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: 0975042
Sex: F
Age: 79
State: MD

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No Know Allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient called over nurse and stated she felt like her heart was racing. Vitals taken and pulse 64-72 and regular. Patient states she is feeling very emotional and she states she thinks this is anxiety. Patient reassured and monitored until 2 :20. All symptoms resolved and patient states she felt fine prior to discharge

Other Meds: Tamoxifen, Statin

Current Illness:

ID: 0975043
Sex: F
Age: 68
State: OK

Vax Date: 01/07/2020
Onset Date: 01/08/2020
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: No appetite. Diarrhea fatigue Lasted 7 days.Then normal.

Other Meds: Heart meds diabetic meds cholesterol meds cops meds

Current Illness: Copd round of steroids

ID: 0975044
Sex: F
Age: 47
State: FL

Vax Date: 01/25/2021
Onset Date: 01/26/2021
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: NO

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

Symptoms: Fever, strong muscular pain, muscular weakness, headache, chills

Other Meds:

Current Illness: Hypothyroidsm

ID: 0975045
Sex: F
Age: 44
State: TX

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Sudden onset of substernal chest pain radiating to back. Headache radiating to left shoulder and redness of hands

Other Meds: Trazidone, Crestor, Hormones

Current Illness:

ID: 0975046
Sex: M
Age: 79
State: MD

Vax Date: 01/24/2021
Onset Date:
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: None

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

Symptoms: Moderna COVID -19 Vaccine EUA No adverse effect Mod

Other Meds: Toprol, lissinopril, vitamin D, multi vitamin, statin, vitamin C

Current Illness: None

ID: 0975047
Sex: F
Age: 63
State:

Vax Date: 01/21/2021
Onset Date: 01/23/2021
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:

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

Symptoms: Temperature of 102, vomiting, shaking all over & weakness in legs

Other Meds:

Current Illness:

ID: 0975048
Sex: F
Age: 40
State: TN

Vax Date: 01/21/2021
Onset Date: 01/26/2021
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: I got lip filler 11 months ago and today I have some swelling in my top lip.

Other Meds: Spironolactone Metformin Birth control Daily multivitamin

Current Illness: None

ID: 0975049
Sex: F
Age: 84
State: MI

Vax Date: 01/17/2021
Onset Date: 01/18/2021
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: Ampicillin, Lisinopril, Propoxyphene, Keflex

Symptom List: Pharyngeal swelling

Symptoms: Temperature 101.1 degrees Fahrenheit on 1/18/2021 @ 1:28pm. Tylenol 650mg administered. Orders obtained to admnister one liter of normal saline via intravenous route due to resident's poor oral intake. IV fluids initiated. Temperature 98.9 degrees Fahrenheit on 1/18/2021 @ 4:35. Temperature 101.0 degrees Fahrenheit on 1/18/2021 @ 11:54pm. Cold compresses applied. Temperature 98.8 degrees Fahrenheit on 1/19/2021 @ 12:52am.

Other Meds: Biotene dry mouth mouthwashes 15mL one time daily. Coumadin 3mg one time daily. Gabapentin 200mg three times daily. Losartan potassium 100mg one time daily. Magnesium oxide 400mg one time daily. Metoprolol tartrate 25mg two times daily. Mi

Current Illness: None noted

ID: 0975050
Sex: F
Age: 58
State: MO

Vax Date: 12/23/2020
Onset Date: 12/24/2020
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient unable to work on 12/24/2020 - fever of 101.0, muscle ache, nausea, diarrhea. 12/25/2020 some better, fever persists at 99.8, and diarrhea 12/26/2020 better, no fever, still has diarrhea 12/27/2020 better, no fever, still has diarrhea 12/28/2020 better, no fever, small amount of diarrhea.

Other Meds:

Current Illness:

ID: 0975051
Sex: F
Age: 19
State: NY

Vax Date: 08/29/2020
Onset Date: 08/29/2020
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: Denies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Developed swelling to hands and feet as well as hives. Symptoms occurred same day as vaccine administration day. Symptoms lasted for 1 week.

Other Meds: Currently on Birth control

Current Illness: Denies

ID: 0975052
Sex: F
Age: 33
State: MI

Vax Date: 01/19/2021
Onset Date: 01/24/2021
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: Amoxicillin

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

Symptoms: Blood clot, DVT of a ill art vein acute left

Other Meds: None

Current Illness: None

ID: 0975053
Sex: M
Age: 26
State: WA

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Dairy approximately >150mL

Symptom List: Rash, Urticaria

Symptoms: -Swollen lymph nodes palpated on the armpit and under the injection sites -Fatigue

Other Meds: Fish oil and multivitamin supplement

Current Illness: N/A

ID: 0975055
Sex: F
Age: 40
State:

Vax Date: 01/11/2021
Onset Date: 01/20/2021
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: NA

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

Symptoms: Numbness of all 10 toes

Other Meds: Vitamin D 3x/week, Vitamin B12 3x/week, Selenium Iodine 2x/week, Spironolactone 12.5 mg 2x/week

Current Illness: NA

ID: 0975056
Sex: F
Age: 82
State: FL

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Unknown

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

Symptoms: Per EMS report, within 15-minutes of vaccination, patient underwent an anaphylactic reaction. Patient's care was managed on site.

Other Meds:

Current Illness:

ID: 0975057
Sex: M
Age: 70
State: CA

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 01/26/2021
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: Erythromycin; Cefaclor; Scopolamine Tramadol

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

Symptoms: *Atrial fibrillation . No prior instances.* Vaccine 1/20/2021. On 1/21, 25 hours after vaccine felt slight pressure in chest and rapid heat beat. Heart rate 150. EKG in Cardiologist's office. Admitted to hospital On 1/22/2021 -- DC (Direct Current) Cardioversion Procedure Prior to the procedure, a transesophageal echocardiogram was performed which showed no evidence of left atrial appendage thrombus. The patient was successfully cardioverted on the 1st attempt after administration of 150 joules using a bi-phasic defibrillator. A post cardioversion EKG was obtained and reviewed. The patient tolerated the procedure well with no complications. Post-procedure vitals: HR 65 BP 119/71 O2 sat 99%

Other Meds: Finasteride 5 mg oral tablet- Brand Name: PROSCAR 1 tablet daily. Terazosin 5 mg capsule- Brand Name: HYTRIN. 1 capsules 2 times daily. Rosuvastatin 10 mg oral tablet- Brand Name: CRESTOR 1 tablet daily. Aspirin 81 mg oral tablet 1 tab

Current Illness: N/A

ID: 0975058
Sex: M
Age: 69
State: CA

Vax Date: 01/24/2021
Onset Date: 01/26/2021
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: none

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

Symptoms: acute spasmodic pain in left forearm

Other Meds: none

Current Illness: left wrist injury 11/16/2020

ID: 0975059
Sex: F
Age: 32
State: MN

Vax Date: 01/26/2021
Onset Date: 01/26/2021
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: morphine, Tylenol, others

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

Symptoms: Pt received vaccine. She was sitting in the observation area after vaccine. About 10 minutes after vaccine, Pt reported feeling numbness in hands and feet, chest tightness and slight difficulty breathing. Pt was offered and ingested diphenhydramine 25mg at 1230 and another 25mg at 1238. Pt continued with same symptoms (not better and not worse). 911 ambulance was called. Pt remained conversing with full sentences with one breath during observation. Radial pulse was strong and regular. No rash. No apparent swelling. Respirations were quiet (no stridor). Ambulance arrived and took over care and eventually transported pt to the ETC.

Other Meds: unk

Current Illness: unk

ID: 0975060
Sex: F
Age: 44
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Rash / Headache / Fatigue / Muscle weakness

Other Meds:

Current Illness:

ID: 0975061
Sex: F
Age: 54
State: NY

Vax Date: 01/15/2021
Onset Date: 01/22/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient developed an infection 7 days post-injection. Patient experienced arm redness/swelling/pain and fever of 100f. Patient also had chest pain.

Other Meds:

Current Illness:

ID: 0975062
Sex: F
Age: 50
State: MO

Vax Date: 12/23/2020
Onset Date: 12/23/2020
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:

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

Symptoms: Employee experienced pretty bad achiness, within 48 hours developed rash, still has at time message left (12/28/2020), injection site pain.

Other Meds:

Current Illness:

ID: 0975063
Sex: F
Age:
State: TX

Vax Date: 01/01/2021
Onset Date: 01/26/2021
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: None

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

Symptoms: Swelling pain at injection site, fatigue, chills, bodyaches, and fever.

Other Meds: Spirinolactone Veltin Vitamin d

Current Illness: None

ID: 0975064
Sex: F
Age: 24
State: NC

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: Allergic to zithromycin, and some foods not sure what.

Symptom List: Unevaluable event

Symptoms: Soreness of the arm 2 hours after injection. The night of the injection I had chills, muscle and joint pain the point I could not sleep and a severe headache and tiredness.

Other Meds: Birth control

Current Illness: No

ID: 0975065
Sex: F
Age: 51
State: MA

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Dizzyness Flushed face and neck Swollen tongue Minor facial swelling around eyes Epi Pen and 50mg of Benedryl, bp remained normal, patient remained fully conscious. 911 called and transport to Emergency Dept

Other Meds:

Current Illness:

ID: 0975066
Sex: M
Age: 33
State: CO

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: apricots

Symptom List: Injection site pain, Pain

Symptoms: flu-like sxs. joint and muscular pain. abdominal cramping. pins and needles/hypersensitive skin. headache. fever. unable to sleep. sxs had rapid onset appx 12 hrs after dose administration, have continued for 12 hrs to current time.

Other Meds: none

Current Illness: none

ID: 0975067
Sex: F
Age: 50
State: CA

Vax Date: 01/13/2021
Onset Date: 01/23/2021
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: adhesive

Symptom List: Injection site pain, Menorrhagia

Symptoms: pt stated she was feverish, had headache and fatigue for about 1 1/2 days after covid vax. Pt stated she started having diarrhea and developed a itchy nodule on the left side of her neck about a week later along w/ fatigue. Pt has an appt w/ ENT Dr. tomorrow 1/27/2021.

Other Meds: naproxen

Current Illness: none

ID: 0975068
Sex: F
Age: 48
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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: While at vaccine pod patient developed hives on left deltoid and neck/chest region. Patient given Benadryl and brought back to first aid tent. Patient developed sore, scratchy throat and headache. No further symptoms before resolve. Give ibprofen.

Other Meds:

Current Illness:

ID: 0975069
Sex: M
Age: 55
State: WI

Vax Date: 01/20/2021
Onset Date: 01/21/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Diffuse abdominal pain onset approximately 10-12 hr post dose. I was initially awoken that first night with nausea and abdominal pain. This continued through 1/22/21. My nausea had subsided and I was able to eat in small quantities. My abdomen felt bloat with mild distention. The AM of 1/23/21, I awoke and the diffuse abdominal pain had abated. I was left with RLQ abdominal pinpoint pain. This became progressively worse throughout the day. I presented to the ER on 1/23/21. Chem panel was normal. CBC also normal. I received an abdominal CT scan with IV contrast for R/O appy. My appendix was normal. The scan revealed a serosal venous thrombophlebitis wth inflammation in the mesentery and transverse colitis. The pain continued to progress, so I presented to the ER again on 1/25/21. I received another abdominal CT along with additional lab work. Lactate normal. D-Dimer mildly elevated at 0.7 and CRP was 9.7. Again CBC was normal. This CT did not reveal the micro-emboli or colits but rather omental inflammation. At this point, surgery was consulted along with hematology for opinion regarding anticoagulation. The decision to anti coagulate was deferred. The diagnosis I received was omental infarct. I remain on pain medications and continue to monitor for changes in my pain and a fever.

Other Meds: Lisinopril, ASA 81 mg.

Current Illness: None

ID: 0975070
Sex: F
Age: 70
State: GA

Vax Date: 01/16/2021
Onset Date: 01/24/2021
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: RA

Lab Data:

Allergies: clindamycin, Novocain, penicillins, Sulfa Drugs

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Rash at injection site is erythematous and mildly raised and bilobed with a "figure8" appearance. Rash began showing 8 days after injection given

Other Meds: Buspirone, Clobetasol, Escitalopram, Multivitamin, Omeprazole, raloxifene, sucralfate, zolpidem

Current Illness:

ID: 0975071
Sex: F
Age: 20
State: WV

Vax Date: 01/23/2021
Onset Date: 01/23/2021
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: N/A

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

Symptoms: Roughly an hour after started getting numb feeling in the roof of my mouth. Feeling went away rather soon but was back by around 9 am the next morning. Over the course of six hours the feeling was moving into the tongue and back of throat. Throat and mouth started hurting as well.Stopped being able to swallow properly. Was given Benadryl and a steroid at urgent care and have not had any more swelling over the past two days.

Other Meds: Zoloft Metformin Spiralactin Biotin Vitamin D Melatonin

Current Illness: N/A

ID: 0975072
Sex: F
Age: 39
State: MA

Vax Date: 01/13/2021
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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Fatigue, body aches, low grade fever Pregnant DOD 04/11/2021

Other Meds: Prenatal vitamins Baby aspirin

Current Illness: Had covid two weeks prior

ID: 0975073
Sex: M
Age: 64
State: FL

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Chills,fever of 101.8, night sweats

Other Meds: MVI VITAMIN D

Current Illness: None

ID: 0975074
Sex: F
Age: 92
State: CA

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: Prevacid

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

Symptoms: 11:00 pm on day of vaccine had fever, chills, headache, dizziness Next morning had temperature of 102

Other Meds: Atorvastatin. Levothyroxine . Multi vitamins . Calcium

Current Illness:

ID: 0975075
Sex: F
Age: 77
State: NJ

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: DoxycyclineGI Upset, Headache GabapentinDizziness Seroquel [Quetiapine]Headache Sulfa AntibioticsItching, Rash

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

Symptoms: patient reports her upper lip began to get numb, feeling like novacaine from the dentist. no swelling or difficulty breathing. then her eyes began to feel dry and her ears feel "swollen inside" but no pain.

Other Meds: ALPRAZolam 0.5 MG tablet 0.125-0.25 mg, oral, Once PRN amoxicillin-clavulanate 875-125 mg per tablet 1 tablet, oral, 2 times daily with meals B Complex Vitamins (B COMPLEX 1 PO) 1 tablet, oral, Daily C

Current Illness: admitted overnight with small right apical pneumothorax after intercostal nerve block for post herpetic neuralgia. She underwent an intercostal nerve block on the right earlier that day and presented with pleuritic chest pain and shortness of breath. Chest x-ray showed a small right apical pneumothorax. She was admitted overnight and by the next morning her pneumothorax had improved. She was discharged home uneventfully not requiring intervention.

ID: 0975076
Sex: F
Age: 54
State: NY

Vax Date: 01/15/2021
Onset Date: 01/22/2021
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: redness, swelling, pain in arm and chest, diagnosed with infection 7 days after vaccine with fever of 100F

Other Meds: centrum vitamin and acidopholis

Current Illness: none

ID: 0975077
Sex: M
Age: 49
State:

Vax Date: 12/29/2020
Onset Date: 12/30/2020
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: Erythema, Pruritus

Symptoms: Rash / Nausea

Other Meds:

Current Illness:

ID: 0975078
Sex: F
Age: 43
State: NY

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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: Diflucan, ? Hazlenut

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

Symptoms: At 08:15, first response was called to tend to a hospital employee at the vaccine clinic as she was unable to swallow and disclosed that she self-medicated using Benadryl 2 hours after her first COVID vaccine d/t symptoms of "scratchy throat" She did not say "yes" to any of the consent questions prior to administration of 2nd vaccine dose to indicate any concerns. Symptoms progressed to difficulty breathing within a few min. and 25 mg of Benadryl IM and Epi 1mg SQ was given on-site. The employee was subsequently transferred to ED at 08:40 am. She was given Decadron 10 mg IV and Famotidine discharged home. Today 1/26, her wheezing/stridor persist and she has schedule to f/u w/ her PCP.

Other Meds: Collgen Supplement, Advair 250/50, Combivent (PRN), Ibuprofen

Current Illness: Moderate Persistent Asthma

ID: 0975079
Sex: F
Age: 81
State: SC

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Pt complained of feeling flushed and tightness in her chest. Pt face was visibly red and she began to have blotches down her back. BP 170/84 at 1:30. Benadryl 50mg given IM at 1:40pm. 2 L of O2 via nasal cannula at 1:42pm. On call physician assessed pt at 1:42 at which time pt started complaining of nausea. BP 132/76 @ 1:45pm.

Other Meds: Losartan 25mg tablet Lorazepam 0.5mg tablet Synthroid 50 mcg tablet Nitrostat 0.4mg tablet Phenazopyridine HCl 200mg tablet Hyoscyamine Sulfate 0.125mg tablet

Current Illness:

ID: 0975080
Sex: F
Age: 37
State: DE

Vax Date: 01/12/2021
Onset Date: 01/14/2021
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: eggs, shrimp, erythromycin, levemir, lantus

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: rash around waistline and under armpits - given triamcinolone ointment by physician

Other Meds: metformin, xultophy, actos, tompamax, lisinopril, lipitor, bisoprolol, xyzal, prilosec, seasonique, vascepa, vitamin e, vitamin d, vitamin b complex, vitron c, multivitamin, slofe,

Current Illness:

ID: 0975081
Sex: F
Age: 45
State: VA

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: 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: mild soreness at injection site 3 hours after injection and less sore the next day

Other Meds: Diamox, Contrave, pepcid, advil, Celsius energy drink

Current Illness: none

ID: 0975082
Sex: F
Age: 30
State: MO

Vax Date: 12/23/2020
Onset Date: 12/23/2020
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:

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

Symptoms: Patient had red raised area at injection site, warm to touch

Other Meds:

Current Illness:

ID: 0975083
Sex: M
Age: 62
State: OH

Vax Date: 01/21/2021
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: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Chills and low grade fever for 19 days after 2nd dose of Pfizer covid vaccine

Other Meds: Tenofovir Allopurinol Omeprazole Vitamin d Candesartan Centrum men

Current Illness:

ID: 0975084
Sex: M
Age: 45
State: VA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
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: Codeine Environmental

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

Symptoms: Night of injection, arm soreness, chills and fever of 101.6. Afebrile currently but has headache.

Other Meds: Flonase, Zyrtec, Omeprazole

Current Illness: None

ID: 0975085
Sex: M
Age: 42
State: IL

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Seasonal Allergies

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

Symptoms: At approximately 5 minutes after the injection, I experiences a short period of Rapid Heart Rate and a feeling of "Flush"\Warm. This lasted about 1-2 minutes. I did not receive any treatment for this. There was no further outcome to report. After 2 minutes it passed, I remained in the waiting area for an extra 5 minutes following my initial 15 minute observation period and left without incident.

Other Meds: Men's 1-A-Day Multi Vitamin

Current Illness: None

ID: 0975086
Sex: F
Age: 75
State: IL

Vax Date: 01/15/2021
Onset Date: 01/18/2021
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: Feldene, propellants for sinus products, Biaxin, sensitive to quinalones, ibuprofen

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

Symptoms: 18 Jan began to have strong lethargy, major muscle (ex: quads, low back, neck & shoulder) soreness which continued and began to lessen on 22nd. Generalized headache. Late 22nd began to itch at upper left arm in area of injection. At bedtime saw 4" x 5" (approx) on arm was quite red, skin tight from swelling, had little additional bumps, hot to touch. Morning 23rd additional area red, hot, swollen just below left collarbone. Also small red spots on low back, thighs, forearms. Former 3 areas itchy. Visit Immediate Care; advised to ice, take Claritin, apply triamcinalone acetoid lotion. Reacted to Claritin; discontinued. Still using ice, lotion. On 19th used Tylenol which did not help. Told it is delayed histamine reaction; still subsiding.

Other Meds: mineral supplement, vitamin D, biotin, B complex, lutein, hyalauronic acid, estradiol cream

Current Illness: None

ID: 0975087
Sex: F
Age: 42
State:

Vax Date: 01/04/2021
Onset Date: 01/14/2021
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:

Symptom List: Vomiting

Symptoms: Red, raised, itchy rash at the injection site 10 days after injection

Other Meds:

Current Illness:

ID: 0975088
Sex: F
Age: 70
State: TX

Vax Date: 01/16/2021
Onset Date: 01/22/2021
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: Iodine, Codine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Redness, slight swelling, pain at injection site that re-started after 7 days. Original ache / redness went away after 3 days.

Other Meds:

Current Illness:

ID: 0975089
Sex: F
Age: 41
State: NY

Vax Date: 01/07/2021
Onset Date: 01/09/2021
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: petechial rash above injection site

Other Meds:

Current Illness:

ID: 0975090
Sex: F
Age: 50
State: NM

Vax Date: 01/12/2021
Onset Date: 01/13/2021
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: PCN

Symptom List: Injection site swelling, Limb discomfort

Symptoms: The day after receiving the second COVID-19 vaccine, I had a massive headache, to the point where I stayed in bed and slept all day. I also noticed that my brain was foggy. The next day I was able to move to the couch, but the headache was still severe with continued brain fog. I called by PCP to see if there was anything that I needed to be doing or taking and she told me that I should start feeling better the next week. The headache remains but is mild. I have memory loss and difficulty concentrating. I am a nurse and over my weekend at work, I had difficulty doing my job because I couldn't keep track of what I was supposed to be doing and had difficulty charting. My coworkers even commented that I seemed "really different", that my memory was poor, I had personality changes (according to one person) and that my standard of care was much less than usual. One person also commented that seemed to not be able to hear her and kept asking her to repeat herself. I find myself having to concentrate harder to see when I am reading or typing something. I missed work on January 14 and 15 because of the mental fogginess and headache. I thought I was doing better, but I realized that I wasn't when I returned to work on January 23 and 24. I have spoken to my PCP on the phone once and am awaiting calls from my PCP and neurologist regarding this event.

Other Meds: Plavix, ASA, metoprolol, isosorbide, ranolazine, gabapentin, tizanidine, Prozac, Metanx, Super B complex, Magnesium, atorvastatin, Colace, Tylenol

Current Illness: none

ID: 0975091
Sex: F
Age: 88
State: CO

Vax Date: 01/20/2021
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: noted erysipelas to right arm during bath on 6th day after vaccine, 10x5cm area below 2cm target area of incision site, warm to touch with clear borders, no systemic symptoms

Other Meds: nystatin, tylenol, dulcolax, atropine sulfate eye drops, artificial tears, milk of magnesia, senna s

Current Illness: intertrigo

ID: 0975092
Sex: F
Age: 39
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient felt heavy tongue, lump in throat, dizziness, weakness, palpitations shortly after receiving her dose. She was immediately taken to the ED for further evaluation.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm