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: 0975709
Sex: F
Age: 27
State: OH

Vax Date: 12/29/2020
Onset Date: 01/06/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Hives began on underside of upper arms and thighs, spread sporadically on body and is still intermittently persisting, especially at night.

Other Meds: Levothyroxine, melatonin, kurvelo birth control

Current Illness: None

ID: 0975710
Sex: F
Age: 16
State: MN

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: unknown

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccine Administration Error. Vaccine given to underage client. Client reports a nausea and queasy stomach but symptoms resolved after 72 hours.

Other Meds: unknown

Current Illness: unknown

ID: 0975711
Sex: F
Age: 88
State: AK

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: lisinopril benzos pcn lovastatin fluoxetine glargine insulin

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

Symptoms: R arm pain headache

Other Meds: L thyroxine amiodarone citalopram losartan Vitamin D3

Current Illness:

ID: 0975712
Sex: F
Age: 38
State: CA

Vax Date: 01/13/2021
Onset Date: 01/24/2021
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: no medication allergies, possible seafood allergy as of 11/01/2020.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Left arm with two separate circular red, inflamed rashes. one are directly over site of vaccine. Urgent Care MD reports reaction to Moderna, prednisone injection provided for reaction.

Other Meds: birth control, B12, Vitamin D

Current Illness: N/A

ID: 0975713
Sex: F
Age: 91
State: NJ

Vax Date: 01/22/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Vial was thawed on 1/11/21 and due to expire on 1/16/21 - patient was immunized with this expired vaccine on 1/22/21.

Other Meds:

Current Illness:

ID: 0975714
Sex: F
Age: 38
State: TX

Vax Date: 01/20/2021
Onset Date: 01/21/2021
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: latex, peaches

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

Symptoms: I had terrible insomnia and the worst headache Wednesday night. When I finally went to sleep I tossed and turned and was cold and hot. I woke up with barely any strength. I slept from 8am-1:30pm Thursday. I had body aches, an upset stomach, muscle aches, and overall felt yucky. Friday I went to work for a presentation and was feeling awful. I had a fever and took some ibuprofen. My injection site was swollen and warm to the touch. I was dripping sweat last night Friday night. My lymph nodes are still swollen under my arm where I got the vaccine and my neck.

Other Meds: zoloft

Current Illness: none

ID: 0975715
Sex: F
Age: 47
State: ND

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

Lab Data:

Allergies: Seasonal allergies (not diagnosed)

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: My eyes, nose, throat, and ears started to itch and burn. My eyes swelled to the point that one eye was completely swollen shut. My lower lip started to swell slightly, but not much. I took Cetirizine Hydrocloride 10 mg. I took one pill in the morning and one in the evening until the evening of 1/25. The burning and itching subsided in an hour. The swelling in my eyes was not completely resolved until the morning of 1/26. 1/22 - 1/24, I was extremely fatigued, sleeping most of the time day and night. On 1/26, I felt that my symptoms had completely resolved.

Other Meds: Oxybutynin 5 mg Docusate Sodium 100 mg Esomeprazole Magnesium 20 mg Vitamin D3 (2000 IU) Airborne

Current Illness: none

ID: 0975717
Sex: M
Age: 18
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:

Symptom List: Pharyngeal swelling

Symptoms: Feeling lightheaded

Other Meds:

Current Illness:

ID: 0975718
Sex: M
Age: 48
State: PA

Vax Date: 01/24/2021
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: Percocet

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I had my second injection on Sunday morning 1/24/21 at 9:00 AM. I was fine through the day. The previous dose (dose #1) was on 12/29/20 and I became symptomatic the following day. I had aches, malaise and fevers of 102.7 on 12/30/20. The fevers lasted approximately 12 hours and resolved with Tylenol. My left deltoid was very swollen and quite painful. The swelling and pain resolved within 24 hours after the first injection. Prior to dose #2 and through the day on 1/24, I used Tylenol and Celebrex, both medications were ingested at 8:45 and the tylenol wa again ingested at 11pm prior to going yo bed. By 12:15, I had severe bilateral calf pain. Fever started shortly after that. Severe Headaches and Photophobia began at around 1 am. I had a vey difficult time walking and was quite dizzy through the night. Unable to sleep more than a couple of minutes at a time. By 6:45 am, my fever was around 103.5. I have used Tylenol and Ibuprofen since 1/25/21, 6:45 am. both medications have been utilized around the clock on TID basis. Fever dissipated by 1/25/21 evening. Only a mild headache is present. The injection site was swollen, indurated and painful to touch similar to cellulitis. I have not used antibiotics, drew a line and have monitored the redness, it is slowly resolving. By 17:30 on 1/26/21, I have a mild headache, mild malaise and chills. No fever. Arm is still swollen red and hot. I have not had respiratory or GI symptoms and have no history f Covid Exposure and have tested negative on multiple occasions.

Other Meds: Flecanide Albuterol Vitamin C

Current Illness: Less severe reaction to the first dose of Moderna Vaccine

ID: 0975719
Sex: F
Age: 48
State: NH

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: oxycontin, erythmycin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: next day extremely tired. Slept in car during work lunch break, then straight home went to bed at 5 pm and got up the next morning.

Other Meds: Meloxicam, Vyvanse

Current Illness: no

ID: 0975720
Sex: F
Age: 37
State: OH

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:
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: Swelling and redness surrounding the injection site (the whole upper arm area), some itching, and what seems to be a painful/swollen lump (lymph node) in my lower left armpit.

Other Meds: None

Current Illness: None

ID: 0975721
Sex: F
Age: 49
State: VA

Vax Date: 01/23/2021
Onset Date: 01/23/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: I became very tired after receiving the injection, followed by severe chills that evening, started running a fever during the night. I believe it got up to 100.9. The next day (Sunday) I slept a lot while continuing with the chills and fever. Monday was better, just very weak, temp was about 99.5. Today was good. No fever, a little sluggish, but much better.

Other Meds: Zoloft

Current Illness: None

ID: 0975722
Sex: F
Age: 38
State: CO

Vax Date: 01/05/2021
Onset Date: 01/17/2021
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 and penicillin

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

Symptoms: Rash 12 days after injection around injection site. Severe back ache chills. Inflammation of whole body. Rash spread to neck and left side of face. Then I started having worse back pain, pelvic pain, incontenance, painful to pee, urge to pee all the time. Abdominal swelling. Tests came back all negative for infection but steroids and antibiotics are helping.

Other Meds: Daily vitamins

Current Illness: None

ID: 0975723
Sex: M
Age: 98
State: CA

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: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Pt began to lose consciousness during a conversation with observation RN.

Other Meds: None

Current Illness: None

ID: 0975725
Sex: F
Age: 74
State: TX

Vax Date: 01/16/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Hot, red raised area in vaccination area

Other Meds: Levothyroxine Zinc Fish oil Vitamins B C D3

Current Illness: None

ID: 0975726
Sex: M
Age: 88
State: NJ

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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: Vial was thawed on 1/11/21 and due to expire on 1/16/21 - patient was immunized with this expired vaccine on 1/22/21.

Other Meds:

Current Illness:

ID: 0975727
Sex: F
Age: 48
State: CA

Vax Date: 01/19/2021
Onset Date: 01/20/2021
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:

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

Symptoms: Fever body aches

Other Meds:

Current Illness:

ID: 0975728
Sex: F
Age: 54
State: PA

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: 102F FEVER, CHILLS

Other Meds: SYNTHROID 50MG, HYDROCHLOROTHIAZIDE 25MG, INVOKANA 100MG, LISINOPRIL 10MG, METTFORMIN HCL 10MG, CETIRIZINE 10MG, THYRIXINE 75MCG, ATENOLOL 50MG, ALLOPURINOL 100MG, CYCLOBENZAPRINE HCL 10MG

Current Illness: MIGRAINE

ID: 0975729
Sex: M
Age: 44
State: CA

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

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Felt light headed after vaccine and has continued to have "dizzy spells" and vertigo up to several times a day, especially on arising. Gives a history of "low blood pressure," but unsure of what the numbers typically are. Has had two events of nausea and headache on other days in the past two weeks since vaccine but doesn't believe it's related to the vaccine. States that events have gotten better over time. Encouraged to see his PCP.

Other Meds: Synthroid

Current Illness:

ID: 0975730
Sex: F
Age: 34
State: OR

Vax Date: 01/08/2021
Onset Date: 01/09/2021
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: Surgical adhesion tape Cephalexin

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

Symptoms: Pregnancy hx: currently pregnant, 1 prior pregnancy resulting in live birth EDD for current pregnancy: 7/2/2021 ADEs: likely robust immune response. Extreme fatigue, pounding headache, and reduced appetite X 36 hours. Onset about 6 hours after immunization. Also had very sore deltoid at site if immunization. No fever / rash / swelling. Symptoms relieved with APAP.

Other Meds: Prenatal vitamin

Current Illness: None

ID: 0975731
Sex: M
Age: 76
State: CA

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

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

Symptoms: initially, nausea and "weird" feeling for approximately 12 hours.Tthe injection site continued to be uncomfortable , and on 8th day after injection, the injection site began to itch. On 9th day, there was intense itching, and injection site began to swell. by 10th day (today), the swelling and itching is subsiding, but not gone.

Other Meds: altorvastatin 10mg, dosazosin mesyl 2mg, thyroxine 112mcg, metoprolol tartrate 25mg, furosemide 20mg, vitamin d, baby aspirin

Current Illness:

ID: 0975732
Sex: F
Age: 22
State: VT

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Called out of work over weekend

Other Meds:

Current Illness:

ID: 0975733
Sex: M
Age: 50
State: CA

Vax Date: 01/15/2021
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: Bee Stings

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

Symptoms: COVID Positive.: Fatigue body aches

Other Meds: Glyburide 5mg, Losartan 50mg

Current Illness:

ID: 0975734
Sex: F
Age: 44
State: WI

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

Lab Data:

Allergies: Penicillin and levaquin

Symptom List: Injection site pain, Pain

Symptoms: Severe muscle aches, shaking chills, fever, severe pain at injection site all started 12 hours after immunization. Not relieved by Tylenol or ibuprofen.

Other Meds: None

Current Illness: None

Date Died: 01/25/2021

ID: 0975735
Sex: F
Age: 83
State: AR

Vax Date: 01/06/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
Hospital: Y

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

Lab Data:

Allergies: Aricept, codeine, hydrocodone, sulfa abx

Symptom List: Injection site pain, Menorrhagia

Symptoms: VACCINE ADMINISTERED 01/06/21 ACQUIRED COVID 19 01/10/21 RESIDENT HAD MULTIPLE CO MORBIDITIES AND WAS DECLINING PRIOR TO VACCINE. RESIDENT EXPIRED ON 01/25/2021

Other Meds: zinc, acidophylis, albuterol inhaler, vitamin d, mirtazapine, Pepcid, vitamin c, Lasix, magnesium oxide, Depakote, cranberry, melatonin, Zoloft, folic acid, pericolace, simethicone, xarelto, asa, mvi with mineral, synthroid, evista,

Current Illness: COVID 19 01-10-2021 GERD DELUSIONS VASCULAR DEMENTIA WITH BEHAVIORS INSOMNIA CHRONIC DVT LEFT LOWER EXTREMITY HEMOCHROMATOSIS PSYCHOSIS MAJOR DEPRESSIVE DISORDER WITH ANXITY IMPULSE DISORDER VITAMIN DEFICIENCY EDEMA CONSTIPATION HALLUCINATIONS HYPOTHYROIDISM HX OF SKIN CANCER CARPAL TUNNEL LT HAND DYSTHYMIC HTN

ID: 0975736
Sex: F
Age: 36
State: WY

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: SYR
Vax Site: LA

Lab Data:

Allergies: Allergic to Demerol

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

Symptoms: Localized reaction. Area of about 4 inches wide by 2 inches tall, warm to the touch, redness, hardened

Other Meds: No medications were being taken at the time of vaccination

Current Illness: None

ID: 0975737
Sex: M
Age: 60
State: TX

Vax Date: 01/22/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Headache and nasal congestion like a sinusite

Other Meds: Olmesartana Medoxomila 40mg Anlodipino 5mg

Current Illness: None

ID: 0975738
Sex: F
Age: 21
State: AZ

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: RA

Lab Data:

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Migraine set in within 2-3 hours, sore arm immediately after for about an hour and a half

Other Meds: Vyvanse, Imitrex, Promethazine HCl, Venlaflaxine HCL, Amphetamine-Dextroamphetamine

Current Illness: N/A

ID: 0975739
Sex: M
Age: 17
State: OR

Vax Date: 01/12/2021
Onset Date: 01/12/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Minor age 17 received Moderna vaccine. no adverse effects reported.

Other Meds:

Current Illness:

ID: 0975740
Sex: M
Age: 63
State: SC

Vax Date: 11/10/2020
Onset Date: 11/10/2020
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: RA

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: Patient reported 1-26-21 that he has maintianed a hard knot at the sight of shingrix vaccine five 11-10-2020 had never reported any adverse effect up to this date

Other Meds: none

Current Illness: none

ID: 0975741
Sex: M
Age: 50
State: PA

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

Lab Data:

Allergies: Penicillin Sulfa

Symptom List: Injection site pain

Symptoms: Loss of taste approximately 12 hours after my second dose.

Other Meds: Multi Vitamin Escitalopram 10mg

Current Illness: None

ID: 0975742
Sex: F
Age: 57
State: MA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
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: Penicillin, and Sulfur

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

Symptoms: Arm was tender and started the same day in evening , Blinding pounding head arch 12/31/2020. Message her Dr. and asked if she could take the headache Napicine Sodium 1 550 mg. Day 8 arm swelled up at injection site, hot, and itchy and slight fever, body was warm , day 9 went to talk with nurse and was given ice pack . Following day was not able to lift to extend to work . Recommended to take an allergy pill, she left half day of work and she rested and illness subside.

Other Meds: High Blood Pressure Losartan 100mg , Naproxen Sodium 550 mg as needed, vitamin C

Current Illness: No

ID: 0975743
Sex: F
Age: 27
State: MN

Vax Date: 08/01/2020
Onset Date: 08/01/2020
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: Nausea, vomiting, stomach cramping, diarrhea. 7 months pregnant

Other Meds: Prenatal vitamin, vitamin D

Current Illness:

Date Died: 01/15/2021

ID: 0975744
Sex: F
Age: 87
State: CA

Vax Date: 01/07/2021
Onset Date: 01/15/2021
Rec V Date: 01/26/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

Symptom List: Tremor

Symptoms: See initial report

Other Meds: Atorvastatin Calcium 10mg, Ceftriaxone 1GM, Famotidine, Hydrocodone-Acetaminophen 5-325mg, Levothyroxine 25mcg, Senna, ASA, Docusate

Current Illness: The resident was febrile on 1/9/2021 after receiving the Pfizer vaccine on 1/7/2021. On 1/9/2021 UA, CBC, and CMP ordered indicating she had UTI. SARS-CoV-2 testing was performed using POCT GeneXpert on 1/9/2021. No SARS-CoV-2 was detected. The resident continued to decline and on 1/15/2021 she became tachycardiac and was having trouble breathing. She was transferred to ER where she later died.

ID: 0975745
Sex: M
Age: 37
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: chills with fever of 101. Now down to 100.7, bad heart burn. Woke up early due to coughing due to Heart Burn.

Other Meds:

Current Illness:

ID: 0975746
Sex: F
Age: 60
State: NY

Vax Date: 01/25/2021
Onset Date: 01/25/2021
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: None

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

Symptoms: The patient experienced syncope within 30 minutes after receiving the covid-19 vaccine. At 2:30pm, she felt dizziness, her head was spinning, weakness of the arms, and slurred speech. Her FS was at 108 (Normal), BP 195/105 (Extremely high), Pulse 91, O2 saturation was at 100%. At 2:48PM, her BP lowered to 167/92. At this time, she can smile, she can put her hands up, she can kick her feet and she can opened/closed her eyes. Due to her high BP, Doctor requested that the should go to the ER via the ambulance.

Other Meds: None

Current Illness: None

ID: 0975747
Sex: M
Age: 92
State: NJ

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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: vancomycin, Ceftin, iodine, Fortaz

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

Symptoms: Vial was thawed on 1/11/21 and due to expire on 1/16/21 - patient was immunized with this expired vaccine on 1/22/21.

Other Meds:

Current Illness:

ID: 0975748
Sex: M
Age: 87
State: MN

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: sore and black and blue 4 inch long

Other Meds:

Current Illness:

ID: 0975749
Sex: F
Age: 38
State: CA

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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: I have huge red itchy hives from head to toe. I went to the ER Saturday and Sunday. Nothing is helping. I?m taking prednisone, Pepcid, benedryl, ibuprofen, Allegra and Zyrtec. I am so miserable.

Other Meds: Minocycline

Current Illness: None

ID: 0975751
Sex: F
Age: 36
State: MO

Vax Date: 01/22/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: Migraine, muscle cramps, fever, chills, fatigue. Seen in ER for migraine after 4 days

Other Meds: Singulair, allegra, azo cranberry, vitamin d, lexapro

Current Illness: None

ID: 0975752
Sex: F
Age: 67
State: NJ

Vax Date: 01/21/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Quarter-sized soreness at injection site for two days following the shot. Some swelling on the third day, and by the 4th, physical therapist thought the area looked infected. It was hot to the touch, and roughly 10cmx10cm. Recommended seeing a doctor immediately. Family physician later that day prescribed Cephalexin.

Other Meds: Arimidex, Fosamax, Lexapro, calcium, Vitamin D

Current Illness:

ID: 0975753
Sex: M
Age: 37
State: CA

Vax Date: 01/06/2021
Onset Date: 01/06/2021
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:

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

Symptoms: 01.06.21 Fever of 100.3 with chills for 12 to 36 hours.

Other Meds:

Current Illness:

ID: 0975754
Sex: F
Age: 85
State: FL

Vax Date: 01/04/2021
Onset Date: 01/04/2021
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: No food allergies. I?m allergic to Cortizone and Cipro

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

Symptoms: I have a rash on my face primarily around my eyes and it?s continued since 1/4. I also had a black and blue big right toe and my veins in my lower leg are dark as well. I did not injure my toe or leg.

Other Meds: Levothyroxine, Hydroclorothyazide, Magnesium Oxide, Omeprazole

Current Illness: I?ve been in good health.

ID: 0975755
Sex: F
Age: 51
State: IL

Vax Date: 01/19/2021
Onset Date: 01/20/2021
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: Sulfa

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

Symptoms: With dose #1, some HA, arm pain (in particular arm pit pain). With this dose #2, uncontrollable rigors at about 12 hours post-dose for at least 1-2 hours, Tm to 103.3F, HA, myalgias, right leg pain, weakness and again, significant, severe arm pit pain on same side as injection site. At 34 hours, much improved (almost 100%), but arm pit pain did not dissipate until about day 5.

Other Meds: None

Current Illness: None

ID: 0975756
Sex: F
Age: 35
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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: seafood, bee stings (carries epipen but did not have it today | may be expired)

Symptom List: Vomiting

Symptoms: Patient seated in observation area reported itchiness & burning at right shoulder 4:24 patient self ambulated to private observation area, accompanied by RN and EMT 4:26 VS 124\97 | HR 86 | PO2 98% ice bag provided to help with itchiness\ redness noted at left neckline | no redness noted on back 4:31 husband arrived in private observation (he is a cardiologist MD) 4:33 Benadryl 25mg given with water | 50 mg declined recommended that patient premedicate w/Bendryl prior to 2nd vaccine dose, also recommended she bring her epipen & husband 4:35 itchiness improved | additional redness noted at chest husband and patient took baseline pictures & RN shared medication time | family confirmed that Benadryl available at home 4: VS38 132\98 | HR 83 | PO2 99% family declined transport \ need for emergency care | husband MD signed VAERS form patient discharged and self ambulated with husband to car

Other Meds: Metformin

Current Illness: n/a

ID: 0975757
Sex: M
Age: 1
State: NJ

Vax Date: 03/15/2019
Onset Date: 03/15/2019
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: None that I am aware of

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: My son broke out in hives all over his body the day after vaccines on the 2nd or 3rd day the hives were so bad I called the doctors office and was told to give tylenol and benadryl and a warm bath he had marks that look like bite marks he immediately started to regress and started doing circles in the floor, extreme tantrums and non stop crying I knew it had to be the vaccines because it was the only thing we had done in those days, there were no new foods or anything like that. He also stopped eating he only wanted milk.

Other Meds: Just tylenol at times for teething

Current Illness: When my son received vaccines on 3/15/2019 he broke out in hives all over his body it spread about 2 days later and I called the office and spoke to nurse and was told to give benadryl and tylenol I was also told that it was weird that my son broke out in hives because vaccines don?t cause it. I followed the recommendations from the office.

ID: 0975758
Sex: F
Age: 53
State: NC

Vax Date: 01/26/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient is a staff member at a LTC facility. After receiving the vaccine she stated that got very dizzy and nauseous within 5 minutes of receiving the vaccine. Stated that her head was pounding and that she was very cold. Family came and took her home. Have not heard from the family or patient since.

Other Meds:

Current Illness:

ID: 0975759
Sex: F
Age: 40
State: KS

Vax Date: 01/08/2021
Onset Date: 01/09/2021
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: sulfa

Symptom List: Injection site swelling, Limb discomfort

Symptoms: on 1/9/21 started having muscle aches in left shoulder and neck, then proceeded to feeling extreme fatigue. on eve of 1/9/21 began to have nausea, continued fatigue. 1/10/21 had a headache and had a 99 temp and felt feverish thoughout the day and also with continued shoulder and neck pain that lasted through 1/11/21. Fatigue continued until 1/14. on 1/13 had cramping and menstrual bleeding when it was not during time of normal period.

Other Meds: birth control

Current Illness: none

ID: 0975760
Sex: M
Age: 82
State: AZ

Vax Date: 01/22/2021
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: RA

Lab Data:

Allergies: none

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

Symptoms: dizziness 4 days post vaccine

Other Meds: metoprolol; tamsulosin; gabapentin; asa; vit c; vit d

Current Illness: none

ID: 0975761
Sex: F
Age: 22
State: KY

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

Lab Data:

Allergies:

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

Symptoms: Moderna COVID-19 Vaccine EUA Fever, chills, headache, sore throat, nausea, injection site pain, body aches, fatigue

Other Meds:

Current Illness: COVID-19

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm