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: 0985040
Sex: F
Age: 41
State: NY

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/29/2021
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 known allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt. Was seen for covid-19 vaccination on 1/13/21. She presented to observation at 12:29pm for her 15 minute observation. Between 12:34-12:38pm pt. Endorsed sudden onset of dizziness and chills. I called for RN assistance who obtained VS and I began clinical assessment. Pt. Denied CP, SOB, DOE, difficulty swallowing was reported. She was able to speak in full sentences, no audible wheezing, facial swelling, one sided weakness or difficulty with speech production. On exam: breath sounds clear, pt. diaphoretic, cool to touch, visible pallor. She denies prior allergic rxn to vaccinations, denies daily medication. Reports medical hx including Sj?gren's syndrome and psoriasis. She reports eating breakfast (meal&juice) prior to vaccine administration. Denies allergies to food or medications. 12:40pm: BP 60/49, pulse 81, 02 sat 100%, RR 16. Repeat BP 60/33, rapid response (code blue) was called. Pt assisted transferred to clinical reclining chair, placed in supine reclining position, fluids started (500 bolus NS),FS glucose 93, and EMS called. Patient remained a&o x3, no syncope. 12:46-12:50pm: reported onset of stiffening of hands and l/e. below the knee. AROM remained intact in extremities. Approximately 12:56pm EMS arrived, EKG WNL (per EMS), patient able to ambulate with assistance from reclining chair to EMS transport chair. Approximately 12:58pm BP 93/47. Pt. was stabilized in DTMO following 500 mL NS, BP 92/54 prior to departure to ED at 1:05pm. RN contacted pt. Emergency contact (as documented in RN note) with EMS arrival and prior to ED departure. Pt. Belongings were collected, including cellular phone, and placed in patient belonging bag and given to patient prior to her departure. RN will follow up with patient tomorrow and schedule in office follow up. PCP notified per rapid response report.

Other Meds: None, per pt.

Current Illness: pt. denied illness at the time of vaccine or up to 1 month prior

ID: 0985041
Sex: F
Age: 24
State: VA

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
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: Seafood, Sulfa drugs

Symptom List: Anxiety, Dyspnoea

Symptoms: Nausea, vomiting, diarrhea, headache, fatigue, muscle soreness

Other Meds: Birth Control Pills, Paxil

Current Illness: No

ID: 0985042
Sex: F
Age: 55
State: CA

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/29/2021
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: nka

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

Symptoms: Symptoms: Leg & Body Aches; Temp. 100.1; Heart Rate above 110's; Headache; weakness, lasting 2 days.

Other Meds: none

Current Illness: none

ID: 0985043
Sex: F
Age: 43
State: FL

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: Cats

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: at 12 midnight 1/27/2021 I started with the Chills, and Joint pain, Fever, dizzy spells, and on 1/29/2021 started with left side facial inflammation and pulsing pain from head to left eye. I called my Employee Clinic and they stated to call and recording says to fill out reaction report

Other Meds: Metformin, Allegra, Vit D, Prenatal,

Current Illness: none

ID: 0985044
Sex: M
Age: 68
State: NC

Vax Date: 01/20/2021
Onset Date: 01/25/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: Timothy grass, IVP dye, erythromycin

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

Symptoms: Shingles despite having had shingles vaccine (Shingrex) completed two years ago

Other Meds: Amlodipine, Lisinopril, metoprolol, sodium bicarbonate, metformin, meloxicam, gabapentin, myrbetric, montelukast, zolpidem, coenzyme Q10, glucosamine chondroitin, sublingual allergy drops

Current Illness: None

ID: 0985045
Sex: F
Age: 57
State: VA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/29/2021
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: penicillin, amoxicillin mold, seasonal, animals

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

Symptoms: COVID-19 Vccine stomach aches, low fever, headaches, general malaise for 3 days. Currently, I am still having stomach aches all day/night.

Other Meds: Ventolin (as needed) Prozac (10mg/1xday) Singulair (10mg/1xday)

Current Illness:

ID: 0985046
Sex: F
Age: 57
State: PA

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 01/29/2021
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: headache like a migraine

Other Meds: multi vitamin

Current Illness: none

ID: 0985047
Sex: F
Age: 64
State: MI

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

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

Lab Data:

Allergies: ARBs, Diphenhydramine, Desloratadine, Coconut oil, nuts

Symptom List: Pharyngeal swelling

Symptoms: Patient was at end of 30 minute monitoring and stated she "felt off, my throat feels dry." Able to sip water. Continuously monitored for additional 10 minutes when she stated her throat felt tight. BP 150/85, HR 97, RR 20, p. ox 99%. Sent to critical bed in emergency. Epinephrine, Solu-medrol, and normal saline given. Monitored until 11:18 (3.5 hours from onset) and discharged.

Other Meds:

Current Illness: none

ID: 0985048
Sex: F
Age: 34
State: RI

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
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 z pac

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever up to 104, body aches, chills, headaches Tylenol and Motrin alternated every 5 hours Symptoms started on Wednesday 1/27/21 @ 2am and finished on Thursday morning 1/29/2021

Other Meds: Wellbutrin XL Multivitamin Zyrtec

Current Illness:

ID: 0985049
Sex: F
Age: 29
State: IN

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
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: N/a

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Chills and aches started about 8-9 hours after vaccine (10-11pm). Chills and likely fever all night. On 1/28 at 6:15 am, fever 101, vasovagal syncopal episode and nausea. Took Tylenol at 6:30am and drank fluids. Temperature down to 99.7 by 8:30am, 99.6 at 1pm, 99.0 at 10pm on 1/28 (day after vaccine). Headache and fatigue on 1/28 also.

Other Meds: prenatal vitamins, zertec PRN

Current Illness: breastfeeding mom

ID: 0985050
Sex: F
Age: 34
State: MA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: Naproxen

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

Symptoms: Large red mark surrounding injection site almost immediately after vaccine 1/25/21 Body aches starting around 8:30PM 1/25/21 Nausea starting around 9:00PM 1/25/21 Chills starting around 9:30PM 1/26/21 (quickly resolved) Felt feverish starting at 5:00AM 1/27/21 (on and off 1/27/21-1/28/21) Body aches lasted until about 6:00PM 1/28/21, then started to recur overnight; woke up feeling congested and achy, went to work and started to feel feverish, nauseous and more achy. Left work to go get a rapid covid test.

Other Meds: Altavera Citalopram Flonase Acetominophen

Current Illness: Cold symptoms 2 weeks before

ID: 0985051
Sex: F
Age: 56
State: IA

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Headache; nausea Left work early

Other Meds:

Current Illness:

ID: 0985052
Sex: F
Age: 71
State: TX

Vax Date: 01/20/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: codeine

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

Symptoms: On 8th day( Jan 28) injection site of Moderna Covid-19 started itching & slight rash. On 9th day ( Jan 29) injection site has a more prnounced rash that is medium pink , warm & itching. Took a Benadryl.

Other Meds: Vit D

Current Illness: none

ID: 0985053
Sex: F
Age: 49
State: NY

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
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: No known allergies

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

Symptoms: Patient became dizzy and light headed, passed out into chair (briefly), employee felt tightness in chest, SOB, taken to emergency room at this point, increased heart rate, blood pressure and SOB. Patient given Neb treatment, Solu-Medrol, Toradol (for migraine). Patient discharged from emergency room with improved breathing. Patient reports she is still SOB at times, has muscle aches, fatigue and soreness at injection site.

Other Meds: Metformin 1000mg, crestor 10mg, Levothyroxine 135mcg, Fluoxetine 20mg, Oxybutynin 10mg, Lisinopril 10mg, Pantoprazole 20mg, ASA 81, Zyrtec (generic brand), Co-q10 joint health, multivitamin, Toradol on 1/25/21, Advil 1/25/21, excerdin on 1/

Current Illness: Migraine started on 1/25/21, present at time of vaccine

ID: 0985054
Sex: F
Age: 76
State: OK

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
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: NSAIDS

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

Symptoms: I had no reactions with the first dose. The next morning on the 28th I woke up and couldn't get out of bed. I tried to get out bed and couldn't my husband had to come help me. I could barely walk because I hurt so bad. He helped me to the bathroom and then to my chair in the living room. It hurt so bad I couldn't stay long. My husband helped me back to bed, I stayed in bed all day besides when I needed to go to the bedroom. Today I am shaky, my stomach is bothering me, I can walk today but I real tired and shaky and have to come right back to my chair to sit down. I am better then I was yesterday. If I don't feel better by noon I will call my doctor.

Other Meds: Zyrtec once a day, Montelukast 10 MG once a day, Symbicort 2 puff twice a day, Folic Acid 1 MG once a day, Duloxethine 30 MG once a day, Acyclovir USP5% ointment, Proair inhaler as needed, Leslunomide 20 MG once a day, Gabapentine 600 MG 3

Current Illness:

ID: 0985055
Sex: F
Age: 24
State: SC

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
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: Allergic to bananas and sometime other raw fruits and vegetables

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

Symptoms: Temperatures exceeding 102 Body aches and chills Muscle pain / weakness Headaches Large red skin bump

Other Meds: 40mg Vyvanse 10 mg Lisinopril 5mg escitalopram 100mg wellbutrin XR

Current Illness: None

ID: 0985056
Sex: F
Age: 56
State: NY

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
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: sulfa, levoquin, PCN

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

Symptoms: 10 minutes into 30 minute observation post vaccination client reported feeling warm with erythema developing on her chest.

Other Meds: unkn

Current Illness: none

ID: 0985057
Sex: F
Age: 67
State: FL

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 01/29/2021
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: Very strong chills for 6 hours around bedtime... bad headache...it has been about 24 hours, still have headache, left arm very sore.

Other Meds: levothroxine .80 mg 1 per day

Current Illness: none

ID: 0985059
Sex: F
Age: 58
State: FL

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Chills, Fever, fatigue, headache lasted 36 hours. Dizziness lasted 96+ hours

Other Meds: Losartin, baby aspirin, B12 and Multivitamin

Current Illness: None

ID: 0985060
Sex: F
Age: 48
State: SC

Vax Date: 01/10/2021
Onset Date: 01/11/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: Dulera, Latex, Walnuts, Trees, Molds, Mildews, Animals

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

Symptoms: Total body joint pain, low grade fever, headache x 16hrs Injection site pain, axillary pain/tenderness x 1 week

Other Meds: Metoprolol, Zyrtec, Breo Ellipta, QNasal, Sertraline

Current Illness: None

ID: 0985061
Sex: F
Age: 29
State: MN

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/29/2021
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: Chills started around 8:30pm, uncontrollable shaking from the chills, my skin hurt. My temperature was 103.5F when I checked it at 12:30am. I removed clothing and put ice on my neck, and took tylenol and the fever came down to 102.5F in 30 min. I had a moderate headache, felt lightheaded and a little disoriented, and nauseous. The following morning and the entire next day I had a moderate to severe headache, malaise, nausea, and a low grade temp 99-99.8F.

Other Meds: Liothyronine daily Prenatal vitamin Vitamin D3 Fish oil Magnesium Sunflower lecithin Moringa powder Vitamin C Probiotic Zinc

Current Illness: None

ID: 0985062
Sex: F
Age: 31
State: OR

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: Sulpha drugs

Symptom List: Unevaluable event

Symptoms: At midnight on 1/28/21 I had 101 degree fever, chills, sweats, migraine headache, nausea that lasted until I could take 2 Ibuprofen around 8:00 AM. The fever returned after the ibuprofen wore off. Today is 1/29/21 and I am still experiencing a 99 degree fever, sweats, chills, light headache, and diarrhea. Two days of work missed.

Other Meds: Escitalopram 25 mg/day Trazodone 100 mg/night

Current Illness: None

ID: 0985063
Sex: F
Age: 53
State: VA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Fever, lethargy, headache, pain at injection site

Other Meds: Atenolol, Ropinirole, Levthyroxine, Furosemide

Current Illness: None

ID: 0985065
Sex: F
Age: 72
State: FL

Vax Date: 01/21/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
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: morphine, codeine, durecef

Symptom List: Injection site pain, Pain

Symptoms: On day of vaccine I had localized swelling , pain, and some itching. This went away in about 3 days. On 1/27/2021, I started experiencing , itching and redness on the spot of the injection. Today is the 29th and I am still experiencing these symptoms.

Other Meds: Eliquis, Levothyroxine, Losartan, famotidine, Crestor, Vitamin D3, CoQ10

Current Illness: none

ID: 0985066
Sex: F
Age: 58
State: KY

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever Fatigue Headache Nausea *Lasting approx. 30 hours. *Bedrest & Ibuprofen

Other Meds: Hydrochlorothiazide; Lisinopril; Paroxetine; Biotin

Current Illness: N/A

ID: 0985067
Sex: M
Age: 41
State: TX

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/29/2021
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: no

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

Symptoms: 22 Jan 2021-Friday-Tired,SOB 23 Jan 2021-Saturday-Tired 24th Jan 2021-Sunday-folding laundry-winded & tired 25th Jan 2021-Monday-winded, tired-climbing stairs 26th Jan 2021-tired & winded, 27th same, 28th Tired & winded 29th Today January-2021-Tired & winded-Reminded patient to GO to ER if his SOB get worse, or see his PCM Took naproxen for his tiredness

Other Meds: Naproxen, Vitamins, ashwaganda

Current Illness: none

ID: 0985068
Sex: M
Age: 86
State: MI

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/29/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: 1-8-21 Body aches

Other Meds:

Current Illness:

ID: 0985069
Sex: F
Age: 67
State: TX

Vax Date: 01/19/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Itching, feverish tender, raised rash approximately 1.5 inches in diameter at injection site developed 9 days following the injection

Other Meds: Estradiol .5 mg Vitamin D 3 5000 IU daily Furosemide 40 mg once daily Pot CL MICRO 20 MEQ ER twice daily

Current Illness: NA

ID: 0985070
Sex: F
Age: 31
State: KY

Vax Date: 01/12/2021
Onset Date: 01/24/2021
Rec V Date: 01/29/2021
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: none

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

Symptoms: One week post vaccination there was a small amount of erythema developed, centered at the vaccination site. This disappeared after several days. Then a large rash appeared on the left arm around the vaccination site 12 days post vaccination. It spread downward toward the elbow over several days, covering the majority of the bicep, but the rash resolved with repeated administration of hydrocortisone 1% cream and PO diphenhydramine.

Other Meds: Lexapro 10mg qam yasmin 1 tab hs fexofenadine 180mg hs Flonase 1 spray each nostril hs

Current Illness: none

ID: 0985071
Sex: F
Age: 83
State: MI

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/29/2021
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: 01-07-21 Headache, Runny nose

Other Meds:

Current Illness:

ID: 0985072
Sex: F
Age: 49
State: TN

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: Keflex Macrobid Levaquin

Symptom List: Injection site pain

Symptoms: injection site inflammation upon wakening the next morning was better by day three however began itching on day four and slightly irritated by day six was seriously inflamed borders were marked before bed and upon wakening day seven, had enlarged past borders area morning of day seven is 3.5 inches across and 2 inches long, very red, raised and hot to the touch with occasional itching

Other Meds: Adderall Synthroid vit-D glucosamine chondroitin calcium Celebrex Metamucil arthritis Tylenol stool softener culturelle probiotic Benadryl Aygestin Nexium selenium

Current Illness: none

ID: 0985073
Sex: F
Age: 67
State: KY

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: Yes! Gave them a list at the event. Checked by medical personnel told I would need to stay 30 minutes in holding area.

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

Symptoms: Day of vaccine. Bright red flushing throughout my body. Looked like sunburn. Lightheaded, very tired, headache and feeling shaky. My arm was swollen and redness act injection site Day 2. Low grade fever. Very tired. Achiness. swollen arm. Redness at injection site. Slight headache. Day 3. No fever. Some tiredness. Arm still swollen and tender. Still redness at injection site.

Other Meds: Sprolactone, Lipitor, Prilosec, Multivitamin, Clariten

Current Illness:

ID: 0985074
Sex: F
Age: 58
State:

Vax Date: 01/10/2021
Onset Date: 01/16/2021
Rec V Date: 01/29/2021
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: clavulanic acid

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

Symptoms: Swollen , painful lymph nodes underneath armpit and underside of arm. Started as slightly tender and now has increased to encompass whole upper arm being painful and having trouble moving the arm.

Other Meds: rosuvastatin, metformin, lisinopril, aspirin

Current Illness: none

ID: 0985075
Sex: F
Age: 71
State: IN

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
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: Did not feel like eating for the dinner meal. She ate some of a baked potato and diet coke.

Other Meds: Memantine Allopurinol Aspirin 81 mg Atorvastatin Biotin Calcium Exelon Patch 13.3 mg Lisinopril Oxybutynin Citalopram Vitamin D3 - 4000 units Bacopa Extract 450 mg CoQ10 300 mg Biotin 10,000 units Centrum Silver Multivitamin Zink 50 mg

Current Illness: None

ID: 0985076
Sex: F
Age: 77
State: PA

Vax Date: 01/19/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
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: lamasil, fosamax, plavis, hypersensitive to nitroglycerin

Symptom List: Erythema, Pruritus

Symptoms: Large red rash area at site of injection with some hardness and more headaches than usual. Eight days out now from receiving this dose #1 of Moderna.

Other Meds: amlydopine, crestor, benicar, low dose aspirin, probiotic, claritin, vitamin C and D

Current Illness:

ID: 0985077
Sex: F
Age: 91
State: MI

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/29/2021
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:

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

Symptoms: 01/08/2021 Body aches

Other Meds:

Current Illness:

ID: 0985078
Sex: F
Age: 34
State: MA

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Sulfa

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

Symptoms: Received my second dose of Covid vaccine 1/26/21 at 1320. No immediate adverse reaction occurred. I started experiencing injection arm soreness around 2100. By midnight I was experiencing chills and body aches. The morning of 1/27 my Temp was 100.0 and I was still having body aches and chills/feeling feverish. This continued throughout the day. I took one dose of Tylenol 1g and later ibuprofen 600mg. The morning of 1/28 I still had a mild headache and temp of 100.00 but overall was feeling much better - no more chills or body aches. My temp prior to going to work that night was 98.6 and my headache had resolved.

Other Meds:

Current Illness:

ID: 0985079
Sex: F
Age: 29
State: OK

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: The date of injection I didn't have any symptoms. The next morning i woke up and my arm felt like it was on fire. I had a rash on the opposite arm that i had the injection. I took benadryl to help with the rash in the morning and at night. That night i was freezing and i woke up in a sweat. This morning i woke up and the rash looks worse.

Other Meds: Isibloom(birth control), Lexapro, vit d3, zyrtec

Current Illness: none

ID: 0985080
Sex: M
Age: 68
State: NY

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
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: codien

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: fever, chillis, restlessness, unable to sleep, exprem fatigue

Other Meds: ambien

Current Illness: noneno

ID: 0985081
Sex: M
Age: 54
State:

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
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: None

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

Symptoms: Fever of 102F and headache, which both lasted for 7 hours

Other Meds: None

Current Illness: None

ID: 0985082
Sex: M
Age: 72
State: FL

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: shellfish

Symptom List: Pain in extremity

Symptoms: sore arm, fatigue, muscle and joint pain in the body full day after the shot

Other Meds: amlodopine 10mg grapeseed extract 400 mg Omega-3 900 mg phosphatidylserine 100 mg curcumin 500 mg 10 billion probiotic

Current Illness: none

ID: 0985083
Sex: M
Age:
State: IL

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 01/29/2021
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: [Moderna COVID-19 mRNA Vaccine] treatment under Emergency Use Authorization(EUA): Patient received Moderna COVID-19 vaccine on 1/23/201. It was determined after her received this that he had received Bamlanivimab monoclonal antibody therapy on 12/24/2020. Patient has had not adverse reactions after receiving the vaccine. His second dose of the Moderna vaccine will be deferred until early April (90 days after receiving Bam therapy).

Other Meds:

Current Illness:

ID: 0985084
Sex: F
Age: 31
State: NY

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 01/29/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Fever up to 101.2 (persistent) Headache Chills Pain at site of injection

Other Meds: None

Current Illness: COVID-19 (01/06/2021)

ID: 0985085
Sex: F
Age: 60
State: KS

Vax Date: 12/19/2020
Onset Date: 12/25/2020
Rec V Date: 01/29/2021
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: Codeine (very allergic), Prozac, Adovan

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

Symptoms: After my vaccine, started coughing so bad. I had a Covid test which was negative and they gave me antibiotics. They also gave me an inhaler for my wheezing. I also felt a tightness sensation in my chest and lungs from all the coughing.

Other Meds: Lisinopril, Simvastatin, Levothyroxine, tumeric, vital med

Current Illness: I have allergies, occasional cough that came and went. I got tested for Covid which was negative.

ID: 0985086
Sex: F
Age: 58
State: VA

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/29/2021
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: sulfa

Symptom List: Vomiting

Symptoms: loss of taste, still persists Noticed when I woke up the next morning after receving the vaccine and my coffee tasted like hot water.

Other Meds: Bisoprolol 5 mg qd, HCTZ 12.5 mg qd

Current Illness: none

ID: 0985087
Sex: F
Age: 56
State: MA

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: received second vaccine at 0820 1/28/2021. no issues until evening at approx. 1900 when chills started. took Tylenol and fell asleep. 2 hrs later awoke and chills and malaise continue. Took ibuprofen and went to bed. awoke in night with fever, chills and major headache. took Tylenol. Came to work to try to see if could work through it but by 7:30 symptoms returning and unable to continue. called employee health and went home.

Other Meds:

Current Illness:

ID: 0985088
Sex: F
Age: 67
State: OH

Vax Date: 01/15/2021
Onset Date: 01/26/2021
Rec V Date: 01/29/2021
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: Penicillin , poison Ivey, mold

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

Symptoms: About 10 days after injection developed two circular rash es on right arm near injection site. Rash is itchy , red, swollen and burns. About 2-3 inches in diameter. It resembles a poison ivy rash. No other symptoms but rash has not resolved 5 days since noticing it.

Other Meds: Vitamin b, vitamin d, omeprazole

Current Illness: GERD

ID: 0985089
Sex: F
Age: 32
State: MI

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 01/29/2021
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: No allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Immediate hematoma at injection site, normal injection soreness, no itching, no redness. 10 minutes later felt dizziness and light headedness but it only lasted 5 minutes. 20 minutes later pt still has a small bleb at injection site.

Other Meds: Birth control

Current Illness: None

ID: 0985090
Sex: F
Age: 37
State: NY

Vax Date: 01/20/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Since around 1/26/2021 Having a very itchy rash on the injection side started as a little itchy bump is getting bigger, looks like a red ring very itchy, hot to the touch and hard too. Also I been having a headache since 1/28/2021 not sure if is related. Also felling very tired not sure if is related as well.

Other Meds: N/A

Current Illness: Possible Fatty liver, getting tested right now

ID: 0985091
Sex: F
Age: 32
State: TN

Vax Date: 01/12/2021
Onset Date: 01/21/2021
Rec V Date: 01/29/2021
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: Latex

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

Symptoms: 12x14 cm induration at the injection site, extending distally. Superficial skin reaction causing blistering and subsequent excoriation of 4 cmx6 cm. Treated with ice, topical cortisone, and oral benadryl x 4 days. Induration resolved by day 4, skin healing still in progress at day 8. Picture available upon request.

Other Meds: Amitiza, Lexapro, Motegrity, Qdexy, Saeyda, Synthroid. multivitamin, lysine

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm