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: 0985705
Sex: F
Age: 36
State: CT

Vax Date: 01/07/2021
Onset Date: 01/11/2021
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: Bee sting venom

Symptom List: Dysphagia, Epiglottitis

Symptoms: Axillary lymph nodes swollen 4 days after vaccine. Then 2 days later red Raised firm slight itchy rash area of tennis ball, appeared around injection site. Lasted 2 days. Lymph nodes got smaller and just 1 slightly raised 2 wks later

Other Meds: Venlaflaxinevxr 150 mg daily

Current Illness:

ID: 0985706
Sex: M
Age: 66
State: NY

Vax Date: 01/22/2021
Onset Date: 01/24/2021
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: Sulfa

Symptom List: Anxiety, Dyspnoea

Symptoms: The patient started to feel an incessant itching from her head to her knees, with a more intense sensation at the injection site and her back, although she has no rash or redness. She tried everything from moisturizers to Benadryl with no relief and decided to go see her PCP who put her on Prednisone daily until the itching stops.

Other Meds: Unknown

Current Illness: Unknown

ID: 0985707
Sex: F
Age: 63
State: NY

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

Lab Data:

Allergies: chloroform dust mites

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

Symptoms: low grade fever of 100 muscular fatigue headache All resolved within 36 hours

Other Meds: none

Current Illness: none

ID: 0985708
Sex: F
Age: 75
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: Shellfish. Advair Diskus, penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient developed a headache the evening following getting the injection. This is eight out of 10 pain on a 0 to 10 pain scale that goes down into her neck. Today when she woke up she is experiencing weakness, dizziness, lightheaded and continued headache with eight out of 10 pain on 0 to 10 pain scale. Patient reports her right arm where injected is also eight out of 10 pain on 0 to 10 pain scale and tender to touch

Other Meds: Vitamin D3 Vitamin C Levothyroxine sodium Paroxetine HCI Lisinopril Amlodipine bestlate Janumet Montelukast sodium Topiramate Propranolol HCI Lantus Solostar subcutaneous solution pen injector

Current Illness:

ID: 0985709
Sex: F
Age: 77
State: OH

Vax Date: 01/26/2021
Onset Date: 01/26/2021
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: CODIENE AND TAPE

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

Symptoms: 1/26/21 @ 5PM C/O TINGLING ALL OVER BODY AND RIGHT EYE". DENIES ANY TROUBLE BREATHING OR SWALLOWING, NO EDEMA OF LIPS. A/0 X3, SKIN PINK W/D, RESP REG WITH EASE. 1/26/21 @ 5:15PM CLIENT STATES SYMPTOMS ARE THE SAME AND "WILL TAKE BENADRYL WHEN SHE GETS HOMEIF NEEDED". 1/27/21 @ 9:25AM CLIENT STATES ALL SYMPTOMS HAVE RESOLVED.

Other Meds:

Current Illness:

ID: 0985711
Sex: F
Age: 33
State:

Vax Date: 01/28/2021
Onset Date: 01/28/2021
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:

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

Symptoms: Throat felt funny for 30-45 minutes Benadryl 25mg and prednisone 20mg were given PO HR-117

Other Meds:

Current Illness:

ID: 0985712
Sex: F
Age: 42
State:

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

Lab Data:

Allergies: Septra-rash and throat swelling, Penicillin-rash, Clindamycin-rash

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Approx. 25min after injection pt began c/o her entire left arm and down to her hand burning. Describes it as inside her am and not just the skin. Vitals WNL No other complaints initially. After observation for approx. 10 min pt's fingers on her left hand appeared discolored. Burning in her arm unchanged. Transported to urgent care by RN. During transport pt began c/o burning sensation in her left calf.

Other Meds: birth control pills

Current Illness: none

ID: 0985713
Sex: F
Age: 57
State: FL

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Headache and body ache started on 01/29/21 after the Second Covid-19 vaccine was administered on 01/28/21

Other Meds: Losartan, Simvastatin, Trulicity, Vitamin D3, Vitamin B12, and Omega-3

Current Illness: None

ID: 0985714
Sex: F
Age: 42
State: MN

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

Lab Data:

Allergies: Egg, Ephedrine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: c/o weird taste in mouth, warm, rash on chest and right deltoid around injection site only, pt given benadryl 25mg , water, and ice pack, waited 30 minutes, rash subsided and pt feeling ok

Other Meds:

Current Illness:

Date Died: 01/02/2021

ID: 0985715
Sex: M
Age: 80
State: FL

Vax Date: 12/29/2020
Onset Date: 01/02/2021
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: no known allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received the vaccine on 12/29/20 and presented at the ER at the Hospital on 12/30/20 stating that he wasn't feeling well. It is stated that his health had declined over the past few weeks and currently on hospice. Visit was unremarkable. Patient stated that wanted to stop dialysis. Patient passed away on 01/02/2021.

Other Meds: metoprolol 25mg vitamin D3 1000IU furosemide 80mg Norvasc 5mg aspirin 81mg Renvela 800mg atorvastatin 20mg vitamin B12 1000mcg

Current Illness: high blood pressure dialysis GI bleed/ symptomatic anemia

ID: 0985716
Sex: F
Age: 56
State: AZ

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: SYR
Vax Site: LA

Lab Data:

Allergies: Amoxicillin Tree nuts and peanuts

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

Symptoms: That evening my heart was pounding very hard throughout my entire body that's all I could hear laying down I thought that I was going to either have a heart attack or a stroke. I got up and took one of my blood pressure medications. It's slowed down but I was unable to sleep due to feeling jittery and my heart pounding hard. The next day I felt exhausted my stomach hurt. I have had a sore throat the worst being on the Thursday following. Today Friday things seem to be subsiding. However my concern is not to get the second dose if I had such a bad reaction the first time I definitely will have a heart attack the second time.

Other Meds: Lisinopril Amlodipine besylate 5 mg Simvastatin 10 mg Cetirizine 10 mg Famotidine 20mg Jardiance 25 mg Montelukast 10 mg Metformin 1000 mg eldberry gummies immune support vitamin D3 5000 iu magnesium 300 mg Breo inhaler 25 mcg

Current Illness: Possible air allergies

ID: 0985717
Sex: F
Age: 66
State: NY

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

Symptom List: Rash, Urticaria

Symptoms: Fever of 102 degrees F for about 20 hours accompanied by chills, diffuse muscle aches (especially neck and lower back), extreme fatigue. The fever broke after about 20 hours. Muscle aches and fatigue persisted an additional 24 hours or so.

Other Meds: aspirin, metoprolol XL, amlodipine, Vitamin D, atorvastatin

Current Illness: none

ID: 0985718
Sex: F
Age: 48
State: CA

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

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

Symptoms: Jan 21 , headaches, scratchy throat, bodyaches, weakness Jan 22- current - weakness, balance issue, tachycardia,dizziness, shortness of breath

Other Meds: Metformin HCL ER 500 mg, Jardiance 10 mg, Atorvastatin 20 mg, Vitamin C 500 mg

Current Illness: None

ID: 0985719
Sex: F
Age: 53
State: TX

Vax Date: 01/21/2021
Onset Date: 02/11/2021
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: PINEAPPLE

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

Symptoms: ON MY RIGHT SIDE FROM MY HIP TO THE BOTTOM OF MY BUTT I FEEL LIKE THE SHOT WAS GIVEN THER. I HAVE NEVER HAD THIS PAIN AND I HAD MY SHOT ON THURSDAY AND SUNDAY MORNING I WOKE UP AND COULDNT GET UP THE PAIN WAS REALLY BAD. I SHOWERED AND LET THE HOT WATER RUN AND IT FELT GOOD. I DONT KNOW IF ITS RELATED TO THE SHOT BUT BECAUSE IVE NEVER HAD THIS PAIN WASNT SURE. AS THE DAY WENT BUT IT WAS OK BUT WHEN RESTING IT WOULD GET BAD AGAIN. IT FEELS LIKE WHEN I FIRST GOT THE VACCINES THAT SAME PAIN. ITS GOTTEN BETTER BUT ITS LINGERING.

Other Meds: ATENOLOL, HYDROCHLOROT,

Current Illness: NO

ID: 0985720
Sex: F
Age: 73
State: CA

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

Lab Data:

Allergies: **hypaque (resp arrest), lanroprost (chest pain), combigan (black outs, nosebleeeds), zioptan (cough, headache)

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

Symptoms: Pt. c/o flushing/burning in vaccinated arm, nausea and light headed.

Other Meds: vitamin c, lovastatin, aspirin 81mg

Current Illness: sinusitis

ID: 0985721
Sex: F
Age: 43
State: MN

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No anaphylaxis history

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

Symptoms: 20 minutes after vaccine c/o dizziness, "fuzziness", started crying. Become diaphoretic, flushed, described hotness and weakness. Became nauseous as time advanced. 0915-188/92, 92 0917-20ml/50mg Benadryl liquid oral 0927-190/100, 90 0934-190/118, 92, feet raised 0935-Epi Adult Pen, R thigh (KN) 0939 20ml/50mg Benadryl liquid oral 0941-188/90, 88 0942-Epi Adult Pen, L thigh 0947-194/104, 104, R32 0952-178/105, 80, R28 0953-EMS Arrival, pt taken to ED

Other Meds: Unknown

Current Illness: Unknown

ID: 0985722
Sex: F
Age: 56
State: CO

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

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

Symptoms: Woke at 11:30 pm on 1/21/2021 unable to breathe, gasping for breath, heaviness in the chest, severe body joint pain, headache, and nausea. Took Flonase and ibuprofen and drank cold water to reduce inflammation in the chest for 20 minutes. Symptom relief. Continued 400mg of ibuprofen q 6 hours for 48 hours. 1/23/2021 at 6:00 am fluid-filled ears, heaviness in the chest. Administered Flonase.Symptom relief after one hour.

Other Meds: Estradiol 1mg, Flonase mist, Tylenol 32d ER Flonase and Tylenol were taken as a precaution prior to vaccination

Current Illness: None

ID: 0985723
Sex: F
Age: 71
State: GA

Vax Date: 01/25/2021
Onset Date: 01/26/2021
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: I DEVELOPED COVID ARM THE MORNING AFTER THE VACINATION. IT IS RED, SWOLLEN AND ITCHY. I AM ON DAY 4 AND IT HAS GOTTEN SOME BETTER, BUT IS STILL THERE.

Other Meds: SYNTHROID

Current Illness: NO

ID: 0985724
Sex: F
Age: 34
State: DC

Vax Date: 01/27/2021
Onset Date: 01/28/2021
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 known

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Body aches, stiffness in muscles, chill but no fever, soreness at injection site and up through neck on left side, extreme tiredness and exhaustion. Side effects were most severe the evening of and day after the vaccine was administered. Took a sick day from work to rest and treated with ibuprofen and fluids. 2 days after the vaccine side effects are less but still present and injection site is red, warm, and swollen.

Other Meds: Vyvanse, Spironolactone, Syeda (birth control), Advair, loratadine, Flonase

Current Illness: None

ID: 0985725
Sex: F
Age: 58
State: NC

Vax Date: 01/27/2021
Onset Date: 01/28/2021
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: latex, sulfa, plums

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

Symptoms: chills, myalgias, fever, fatigue

Other Meds: euthyrox, align, osteobiflex, Colace, benefiber,Viactiv, Zyrtec, krill oil, flonase, Premarin cream, Tylenol. aleve

Current Illness: none

ID: 0985726
Sex: F
Age: 51
State: CA

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: 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: My arm has a large lump, red, swollen and hot. Arm is very painful to move.

Other Meds: none

Current Illness: none

ID: 0985727
Sex: F
Age: 31
State: IN

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

Lab Data:

Allergies: Lortab, codine, plastic-latex tape, dawn dish soap.

Symptom List: Unevaluable event

Symptoms: 4pm- tiredness 7pm-tiredness,nausea and chills 11pm- stomach cramping, tiredness, nausea, chills 1/29 @1am- nausea, vomiting, severe chills, shaking, body aches, tiredness. 1/29- bodyaches continue through day.

Other Meds: Propranolol, venlafaxine, methimazole.

Current Illness: HSV

ID: 0985728
Sex: F
Age: 46
State: AZ

Vax Date: 01/28/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: amoxicillin, chocolate

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

Symptoms: within 5 minutes of getting vaccine, patient complained of generalized itching and feeling of fullness in throat; was given 50mg diphenhydramine IM and within 5 minutes symptoms had resolved

Other Meds: citalopram, cholecalciferol, aripiprazole, prazosin, lithium

Current Illness: none

ID: 0985729
Sex: F
Age: 51
State: MD

Vax Date: 01/21/2021
Onset Date: 01/22/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: When I took the second shot on 1/21/2021 I was fine just slight headache and sore arm the next am. but then around 12 noon i got the chills/ aches. and then 6 pm I went straight to bed and slept on and off since I was very tired til next day at 9 am and felt fine (1/23/2021). Also had fever on 1/22/2021.

Other Meds:

Current Illness:

ID: 0985730
Sex: F
Age: 32
State: MN

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Headache, body aches, fatigue, chills, and temp.

Other Meds:

Current Illness:

ID: 0985731
Sex: F
Age: 36
State:

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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: After receiving vaccine in R arm, patient noticed slight alteration in taste while chewing gum, with a feeling of minimal swelling to tongue. Called this RN to c/o dizziness and a hazy feeling. Given apple juice, with no relief. Moved to wheeled chair, and transferred to private monitoring/holding room. Pt c/o slight vertigo on standing, when transferred to gurnee. At 0851: Heart rate 76bpm. Pulse ox: 99%. B/P 110/78 in the left arm. States she noticed altered taste with gum, but was able to taste apple juice fine. Pt also stated feeling a tingle/rushing sensation transfer from right, to left side of body, up shoulders and neck. At 0904: Heart rate was 64bpm, Pulse ox: 99%. B/P 104/72 in L arm. Verbalizes less dizziness, slight amount of vertigo when turning head sharply. 09:19. Heart rate 63 bpm, puse ox 99%, B/P 104/71. States BP normally around 100's/68. Pt sat up at the side of the bed, standing without difficulty or dizziness. Ambulated throughout room x1. Ambulated to end of hall and back without incident. Pt Verbalizes feeling able to leave to home. Left at 09:23.

Other Meds:

Current Illness:

ID: 0985732
Sex: M
Age: 83
State: AL

Vax Date: 01/26/2021
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: LA

Lab Data:

Allergies: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received first dose of Moderna on 01/12/2021 at Health Department. Appointment was made for patient to return on Feb. 9, 2021 for 2nd dose. Vaccination card was given to patient. Patient thought he could receive in 2-4 weeks and was anxious to receive his 2nd dose so he returned to clinic on 01/26/2021 for 2nd dose. In oversight date of his first dose was overlooked and 2nd dose was administered inadvertently.

Other Meds: unknown

Current Illness: unknown

ID: 0985733
Sex: F
Age: 55
State: VA

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: sulfa

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fever up to 101.2 for 24 hrs, muscle aches, headache, rash and swelling at and around injection site, Sore arm and lymph node in same arm

Other Meds:

Current Illness: no

ID: 0985734
Sex: F
Age: 31
State: MN

Vax Date: 01/21/2020
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: None

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

Symptoms: Cough beginning 01-26-21. Cough/sore throat 01-27-21 Cough/sore throat/fever/sneezing/body aches/chills/headache/fatigue. 01-28-21. Temp of fever was 102.5. Took Aleve and Nyquil. Fever gone on morning of 01-29-21. Still feel tired, aches, congestion, headache.

Other Meds: Wellbutrin XL 450mg Effexor 75mg Amitryptiline 100mg

Current Illness: None

ID: 0985735
Sex: M
Age: 29
State: LA

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: 1407: Patient c/o extreme dizziness and weakness stating "feels like all of the energy left my body", BP 150/80, P121, O2 99, denies hx of hypertension and post injection reactions, nurse offered juice and will increase monitor time. 1420: BP 160/84, P 118, dizziness persisted and c/o heaviness in tongue lasting about 4 seconds. 1430: BP 164/82, P 122, O2 98, nurse encouraged patient to go to ER for further evaluation, patient refused ambulance and stated "I have to call my supervisor". 1447: Supervisor arrived, patient still c/o dizziness and "feeling weird" 1503: Supervisor and nurse escorted patient to security vehicle for safety, patient will go to ER. Cormier, Markus, RN 1/29/2021 08:37:21 AM > Contacted patie

Other Meds:

Current Illness:

ID: 0985736
Sex: F
Age: 34
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Peppers

Symptom List: Injection site pain

Symptoms: 1/26/21 nausea, dizzy, 1/29 back pain, nauseous continuing

Other Meds: Ibuprofen 400 mg

Current Illness: None

ID: 0985737
Sex: F
Age: 37
State: TX

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

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

Symptoms: Patient was being elevated because she was warm. BP 115/93 at 11:44 am. Patient has Type 2 DM. She felt better denies SOB, or feeling fainting. Denies any tachycardia at 12:00 or any other complaints. Patient was released was advised to call 911 if she has SOB or chest tightness.

Other Meds: N/A

Current Illness: N/A

ID: 0985738
Sex: M
Age: 57
State: CA

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

Lab Data:

Allergies: Unknown

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

Symptoms: vaccination given at 0756am symptom onset 0759 episodic chest pain, light headedness, nausea, flushing, inclusive of chest pressure rated at 2/10 lasting minutes in duration- intermittent, intermittent light headedness 0812 136/69 hr 61 o2 sat 98 on room air. 0820 rapid response called 0822 132/79 hr 54 o2sat 98 on room air. 0827 127/76 hr 54 o2sat 98 on room air. 0832 pt wheeled to ED with RRT.

Other Meds: Unknown

Current Illness: Unspecified chest pain

ID: 0985739
Sex: F
Age: 70
State: WA

Vax Date: 01/15/2021
Onset Date: 01/17/2021
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: Band-Aids

Symptom List: Tremor

Symptoms: right side of jaw got nodule, moved to chin and was swollen

Other Meds: .75 Levothyroxine

Current Illness: n/a

ID: 0985740
Sex: F
Age: 20
State:

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Tachycardia and sensation in throat 15-30 minutes after vaccination. HR-140 BP-180/120 HR went back down to 115 and BP 136/67. Received Solu Medrol for reaction. Advised not to received 2nd dose per CDC guidelines.

Other Meds:

Current Illness:

ID: 0985741
Sex: M
Age: 23
State: AL

Vax Date: 01/23/2021
Onset Date: 01/27/2021
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: Rocephin, Cefzil, Sulfa

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

Symptoms: Red, dry circular spot next to injection site. It popped up a few days after the vaccine. I received the vaccine on Saturday and noticed the red spot Thursday. I'm not sure if it came earlier than that.

Other Meds: Fluoxetine, Hydroxyzine

Current Illness: N/A

ID: 0985742
Sex: F
Age: 41
State: TN

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: Ibuprofens, aspirin

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

Symptoms: headache, low grade fever; 12 hr duration, treated with Tylenol 650 mg BID

Other Meds: Metformin 1000mg BID, Symbicort 2 puffs every morning, Desvenlafaxine Suc ER 100 mg daily, Bupropion 150 mg daily, Quetiapine ER 150 1 tab 3 hrs before HS, Alprazolam 0.5mg up to TID as needed, Eliquis 5 mg BID, Ferrous sulfate 325mg BID,

Current Illness: none

ID: 0985743
Sex: F
Age: 50
State: AR

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: feeling weak, dizzy, light headed and intense headache

Other Meds:

Current Illness: surgery approximately 3 weeks prior

ID: 0985744
Sex: M
Age:
State: MI

Vax Date: 01/22/1921
Onset Date: 01/23/2021
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: No allergies to food or medication Seasonal allergies since a child.

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

Symptoms: Began to experience severe body aches, mental fog and chills ~21 hrs after Covid 19 injection. Sore shoulder prior to on set of body aches and chills. Symptoms lasted ~24 hrs. Mental fog continued for ~72 hrs.

Other Meds: Lisinopril -HCTZ 10/12.5 mg 1x/day Methylphenidate: 18 mg ER OSM 1x/day

Current Illness: No

ID: 0985745
Sex: F
Age: 61
State: SC

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

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

Symptoms: Chills, muscle and joint pain headache general malaise for about 24 hours

Other Meds: Hunira, gabapentin,

Current Illness: pyoderma gangrenosum

ID: 0985746
Sex: M
Age: 36
State: AZ

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: None

Symptom List: Pain in extremity

Symptoms: Headache, nausea, tiredness

Other Meds: None

Current Illness: None

ID: 0985747
Sex: F
Age: 40
State: MN

Vax Date: 01/29/2021
Onset Date: 01/29/2021
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: Percocet, Augmentin, morphine, latex, cashews, non specified

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

Symptoms: patient developed itching and rash on chest and neck with some throat tightness. RRT called and she was transferred to the ER

Other Meds:

Current Illness:

ID: 0985748
Sex: F
Age: 39
State: MD

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:

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

Symptoms: Fever, chills and shortness of breath occurred approximately 23 hours after administration. Went to ED and was released to home.

Other Meds:

Current Illness:

ID: 0985749
Sex: F
Age: 45
State: TX

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Zithromax

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

Symptoms: 26th January 2021-after the injection-she became foggy funny headed for about an hour-her words 27th January 2021-Chills, nauseated 28th January 2021-Body aches, left deltoid area extra tender, nauseated, HA, she has a history of migraines 29th January 2921-A lot better today she took Tylenol for her symptoms-told to go to the ER if her symptoms get worse, PCM if she needs to

Other Meds: injectable B-12, hormone gel, Vitamins-C & D, calcium

Current Illness: none

ID: 0985750
Sex: F
Age: 31
State: CO

Vax Date: 01/27/2021
Onset Date: 01/29/2021
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: Swollen face and lips, previous filler injected

Other Meds: Ibuprofen and Tylenol

Current Illness:

ID: 0985751
Sex: F
Age: 71
State: ND

Vax Date: 01/13/2021
Onset Date: 01/16/2021
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: None.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Started on 1/16/21, noticed droopiness and slurring on the left side of her mouth, and the eyelid did not want to shut properly, could not raise the eyebrow on that side. Stayed that way until yesterday, 1/28/21, was able to raise the left eyebrow and her lip was starting to normalize, but still having some droopiness from it. Called her provider and looked it up on the internet, and was told she had Bell's Palsy. Told her to keep an eye on it, and if anything else happened to go into the hospital to see if it was a stroke. It did not affect her limbs or have any other stroke symptoms, just the left side of her face.

Other Meds: Tramadol, Mirapex.

Current Illness: None.

ID: 0985752
Sex: F
Age: 44
State: MA

Vax Date: 01/28/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Mushrooms, Agave, All forms of Penicillin, Nighttime alcohol-free Rubitussin, Bee/Wasp sting, aerated alcohol

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

Symptoms: 0 - 30 minutes: Dizzyness, mild bronchial tightening, aching at location, aching and cold sensation on dorsal 2-3 tarsal hand. 30min to 4 hours: increase in sourness. No decrease in other symptoms. 4 - 6 hours: small rash at injection site developed, swelling, hardness, and inflammation developed at the injection site. Increase in nerve ache at the hand, now including the wrist. A decrease in dizziness. No more bronchial tension. 6 - 12 hours: Soreness at injection site increased. Nerve pain with cold, ache, and numbness through the left anterior arm and left anterior and posterior forearm with weakness in the left hand. Swelling on the lymph nodes in the Left arm pit. 12 - 22 hours: Increased swelling of the left auxillary lymph nodes with associated pain. Large node bulge is developing. Inabiility to fully rest arm at side. When anything less than 15 degrees (addcution or at rest) the nerve pain and lymph node pain increases to the point of mild nasea.

Other Meds: Vit D and Coenzyme Q

Current Illness: None

ID: 0985753
Sex: F
Age: 80
State: CT

Vax Date: 01/23/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Allergic to mold, dust, pollen, cigar/cigarette smoke, certain perfumes/room sprays

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Severe, painful leg cramps- entire leg, but more intense in the upper thighs - lasting the night into morning/ time ( now 12:30 pm and still have mild cramps)- disrupted sleep. During evening took quick-dissolving tables of Hylands Leg Cramps PM. Fell asleep about 7:30 am till 11:30 am. Last night also early evening mildly nauseated. Either the 26th or 27th felt slightly nauseated, had some diarrhea and mild stomach cramps.

Other Meds: Supplements: B-Complex, B-12, C, D3, Omega-3, Magnesium, Zinc, French Grape Seed Extract

Current Illness: CCL - Chromic Lymphocytic Leukemia

ID: 0985754
Sex: F
Age: 78
State: SC

Vax Date: 01/25/2021
Onset Date: 01/26/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 0985756
Sex: F
Age: 48
State: WA

Vax Date: 01/15/2021
Onset Date: 01/16/2021
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: Flagyl

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

Symptoms: nausea, vomiting, malaise

Other Meds: Exedrin, Vit D3, Zegrid, Benadryl, L-Theanine, Progesterone

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm