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: 0923981
Sex: F
Age: 72
State: CT

Vax Date: 12/23/2020
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: January 3, 2021 noted a 2- 2 1/2 inch red area on my left arm at the injection site. This was 2 weeks since I had the vaccine. Area was not hot to touch but was itchy. Slowly fading

Other Meds: Synthroid

Current Illness: none

ID: 0923982
Sex: F
Age: 64
State:

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
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: Penicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Moderna COVID-19 Vaccine EUA Rash developed at injection site

Other Meds: Synthroid 50 mcg Vitamin D 1000 IU Aspirin 80mg Aleve 200 mg Calcium

Current Illness:

ID: 0923983
Sex: F
Age: 32
State: TX

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
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: Penicillin, Bees/wasp

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

Symptoms: Dose two of the Pfizer vaccine lot: ELU140 administered to right arm at 0800 01/04/2021. Symptoms began at 2000 01/04/2021 which are; Fever 101.8, resting heart rate sustaining 140 bpm, right wrist pain and swelling to that joint, right supraclavicular node enlargement, tremors, burning sensation on skin to the entire body, severe headache, weakness, frequent urination, fatigue, eye pain, chills, sweating.

Other Meds: Vitamin A,D,K,C,B12, thyroid NP 0.5 gr.

Current Illness: No

ID: 0923984
Sex: F
Age: 50
State: MI

Vax Date: 12/28/2020
Onset Date: 01/03/2021
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Beginning 1/3/2021, patient noted her injection site and surrounding area becoming pink. On 1/4/2021, patient noticed redness at and around injection site measuring roughly 3 inches in diameter. By the next day, the redness has become more prominent and larger. She contacted her primary care physician who felt it was likely a delayed allergic response. 1/6/2021, the redness has become a lighter pink and patient reports the area to be "markedly improved" from days previous.

Other Meds: unknown

Current Illness: none

ID: 0923985
Sex: F
Age: 64
State: IA

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/06/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Woke up on morning of 1/1/2021 with fever of 101 that lasted for 4-5 hours and Tylenol did take the temperature down. Was also nauseated, exhausted, loss of appetite for 24 hours.

Other Meds: Unknown

Current Illness: None

ID: 0923986
Sex: M
Age: 26
State: OH

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: none

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

Symptoms: 1/5/2021 8am pain started in the left shoulder, trapezius muscle and neck pain. Took 600mg of Ibuprofen with no relief. Pain lasted until 2-3pm on 1/5/2021

Other Meds: Triumeq 600-50-300mg

Current Illness:

ID: 0923987
Sex: F
Age: 40
State:

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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: LOCAL SITE REACTION - severe itching and nodule

Other Meds: MELATONIN 2 MG BEDTIME

Current Illness: NONE

ID: 0923988
Sex: F
Age: 45
State:

Vax Date: 01/03/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: sulfa, aged cheese, red wine

Symptom List: Pharyngeal swelling

Symptoms: initially started with body aches at 11:00 am on 1/4/2021 and then developed a fever and chills at 4:00 and 5:00 severe body aches with difficulty moving/walking due to pain and also had slight sore throat - best description is I felt like I had been hit by a truck. Napped from 5-6:30 and then to bed at 10:00. Woke up on 1/5/2021 without body aches but continued with slight ichy throat and feeling like the roof of mouth and tongue were burnt. Continuing to feel those symptoms on 1/6/2021

Other Meds: D3, Probiotic, Glucosamin Chondroitin, Magnesium

Current Illness: COVID 19 11/23/2020

ID: 0923989
Sex: M
Age: 32
State: IN

Vax Date: 01/04/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Lump on base of the left side of neck

Other Meds: Omega-3 supplement Nexium 20 mg

Current Illness: None

ID: 0923990
Sex: M
Age: 17
State:

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: A nurse administered the vaccine. 5-10 minutes later, during the blood draw, patient felt pins and needles sensation throughout the body, traveling to the head. Patient also felt tired and face was pale at that time. 30 minutes after the vaccine was administered, patient felt generally weak but no fever or other symptoms. One day after vaccine administered, felt unwell and weak. Area around injection site was slightly red. Had malaise and headache. Three days after vaccine, back to baseline.

Other Meds:

Current Illness:

ID: 0923991
Sex: F
Age: 27
State: CA

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

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

Lab Data:

Allergies: nkda

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

Symptoms: Severe swelling at injection site. Nerve involvement - tingling and numbness in whole arm and extending up to neck. Pain scale 7-8 near injection site. Moderate headache and scratchy throat with mucus. Slowly getting worse (24 hours after injection).

Other Meds: Methimazole 10 mg

Current Illness: Graves disease

ID: 0923992
Sex: F
Age: 49
State: MD

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: celiac disease Epinephrine reaction (require carbocaine in dental office )

Symptom List: Rash, Urticaria

Symptoms: swelling/puffiness in both eyes - redness - woke up in the morning and continued throughout day - called employee health at hospital where shot was given and was advised to take benadryl and cold compresses on eyes. No swelling anywhere else - Was advised to if swelling gets worse or lasts more than 48 hours to call back or go to Dr.

Other Meds: breo Lo Lo estrin tirosint ventalin

Current Illness: n/a

Date Died: 01/02/2021

ID: 0923993
Sex: M
Age: 62
State: NC

Vax Date: 12/30/2020
Onset Date: 01/02/2021
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: Hay fever

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

Symptoms: Patient was vaccinated Dec 30, 2020. Prime dose of Moderna vaccine. Observed for full 15 minutes post-injection. No complaints when asked during observation. Released. Subsequently, vaccine clinic staff learned from the patient's supervisor that on Jan 4, 2021 that the patient had expired on Jan 2, 2021. By report from the supervisor, the patient was found dead at his home. The patient's primary care provider was unaware of his death when contacted by this reporter today (Jan 6, 2021). Electronic Medical Record without any information since the vaccination.

Other Meds: Unknown

Current Illness: No

ID: 0923994
Sex: F
Age: 20
State: WI

Vax Date: 12/29/2020
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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:

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

Symptoms: Shot arm became itchy and small red bump formed. Over the past 24 hours, the bump grew and is still red and warm to the touch. Soreness throughout right arm where I got the shot.

Other Meds: Birth Control- Syeda

Current Illness:

ID: 0923995
Sex: F
Age: 36
State: CA

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

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

Symptoms: Redness, warmth, irritation, inflammation, itchiness, soreness at injection site >1 week post vaccination

Other Meds: No

Current Illness: None

ID: 0923996
Sex: F
Age: 45
State: TX

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
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: Watermelon, PCN, Sulfa, Ambien

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

Symptoms: Reaction- nausea/vomiting, flushing, lips tingling, dry mouth, lightheaded (not dizzy though)- onset of symptoms approx. 12 min post injection, temp elevation in ER ER about 1 hr- given ODT Zofran, IM Benadryl and Solumedrol

Other Meds: Multivitamin, Wellbutrin, Claritin

Current Illness: No

ID: 0923997
Sex: F
Age: 32
State:

Vax Date: 12/23/2020
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
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:

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

Symptoms: local erythema

Other Meds:

Current Illness:

ID: 0923998
Sex: F
Age: 34
State: MI

Vax Date: 01/03/2021
Onset Date: 01/03/2021
Rec V Date: 01/06/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 12 hours after vaccination I got a low grade fever of 101. I had severe body back aches that were so severe I had a difficult time walking. My injection site (Left deltoid) was swollen and sore, although not more than usual after receiving a vaccine. I had no headache at all. The major concern was the fever and the backaches. I could not get warm, and I was shaking badly because I was so cold. I had ZERO relief despite taking 700 Mg of Tylenol. Side effects finally subsided after about 5 hours.

Other Meds: Lexapro 20 mg 1 x per day. Accutane 80 mg 1x per day.

Current Illness: None

ID: 0923999
Sex: M
Age: 34
State: CA

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

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

Lab Data:

Allergies: Motrin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Complaining of tingling to injection site after 10 minutes. Also complaining of light numbness to left thigh. All symptoms resolved after 20 minutes.

Other Meds: None

Current Illness: None

ID: 0924000
Sex: F
Age: 44
State: NY

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

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

Lab Data:

Allergies: Shellfish Penicillin Latex

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

Symptoms: Woke up with flu like symptoms 105 fever chills body aches

Other Meds: N/A

Current Illness: Surgery for mastectomy reconstruction done 12/22/2020

ID: 0924001
Sex: F
Age: 43
State: CA

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

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: Patient received the covid vaccine dose #2 on 1/5/2021. She tolerated the vaccinations without problem. She reported that she is very concerned that the second dose of Pfizer vaccine was administer at an "unusual site" in her arm where the adipose tissue. She took picture of the injection site. Denies any pain, swelling, redness at the injection site. She is concerned about the efficacy of the second dose.

Other Meds:

Current Illness:

ID: 0924002
Sex: F
Age: 51
State: PA

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

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

Lab Data:

Allergies: Not on file

Symptom List: Unevaluable event

Symptoms: Palpitations reported by patient. 35 minutes monitored Vital Signs within normal limits Symptoms resolved. Released to home.

Other Meds: unknown

Current Illness: Unknown

ID: 0924003
Sex: F
Age: 34
State: MI

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Numbness in mouth lasting more than 5 hours now, no musculature involvement

Other Meds:

Current Illness: Migraine with aura (sensory aura, usually one side of mouth goes numb)

ID: 0924004
Sex: F
Age: 40
State: OH

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: Sulfa drugs, amoxicillin, ibuprofen

Symptom List: Injection site pain, Pain

Symptoms: Pain at injection site that persisted followed by numbness and tingling down medial aspect of arm for approximately 24 hours after the injection, upper extremity and neck ache, headache with associated eye pain, fatigue

Other Meds: None

Current Illness: None

ID: 0924005
Sex: F
Age: 45
State: TX

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

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

Lab Data:

Allergies: Watermelon, PCN, Sulfa, Ambien

Symptom List: Injection site pain, Menorrhagia

Symptoms: Reaction- nausea/vomiting, flushing, lips tingling, dry mouth, lightheaded (not dizzy though)- onset of symptoms approx. 12 min post injection, temp elevation in ER ER about 1 hr- given ODT Zofran, IM Benadryl and Solumedrol

Other Meds: Multivitamin, Wellbutrin, Claritin

Current Illness: No

ID: 0924006
Sex: M
Age: 55
State: PA

Vax Date: 12/28/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
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: none known

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

Symptoms: redness, swelling, warm to touch, itchy 9 days later.

Other Meds: multi vitamin, amiodipine 5 mg, losartan 100 mg, rosuvastain 5 mg

Current Illness: none

ID: 0924007
Sex: F
Age: 42
State: CA

Vax Date: 01/04/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: "Moderna COVID-19 Vaccine EUA" Woke up to a large red welt about 2 inches below the injection site,

Other Meds: 1/2 tab of 20-25 mg Lisinopril/Hydrochlorothiazide, 1 cap 20 mg Prozac, 300 mg tab Bupropion, Naltrexone 25 mg tab

Current Illness: No

ID: 0924008
Sex: F
Age: 38
State:

Vax Date: 12/23/2020
Onset Date: 12/27/2020
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: HA Flu like Sx

Other Meds:

Current Illness:

ID: 0924009
Sex: F
Age: 39
State: IN

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

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

Symptoms: Patient scheduled return visit, sat down and after about 10 minutes she complaint of not being able to breath. Line monitor called EMS and APRN. Patient was brought by WC to a room.

Other Meds: Xanax, metformin

Current Illness: DM, Anxiety, morbid obesity

ID: 0924010
Sex: F
Age: 51
State: NY

Vax Date: 12/18/2020
Onset Date: 12/18/2020
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: Prednisone

Symptom List: Nausea

Symptoms: Patient complained of episodes of numbness on left side of face along with difficulty speaking lasting up to 5 minutes. She has had 4 episodes since vaccination, last one was 1 week ago

Other Meds: Ibuprofen 400 mg

Current Illness:

ID: 0924011
Sex: F
Age: 46
State: MD

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

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

Lab Data:

Allergies: penicillin codeine lortab percocet darvocet lexapro lyrica HCTZ gabapentin metoprolol

Symptom List: Injection site pain

Symptoms: Moderna COVID-19 Vaccine EUA sharp piercing headache at back of head onset at time of injection. After 2-3 minutes the headache diminished but did not go away fully. Patient took Tylenol 500mg to combat the headache. Headache has lasted throughout the next few days and has finally gone away on day 7 post injection. The headache was unusual in that when the patient moved their eyes or read or moved facial muscles the pain became stronger. The patient's eyes were sore and tender for the duration of the timeframe mentioned. Also, the injection site was completely pain-free on the day of the injection. However, the following 5 days after injection, the site became very sore and tender with no redness or swelling present. Patient did contract the COVID virus and tested positive on day 4 post-injection

Other Meds: garlic multivitamin vitamin C Meloxicam 15mg Dicyclomine 40mg Nortriptyline 50mg vitamin B12 vitamin D3

Current Illness: N/A

ID: 0924012
Sex: F
Age: 68
State: PA

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient reported bruising and painful injection site reaction post vaccination.

Other Meds: Aspirin Omeprazole

Current Illness:

ID: 0924013
Sex: F
Age: 57
State: NY

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: No Known Allergies

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

Symptoms: patient became itchy on her chest and arms at 1510, felt heart palpitations, and cold Benadryl 25mg given at 1512 and a second Benadryl 25mg at 1530 Patient states feeling better at 1347

Other Meds: Hydrochlorothiazide, Losartan, Celebrex, Tizanidine, Lotemax, Artificial Tears, Vitamins C, Magnesium, Zinc

Current Illness: HTN, Fibromyalgia

ID: 0924014
Sex: F
Age: 42
State: MA

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
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: Level four allergy to hornets

Symptom List: Tremor

Symptoms: Day 2 and 3 migraine Day 3 - 8 muscle aches legs, fatigue, some join aches, loss of appetite Day 7 - 8 swelling of lymph node under left arm , rash and swelling at injection site

Other Meds: Lamotrigine, LoLoestrin, Vit D, Multivitamin,

Current Illness: none

ID: 0924015
Sex: F
Age: 21
State: TX

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: Moderna COVID-19 vaccine administered outside of company's standing order protocol(patient received vaccine while pregnant) no symptoms or adverse events reported by patient

Other Meds:

Current Illness:

ID: 0924016
Sex: F
Age: 25
State: KY

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

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

Symptoms: Nausea, Fever/chills, body aches, lingering headache starting at 3:30AM 01/05/2021. Symptoms continued all day 01/05/2021. Fever spiked to 102 around 10PM on 01/05/2021.

Other Meds: Pantoprazole; Amitriptyline; Blisolvi FE

Current Illness:

ID: 0924017
Sex: F
Age: 70
State: WI

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Patient reported to emergency room for reported shoulder bursitis. Patient is receiving Vicodin for pain and has since been discharged as of 01/05/21.

Other Meds: Unknown

Current Illness: Unknown

ID: 0924018
Sex: F
Age: 72
State:

Vax Date: 12/26/2020
Onset Date: 12/26/2020
Rec V Date: 01/06/2021
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: Experienced tingling 10 minutes after the injection. Describes tingling on the left side from ear to her jaw including tongue and throat feeling "funny". Patient escorted to ER . CT scan negative

Other Meds:

Current Illness:

ID: 0924019
Sex: F
Age: 32
State: NH

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

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

Symptoms: Arm soreness, facial flushing immediately following injection. Pt later became short of breath with mid sternal pain.

Other Meds:

Current Illness:

ID: 0924020
Sex: F
Age: 34
State: NV

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: shellfish, latex

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

Symptoms: Tingling in the throat, tongue swelling, shortness of breath

Other Meds:

Current Illness: none

ID: 0924021
Sex: M
Age: 35
State: MA

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: Penicillins

Symptom List: Pain in extremity

Symptoms: Patient reported noticing an erythemic area around injection site that began 7 days after his injection. The area was noted to be puritic and erythematous. To date, entire erythematous site is about 10cm by 4cm. The patient has left axillary lymphadenopathy but is otherwise asymptomatic. The patient encircled the area last night and noticed about 1 cm spread this AM. He took loratidine last night and this morning without effect.

Other Meds: Melatonin as needed for sleep

Current Illness:

ID: 0924022
Sex: M
Age: 32
State: VA

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: Codeine, Trileptal, bee venom

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

Symptoms: 5 MIN POST ADMINISTRATION: SOB, DIZZINESS, CHANGE IN VISION - GAVE BENADRYL 25 MG AND 1 VIAL ALBUTEROL VIA NEB 1 HOUR POST ADMINISTRATION: SWOLLEN LIPS, RASH ON CHEST AND ARMS - GAVE 1 DOSE OF EPI PEN AND IM SOLU-MEDROL, CALLED EMS, LEFT TO GO TO ER BP, HR, OXYGEN STABLE THROUGHOUT

Other Meds: promethazine 12.5 mg tab, saline 0.65% nasal spray, multivit, gabapentin 300 mg, klonopin 1mg, diclofenac 50 mg, acetaminophrn 650 mg, dulcolax suppository, senna 8.6 mg tab, mirtazapine 7.5 mg, vit D3 50 mcg, risperidone 0.75 mg

Current Illness: cognitive impairment d/t traumatic brain injury (traumatic subdural hemorrhage with loss os consciousness >24h with return to consciousness), anemia, muscle atrophy, bipolar disorder, aphasia following other cerebrovasc dz, MDD, dysphagia, hx of COVID19 (12/22/20)

ID: 0924023
Sex: F
Age: 37
State: CA

Vax Date: 12/21/2020
Onset Date: 12/23/2020
Rec V Date: 01/06/2021
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: Latex

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

Symptoms: Parasthesias began in my lower extremities intermittently about 36 hours following administration. These spread to my upper extremities and became consistent. Occasionally will appear in lips and trunk. These are associated with sensation of numbness and some discomfort in my extremities. I'm also experiencing significant brain fog, difficulty concentrating, and fatigue. Headaches are occurring about every other day. Symptoms are present currently and have remained relatively consistent in severity. Was evaluated by urgent care on December 28 and encouraged to observe. Was evaluated in the ER by neurology on January 4. There leading hypothesis is vaccine related immune response. Neurologic exam was largely normal, being evaluated by a specialist in the coming days.

Other Meds: None

Current Illness: None

ID: 0924024
Sex: F
Age: 44
State: NY

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: Shellfish Penicillin Latex

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

Symptoms: Flu like symptoms 105 fever, chills, body aches

Other Meds: N/A

Current Illness: Had surgery on 12/22/2020 for breast Reconstruction after mastectomy

ID: 0924025
Sex: F
Age: 48
State: CA

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/06/2021
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: Iodine compound Shellfish

Symptom List: Vomiting

Symptoms: 12/22/2020 2:50pm Shortly after the vaccine was administered experienced SOB and wheezing. Albuterol MDI utilized and symptoms subsided. 3:30pm Mild Headache and back pain. Fatigue and lethargic. Pain scale 3-4 5:15pm Headache increased intensity. Fatigue and lethargic. Back pain still the same, took Motrin 600mg-OTC Wheezing, used Albuterol-MDI 7:30pm Headache and back pain increased intensity 12/23/2020 4:54am Woke up with wheezing, headache and back pain. Pain scale 6 Albuterol-MDI utilized 7:42am Wheezing and SOB, Albuterol utilized and symptoms subsided 3:00pm Headache increased intensity throughout the day. Difficulty focusing and multitasking. Loosing train of thought. Fatigue and lethargic. Pain scale7. Motrin OTC 800mg taken with evening medications and went to sleep. 12/24/2020 7:23am Woke up with severe headache and anosmia. 12/25/2020 Headache and anosmia 12/26/2020 Headache and anosmia 12/27/2020 COVID test-Negative result Headache and anosmia 12/28/2020 Headache and anosmia 12/29/2020 Headache and anosmia. Doctor's appointment. Headache treated with Tramadol 12/30/2020 Headache and anosmia. Pain scale 6 12/31/2020 Headache and anosmia Pain scale 3-4 01/01/2020 Headache and anosmia Pain scale 2-3 01/02/2020Headache and anosmia Pain scale 0-2 01/03/2020 Headache and anosmia Pain scale 0-1 01/04/2020 Anosmia 01/05/2020 Headache and anosmia Pain scale 2-3 01/06/2020 Headache and anosmia Pain scale 3-4

Other Meds: Albuterol-MDI, Allegra, Estradiol cream, Estradiol tablet, Claritin tablet-OTC, Omeprazole capsule, Triamcinolon ointment, Zyertec-OTC, Guaifenesin/Phenylephrine/Acetaminophen tablet-OTC

Current Illness: Asthma, laryngitits, ear infection-twice different ear

ID: 0924026
Sex: F
Age: 53
State: GA

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: Left side neck raised lymphnode

Other Meds:

Current Illness:

ID: 0924027
Sex: F
Age: 58
State: NY

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

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

Symptoms: approx 10-15 minutes post vaccine administration, patient reported tightness in throat, left arm tingling, and right shoulder pain. Epipen was administered, patient was taken by ambulance

Other Meds: aspirin prn

Current Illness: n/a

ID: 0924028
Sex: F
Age: 44
State: PA

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

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Hot; heaviness in right arm / sore; feeling flushed; feeling hot in legs. Monitored for total of 40 minutes. Laid on a stretcher and systems resolved. Released to home.

Other Meds: unknown

Current Illness: unknown

ID: 0924029
Sex: F
Age: 53
State: NY

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

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

Lab Data:

Allergies: none

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

Symptoms: after 20-30 minutes my throat started to get tight, I could not swallow properly, I felt dizzy & my heart was beating fast.

Other Meds: plaquinel synthroid

Current Illness: Lupus Hypothyroidism

ID: 0924030
Sex: U
Age:
State:

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

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

Symptoms: The injection site is warm and has a red bumpy rash

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm