 01/17/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: Benadryl Sensitive to dairy

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

Symptoms: Severe joint pain, myalgias on January 17. Developed fever of 37.9C max, chills and runny nose on January 19. All symptoms resolved by late morning of January 20. Covid test performed on January 20 which was negative.

Other Meds: Centrum multi-vitamins Turmeric capsules Ibuprofen

Current Illness: URI approximately 7 days prior

ID: 0974305
Sex: F
Age: 51
State: OH

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: No allergies

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

Symptoms: Chills, fatigue, nausea, elevated heart rate, tightness in chest, shortness of breathe began in the evening on the day of my injection. Symptoms are continuing on day 4, post vaccine. I am seeing my family doctor this afternoon.

Other Meds: Vitamin B, Vitamin D3, Zyrtec, Vivelle Dot, baby aspirin, Krill Oil

Current Illness: None

ID: 0974306
Sex: F
Age: 39
State: IN

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: Chantix, "four antidepressants", doxycycline

Symptom List: Unevaluable event

Symptoms: "itchy, swollen throat" - resolved with Benadryl (50mg) by month. steroids later prescribed

Other Meds: multivitamin, vitamin B

Current Illness: none

ID: 0974307
Sex: F
Age: 76
State: PR

Vax Date: 01/11/2021
Onset Date: 01/18/2021
Rec V Date: 01/26/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Left arm swelled, turned red and was very painful. Lasted about 5 days

Other Meds: Losartan, hyddrochlorothiazide Citalopram Rosuvastatio

Current Illness:

ID: 0974308
Sex: F
Age: 81
State: VA

Vax Date: 01/14/2021
Onset Date: 01/22/2021
Rec V Date: 01/26/2021
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: Percocet

Symptom List: Injection site pain, Pain

Symptoms: 10 days after receiving my first shot I notices a red area where the shot was administered. The site is about 3" wide and 5" long. It is warm to the touch and is firmer that the areas not affected. It itches a little but has not caused and other symptoms or problems. I started to rub the area and it seems to grow bigger like there is a pocket of liquid just under the skin.

Other Meds: Pravastatin, Atenolol, Forteo, Acyclovir, Aspirin, Polyethylene, Vitamins K, D3, Calcium

Current Illness: None

ID: 0974310
Sex: F
Age: 89
State: NE

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: ON 1/22/21, DEVELOPED REDNESS AT INJECTION SITE.

Other Meds:

Current Illness:

ID: 0974311
Sex: F
Age: 32
State: TX

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/26/2021
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: Started feeling a lump forming under my right armpit. At first it wasn't hurting that much I just felt it was normal of the swelling and soreness, but then I started feeling more pain at night time when I tried to sleep. On Monday the 25th woke up feeling more pain bigger then a pea on my right armpit had a fever of 100.1 in the morning. I went to the doc around the same day in the afternoon. The doc said it was an infection and inflamed from the vaccine I recently got on Friday.

Other Meds: N/A

Current Illness: N/A

ID: 0974312
Sex: F
Age: 57
State: KY

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/26/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Chills, fever, achy joints, high heart rate, UTI symptoms. UTI symptoms and achy joints happened same day as vaccine. Achy joints a couple hours after vaccine. UTI at 14:15, that hit me instantaneously. Chills, fever and high heart rate hit me the next day. 12/31/2020. That's when I went and the sent me to the ER.

Other Meds: Liothyronine, Levothyroxine, Metformin, Gabapentin, Omeprazole, Trazodone, Meloxicam, Venlafaxine ER, Atorvastatin, Fish Oil, Complete Multivitamin, Biotin, Vitamin C, Folate, D3, Calcium/Magnesium/Zinc.

Current Illness: Covid and Pneumonia

ID: 0974313
Sex: F
Age: 54
State: WI

Vax Date: 01/22/2021
Onset Date: 01/24/2021
Rec V Date: 01/26/2021
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: Patient vaccinated on 1/22. The next morning (1/23), patient experienced diminished sensory and motor function in left arm and leg, as well as facial numbness. Presented to the hospital on 1/24, and was found to have a small stroke in pontine medullary junction. Discharged on 1/25. There is some suspicion that her COVID infection in December may have precipitated this, and patient is currently being evaluated for coagulation disorders, primarily antiphospholipid antibody testing. It is unlikely that the vaccine contributed to this, but given close timeline between the two, filing this report.

Other Meds: Cholecalciferol daily, fish oil daily, garlic capsule daily, glucosamine daily, losartan daily, zinc daily, metformin 500 mg po daily (most doses are unclear from her medication history)

Current Illness: Patient was confirmed to be COVID positive in early December (did not require hospitalization).

ID: 0974314
Sex: F
Age: 59
State: CA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/26/2021
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: Unknown

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

Symptoms: Med Error: An empty syringe with 0.5 ml of air was inadvertently administered into the left deltoid instead of the Moderna COVID-19 vaccine. The RN giving the medication disclosed the error to administration and to the patient. The patient was called back to receive the dose of Moderna as planned that same day. Writer is not aware of any adverse reaction due to the medication error.

Other Meds: Unknown

Current Illness: Unknown

ID: 0974315
Sex: F
Age: 89
State: NE

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 01/26/2021
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: ON 1/22/21 DEVELOPED RED, RAISED RASH AT INJECTION SITE.

Other Meds:

Current Illness:

ID: 0974316
Sex: M
Age: 43
State: NY

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: felt itchy in the face and legs. Benadryl 25mg po at 1135 with good effect

Other Meds: Novolog

Current Illness: Type 1 Diabetes

ID: 0974318
Sex: F
Age: 69
State: FL

Vax Date: 01/12/2021
Onset Date: 01/15/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: Levaquin Silk Tape

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

Symptoms: site inflammation, redness, approx. size of reddened area 5cm x 5 cm still persist 2 weeks out

Other Meds: Ativan as needed Meclazine as needed

Current Illness: N/A

ID: 0974319
Sex: F
Age: 61
State: CA

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Itchy really red, got worse the 2nd day, 01.22.21. Getting redder with bigger circle each day.

Other Meds:

Current Illness:

ID: 0974320
Sex: F
Age: 36
State: CO

Vax Date: 12/24/2020
Onset Date: 01/01/2021
Rec V Date: 01/26/2021
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: Tremor

Symptoms: 1/1/21 itchy, red, warm at site. took benadryl and better. On 1/4 presented to EH. Large pale pink area about 3x5cm and larger red area outside it about 10x18cm. Outline marked w sharpie and date. sent her to pcp for eval. She saw PCP 2/5 and dx as cellulitis and prescribed ABX. She took for one day and stopped. Reaction completely gone 2/10/21. Likely will decline dose #2

Other Meds: none

Current Illness: none

ID: 0974322
Sex: F
Age: 27
State: MI

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
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: Penicillin, lactose

Symptom List: Erythema, Pruritus

Symptoms: Chills, full body aches, headache, upset stomach

Other Meds: Levothyroxine

Current Illness:

ID: 0974323
Sex: F
Age: 35
State: TX

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
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: Penicillin

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

Symptoms: Moderna Covid-19 Vaccine EUA, I experienced headache, nausea, vomiting, diarrhea, fever, chills and aches for several hours. My fever went down around 6AM and was back to normal by 7AM. I am still experiencing headache and aches.

Other Meds: I had an Arbonne energy fizz with water I was drinking during the time I was vaccinated.

Current Illness: None

ID: 0974324
Sex: F
Age: 47
State: NC

Vax Date: 01/19/2021
Onset Date: 01/23/2021
Rec V Date: 01/26/2021
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: Sulfa Drugs

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

Symptoms: New redness and itching at injection site starting 1/23. Redness and itching continued spreading and increasing through majority of 1/24. Area increased to ~1.5-2in wide x ~4in long before beginning to subside quickly 1/24 night. Oral Benadryl and topical hydrocortisone cream used PRN for itching/possible allergic reaction throughout course of event.

Other Meds: Vit C, Vit D3, Gabapentin 600mg, Baclofen 10mg, Metoprolol ER 25mg, Citalopram 40mg, Zolpidem 10mg, Ocrevus Infusion

Current Illness:

ID: 0974325
Sex: M
Age: 23
State: MA

Vax Date: 01/18/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
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: n/a

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: tired and fatigue, site soreness

Other Meds: n/a

Current Illness: n/a

ID: 0974326
Sex: F
Age: 40
State: NE

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/26/2021
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: DEVELOPED OCULAR NEURITIS IN LEFT EYE. PATIENT NOTED THAT SHE DOES HAVE MULTIPLE SCLEROSIS (MS). SHE IS FOLLOWING UP WITH HER PROVIDER.

Other Meds:

Current Illness:

ID: 0974328
Sex: M
Age: 38
State: MN

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/26/2021
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: Environmental allergies

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

Symptoms: Approximately 45 minutes after receiving vaccine patient reported nausea, lightheadedness, and throat tightness. Seen in the Emergency Department and received Prednisone and Benadryl. Was monitored and discharged to home with home care advice.

Other Meds:

Current Illness:

ID: 0974329
Sex: F
Age: 42
State: MN

Vax Date: 01/07/2021
Onset Date: 01/14/2021
Rec V Date: 01/26/2021
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

Symptom List: Pain in extremity

Symptoms: My initial reaction was headache, body aches, and brain fog, lasted about a day and half. Then about a week later i started just itching on my for arms and torso. I have little bumps and they itch. It comes and goes.

Other Meds: Levothyroxine, Multivitamin

Current Illness:

ID: 0974330
Sex: F
Age: 90
State: MI

Vax Date: 01/17/2021
Onset Date: 01/18/2021
Rec V Date: 01/26/2021
Hospital:

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

Lab Data:

Allergies: lisinopril

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

Symptoms: Temperature of 100.3 degrees Fahrenheit noted on 1/18/2021 at 5:40pm. Acetaminophen 650mg administered. Temperature at 7:02pm on 1/18/2021 was 98.3 degrees Fahrenheit. No other adverse reactions noted.

Other Meds: Aspirin EC 81mg once daily. Basaglar 100unit/mL 30 units once daily. Bumex 1mg once daily. Carafate 1 gram two times daily. Ferrous sulfate 325mg two times daily. Gabapentin 100mg once daily. Gabapentin 200mg once daily. Incruse Ellipta Aeo

Current Illness: None

ID: 0974332
Sex: F
Age: 40
State: CA

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 01/26/2021
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: compazine, ciproflaxin, bee sting

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

Symptoms: 5 minutes after I received the shot my left pinky finger and left ring finger went numb. I notified the nurse. She left to get the head nurse. Within 2 minutes my arm was numb below my elbow. This lasted 10 minutes. The feeling came back. Later that day my left upper back was sore. Since then (2 weeks) I still have numbness and tingling in my elbow and left pinky finger with occasional pain in my left upper back.

Other Meds: Multivitamin, ferrous gluconate, hormone balance supplement

Current Illness: none

ID: 0974333
Sex: F
Age: 36
State: SC

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/26/2021
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: fever, chills, severe back/neck ache, nausea

Other Meds:

Current Illness:

ID: 0974334
Sex: M
Age: 27
State: AR

Vax Date: 01/13/2021
Onset Date: 01/14/1921
Rec V Date: 01/26/2021
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: no

Symptom List: Vomiting

Symptoms: Low grade fever and headache

Other Meds: no

Current Illness: no

ID: 0974335
Sex: F
Age: 63
State: WI

Vax Date: 01/19/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
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: Codeine, nickel, betadine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Diarrhea and abdominal cramping 1 hour after second dose of Covid vaccine. Took OTC medication, Imodium, motrin, soft bland diet. Six + episodes of diarrhea in one hour on 1/21/2021 with significant cramping. Went to ER. Received fluids and IV Zofran. CBC and CMP WNL. Stool test also done--negative. Discharged. Severe diarrhea morning of 1/22/2021. Missed work on 1/21 and 1/22. Diarrhea and abdominal cramping continued intermittently. Worked Monday. Stool samples provided. C.Diff negative. Lactoferrin positive. Enteric bacterial panel negative. CT of abdomen scheduled for 1/27/2021

Other Meds: Prilosec, HCTZ, Amlodipine, Zoloft, occuvite, ASA 81 mg., Vitamin D , Motrin prn

Current Illness: None

ID: 0974336
Sex: F
Age: 40
State: NE

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/26/2021
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: DEVELOPED OCULAR NEURITIS IN LEFT EYE. PATIENT NOTED THAT SHE SUFFERS FROM MULTIPLE SCLEROSIS (MS). HAS FOLLOW UP APPOINTMENT WITH HER PCP.

Other Meds:

Current Illness:

ID: 0974337
Sex: M
Age: 30
State:

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
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: While injecting right arm with vaccine - the vaccine fluid squirted out of the syringe an possibly more that half the vaccine did not reach the patient properly. Conferred with HCP and it was ordered to dose the patient with a full dose in the left arm. Orders carried out and vaccine was administered as ordered. Patient tolerated procedure and was understanding.

Other Meds:

Current Illness:

ID: 0974338
Sex: F
Age: 42
State: PA

Vax Date: 01/18/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Nickel sized redness at injection site and tender armpit.

Other Meds: Zyrtec and multivitamin

Current Illness: None

ID: 0974339
Sex: F
Age: 87
State: GA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/26/2021
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:

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

Symptoms: Patient complained of flushing and/or skin edema. 12:03 BP 123/82, HR 64, RR 16, O2 SAT 94% 12:07 BP 121/70, HR 62, RR 15, O2 SAT 96% 12:13 BP 125/75, HR 63, RR 15, O2 SAT 96% PATIENT DECIDED TO LEAVE PRIOR TO END OF THE HOUR AND WAS CALM, ALERT AND ORIENTED X4.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm