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: 0988841
Sex: F
Age: 58
State: IA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: None

Allergies: Benadryl, Opiates

Symptoms: Dizziness occurred 3-4 hours after each dose. It lasted about 2 hours after the first dose and 5 hours after the second dose.

Other Meds: Levothyroxine, Low dose aspirin, Metoprolol, Atorvastatin

Current Illness: None

ID: 0988842
Sex: F
Age: 30
State: TX

Vax Date: 01/08/2021
Onset Date: 01/11/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: none yet

Allergies: penicillin

Symptoms: Began experiencing tinnitus one week after first dose, second dose seemed to amplify symptoms.

Other Meds: none

Current Illness: none

ID: 0988843
Sex: F
Age: 30
State: OK

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: Jellyfish

Symptoms: I became nauseous and having body chills for 4-5 hours with 1 episode of vomiting. I then had a sustained headache with nausea until 8:00 am on 1/27/2021.

Other Meds: Zyrtec

Current Illness: No

ID: 0988844
Sex: F
Age: 57
State: WA

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: CBC, CMP, Ethanol, T4, TSH, UA, CT head w/out contrast, ECG 12 lead, XR chest and R elbow

Allergies: NKA

Symptoms: Temp through the evening/night 99.5+, woke in the AM, went upstairs to let dogs out. Started to feel dizzy, passed out, woke approx 5-10minutes later with contusion to back of head. Went to ED, still dizzy and nauseous. X-rays/CT done. DX-Closed fx of skull w/severe concussion, laceration to scalp requiring 3 staples.

Other Meds: Levothyroxine 88mcg

Current Illness: NA

ID: 0988845
Sex: F
Age: 33
State:

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: None

Allergies: Metronidazol Lactose Avocado Banana Peach Pineapple

Symptoms: Rash distal. V?rtigo Dolor muscular y articular generalizado Fiebre Gripe Escurrimiento nasal Cefalea Dolor abdominal Diarrea N?useas Disgeusia Fatiga

Other Meds: Venlafaxina 75mg per day Adimod 400mg single dose

Current Illness: None

ID: 0988846
Sex: M
Age: 59
State: OR

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: none

Allergies: Amoxicillin, rash

Symptoms: fever 102.0, headache, myalgias, severe for 6 hours, moderately severe for the next 12 hours, fatigue only by 48 hours after injection, 100% resolution by 72 hours post injection

Other Meds: Cetirizine, Doxycycline

Current Illness: allergic rhinitis, Sinusitis

ID: 0988847
Sex: M
Age: 50
State: UT

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: Did not seek medical attention.

Allergies: Amoxacillin

Symptoms: Starting around 1:00 in the morning, the night of receiving the vaccine, I started with the aches, joint pain, chills, and low-grade fever. I forced myself to go to work. I am a Registered Nurse. The joint pain and aches increased throughout the day along with altered periods of chills and hot flashes. Around 6 PM on the 29th is started feeling worse. I felt like I was tachycardic. I had my wife take my blood pressure. My normal vitals are Pulse-50, BP 110/60. When I took my vitals at 6:00 pm my pulse was 91 and my BP was 85/53. Clearly an allergic reaction. I had no difficulty breathing. Finally, around 1:00 am on 1/30, my fever broke and my heart rate and BP returned to normal ranges. My first vaccination was unremarkable with only a sore arm for three day.

Other Meds: Levothyroxin

Current Illness: None

ID: 0988848
Sex: F
Age: 39
State: AZ

Vax Date: 01/21/2021
Onset Date: 01/28/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: N/A. I don't have a primary care provider or health insurance currently.

Allergies: Had allergic reaction to seafood in the past but haven't had a reaction in years or need for medication.

Symptoms: Aside from a very sore left arm for two days after vaccination, a more serious symptoms began on Thursday morning around 6:00 am, January 28th 2020, and the lower right side of my face started swelling and numbness followed. Also I felt some pain and have lost movement on the right side of my face. It looks like I had a stroke. Upon research, I came across Bell's Palsy and its the closest description to what I am currently experiencing. In the last two days, the swelling has subside and it's a little bit better, however, my face is still compromised.

Other Meds: None

Current Illness: None

ID: 0988849
Sex: F
Age: 65
State: CA

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: none

Allergies: morphine, codine

Symptoms: numb lips with tightness and itching in throat, flushing

Other Meds: none

Current Illness: none

ID: 0988850
Sex: M
Age: 75
State: AZ

Vax Date: 01/22/2021
Onset Date: 01/28/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: none

Allergies: augmentin--rash

Symptoms: Noticed red rash 1X2 in at injection site on 1/28 1/29 color had faded, rash doubled in size 1/30 separate red blotches and streaks on arm and chest photos taken each day

Other Meds: calcium/zinc/mag vit D vit C aspirin 81mg probiotic

Current Illness: none

ID: 0988851
Sex: F
Age: 28
State: NY

Vax Date: 01/31/2020
Onset Date: 01/03/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: Shrimp

Symptoms: Hemmorid. 3 days after receiving vaccine.

Other Meds: None

Current Illness: No

ID: 0988852
Sex: F
Age: 50
State: FL

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: Yes. Celebrex, Shellfish, environmental.

Symptoms: Chills, fever 101.3, very sleepy, fast heart rate. headache, still occurring 01/30/21 @ 11:23 pm.

Other Meds: No

Current Illness: No

ID: 0988853
Sex: M
Age: 63
State: NJ

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Dizziness

Other Meds:

Current Illness:

ID: 0988854
Sex: F
Age: 45
State: NH

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: None

Allergies: Dust, mold, cats, grass, pollen

Symptoms: 15 minutes after receiving shot, I started feeling itchy in many places. My face flushed red and my skin has red splotches on my upper chest. I had just been released from the vaccination observation area, and I returned for additional guidance. They told me since I drove out of observation, they could not do anything and I had to go to an urgent care center. I phoned my regular doctor and the triage nurse in the office instructed me to take 2 Benadryl immediately. I drive to a pharmacy and took the Benadryl. The Benadryl relieved the symptoms for about 2.5 hours and then they returned. I took 2 Benadryl every 4 hours until the itchiness stopped approximately 12 hours after receiving the shot.

Other Meds: Losartan 50 mg, hydrochlorothiazide 25mg

Current Illness: None

ID: 0988855
Sex: M
Age: 30
State: CA

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: None so far

Allergies: None that I?m aware off.

Symptoms: Headache, fatigue, muscle soreness, and chills started the morning after being vaccinated.

Other Meds: Possible caffein in my system. No other drugs.

Current Illness: None.

ID: 0988856
Sex: M
Age: 33
State: MD

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: NKDA

Symptoms: Moderna COVID-19 Vaccine EUA Body aches, shiver and chills (12 hrs following injection and last about 6 hrs), tender skin and muscles to touch and temp, pain in low back and hips, rash (small bumps and red skin) in the low back and along right oblique, tenderness under right arm and right arm pit

Other Meds: Vitamin C, Vitamin D, Host Defense Mushrooms-Comprehensive Immune Support, acetaminophen (taken after for chills/shivering, body aches)

Current Illness: No illness. Sore back from previous back injury (herniated L5/S1)

ID: 0988857
Sex: F
Age: 25
State: CT

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: none

Allergies: None. Seasonal allergies.

Symptoms: Anaphylactic reaction, with tachycardia, hypertension, throat swelling/dyspnea, facial swelling, and diffuse hives.

Other Meds: Claritin

Current Illness: None.

ID: 0988858
Sex: F
Age: 39
State: VA

Vax Date: 01/18/2021
Onset Date: 01/27/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: Negative covid test results 1/29/2021

Allergies: Amoxicillan

Symptoms: The next two days I had a sore arm. But a week later, the following Monday and Tuesday, I had fatigue and headaches. I put the date as Wednesday because that is when the concerning possible reactions began. I woke with clogged ears feeling very sick. I took Advil Cold and Sinus and arranged to miss work. It felt like a possible ear infection in my left ear. Also my forearms were painfully sore. I had lifted a heavy box up the stairs the afternoon before but the pain in my arms was immeasurably more than ever expected. My ankles were also very tender as I had done a little jogging the day before and I normally walk. As the day progressed I was barely able to get out of bed. Sleeping and just laying there. My highest temperature was 101.25 at 2:45 pm. I had severe chills on and off. I reported these afflictions and was mailed a covid test by Thursday. The test came back negative by Friday evening. Wednesday night my whole body was tender and I had no appetite. I took tons of vitamins and drank tonic tea and took advil and nasal allergy medication. I am still using all of those. Thursday I woke drenched in sweat. My head was mostly cleared just a wet ear and I had a low grade fever on and off through the day. Just touching my body against a surface was painful. Or putting my hand on my hip. My forearms and ankles were no longer worse than the rest. I received my covid kit and taking it to be mailed was the only time I left my house. I was surprised to find extreme difficulty walking down the stairs with muscle strain and pain in my joints. I was not nauseous but had no appetite. Friday I woke up hungry and felt better. No fever. Fatigue and body tenderness but it was better. Saturday my body is only sore on my glands and jaw and back of head. And my muscle is sore in my left arm. The oddness of that being where my shot was given is what makes me wonder if it was an extreme reaction to the vaccine. Maybe it is a flu. I have never had the body pains I try to describe before.

Other Meds: Sronyx

Current Illness: Migraine end of december/caffeine withdrawal i believe

ID: 0988859
Sex: F
Age: 30
State: FL

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

Lab Data: None

Allergies: Zithromax

Symptoms: Premedicated 1 hour prior to injection with oral Benadryl 1.5 tsp 5 minutes after injection-tachycardia (121 bpm) which resolved within 10 minutes, scratchy throat which resolved in two days 3 hours after injection- diarrhea and localized erythema, edema at injection site (size of quarter), diarrhea resolved the next day, localized reaction continued Benadryl continued to be given orally twice daily at 1.5 tsp, aleve taken PRN 1/28/21 Arm began itching at site of injection, within 12 hours erythema tripled in size, became warm to touch. Benadryl cream added with no noticeable impact appreciated 1/29/21 allergist consulted topical triamcinolone 0.1% cream applied twice daily beginning night of 1/2. Lesion currently still noticeable and has not reduced in size.

Other Meds: Allegra, Nasocort, Lexapro, Hydroxychloroquine

Current Illness: None

ID: 0988860
Sex: F
Age: 43
State: TX

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: Ancef

Symptoms: Extreme dry mouth the day following the injection and small blisters on my tongue the following two days. I?ve never had that before.

Other Meds:

Current Illness:

ID: 0989135
Sex: F
Age: 41
State: NJ

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

Lab Data:

Allergies: NKA

Symptoms: pain and swelling on vaccination site pain radiates arm to shoulder to under arm down side; muscle ache around site pain down to wrist + fingers

Other Meds: Bystolic /hydrochlorothiazide /vit C

Current Illness:

ID: 0989136
Sex: F
Age: 49
State: NJ

Vax Date: 01/12/2021
Onset Date: 01/19/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: Penicillin

Symptoms: Itchiness at site and red and swollen (R) arm

Other Meds: None

Current Illness:

ID: 0989137
Sex: F
Age: 36
State: NJ

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: swelling Increasing Redness Itching

Other Meds: None

Current Illness: None

ID: 0989138
Sex: F
Age: 56
State: NJ

Vax Date: 01/25/2021
Onset Date: 01/27/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data: No

Allergies: Augmentin

Symptoms: injection site - Redness, hot to touch, swelling, soreness, prolonged.

Other Meds: ASA Crestor Ramapril MVI Fish Oil Vit D CoQ10

Current Illness:

ID: 0989139
Sex: F
Age: 67
State: NJ

Vax Date: 01/22/2021
Onset Date:
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: PNC; chemicals

Symptoms: Strong flu-like symptoms since Friday night. Wake up 230 Am Extreme headache, nausea, joins pain, lost of appetite

Other Meds: PRN- Nexium

Current Illness: NONO

ID: 0989140
Sex: M
Age: 17
State: MN

Vax Date: 01/30/2021
Onset Date:
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pt administered 1st dose of Moderna Covid vaccine 1/30/21. Pt is 17 years old. Vaccine is currently approved for 18 and over. No adverse effect

Other Meds: N/A

Current Illness: none

ID: 0990851
Sex: F
Age: 22
State: IN

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Right after my second dose of the Pfizer Covid vaccine I had three (currently having my third so it could go on to have more) flare us of my oral herpes. I typically have 1-2 a year. This was 3 in a week. I am not experiencing increased stress.

Other Meds: Albuterol

Current Illness:

ID: 0990853
Sex: F
Age: 38
State: NC

Vax Date: 01/07/2021
Onset Date: 01/24/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pfizer Covid 19 vaccine treatment under Emergency Use Authorization(EUA): My menstural cycle has changed and I have started with old brown bleeding with clots 10 days prior to my normal cycle. I have never had this happen and have never had any issues with my periods. Will be seeking medical treatment on 1/27/21 with OBGYN.

Other Meds:

Current Illness:

ID: 0991296
Sex: F
Age:
State: IA

Vax Date: 01/29/2021
Onset Date: 01/29/2020
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Moderna Covid vaccine] treatment under Emergency Use Authorization(EUA): Pt. first reported neck stiffness that 10 min later said she didn't feel right. She was very flushed and blotchy. this was 2nd dose no reaction from the 1st. Time of 2nd vaccination was 10:00 and symptoms started around 12:15.

Other Meds:

Current Illness:

ID: 0991302
Sex: F
Age:
State: KS

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: [Moderna COVID19 Vaccine] treatment under Emergency Use Authorization(EUA): Post-injection, patient felt scratchy throat, had inability to speak, and was tachycardic. Rapid response team was called.

Other Meds:

Current Illness:

ID: 0991310
Sex: F
Age: 37
State: SC

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/30/2021
Hospital: Y

Lab Data:

Allergies: Reports allergy to: Acetaminophen, aspirin, and oxycodone

Symptoms: Pfizer vaccine treatment under Emergency Use Authorization(EUA): Patient administered the Pfizer-biontech Covid 19 vaccine on 1/28/2021 at 15:19 in her LEFT deltoid. Patient reported feeling numbness and tingling to hands, face and leg within 15 minutes of the injection. No dyspnea, nausea, dizziness, abdominal pain, vision changes, or gait abnormality. VS 97.9F, 76, 16, 131/69, pulse ox 100%. ECG sinus rhythm.

Other Meds: Medications patient takes at home: Dandelion Root 2 tab PO BID RF: 0 Pre Work Out Powder 1 pkt PO DAILY RF: 0 cyanocobalamin (vitamin B-12) [B-12 DOTS] 500 MCG tablet 500 mcg PO DAILY RF: 0 cinnamon bark 500 MG capsule 500 mg PO DAILY RF: 0

Current Illness:

ID: 0991329
Sex: F
Age:
State: NC

Vax Date: 01/16/2021
Onset Date: 01/26/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Received the Moderna vaccine (shot 1) on 1/16/21 and developed cellulitis on 1/25/21. The day after shot area red and arm was sore and painful. Went away the following day. On 1/24/21 noticed my arm was hurting again it wasn't until 1/25/21 that the big red rash area was seen at shot site and grew up my arm and my hands developed rashes.

Other Meds: Atenolol 25mg, triamterene-hydrochlorothiazide, Mirena, Vitamin B & D, multivitamin

Current Illness: None

ID: 0991339
Sex: F
Age:
State: OR

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies: apples

Symptoms: 2hrs after taking the 2nd shot of Pfizer vaccine experienced a burning sensation across my upper back and lower right back. It only lasted 10seconds but I have never ever felt something like this before. 2nd dose in the right arm.

Other Meds: no medications; No OTCs. No vitamins in last 2 weeks in preparation of the vaccine.

Current Illness: no smoking

ID: 0991347
Sex: M
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 01/30/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: [Casirivimab/indevimab] treatment under Emergency Use Authorization(EUA): Infusion started at 9:45 and was stopped at 11:00. At 11:30 Patient developed SOB and drop in Sat from >96% to 88%. Patient had a large cough and expectorated a quarter size of brown phlegm. Code blue was activated, patient placed on NRB 180/81, 72, 24, 91%. Patient was AAOx3 and talking during this time. Patient transferred to the ER gurney and transported to ER for further evaluation. From H&P: tested positive for COVID-19 outside facility on 1/22 w/onset of covid sxs on 1/18 after returning from hunting trip with son on 1/17. Patient s/p Moderna vaccine #1 on 1/14/2021. Initially symptoms were just fatigue, cough, and chills and then spiked low grade fever on 1/20. Patient began to experience weakness and difficulty walking on 1/24 and fell from standing on 1/25 and possibly hit his head but without LOC. Patient presented to ED complaining of SOB that began after receiving monolconal antibodies about an hour PTA. Patient states that prior to the infusion, he was not feeling overly short of breath. After the transfusion, a code blue was called in the parking lot due to the patient becoming light-headed and short of breath - he never lost pulses. Upon arrival to the ED, he was in obvious respiratory distress and O2 sats were 92% on 15L NRB and patient switched to BIPAP. Patient given dose of epinephrine injection,after which he states he began feeling better.

Other Meds: Casirivimab/imdevimab; apixaban; captopril; fluticasone nasal spray; HCTZ/triamterene; omeprazole; simvastatin

Current Illness:

ID: 0991365
Sex: F
Age: 55
State: IN

Vax Date: 01/22/2021
Onset Date: 01/26/2021
Rec V Date: 01/30/2021
Hospital: Y

Lab Data: PLATELETS, 01/26/2021, 2000 CELLS PER MICROLITRE

Allergies:

Symptoms: [COVID-19 Vaccine, Pfizer] treatment under Emergency Use Authorization(EUA): Patient presented to outside hospital with petechial rash around injection site and within mouth. COVID Vaccine was administered 1/22. For 2 days following the vaccine she felt extreme fatigue and headaches. By Monday 01/25/2021 her symptoms had improved but then developed a diffuse rash and sores on her gums. Evaluation in the outside ED showed a platelet count of 2,000. Patient was transferred to our hospital for increased level of care, hematology consult, and platelet transfusion. Thrombocytopenia likely sec immune mediated destruction vs infection vs medications vs unlikely MDS or marrow infiltrative process.

Other Meds: Albuterol inhalation; Trulicity injection; Lexapro; Amaryl; Hydrochlorothiazide; Basaglar Insulin injection; Lisinopril; Lorazepam; Metformin

Current Illness:

ID: 0991368
Sex: M
Age:
State: NJ

Vax Date:
Onset Date: 01/26/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 3mL 23Gx1 inch syringes used to administer Moderna COVID-19 vaccine treatment under Emergency Use Authorization(EUA): I would like to make two product complaints about these syringes. 1. We have consistently only been able to withdraw 9 doses from the Moderna COVID-19 vial when using these syringes. This device appears to have a very large "dead space" as the safety shield is a separate piece which is leur-locked between the syringe and the needle. This large space is likely the cause of the lost vaccine liquid. 2. We had an incident today where the vaccinator injected Moderna COVID-vaccine into the above patient. Upon withdrawing the syringe from the patient's arm, the syringe and safety shield disconnected from the needle and the needle and needle hub remained in the patient's arm, requiring the vaccinator to use his hand to withdraw the needle. The patient did not notice the device malfunction. The removed needle was examined to be intact and was discarded into the sharps container. Patient tolerated the vaccination without other incident. There was no harm to the patient. Syringe REF # 4236, Lot # 4014236, manufacture date 2020-09-23, ex 2025-09-23, GTIN 20351688048827

Other Meds:

Current Illness:

ID: 0991388
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient started having itching starting at the ankles, circumfrentially, symmetrical on both legs. This continued upward the legs to the body. Back and back of arms. Rash. Treatment with anti-histamine (anti-H1) drug and acid reducer anti-H2 famotidine. Patient presented a rash after receiving the vaccine. The notes informed us that it started next day after receiving the vaccine.

Other Meds:

Current Illness:

ID: 0991400
Sex: F
Age:
State: CA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: patient received 2nd dose of Shingrix vaccine. Developed nausea and fever (Tmax 102.0) later that evening. Resolved within 24 hrs.

Other Meds:

Current Illness:

ID: 0991407
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/30/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: Patient is a healthcare worker who received COVID-19 vaccine through her employee health vaccination program. 2 days later, patient developed subconjunctival hemorrhages, then fever, headache, and blisters on trunk. Over the next several days the blisters developed into pruritic pustules including extremities, palms, and soles and patient had increasing joint pain and stiffness in extremities. Patient was seen by rheumatology who thought this may be flare of her psoriatic arthritis or a viral etiology. They deferred treatment with steroids since she was due to receive her 2nd dose of the COVID-19 vaccine soon. Patient received 2nd dose of COVID-19 vaccine and called employee health 2 days later with fever, headache, nausea, swollen lymph nodes, rash spreading to head, and congestion. COVID-19 swab neg. She was seen at an urgent care and diagnosed with pneumonia and was started on doxycycline. Three days later, she presented to the emergency department and was admitted with fever, cough, sob, continued rash (macular and pustular), reported worst headache of life and continued worst arthritis flare of life. Patient was seen multiple times by a variety of clinicians throughout her illness including dermatology, rheumatology, emergency medicine, and internal medicine. Patient had an extensive work-up to identify causes including negative blood cultures, RPR, varicella PCR, respiratory pathogen panel, gonorrhea/chlamydia PCR, HIV, and lumbar puncture with bacterial, viral, and fungal testing. The most common themes of provider assessments were that patient had a psoriatic arthritis flare (worst of life per patient report) which may have been related to the first dose of the COVID-19 vaccine. After 2nd dose of vaccine, patient was diagnosed with guttate psoriasis which was thought to be either related to COVID-19 vaccine or Humira as TNFi has been linked to guttate psoriasis, although Humira was not a new med, and this had not happened in the past.

Other Meds: Humira, celecoxib, leflunobide, lisdexamfetamine, omeprazole, tizanidine, amlodipine, COVID-19 vaccine

Current Illness:

ID: 0991422
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient started having itching starting at the ankles, circumfrentially, symmetrical on both legs. This continued upward the legs to the body. Back and back of arms. treatment with anti-histamine (anti-H1) drug and acid reducer anti-H2 famotidine

Other Meds: Moderna Vaccine Lot number 013LZoA

Current Illness:

ID: 0991434
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: The patient developed an acute right posterior frontal stroke with weakness, dysarthria and hemineglect at 1015pm on 1/26. He had received the Moderna vaccine second dose on 1/25. He received tPA and is now in the ICU for monitoring. Also found to have atrial fibrillation on EKG which seems to be a new finding.

Other Meds: none; none

Current Illness:

ID: 0991441
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient received 2nd dose of COVID vaccine (Pfizer) 24 hours before adverse reaction began. Patient was originally having fever, muscle aches, and fatigue. Patient began having sharp, non radiating pain to substernal area and began feeling short of breath which brought her to the hospital.

Other Meds: chlorthalidone, potassium citrate, None

Current Illness:

Date Died:

ID: 0991450
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: The patient developed left sided neck and trapezoid tightness and pain after receiving the moderna covid vaccine in her left shoulder. The injection site is non tender and does not show any erythema or tenderness. The tenderness is over the left trapezius and left lateral neck area. It also feel tight like a muscle spasm.

Other Meds: Lisinopril, furosemide, omeprazole, amlodipine, meclizine, loratadine

Current Illness:

ID: 0991465
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/30/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: Patient previously was diagnosed with COVID-19 and recovered in 12/20. Patient received MODERNA COVID-19 vaccine 72 hours PTA. Patient developed soreness and achiness and fevers 48 hours PTA. This was followed by progressive redness of the skin on left upper arm at vaccine injection site. Patient was then admitted with left upper arm cellulitis with sepsis criteria.

Other Meds: simvastatin, meloxicam, losartan, fluticasone propionate, bisoprolol-hydrochlorothiazide, albuterol

Current Illness:

ID: 0995143
Sex: M
Age: 82
State:

Vax Date: 01/23/2021
Onset Date: 01/24/2021
Rec V Date: 01/30/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: falling, weakness Narrative:

Other Meds:

Current Illness:

ID: 0995144
Sex: M
Age: 76
State:

Vax Date: 01/27/2021
Onset Date: 01/29/2021
Rec V Date: 01/30/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: possible M/I chest pain Narrative: On 1/29/20 patient taken to local hospital via ems then was transferred to second hospital to rule M/I

Other Meds:

Current Illness:

ID: 0995148
Sex: M
Age:
State:

Vax Date:
Onset Date: 09/17/2020
Rec V Date: 01/30/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: PERICARDIAL EFFUSION Narrative: Patient with history of pleural effusions and recurrent pericardial effusions presented 9/11/20 to facility ~7 days following influenza vaccination for routine imaging and found to have abnormal chest CT with concern for pericardial effusion. Patient not admitted at the time, however presented to ED 9/25/20 with worsening shortness of breath and cough. Patient admitted for bacterial pneumonia with parapneumonic effusion. Discharged 10/10/20. At 10/16/20 PCP visit, patient reported he believed the event was triggered by influenza vaccine.

Other Meds:

Current Illness:

ID: 1417004
Sex: F
Age: 54
State:

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Headache, Arthralgia, Fever, Chills, fatigue Narrative

Other Meds:

Current Illness:

ID: 1417005
Sex: F
Age: 42
State:

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/30/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Headache Chills Narrative:

Other Meds:

Current Illness:

ID: 1417008
Sex: M
Age: 49
State:

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

Lab Data:

Allergies:

Symptoms: Headache & Myalgia Narrative:

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm