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: 0982792
Sex: F
Age: 38
State: MD

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/28/2021
Hospital:

Lab Data: No

Allergies: ibuprofen; Insaids; Motrin; aspirin

Symptoms: From Thursday- Sunday, I had no usage of the left arm - couldn't raise it or move it. It hurt. I couldn't lift it at all. Friday = slept all day, very tired. Saturday night I went to ER because it hurt so bad: they gave me Lidocaine patches to help with pain but it didn't help. Monday, the 4th of January, saw my dr. - he was prescribed pain -Percocet 10/325 .That helped me so I could raise my arm finally. January 5th, I was still sick and woke up with a huge migraine; nauseous and fatigue/ I vomited once that night. Jan 6, I could work that day - but still fatigued, short of breath, but no fever at all, nauseous. January 7th - everything was gone (all symptoms resolved) and I felt fine.

Other Meds: Birth Control pills

Current Illness: no

ID: 0982793
Sex: F
Age: 32
State: PA

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: none. I can provide photos of the rash I've developed. os of the date of this form I still have the rash.

Allergies: Penicillin

Symptoms: Swelling for several and a tight feeling around a large area where the vaccine was shortly after the shot was given (maybe a few hours to a day) I normally have some swelling so thought nothing of it. It then started itching itching is reduced that subsided and now I have a large red rash around my arm that looks a bit like a lymes disease ring rash.

Other Meds: Flouxetine

Current Illness: none

ID: 0982794
Sex: F
Age: 83
State: IN

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital: Y

Lab Data: Contact Hospital

Allergies: None

Symptoms: Fever delirium we and then subsequent hospitalization still inpatient

Other Meds: Fuosemude eloquis

Current Illness: None

ID: 0982795
Sex: M
Age: 24
State: WA

Vax Date: 01/25/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: none

Allergies: None

Symptoms: Patient states a painful rash developed in the eft axilla accompanied by a single hard nodule about the size of a quarter 24 hrs post vaccination. I saw the patient on day two. Noted multiple flat erythemic rash at the left axillary pocket there is no palpable nodule but site is tender to touch. There is also a single flat discrete erythemic plaque located along the mid axillary line, right next to the serratus muscle. Vital sign is stable, member is afebrile, ROM is not affected. Member advised to take Tylenol for treatment of pain

Other Meds: PreviDent 5000 Plus

Current Illness: None

ID: 0982796
Sex: F
Age: 67
State: GA

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: Codiene

Symptoms: RED AREA WITH HARD KNOT UNDERNEATH EXTREMELY NAUSEOUS FOR LAST 2 DAYS

Other Meds: Atenelol 50 mg QD

Current Illness: none

ID: 0982797
Sex: F
Age: 57
State: TX

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: no test

Allergies: none

Symptoms: Moderna Covid -19 vaccine with pink swollen rectangular shape for 8-9 days on upper left arm

Other Meds: Benedryl D

Current Illness: arthritis

ID: 0982798
Sex: F
Age: 54
State: NC

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: She states she had nausea, HA, face flushing & chills. At 3 in the morning after the vaccine, she woke up and her heart was pounding, she felt chest tightness, and describes feeling that her body was jerking and shaking. She states her husband woke up and did not see or feel her jerking or shaking during that time. Reaction was more improved when I spoke with her at 9:00.

Other Meds:

Current Illness:

ID: 0982799
Sex: F
Age: 64
State: CA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: none

Allergies: mo

Symptoms: developed a fever in the evening that lasted all night. the next day still had some fever which progressed to chills and extreme tiredness. didn't feel "normal" until the 2nd morning afterwards. of course the injection site hurt just like any other shot.

Other Meds: leveothyrxoine 100 juice plus vit d, fish oil, basch & lomb eye vitamins

Current Illness: none

ID: 0982800
Sex: F
Age: 90
State: CA

Vax Date: 01/23/2021
Onset Date: 01/25/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: Penicillin, hydrocodone,

Symptoms: soreness, stomach problems, constipated took prune juice, milkamagnesia, next day felt, bad chills, has not gotten out of bad, no energy, weak feeling in her legs, 3rd day hand were very hot, have no energy at night lots of chills, pain between shoulder blades, no apatite, pain in legs and still weak today.

Other Meds: Eliquis, Metropole, spironolactone, furosemide,

Current Illness:

ID: 0982801
Sex: M
Age: 36
State: WV

Vax Date: 01/01/2021
Onset Date: 01/28/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Fever 103.0 F, chills, myalgias, arthralgias, headache, fatigue. Symptoms last 36 hours with minor relief from naproxen.

Other Meds:

Current Illness:

ID: 0982802
Sex: F
Age: 26
State: IL

Vax Date: 01/25/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: Facial swelling, nausea, vomiting, diarrhea, body aches, headache, dizziness, fever 101.

Other Meds: Mesalmine, ibuprofen, tylenol, zyrtec, MVI, Tumeric, colace, iron, Vitamin D.

Current Illness: none

ID: 0982803
Sex: F
Age: 56
State: IN

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: Latex

Symptoms: Swollen, Large Red whelp with hard knot inside arm. Burning and itching sensation. Ibuprofen and ice packs did not improve area.

Other Meds: Vitamin C, B-12, & D. Levothyroxine 75mcg

Current Illness: None

ID: 0982804
Sex: M
Age: 48
State: VA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Fever, chills, uncontrollable shaking, night sweats, starting approx. 12 hours after vaccination. Lasted about 18 hours. Also with injection site erythema and minor swelling starting same day as vaccination.

Other Meds:

Current Illness:

ID: 0982805
Sex: F
Age: 67
State: SC

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: Positive for COVID-19 on 11/21/2020, which lasted 10 days of symptoms.

Allergies: n/a

Symptoms: Severe chills and shivering, violent abdominal cramping, and lethargy for 72 hours.

Other Meds: Atorvastatin 20mg and metoprolol ER 50mg

Current Illness: n/a

ID: 0982806
Sex: F
Age: 34
State: MI

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: No

Symptoms: Extreme shoulder pain. Lack of any mobility. No weight bearing possible/lifting of any objects. Can?t raise arm past 90 degrees without extreme pain. Cannot twist shoulder socket at all

Other Meds: Spironolactone 100mg qd Vitamin d

Current Illness: No

ID: 0982807
Sex: F
Age: 33
State: PA

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Same day: fever, chills, headache, severe pain in unloved arm, fatigue 2 days after: blisters inside of lips

Other Meds: Metoprolol 50 mg QD Muktivitamin Vitamin c Vitamin D3 Magnesium

Current Illness: None

ID: 0982808
Sex: F
Age: 65
State: NV

Vax Date: 01/01/2021
Onset Date: 01/28/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: Didn?t go to Dr?s office or ER.

Allergies: Shellfish PNC

Symptoms: Had very red face and hands. My BP felt high, and my heart rate was a bit higher. Took 1 Benadryl and waited an additional 15 minutes. When I got home I used my rescue inhaler. Felt much better and more relaxed . Took BP. Systolic was elevated to 147. Diastolic was in good range. Heart rate was in good range.

Other Meds: Benadryl Inhaler

Current Illness: None

ID: 0982809
Sex: F
Age: 46
State: CA

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: High Fever bones hurt sores under tongue and inside throat Weak

Other Meds:

Current Illness:

ID: 0982810
Sex: F
Age: 33
State: ME

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: kiwi

Symptoms: I received the second dose in the afternoon and work up the next day feeling drained. Within the next couple of hours I had chills (did not check for fever), fatigue, headache and overall weakness. Most of the symptoms subsided after 12ish hours later- the head ache lingered for an additional 24 hours. I also experienced upper abdominal pain around30 hours after receiving the vaccine. I was seen by my healthcare provider and they believe the abd pain was related to an ulcer separate from the other symptoms.

Other Meds: multi vitamin

Current Illness:

ID: 0982811
Sex: F
Age: 30
State: MO

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

Lab Data: none

Allergies: penicillins gluten in all forms (dx celiac disease) corn and corn products sulfa sulphites soy

Symptoms: immediate tingling in injected arm which went after 10 minutes photophobia and blurred near vision 30 mins after vacc 8 hours after vacc: severe headache, chills, joint pain over whole body, extreme fatigue, sinus congestion. these lasted over 24 hour period.

Other Meds: omeprazole vit D3 calcium

Current Illness: none

ID: 0982812
Sex: F
Age: 30
State: MO

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: NSAIDs

Symptoms: General malaise starting almost immediately, and then about 12 hours after vaccine, developed: -Fever (102.0) -Chills -Numb digits (toes and fingertips) -Sore joints and muscles -Headache -Lightheadedness and loss of vision -Memory loss and difficulty concentration. With Tylenol (no ibuprofen, allergic), was resolved within 36 hours.

Other Meds:

Current Illness:

ID: 0982814
Sex: M
Age: 49
State: CO

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: Not on file

Symptoms: Pt received dose #2 Moderna COVID vaccine. Reported tachycardia, dizziness which resolved spontaneously and immediately, R eye tightness. Patient reports similar symptoms associated with first vaccine but occurred that evening. Patient reports symptoms resolved quickly. Patient with VSS and no acute distress noted during visit. Discharged home without escalation of care or intervention. Entered by PSS for tracking.

Other Meds:

Current Illness:

ID: 0982815
Sex: F
Age: 56
State: TX

Vax Date: 12/31/2020
Onset Date: 01/02/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: IGG/IGM test on 01/14/2021 and I was IGG postive so I have immunity.

Allergies: I am allergic to ketamine and plaquenil

Symptoms: I had facial swelling where my eyes were almost swollen shut and violent diarrhea.

Other Meds: I take vitamins.

Current Illness: No

ID: 0982816
Sex: F
Age: 30
State: PA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: NONE

Allergies: STATES SHE HAD ANAPHALAXIS AS A BABY TO PCN, DOES NOT HAVE EPI PEN

Symptoms: WHEN THE 15 MINUTE OBSERVATION PERIOD ENDED, PATIENT NOTED SCATTERED BLOTCHY RED RASH ACROSS HER UPPER CHEST/FRONT SHOULDER AREA. RASH ALSO NOTED OVER L SCAPULAR AREA. SKIN IS CLEAR ON THE REMAINDER OF BACK, ADBOMEN, EXTREMITES, BLOTCHES ARE NOT RAISED OR PRURITIC. FACE FLUSHED. PATIENT STATES SHE GETS THIS RASH WHEN SHE IS ANXIOUS. NO DIFFICULTY BREATHING, NO TIGHTNESS IN THROAT OR CHEST, NO NUMBNESS,SWELLING OR TINGLING OF LIPS/TONGUE. PATIENT REMOVED JACKET LAYERS OF CLOTHING AND MASK, GIVEN WATER AND CRAKERS (ALSO HAD NOT EATEN FOR SEVERAL HOURS). LUNGS ARE CLEAR TO AUSCAULTATION. BP 130/91, PULSE OX 100%, PULSE 93. RASH BEGAN TO SUBSIDE ABOUT 5-10 MINUTES AFTER PATIENT FIRST NOTED IT, AND WAS COMPLETELY GONE WITHIN 20-30 MINUTES. PATIENT STATED SHE FELT WELL, HAD NO FURTHER COMPLAINTS.

Other Meds: FETZIMA 80MG DAILY; GABAPENTIN 500MG TID; MODAFINIL 150MG DAILY; HYDROXYZINE 20MG DAILY; LAMOTRIGINE 100MG HS; AIMOVIG INJECTION MONTHLY; TYLENOL AND ASPIRIN PRN

Current Illness: NONE

ID: 0982817
Sex: F
Age: 78
State: AZ

Vax Date: 01/19/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: NKA

Symptoms: Redness and itchiness at injection site warm to the touch but not painful.

Other Meds:

Current Illness:

ID: 0982818
Sex: F
Age: 74
State: IN

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: None

Allergies: only to bee and wasp stings

Symptoms: Soreness, very slight swelling in left arm. Not terribly painful but noticeable when moving that arm. Now, 4 days later there is still a bit of tenderness. I am expecting there to be less or none tomorrow. I don't think this is a serious result but still it is a reaction but possibly others have encountered.

Other Meds: none

Current Illness: none

ID: 0982819
Sex: F
Age: 20
State: TX

Vax Date: 01/01/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: NKA

Symptoms: Patient came to receive dose 2 of Covid19 Moderna vaccine. States 1 hour after the first dose (administered on 12/28/20) she was at work and her blood pressure dropped, she became dizzy and her face went white. She said her mother insisted she go to the ER to be examined. She states upon examination she was given fluids and tests were ran and the ER staff said she was fine. Explained this to physician at vaccine site and she said it was not a contraindication to receive 2nd dose and it sounds like possible vasovagal reaction or hypoglycemia. Patient states she still wanted to receive vaccine. Was instructed to monitor patient for 30 minutes after vaccination, assist patient in ambulation to waiting area to lower fall risk and provided patient with apple juice and trail mix in case of possible hypoglycemia. About 5-10 minutes after vaccine, patient stated she became dizzy and was dry heaving. She was assisted to supine position; vitals were taken and blood pressure was slightly elevated. 911 was called. Before arrival of EMS, patient stated she was feeling better and vital signs stable. Patient was helped to ambulate around waiting area and upon arrival of EMS, patient states she did not need to be transported. Patient was observed for about 20-25 more minutes and she was fully recovered. Spoke with Dr who was on scene after the incident and she believes it was anxiety.

Other Meds: unknown

Current Illness: N/A

ID: 0982820
Sex: F
Age: 32
State: ME

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: Keflex

Symptoms: headache, fatigue, chills (worse so on the day after vaccine) lasting about 24 hours

Other Meds: Prenatal, CO-Q10, Fish Oil, Aspirin, B-12

Current Illness: none

ID: 0982821
Sex: F
Age: 66
State: CA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: To be determined-will call MD

Allergies: Ampicillin

Symptoms: ?Moderna COVID?19 Vaccine EUA? Within five minutes of injection began to feel some dizziness - it came and went. I was sitting in car the entire timejand I have never felt faint upon receiving shots. On Tuesday evening, approzimately Jan 26, approximately 9PM I began to have chills for several hours, with my teeth actually chattering. Sometime around midnight I was dizzy and had nausea and vomiting - only mucous. Wednesday AM upon arising I had vertigo and dizziness which lessened during the day. This AM Thursday, I have also had vertigo and nausea and will call my internist.

Other Meds: No pharmaceuticals or supplements. Had taken Vit D3 2000 IU (50 mcg) approximately 5 days previous> I take that off and on when I remember

Current Illness: none

ID: 0982822
Sex: F
Age: 42
State: MO

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Nausea, temperature, weakness, and muscle pain.

Other Meds:

Current Illness:

ID: 0982823
Sex: F
Age: 37
State: FL

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: Macrobid, cipro

Symptoms: After 2 hours after getting vaccine on my left arm. It started to get more sore then usually after getting a shot on your arm. I started to think maybe the nurse gave me a shot to close to my shoulder bone. But that was not the case. By the following hours I could bearly move my left arm. I could not raise my arm above my chest with out sharp pain on left shoulder.. I left work early to work from home and it was hard to drive with the pain. By 7:00pm 1/27/2021 The pain was unbearable I had to take 2 ibuprofen 800 mg and a muscle relaxer. I could not sleep all night the next day I called out from work. I woke up with still sharp arm pain and muscle soreness all over my body, tight muscles on both back shoulders and my back. felt body aches.

Other Meds: Adderal 20 mg

Current Illness: Back pain from bad posture.

ID: 0982824
Sex: F
Age: 37
State: FL

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: none

Allergies: clinda, PCN, Brio, Sulfa, fin fish, cod fish ( anaphylaxis), haddock (anaphylaxis)

Symptoms: scratchy throat with difficulty swallowing, pruritic

Other Meds: zoloft, lexapro, trazadone, prazosin, propanolol

Current Illness: none

ID: 0982825
Sex: F
Age: 43
State: IN

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: muscle aches, chills, sweating, extreme fatigue, unable to move arm at all, dizziness, headache, confusion

Other Meds:

Current Illness:

Date Died: 01/26/2021

ID: 0982826
Sex: M
Age: 40
State: NV

Vax Date: 01/21/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: not available

Allergies: unknown

Symptoms: Was at work on 1/26/21 and collapsed, no known complaints a the time. CRP was initiated immediately, transported to ER and pronounced dead

Other Meds: unknown

Current Illness: immunocompromised with reportable conditions

ID: 0982827
Sex: F
Age: 37
State: ME

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/28/2021
Hospital:

Lab Data: None

Allergies: Extensive h/o hydroadenitis suppurtiva and brisk skin reactions

Symptoms: The HCW noted w/i 1 hr of vaccination a constellation of symptoms including dizziness, disorientation, and fatigue; and by 4 hrs she developed swelling LUE with pain and some swelling extending to the L neck. Over the next several days she reported marked swelling and tenderness over the triceps upper arm area; persistent swelling and pain in the neck that required cold packs for a couple days. The reaction appeared to be more pronounced and extensive akin to the Humira local reaction she would ordinarily get; the last dose of that was 4 months prior. By history, it sounds like extensive angioedema. At no point was there any pruritus, erythema, or hive or rash on any other part of the body; no respiratory compromise, stridor or wheeze; and no fever. Symptoms subsided over several days and she was well on day of her presenting for her second vaccination. The vaccinator (who is a pediatrician), an on-call allergist; and this reporter (a medical oncologist) all consulted on best approach. The allergist recommends skin testing; Humira may have a polysorbate component; and we collectively thought a contraindication to proceeding. Given the deliberation the HCW actually elected also not to proceed. We informed her that early data suggests one dose of the Moderna vaccine may confer an approximate 80% protection. She will present to EHS for further evaluation.

Other Meds: Humira

Current Illness: None

ID: 0982828
Sex: F
Age: 66
State: MI

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: na

Allergies: NKA

Symptoms: fever 100.3, emesis x1

Other Meds: lyrica, mvi Tylenol, tramadol, risperidal, atorvastatin, Maalox, Colace, k-dur 10 meq, lorazepam, verapamil,

Current Illness: hemiplegia, anxiety, obesity, htn, gerd, pain, N/D. No acute illnes

ID: 0982829
Sex: F
Age: 25
State: MD

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: Sulfa

Symptoms: The night of the injection she had vomiting, nausea, chills and fatigue. The next day she developed a rash across her back and she took benedryl, throughout the day the rash spread to her stomach and chest and she continued benedryl. The following day the rash spread to her neck and arms and she took more benedryl. She saw her PCP on Friday and they recommended Pepcid, Benedryl and Claritin. The itching has subsided somewhat.

Other Meds:

Current Illness:

ID: 0982830
Sex: F
Age: 46
State: CO

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: no test or labs have been done yet

Allergies: penicillin, erythromycin

Symptoms: fever, body aches, redness and heat to left arm at injection site with significant spreading of the redness and heat starting approximately 4 hours after injection. Fever and body aches resolved after 48 hours. The redness and heat on the left arm continue and this is why I am filling out this form. I am told that if the redness and swelling becomes worse I need to go to my doctor and possibly be treated for cellulitis. The hospital who gave me the vaccine asked me to fill out this form due to the arm reaction.

Other Meds: sprionolactone, protonix, topamax, vitamin C, probiotic, gabapentin, benadryl, 5Htp, Advil, Tylenol, nitrofurantoin,

Current Illness: urinary tract infection

ID: 0982831
Sex: F
Age: 62
State: MO

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Fever up to 100.8 degrees F, headache, body aches, fatigue, lethargy

Other Meds:

Current Illness:

ID: 0982832
Sex: M
Age: 38
State:

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: fever, n/v, chills

Other Meds:

Current Illness:

ID: 0982833
Sex: F
Age: 42
State: PA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: No medical testing or labs were completed

Allergies: Sulfas, Sumatriptan, Red bell pepper, hard cheeses, eggplant, NSAIDS

Symptoms: Within approximately 30 minutes of getting the vaccine my left arm started to itch, then the itching spread across my back and to my other arm. The itching was accompanied by some nausea and moderate joint pains. As time went on I started to experience nausea, stomach pain, increased salivation, rhinorrhea, post nasal drip, itching in my throat and swelling in my throat. These symptoms developed over the course of a few hours and continued to worsen. I eventually went to the ER around 8:00 pm. In the emergency room I was given Benadryl, Pepcid and prednisone, after which symptoms gradually resolved and I was able to discharged around 10:00pm

Other Meds: Propranolol and Zyrtec early in the morning prior to vaccination

Current Illness: none

ID: 0982834
Sex: F
Age: 36
State: WI

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: NKDA

Symptoms: Felt lump in throat 2 minutes after receiving vaccine. 3 minutes later she felt chest pressure and had a metallic taste in mouth and with smell. She was brought to TEC for futher evaluation.

Other Meds: Hydroxyzine, Multivitamin, Mirena

Current Illness: none

ID: 0982835
Sex: F
Age: 51
State: NC

Vax Date: 01/16/2021
Onset Date: 01/20/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: COVID PCR test negative 1/22/2021

Allergies: NKDA, seasonal allergies

Symptoms: chronic headache, sore throat, muscle/joint pain, intermittent nausea, general malaise

Other Meds: meloxicam, citalopram, atorvastatin, pantoprazole, baby aspirin, Restasis, Allegra, Flonase, pseudoephedrine, Vit D, iron

Current Illness: none

ID: 0982836
Sex: F
Age: 65
State: MO

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: NA

Allergies: sulfa cipro Cephfil

Symptoms: Within 10 minutes lips started tingling. Pt did not tell anyone. After her 15 minute wait, by the time she got in her car, her lips were swelling and got tight. Her throat got scratching but did not cause any breathing discomfort. All subsided by the time she got home. She has not had any more symptoms. Has contacted her family Dr. and reported.

Other Meds: Took Rx Hydroclholorathizide Vit D Fish Oil all that am

Current Illness: No

ID: 0982837
Sex: M
Age: 49
State: CO

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies: Not on file

Symptoms: Pt received dose #2 Moderna COVID vaccine. Reported tachycardia, dizziness which resolved spontaneously and immediately, R eye tightness. Patient reports similar symptoms associated with first vaccine but occurred that evening. Patient reports symptoms resolved quickly. Patient with VSS and no acute distress noted during visit. Discharged home without escalation of care or intervention. Entered by PSS for tracking.

Other Meds:

Current Illness:

ID: 0982838
Sex: F
Age: 53
State: MS

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: Unknown. Md sent patient home with steroids. no epi pen used

Allergies: nkda

Symptoms: couldn't breathe through nose, hands shaking, nausea, had elevated blood pressure and pulse when checked. (162/104 and 122 hr)

Other Meds: Phentermine

Current Illness: none

ID: 0982839
Sex: M
Age: 81
State: NY

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: pending

Allergies: NKDA

Symptoms: shortness of breath, increased tremors per patients' wife. he is AOx0 at baseline

Other Meds: levaquin hiprex dutasteride metopolol

Current Illness: UTI

ID: 0982840
Sex: M
Age: 33
State: TX

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient passed out. Witness (girlfriend) reports patient's eyes rolled to the back of his head and his foot hit the gas when waiting in observation area. Symptoms started about 5 minutes after vaccination. Patient reports mild lightheadedness and has history of passing out with needles (panic attack). Patient was observed by EMS and was cleared after 20 minutes.

Other Meds:

Current Illness:

ID: 0982841
Sex: M
Age:
State: CO

Vax Date:
Onset Date: 01/13/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data: N/A

Allergies: NKDA

Symptoms: Skin redness and warm feeling

Other Meds: None

Current Illness: denies

ID: 0982842
Sex: F
Age: 27
State:

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
Hospital:

Lab Data:

Allergies:

Symptoms: states rec'd moderna #2 covid vaccine on 1/27 in the am, on 1/27 in the evening developed inj site pain and redness, had unltra sound done-5 cm contusion on site of vaccine, advised to f/u with physician regarding redo of vaccine.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm