VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 0922988
Sex: F
Age: 50
State: CO

Vax Date: 12/21/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: Unknown

Allergies: Unknown

Symptoms: Employee received the COVID vaccine on 12/21/2020. Employee reports her symptoms started on 12/30/2020. Employee states she cannot turn key in door or use right arm and hand normally. Employee reports parasthesias including slight numbness and tingling. Employee reports pain that is in the back of her shoulder that is rated as 2-3/10. Employee states all of her symptoms have been the same since 12/30 and have not worsened and no new symptoms had started.

Other Meds: Unknown

Current Illness: Unknown

ID: 0922989
Sex: F
Age: 42
State: NJ

Vax Date: 12/21/2020
Onset Date: 12/22/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: 12 hours after injection, developed swelling at injection site that increased over two days to be about 1 1/2 inch in diameter that slowly decreased over 1 week. Developed muscle pain in left jaw, left neck, left chest for two days. Itching at site of injection lasted about 2 weeks.

Other Meds: none

Current Illness: none

ID: 0922990
Sex: F
Age: 54
State: NV

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/06/2021
Hospital: Y

Lab Data: EKG (12/29/20)

Allergies:

Symptoms: The patient received the vaccine indicated above. Immediately following vaccination the patient states that they began feeling lightheaded and dizzy.

Other Meds: NKDA

Current Illness:

ID: 0922991
Sex: M
Age: 61
State: NY

Vax Date: 12/26/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: Blood drawn by my primary doctor. MD office.

Allergies: None

Symptoms: 5 days later December 31st Noticed weakness on my left side of my face. Tearing on the left eye . Unable to open wide on my left lips

Other Meds: Bydureon BCise 2mg/ once a week Amlodipine 10mg / day Lisinopril 40my/day HCTZ 10mg/ day Protonix 10mg/ day Naltrexone 50mg/ day Vitamin D Multivitamin

Current Illness: None

ID: 0922992
Sex: F
Age: 65
State: IN

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: none

Allergies: Rash/hives with penicillin and with sulfa drugs.

Symptoms: Had severe chills that began about 8 pm on 1/5/2021. Had chills all night, and muscle aches began around midnight. When I woke to get a shower around 5:30 am on 1/6/2021, I was extremely lightheaded and laid down on the bathroom floor to keep from passing out and falling. The lightheadedness did not improve and my husband was able to help me back to bed. I was unable to overcome the chills and lightheadedness even with lying down, until about 10 am. I am able to sit up but still some what lightheaded and chills are beginning to fade. I do not feel I would be able to walk more than a few feet or drive at this time due to ongoing symptoms.

Other Meds: Metoprolol succinate ER

Current Illness: none

ID: 0922993
Sex: F
Age: 71
State: CO

Vax Date: 12/28/2020
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: Alatrofloxacin High 12/06/2016 ? Rash Penicillins High 12/06/2016 ? Hives As a child, tolerated cephalosporins since Sulfa (sulfonamide Antibiotics) High 12/06/2016 ? Hives As a child Calcitonin,salmon,synthetic Not Specified 12/06/2016 ? Doxycycline Hyclate Not Specified 12/06/2016 ? Liraglutide Not Specified 12/06/2016 ? Allopurinol Low 12/06/2016 ? Itching Bimatoprost Low 12/06/2016 ? Itching

Symptoms: Delayed onset of warmth and redness at injection site appearing 9 days after injection.

Other Meds: Unknown

Current Illness: Unknown

ID: 0922994
Sex: F
Age: 32
State: MN

Vax Date: 12/23/2020
Onset Date: 12/25/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: Evoked Otoacoustic Emissions test completed 12/30/20.

Allergies: Amoxicillin- nausea and vomiting

Symptoms: One day after vaccine (12/25/20) patient woke up with ringing in her ears, echoing, and diminished hearing. Ringing subsided 12/26/20 but diminished hearing continued. Seen by ENT 12/30/20 and diagnosed with hearing loss, right, with restricted hearing, left.

Other Meds:

Current Illness:

ID: 0922995
Sex: F
Age: 38
State: NE

Vax Date: 01/01/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: Unknown but will requuest

Allergies: NA

Symptoms: Pt became ill around 9pm with chills and felt like her body was on fire and was burning up. No temperature at that time. Woke up around 2p and temp orally was 102.7. Stated had trouble breathing and when walking, felt uncoordinated and legs were weak .Had to hug the wall to get to the bathroom where she vomited. Called ER and was advised to come in with shortness of breath. Stated oxygen level was ok, but was admitted for fluids and monitoring. Stated the symptoms were 10 times worse than when had COVID approximately 3 weeks ago. States CXR showed some residual pneumonia.

Other Meds: Lexapro Tylenol Ibuprofen

Current Illness: Pneumonia 11/2020 COVID 12/14/2020

ID: 0922996
Sex: F
Age: 30
State: AZ

Vax Date: 12/22/2020
Onset Date: 12/24/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: No

Allergies: I have shellfish allergies

Symptoms: I had ear pain on the right side at 4 am and by 8am my right side of the lip had gone numb.

Other Meds: I take zoloft and birth control.

Current Illness: No

ID: 0922997
Sex: F
Age: 49
State: VA

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Vial diluted incorrectly. Patient received 42 mcg of Pfizer vaccine. No adverse reaction reported by patient.

Other Meds:

Current Illness:

ID: 0922998
Sex: F
Age: 45
State: OH

Vax Date: 01/04/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: Sulfa, PCN

Symptoms: diarrhea, fatigue

Other Meds: Ibuprofen, Aleve

Current Illness: None

ID: 0922999
Sex: F
Age: 54
State: IN

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: Nka

Symptoms: Temp 101.9, body aches, headache for 36 hours

Other Meds: Prilosec daily

Current Illness: None

ID: 0923000
Sex: F
Age: 55
State: PA

Vax Date: 12/17/2020
Onset Date: 12/26/2020
Rec V Date: 01/06/2021
Hospital: Y

Lab Data: CT Scan showed acute appendicitis resulting in a laparoscopic appendectomy. Elevated WBCs.

Allergies: None

Symptoms: Severe right lower quadrant pain, anorexia over 12 hours. Went to the emergency department. Lab results showed elevated WBC and CT scan showed acute appendicitis. Admitted for urgent surgery: laparoscopic appendectomy. Was hospitalized from 12/26/20-12/28/20.

Other Meds: Valtrex Wellbutrin Abilify Fish Oil Multi-Vitamin Biotin

Current Illness: None

ID: 0923001
Sex: F
Age: 45
State: CO

Vax Date: 01/02/2021
Onset Date: 01/02/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Per patient: "Side effects experienced with the vaccine obtained on Sat 1/2/2021. I had had covid in August 2020 and received the shot then experienced a strong reaction. Fever of 100-101 for two days, extreme arm pain at injection site for 3 days with swelling and redness, body aches for 3 days, joint and fingers swollen for 2 days. Headache continues still at 5 days and time of this report. Most notably is that my left thigh and gluteus has gone numb. This also happened when sick in August but not to the extreme that it is now. The area of the hip bone is predominately the most numb and sore. This was not the injection site."

Other Meds:

Current Illness:

ID: 0923002
Sex: F
Age: 39
State: NY

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: headache itchiness that started at my neck and head and has spread throughout most of my body. It is not unbearable but it is uncomfortable. I have had no treatment and am monitoring at home.

Other Meds: wellbutrin klonopin Latuda Viibryd

Current Illness: None

ID: 0923003
Sex: M
Age: 36
State: ID

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: NKMA

Symptoms: Underarm lymph nodes swollen about the size of a baseball. Also had fever and muscle soreness. Tried using ice and ibuprofen. Neither were effective in treating swollen lymph nodes. Tylenol was effective in testing fever and muscle soreness. Will see physician later today.

Other Meds: Levothyroxine, atorvastatin, cetrizine

Current Illness:

ID: 0923004
Sex: F
Age: 38
State: NY

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Increased heart rate/ palpitations within 2 minutes of receiving vaccine that lasted approximately 20 minutes

Other Meds: None

Current Illness: None

ID: 0923005
Sex: F
Age: 35
State: NY

Vax Date: 12/26/2020
Onset Date: 01/02/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: none

Allergies: no known allergies

Symptoms: On Jan 2 I noted bicep pain and under arm pit. The following day redness started to appear on previous scarring from vaccine. The lymph nodes felt swollen and painful.

Other Meds: none

Current Illness: none

ID: 0923006
Sex: F
Age: 36
State: IA

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: NA

Allergies:

Symptoms: Patient called clinic the day of receiving COVID19 vaccine to report she is having numbness and tingling that goes down her arm and into her fingers that hasn't gone away. Took ibuprofen 800mg at 1045 the morning of injection. Injection was in left arm. Reports injection site looks fine, no signs of erythema, ecchymosis, or swelling. Can palpate radial pulse. Normal ROM in arm, hand, and fingers. Reports normal cap refill in fingers.

Other Meds: Xulane CHC

Current Illness:

ID: 0923007
Sex: F
Age: 56
State: MO

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: EKG normal. CXR normal. Labs Normal.

Allergies: PCN, Estrogen,lyrica

Symptoms: approx. 10 min after infection my heart started pounding in my chest, felt dizzy and weak. Was monitor for 45 min, blood pressure was stable , heart rate 120s. Was taken to ER, took 2 person assist to transfer to cart because I felt very weak, like I was going to pass out. In ER was given liter of fluid, Benadryl 25mg ivp. After about 45 min my symptoms started improving. By 90 mins later I was able to walk out of the ER

Other Meds: none

Current Illness: none

ID: 0923008
Sex: F
Age: 32
State: TX

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 1/7/21 at 08:00 body chills and at 09:30 fever (Tmax 100.5 no meds taken), at time of call 11:00 temperature of 99.1

Other Meds:

Current Illness:

ID: 0923009
Sex: F
Age: 66
State: CO

Vax Date: 12/26/2020
Onset Date: 01/01/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: Influenza vaccine

Symptoms: Area of erythema and swelling 2.5 cm x 3 cm below injection site. Warm, mild tenderness and itching. Resolved after 5 days

Other Meds: None

Current Illness: None

ID: 0923010
Sex: F
Age: 53
State: VA

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Vial diluted incorrectly. Patient received 42 mcg of Pfizer vaccine. No adverse reaction reported by patient.

Other Meds:

Current Illness:

ID: 0923011
Sex: F
Age: 45
State: KY

Vax Date: 01/02/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: EKG, CBC with diff, CMP, and troponin

Allergies:

Symptoms: Patient had chest pain post administration of vaccine. Patient attributed this to heartburn after eating a large meal just before getting her vaccine (though she didn't typically get heartburn). Since the pain continued to persist her BP was taken and was 160/110. Patient said it may also be nerves but she didn't feel particularly anxious. She also stated she hadn't had her BP medication that morning. Patient took a couple of Tums and her BP was rechecked a few times. Each time the BP stayed above what the patient said was her normal even without BP medication. Due to the persistence of her hypertension and chest discomfort she was taken to the ED to be evaluated. Once patient was in ED she had an EKG, CBC with diff, CMP, and troponin. Provider eventually ruled it as an anxiety reaction (not cardiac related).

Other Meds:

Current Illness:

ID: 0923012
Sex: F
Age: 48
State: CO

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: Amoxicillin, Penicillin, Erythromycin, Ibuprofen, zucchini

Symptoms: Minor hives, tired, runny nose, chills for about 12 hours starting approximately 3 hours after vaccine.

Other Meds: Gabapentin, Losartan, Vitamin D, Daily Vitamin, low dose Aspirin

Current Illness:

ID: 0923013
Sex: F
Age: 45
State: CO

Vax Date: 01/02/2021
Onset Date: 01/02/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Per patient: "Side effects experienced with the vaccine obtained on Sat 1/2/2021. I had had covid in August 2020 and received the shot then experienced a strong reaction. Fever of 100-101 for two days, extreme arm pain at injection site for 3 days with swelling and redness, body aches for 3 days, joint and fingers swollen for 2 days. Headache continues still at 5 days and time of this report. Most notably is that my left thigh and gluteus has gone numb. This also happened when sick in August but not to the extreme that it is now. The area of the hip bone is predominately the most numb and sore. This was not the injection site. "

Other Meds:

Current Illness:

ID: 0923014
Sex: F
Age: 30
State: NC

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: NA

Allergies: Symbyax

Symptoms: Fever, joint and muscular pain, headache, chills. Receive shot at 3o?clock in the afternoon and symptoms didn?t start the show until 10 o?clock that evening.

Other Meds: Prozac

Current Illness: Coronavirus

ID: 0923015
Sex: F
Age: 57
State: MI

Vax Date: 01/02/2021
Onset Date: 01/02/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: Bloodwork, EKG-abnormal, urine . In the ER on 1/2/2021. Was given EpiPen during reaction. In the ER I received benadryl twice and a steroid. After almost 10 hours in the ER, I was sent home with benadryl around the clock and an EpiPen. 4 days later, I'm still on the benadryl with reactions when the benadryl wears off

Allergies: Tetracycline Strawberries Milk Chocolate Statins

Symptoms: Rapid heart rate, shakiness, headache, rash, scratchy throat, raspy voice, dizziness, extreme weakness

Other Meds: Fish oil Vitamin D3 CQ10 Wellbutrin Multivitamin Magnesium Emergent C gummies

Current Illness: Muscular Dystrophy

ID: 0923016
Sex: M
Age: 48
State: MT

Vax Date: 12/29/2020
Onset Date: 01/01/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: COVID rapid test administered 01/04/2021, with negative result. Standard COVID test administered same day.

Allergies: None

Symptoms: January 1, 2021 about 7:00 p.m. Patient experienced sudden onset of "sciatic pain." Pt normally has recurring similar pain, but describes this as more severe. Pain extended from R hip to neck. On the morning of January 2nd, painful muscle spasms extended from lower back, mid back, between shoulder blades and neck spasm on right side, radiating to spine. Patient used ibroprofen and Tylenol. Tylenol provided some relief. Pain so severe, patient reports difficulty breathing due to spasm pain. No further respiratory distress. January 3, 2021 in the afternoon, patient reported to Emergency Department for evaluation. Was given toradol. Prescriptions for Flexeril and hydrocodone were given. As of 1/6/2021, patient is still on meds and reports improvement. However, 1/5/21 significant swelling and slight pain began in Left knee, restricting range of motion.

Other Meds:

Current Illness: None

ID: 0923017
Sex: F
Age: 52
State: OH

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: PCN

Symptoms: All over body pain and chills 30 hours

Other Meds: Celexa

Current Illness: none

ID: 0923018
Sex: F
Age: 44
State: MI

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: sulfa, morphine, codeine, gelatin

Symptoms: Patient had a severe allergic reaction that required a dose of 50mg Benadryl and 2 doses of epi-pen 0.3mg. 911 was called and EMS arrived.

Other Meds:

Current Illness:

ID: 0923019
Sex: F
Age: 41
State: MO

Vax Date: 01/02/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: none

Allergies: NKA

Symptoms: swollen, very painful lymph node in right arm pit that began about 36 hours after receiving vaccination and lasted for about 48 hours

Other Meds: Larin birth control, celexa 20 mg, nexium 20 mg, claritin 10 mg

Current Illness: none

ID: 0923020
Sex: M
Age: 33
State: VA

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Vial diluted incorrectly. Patient received 42 mcg of Pfizer vaccine. No adverse reaction reported by patient.

Other Meds:

Current Illness:

ID: 0923021
Sex: F
Age: 71
State: TN

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: none

Symptoms: Fever 1.07 Uncontrollable Chills Exhausted Diarrhea

Other Meds: Thyroxin

Current Illness: none

ID: 0923022
Sex: F
Age: 19
State: NE

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: Was given oral zofran at emergency department and sent home with prescription.

Allergies: lactose intolerant

Symptoms: Got very nauseous, got headache with nausea, friend drove her home, got home laid in bed, grandma took temperature and temperature was 104.5. Grandma had called hospital who told individual to come in.

Other Meds:

Current Illness:

ID: 0923023
Sex: F
Age: 53
State: IN

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: n/a

Allergies: pennicellins

Symptoms: Bad Headache, lasting 6 hours or longer. Took 2 pills Equate Acetaminophen 500mg at time of onset and helped ease some but did not take it away. Went to bed early and woke up next morning fine. no more headache.

Other Meds: none

Current Illness: none

ID: 0923024
Sex: F
Age: 47
State: CT

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: Amoxicillin, doxycycline Raw fruits/vegetables - apples, peaches, pears, carrots. Almonds, walnuts Soy

Symptoms: Woke up following morning with headache, chills and generalized aches. That night, chills, headache, and diffuse burning sensation on skin. on 12/25/20 - developed rash on neck, face and upper chest. Other symptoms improved, but rash continued for a few days.

Other Meds: None

Current Illness: Covid + 6 weeks prior to vaccine

ID: 0923025
Sex: F
Age: 52
State: NJ

Vax Date: 12/29/2020
Onset Date: 01/02/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: CBC, CMP Pending

Allergies: amoxicillin, erythromycin

Symptoms: Vaccine recipient reported that they received the vaccine on 12/29/2020. On the same day they developed soreness at the injection site which became better the next day. On 1/2/2021 they reported that their left armpit lymph node became swollen and painful which was very concerning, They made an appointment with their primary care provider. They reported on 1/5/2021 that the left armpit lymph node is slightly better. Moderna COVID- 19 Vaccine EUA

Other Meds: none

Current Illness: none

ID: 0923026
Sex: F
Age: 55
State: VA

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Vial diluted incorrectly. Patient received 42 mcg of Pfizer vaccine. No adverse reaction reported by patient.

Other Meds:

Current Illness:

ID: 0923027
Sex: M
Age: 27
State: NY

Vax Date: 12/28/2020
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: Moderna COVID-19 Vaccine EUA Rash on right deltoid formed 8 days after receiving the Moderna COVID19 vaccine. Was not itchy or painful or abnormally warm to touch.

Other Meds: none

Current Illness: none

ID: 0923028
Sex: F
Age: 46
State: VA

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: alpha-gal (beef, pork, lamb, any mammal) - anaphylactic peanut, tree nut, soy - anaphylactic celery, carrots - highly allergic, angioedema

Symptoms: Moderna COVID-19 Vaccine EUA Patient report: I was vaccinated 12/28/2020. I had very mild face itching the day after the vaccine that could have easily been to something else since I am a highly allergic person anyway. On 1/5/2020 I developing itching, bruising, welts, heat and slightly hard (firm but still a little squishy) around the injection site. Approximately 3in x 2in. She did not feel it was cellulitis as she was familiar with this but will continue to monitor for progression of symptoms.

Other Meds:

Current Illness:

ID: 0923029
Sex: F
Age: 55
State: NY

Vax Date: 12/20/2020
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: 15 days post vaccine of the (Pfizer Covid vaccine) on 1/6, I developed a 7 x 5 cm erythematous wheal to left deltoid (injection site) - warm to touch without puritus/fevers or chills.

Other Meds: Centrum daily MVI/ Calcium and omega supplements; Lipitor 10mg daily

Current Illness: None

ID: 0923030
Sex: M
Age: 38
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Headache on right side but is now gone Chills No fever Muscle pain in right side of neck. Can barely move neck. Feels like it needs to be supported in a brace.

Other Meds:

Current Illness:

ID: 0923031
Sex: F
Age: 31
State: LA

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: Left arm venous doppler on 1/5 that confirmed extensive clot (approximately 5 inches in length) of my basilar vein

Allergies: Penicillin

Symptoms: Worsening arm pain after injection that eventually resulted in my being diagnosed with a blood clot in the arm that I recevied the injection on

Other Meds: Yaz, Adderall, Lexapro, trazodone, Hizentra (had not taken this in 2 weeks)

Current Illness: None

ID: 0923032
Sex: M
Age: 63
State: AL

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: none

Allergies: NKA

Symptoms: Immediately following injection, area surrounding injection site began swelling. Site was bright pink and was approximately 4-5cm in size. Swelling considered moderately severe. Swollen area was not centered directly around infection site but slightly above. Area was iced and patient was given 50mg Benadryl po and monitored for additional 30 minutes for any additional adverse affects. Patient was given instructions on to call 911 for any additional severe reactions and to call clinic to report any other non life-threatening reaction. Note: Patient is a physician and is familiar with reactions and side effects to report.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 0923033
Sex: F
Age: 57
State: MD

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: crab

Symptoms: Patient c/o tongue swelling minutes after vaccine. Also c/o itchy throat. No shortness of breath. given IM Benadryl and symptoms resolved. Previous similar reaction to crab.

Other Meds:

Current Illness:

ID: 0923034
Sex: F
Age: 48
State: VA

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Vial diluted incorrectly. Patient received 42 mcg of Pfizer vaccine. No adverse reaction reported by patient.

Other Meds:

Current Illness:

ID: 0923035
Sex: F
Age: 69
State: TX

Vax Date: 12/30/2020
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: A week after first shot the area where injection was started to itch, and turn red. The area became hard and continued to itch.

Other Meds: 1. Zoloft 150mg one daily 2. Gabapentin 100mg one tab three times daily 3. Meloxicam 7.5 mg one tab twice a day 4. Levothyroxin 100mg one tab daily * Hydrocod/acetsm 7.5mg this drug is taken every six hours until I see nerv

Current Illness:

ID: 0923036
Sex: F
Age: 49
State: TX

Vax Date: 12/30/2020
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: Covid test-negative but tested positive for Flu

Allergies: n/a

Symptoms: Dizziness, nauseous, headache, symptoms felt worse later in the day, chills. Went to ER same night and was given Tamiflu after testing positive for Flu.

Other Meds: Metformin 250 mg, Lisinopril/Hctz, Atorvastatin 20mg, Vitamin D2, multivitamin

Current Illness: n/a

ID: 0923037
Sex: M
Age: 58
State: OH

Vax Date: 01/04/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: Sulfa

Symptoms: diarrhea, chills, sinus drainage

Other Meds: Ziagen, Neverpine, Stiloto, HCTZ, Clonidine patch, hydrocortisone, albuterol, vitamin D

Current Illness: COPD, primary/secondary adrenal insufficiency, HIV, hypertension, asthma, emphysema

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm