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: 0991716
Sex: F
Age: 48
State: PA

Vax Date: 01/22/2021
Onset Date: 01/30/2021
Rec V Date: 02/01/2021
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: Imipramine

Symptom List: Dysphagia, Epiglottitis

Symptoms: Bumpy rash at injection site that progressed to red area. Also have rash on left arm.( unsure if related)

Other Meds: Zoloft, gabapentin, carafate, omeprazole

Current Illness: None

ID: 0991717
Sex: M
Age: 60
State: OK

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 02/01/2021
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 Drugs Biox Zocor Penicillin Celebrex Insets

Symptom List: Anxiety, Dyspnoea

Symptoms: Early the next morning I had a red rash on my chest and the back of my shoulders. It really itched and I went to the Doctor. They gave me anti-itch stuff from the injection. Then my Lymph nodes swelled up in my throat. I went home and took my medicine and the itching stopped in about two days.

Other Meds: Vitamin C Vitamin D Magnesium Potassium Other medications

Current Illness: Stage 3/4 Renal failure cancer. November- Covid

ID: 0991718
Sex: F
Age: 63
State: WA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 02/01/2021
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: antibiotics: Sulfa, Nitrofurantoin Ambian Latex Reglan Diflucan

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

Symptoms: itching 3-4 days tremors, weakness

Other Meds: Gabapentin 300mg HS Lamotrigine 225mg daily Xiidra eye dropg Estradiol 1mg daily

Current Illness: none

ID: 0991719
Sex: F
Age: 56
State:

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: peanuts

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: forearm rash

Other Meds: albuterol, losartan, atorvastatin

Current Illness:

ID: 0991721
Sex: F
Age: 70
State: VA

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: Statins

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

Symptoms: Significant pain in R hip approx. 4-5 hours after vaccine. Lasted until next morning.

Other Meds: HCTZ Lisinopril Vitamin D

Current Illness: none

ID: 0991722
Sex: M
Age: 54
State: OH

Vax Date: 01/06/2021
Onset Date: 01/20/2021
Rec V Date: 02/01/2021
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: Went to my doctor thinking it was a very very bad sinus infection. My doctor didn't think it was with the way my headaches were. It hurt on the back right and above the right ear. It hurt to touch. My tongue is not functjioning now. I had to get a MRI because they thought it could of been a mini stroke. MRI came back negative the doctors told me Bell Palsy. They advise me not to get my second dose on 2/3/21.

Other Meds: None

Current Illness: None

ID: 0991724
Sex: F
Age: 65
State: VA

Vax Date: 01/20/2021
Onset Date: 01/28/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Moderna COVID-19 Vaccine EUA Red ring around injection site, red bumps on inside of forearm and red rash in armpit on 8th day after injection

Other Meds: Protonix Fish Oil, biotin, multi vitamin, calcium + D, Crestor

Current Illness: none

ID: 0991725
Sex: F
Age: 56
State: TX

Vax Date: 01/14/2021
Onset Date: 01/30/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: ampicillin,and sulfa drugs

Symptom List: Pharyngeal swelling

Symptoms: after second dose feel like mild flu and body aches, light headache and little nusia

Other Meds: amlodipine/valsartan- bp med and metformin-e.r-500 mg with food.

Current Illness: none

ID: 0991726
Sex: F
Age: 31
State: IL

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin, Hema bate

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Inj site red and hot swollen, itchy still there today, 2/1/21.

Other Meds: Lexapro,

Current Illness: no

ID: 0991727
Sex: M
Age: 74
State: CA

Vax Date: 01/21/2021
Onset Date: 01/30/2021
Rec V Date: 02/01/2021
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: Nka

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Palpitation at rest even wakes up because of palpitation

Other Meds: Coreg irbessrtan glipizice jardiance tradjenta bydureom finasteridr hytrim vitD zinc etc

Current Illness: Mone

ID: 0991728
Sex: F
Age: 43
State: CA

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/01/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: could barely lift arm arm pain when lifted to shoulder level headache fatigue mouth was dry

Other Meds:

Current Illness:

ID: 0991729
Sex: M
Age: 36
State: IN

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 02/01/2021
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, chills, muscle soreness, loss of appetite, fatigue.

Other Meds: None

Current Illness: None

ID: 0991730
Sex: F
Age: 40
State: MI

Vax Date: 01/25/2021
Onset Date: 01/30/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: cephalosporins (anaphylaxis) levothyroxine (anaphylaxis) penicillin (anaphylaxis)

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

Symptoms: Patient administered 2nd dose of Pfizer COVID vaccine on 1/25/2020. Six days later the patient developed generalized hives treated with over the counter antihistamine (benadryl). The next day patient again had hives, trouble swallowing, and difficulty breathing. She presented to an Emergency Department and was treated with epi IM and oral antihistamines (H1 and H2). Discharged to home on prednisone 40 mg PO QD x 3 days and then 20 mg PO QD x 2 days. Patient again had trouble breathing 2/1/2020 and returned to the ED. Patient 10 weeks pregnant.

Other Meds: Vitamin C, docusate sodium, Allegra, pre-natal vitamin, ibuprofen

Current Illness: none

ID: 0991731
Sex: F
Age: 66
State: VT

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/01/2021
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: reports difficulty breathing starting at 1800 same day of vaccine. Required 3 pillows to prop self up in bed. Was able to sleep awoke with no symptoms. History of asthma, did not require emergency care

Other Meds: asthma inhaler, allergy medications

Current Illness: no

ID: 0991732
Sex: F
Age: 67
State: MN

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 02/01/2021
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: bactrim, codeine

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

Symptoms: CHILLS, FEVER

Other Meds: Alprazolam, Amlodipine, apixaban, aspirin, calcium, centrum silver, vitamin D,CoQ-10, flaxseed oil, garlic, NOrco, Arava, bactroban ointment, fish oil, omeprazole, pilocarpine, prednisone, crestor, sotalol, protopic,vitamin c

Current Illness:

ID: 0991733
Sex: M
Age: 36
State: ID

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/01/2021
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: None

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

Symptoms: Patient states he was getting up from the bed that he was laying down on and he began to feel numbness in his fingers and a cold sensation. He is complaining of a throbbing pain in his left shoulder and it runs down his arm to his finger tips. He complains of his stomach feeling tight and having some nausea.

Other Meds: Lansoprazole, Venlafaxine, Losartin, Escitalopram

Current Illness: None

ID: 0991734
Sex: F
Age: 46
State: TX

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/01/2021
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: Oxycodone

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

Symptoms: She stated that she could feel her throat closing, after receiving the vaccine. Patient has history of Crohn's Disease. At 09:43am- BP 133/84, HR 73, R20, O2 sat 99%. Second set of vitals at 09:48am BP 116/75, HR 80 R 20, O2 sat 99%. By second set of vitals, patient states she felt better, accompanied by her sister.

Other Meds: Entyvio 300 mg infusion every 8 weeks: Sertraline 50 mg every night; Benadryl 75 mg every night; Melatonin 15 mg every night

Current Illness: Crohn's Disease

ID: 0991735
Sex: M
Age: 60
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Weakness, Slight Fever, Fatigue, Dizziness.

Other Meds:

Current Illness:

ID: 0991736
Sex: F
Age: 29
State: IN

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

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

Lab Data:

Allergies: Seafood

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The lady?s technique was to put needle in with one hand. Switched the hand she was holding the needle with, then plunged the vaccine into my arm. I could feel the needle moving in my arm. It has been sore since!

Other Meds: Advil and tylonel

Current Illness: None

ID: 0991737
Sex: F
Age: 62
State: MI

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

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

Lab Data:

Allergies: plavix, bleach, color in cocacolanone

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

Symptoms: shot at2pm by 5:15pm rt shoulder started hurting continued to get worse could not lift arm out raise up nostrength inshoulder upper arm severe pain could not continue to work could not turn a light switch on pull open a fridge door screaming when trying to pullup my pants, screaming toget bra off &on shirt on by mon am could get dressed minimum pain armlesspain still no strength still can not reach out or up

Other Meds: candesartin, amlodepine, tramadol , chlorzoxazone, celebrex vitimin c, b-12 ,d,

Current Illness:

ID: 0991738
Sex: F
Age: 54
State: MI

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 02/01/2021
Hospital: Y

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: iodine and shellfish (anaphylaxis); lisinopril, demerol, morphine

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

Symptoms: Dizziness and weakness; Numbness and tingling; Other ADVERSE REACTION Reported: Electrolyte imbalance requiring hospitalization for More than 48 hours with repeated hematology follow up. Patient is a 54-year-old woman with history of Roux-en-Y gastric bypass surgery and some alcohol abuse who presented to the hospital with fatigue, headache, muscle cramps and weakness. She also had a slight fever that followed her 2nd dose of COVID-19 vaccine. She had basic lab work which revealed pancytopenia along with multiple electrolyte disturbances including hypokalemia, hypomagnesemia, hypocalcemia and hyponatremia. She admits that she had heavy alcohol use over the weekend with binge drinking of liquor. She otherwise does drink a couple of mixed drinks a night. She has also been trying to lose a lot of weight. She says that she lost about 60 lb in the last 6 months on purpose. She is doing this so that she can have a panniculectomy and tummy tuck. She recently had a breast reduction in November. She has not been following with a dietitian or having her vitamin levels checked. Despite having pancytopenia, her levels remained pretty stable during her stay. She had a peripheral smear sent which was pending at the time of discharge. She was also checked for vitamin deficiencies. She is given a dose of IM B12, IV iron, IV calcium and started on oral calcium vitamin-D supplements. She does take a daily multivitamin. Due to her reported history of heavy alcohol use she is also given thiamine and folate. After speaking with Hematology, recommendations were for her to have a follow-up appointment which is scheduled on February 10th. I also put in a referral for a dietitian to evaluate her for further recommend deficiencies in the setting of Roux-en-Y gastric bypass surgery with heavy weight loss. I prescribed her calcium vitamin-D along with folic acid. I recommended she continue her multivitamin. I also recommended that she abstain from alcohol use.

Other Meds: ALPRAZolam; citracal; tylenol PM; EpiPen PRN; estradiol; folic acid; furosemide; metFORMIN; MVI; rOPINIRole; traMADol

Current Illness: some weight loss within the prior 6 months; breast reduction in Nov 2020; alcohol use

ID: 0991739
Sex: F
Age: 33
State: MA

Vax Date: 01/09/2021
Onset Date: 01/23/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)

Other Meds:

Current Illness:

ID: 0991740
Sex: F
Age: 75
State: DC

Vax Date: 01/12/2021
Onset Date: 01/24/2021
Rec V Date: 02/01/2021
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: Neulasta

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

Symptoms: Injection site swelling, redness, tenderness, itching

Other Meds: Numerous

Current Illness: None

ID: 0991741
Sex: F
Age: 31
State: AZ

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 02/01/2021
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: Codeine

Symptom List: Injection site pain, Pain

Symptoms: Head ache within the hour, migraine by 8 pm the same day. Stiffness throughout the body, aching joints and muscles. Fever of 100 up to 103.0 day 1 then fever of 100 to 100.8 through out the day so far on day 3. Severe stiffness in the back and neck. Excessively tired since day 1.

Other Meds: Zyrtec 10mg Citalopram 20mg Melatonin 5mg

Current Illness:

ID: 0991742
Sex: F
Age: 50
State: CA

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

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

Lab Data:

Allergies: NONE

Symptom List: Injection site pain, Menorrhagia

Symptoms: NOT FEELING MY NORMAL SELF, HEARTBURN, HOT IN ABDOMINAL, TEMP99, ANIXETY, DIZZY SPELLS, AWKWARD FEELING IN MY HEAD, EXTREAMLY WEAK, THE 1ST DAY NOT SO BAD BUT DAY2-6 MUCH WORSE DAYS 7 &8 GETTING BETTER DAY 9 BACK TO NORMAL SELF.

Other Meds: NONE

Current Illness: NONE

ID: 0991743
Sex: M
Age: 77
State: CO

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/01/2021
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: Hay fever, moderate.

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

Symptoms: First, immediately after receiving the vaccine, I cycled 25 miles. Almost immediatly thereafter, my arm got very sore, I had a dull headache, my resting pulse went up about 20 bpm, and my blood pressure dropped from about 120/70 to 102/60. I felt "rough". I played couch potato for the rest of th eday, and was fine the next morning.

Other Meds: None

Current Illness: May have minor sinus inection

ID: 0991744
Sex: M
Age: 30
State: OK

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 02/01/2021
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: MORPHINE, SHELLFISH

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: FEVER 103.9, RESOLVED. INTERMITTANT TACHYCARDIA 130 BPM, ONGOING.

Other Meds: MULTIVITAMIN

Current Illness: NONE

ID: 0991745
Sex: M
Age: 59
State: OH

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: severe chills/shaking began at about 8 pm and he had a fever of over 101 for about 3 hours, he fell asleep.

Other Meds: brilinta, bupropion, lisinopril, atorvastatin, metoprolol tartrate, low dose aspirin

Current Illness: no

ID: 0991746
Sex: F
Age: 44
State:

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/01/2021
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: PCN, ASA, Keflex, Codeine, Sulfa - anaphylactic reactions in the past

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

Symptoms: 10am Pt c/o SOB, tightness in chest, left arm numbness, dizziness. BP 127/84 P-108 PO 100%. RN came to assist. 10:04am Benadryl 25 mg liquid given PO BP121/73 P 104 PO 97%. Left arm injection site asymptomatic. Pt states this is her 2nd Covid vaccine and did not react to the first one. Pt states she had anaphylactic reactions to PCN, ASA, Sulfa, Keflex and Codeine in the past. C/O blurred vision. 10:10am BP 132/81 p 112 PO 98% with same symptoms. RN present and we discussed going to ER, vs stable and patient declined going. 10:15am BP 133/82 P-114 PO 96%, pt states her breathing is better, thinks the Benadryl caused the dizziness, continued blurred/fuzzy vision, not double vision, A & O x3. 10:20am BP 127/83 P-108 PO98% denies SOB and chest tightness, states she feels better. Crackers, juice and water given. 10:25am BP 123/83 P 105 PO 98% pt states blurred vision has gone. 10:30am BP 129/70 P 105 PO 97% continue to feel better. Talking to her co-worker about getting a ride back to work with her after she receives her vaccine. 10:55am BP 120/72 P 105 Sat 99% went to restroom with another nurse and states she feels fine standing. 11am BP 126/75 P98 PO 98% denies arm numbness, blurred vision and SOB/chest tightness. Report off to 11am Volunteer RN for the monitor room.

Other Meds:

Current Illness:

ID: 0991747
Sex: F
Age: 68
State: AL

Vax Date: 01/25/2021
Onset Date: 01/30/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: My arm started with red sort of rash that spread around the top of my arm (the same arm that I received the vaccine). About the 3rd day it covered the top of my arm but the middle was now lighter than the perimeter. There was no pain or itching. The rash is still present so I cannot answer 19 and 20. I am assuming it will go away.

Other Meds: Lisinopril Simvastatin Citracal with D3 Zinc Famotadine Vitamin C

Current Illness: None

ID: 0991748
Sex: F
Age: 57
State: MI

Vax Date: 12/22/2020
Onset Date: 01/28/2021
Rec V Date: 02/01/2021
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: Injection site pain

Symptoms: Headache over right forehead started 1/28/21 for 24 then sudden runny nose on right nostril, then loss of taste in right side of tongue started 24 hours later and the other symptoms improved. Mild pain over right cheek and into ear have remained over the past 72 hours along with the loss of taste and funny feeling on right 1/2 of tongue. No facial muscle weakness noted. No change in hearing or vision.

Other Meds: Paxil Colase

Current Illness: None

ID: 0991749
Sex: F
Age: 59
State: TX

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Date of symptom onset ? 1/29/21 at 5:45 PM? Symptoms ? EE reports approximately 1 hour after vaccine she began feeling dizzy, lightheaded and pain at injection site. EE denies syncope. + nausea without emesis On Saturday, EE reports continued dizziness and lightheadedness, denies syncope. + joint pain. On Sunday, improvement in symptoms. On Monday, + lightheadedness, no syncope. EE denies fever, recent travel or exposure to COVID-19 without proper PPE. Last day of work and shift - ? 2/1/21 currently at work Home remedies? - rest Any improvement? - yes Recommendation? EE educated to increase fluid intake for hydration and to take ibuprofen as directed in the Medical for joint pain. EE educated to continue to monitor her symptoms and to contact vaccine support line for further questions or concerns. EE educated to manage her symptoms per the TCH Illness in the Workplace Policy. EE verbalized back understanding and denied further needs at this time.

Other Meds:

Current Illness:

ID: 0991750
Sex: M
Age: 46
State: UT

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/01/2021
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: Percocet

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

Symptoms: Fever, hot and cold flashes, extreme body aches all over, headache, ringing in both ears, cramps in both legs, shooting nerve pain up and down both legs, nausea, loss of apatite, agitation, sleepiness.

Other Meds: Testosterone, Duloxetine, Dextroamphetamine, Potassium Chloride, Esomeprazole, Anastrozole, Metoprolol, Losarstan-hctz, Simvastatin, Gabapentin, Sidenafil, Allegra-D, Pobiotic soft gels, L-Lysine, Vitamin C, Vitamin D, Vitimin B-12, Multi

Current Illness: None

ID: 0991751
Sex: M
Age: 29
State: NY

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

Symptom List: Tremor

Symptoms: Vaccine administration error. It is suspected that a 1/2? needle syringe was used instead of a 1? needle syringe IM.

Other Meds: Unknown

Current Illness: Unknown

ID: 0991752
Sex: F
Age: 71
State:

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/01/2021
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: Lipitor, Zocor

Symptom List: Erythema, Pruritus

Symptoms: Chills, muscle aches, injection site pain/irritation, fatigue, no appetite Took Tylenol starting the evening of the day after the vaccine (1/29) and everyday until 2/1 (Friday, Saturday and Sunday)

Other Meds: Lovastatin, Triamt/HCTZ, Omega D3- Fish oil, Vitamin C, Women's multivitamin, Cinnamon Extract. CoQ 10, Vitamin D, Tart Cherry, Calcium + Vitamin D, Turmeric with Black pepper, chromium

Current Illness: None

ID: 0991753
Sex: F
Age: 49
State: CA

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

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: body aches left arm was painful chills fever

Other Meds:

Current Illness:

ID: 0991754
Sex: F
Age: 32
State: MO

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/01/2021
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: Naproxen

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

Symptoms: Started with fever, chills, lethargy, headache and nausea around 0900 on 1/28/21. By 1500 I had severe nausea which resulted in vomiting (water and dry heaving) with a small amount of blood (small clots) with first time vomiting. Then at 1700 I could barely move with severe body aches and headache. Attempted to drink some water and eat soup, but intestines burned too much. Slept from 0800 on 1/28/21 through till 0830 on 1/29/21 with very minimal waking. Only left my bed to throw up one time and use the restroom one time. Took Tylenol around the clock. Upon waking on 1/29/21 noticed a petechiae type rash on both sides of my face, sore throat and mild headache (took tylenol). 1/30/21 no symptoms and facial rash slowly disappearing.

Other Meds: Reclipsen birth control pill and Tylenol

Current Illness: None

ID: 0991755
Sex: F
Age: 34
State:

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 02/01/2021
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: PCN, Doxycycline

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient complained of itching to bilateral cheeks with noted redness following the vaccine. Declined medication (Benadryl IM). No hives noted.

Other Meds:

Current Illness:

ID: 0991756
Sex: M
Age: 82
State: MO

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/01/2021
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: Prednisone

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

Symptoms: altered mental status, weakness, increased falls, fever. Sent to Hospital on 1/29/21.

Other Meds: cozar, multivitmin, protonix, flonase, miralax, synthroid, lipitor, proscar, flomax, metfomin, lorpressor, aspirin, aricept, singulair, albuterol, advil, restoril, tums, zofran, norco,

Current Illness: Tested positive for COVID-19 on 1/2/21.

ID: 0991757
Sex: F
Age: 60
State: PA

Vax Date: 12/27/2020
Onset Date: 12/27/2020
Rec V Date: 02/01/2021
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: Latex, bananas, morphine, hydromorphone

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

Symptoms: chills, shortness of breath, new onset a-fib, overall ache, extreme fatigue Still in a-fib w/ shortness of breath

Other Meds: coumadin, omeprazole, levothyroxine, ibuprofen prn

Current Illness:

ID: 0991758
Sex: F
Age: 63
State: TX

Vax Date: 01/21/2021
Onset Date: 01/27/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: petroleum and chocolate

Symptom List: Pain in extremity

Symptoms: A swollen gland in the left underarm. Tenderness for approximately 48 hours.

Other Meds: Losartan, 50 mg daily PerserVision AReds 2 one tablet twice a day Vitamin D3. (123 mcg) one tablet twice a day AZO Cranberry tablets, two tablets daily

Current Illness: None.

ID: 0991759
Sex: F
Age: 61
State: NY

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

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

Lab Data:

Allergies:

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

Symptoms: Vaccine administration error. It is suspected that a 1/2? needle syringe was used instead of a 1? needle syringe IM.

Other Meds: Unknown

Current Illness: Unknown

ID: 0991760
Sex: F
Age: 72
State: ID

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/01/2021
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: Epinephrine - reaction is panic. Sulfa antibiotics - reaction is GI sickness, reaction not allergy

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

Symptoms: Pt reported about 15 minutes after vaccine that she was experiencing tingling in tongue and roof of mouth. Pt was brought back to observation room and further assessed including VS q5minutes. VS remained stable. Pt reported a few minutes later that she felt the left side of her tongue was numb and possibly swelling. RRT was called at 1014 and arrived at 1020 and assessed patient. Offered ED, pt declined, then it was recommended that she stay another 30 minutes for observation. Pt agreed. VS continued, pt states she feels as though the symptoms are resolving. Called RRT after 30 minutes and they recommended she go home but call PCP to make f/u appt and continue to monitor throughout the day. If symptoms worsening or swelling/SOB occurs, go to ED. Pt verbalized understanding and was escorted out with her husband.

Other Meds: Levothyroxine 100mcg daily. magnesium, calcium, vit D, 1 yr ago had infusion of Reclast.

Current Illness: Gum infection 1/7 started 10 day course of amoxicillin that day.

ID: 0991761
Sex: M
Age: 59
State: CA

Vax Date: 01/15/2021
Onset Date: 01/31/2021
Rec V Date: 02/01/2021
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: Sulfa Drugs, Morphine

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

Symptoms: Sudden light headedness, room spinning, increased heart rate, slight ringing in the ears. Weakness. Lasted about 15 minutes. Felt mildly lightheaded, and had loss of energy symptoms for about 12 hours. Felt good for about 1hour after that then a second episode happened about 10pm. The second episode was about half as severe as the first and only lasted about a minute or two. Woke up this morning 02/01/2021 feeling fairly normal.

Other Meds: levothyroxine

Current Illness: None

ID: 0991762
Sex: F
Age: 48
State: IL

Vax Date: 01/15/2021
Onset Date: 01/18/2021
Rec V Date: 02/01/2021
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: none

Symptom List: Vomiting

Symptoms: 3 days after injection the site became very swollen, warm, and very sore covering a 4 1/2 inch diameter

Other Meds: Stnthroid, Cymbalta, Pepcid, Topamax, Aimovig, Flexeril, vitamins

Current Illness: she took her migraine injection Aimovig the day before the symtoms started 01/17/21 in her thigh

ID: 0991763
Sex: F
Age: 52
State: NC

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 02/01/2021
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: IVP dye Sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: injection site soreness, swelling, itching, hard to the touch and hot to the touch

Other Meds: Metformin Jardiance B-2 Inderal 120mg Synthroid Lexapro 10 mg

Current Illness: none

ID: 0991764
Sex: M
Age: 85
State: MN

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 02/01/2021
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: NKA

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

Symptoms: Weakness, altered balance while sitting, Twitching/jerking of body

Other Meds: Phenobarbitol

Current Illness:

ID: 0991765
Sex: F
Age: 39
State: AZ

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/01/2021
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: penicillin, latex, seasonal

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Injection site developed a large lump and a 2 inch diameter rash that continued after 2 days post vaccination. It has not resolved yet.

Other Meds: Multivitamin, omega 3, desvenlafaxine

Current Illness: None

ID: 0991766
Sex: M
Age: 52
State: KY

Vax Date: 01/13/2021
Onset Date: 01/20/2021
Rec V Date: 02/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: A swollen, itchy, quarter-size erythema appeared seven days post vaccine about one inch lower than the injection site on the left arm. The lesion started growing the following day, reaching a maximum of about three inches in diameter by the third day after onset. The lesion cleared by day 10 after onset. Diphenhydramine 25mg was taken once the evening after onset.

Other Meds: melatonin 10 mg hs

Current Illness: None

ID: 0991767
Sex: F
Age: 48
State: VA

Vax Date: 01/22/2021
Onset Date: 01/29/2021
Rec V Date: 02/01/2021
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: n/a

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

Symptoms: A week after the shot; a red whelp appeared around injection shot along with a rash on legs, hands and arm

Other Meds: Mult-Vit, Vit D

Current Illness: n/a

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm