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: 0991889
Sex: F
Age: 75
State: OH

Vax Date: 01/30/2021
Onset Date: 01/31/2021
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: sulfa gives headache

Symptom List: Dysphagia, Epiglottitis

Symptoms: chills bad headache weakness sensitive skin back pain aches all over

Other Meds: sertraline 100 mg atorvastatin 40mg prasugrel 5mg centrum silver

Current Illness: tested positive for covid december 30

ID: 0991890
Sex: F
Age: 64
State: VA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Cipro Flagyl Augmentn Sulpha Ammoxicillian Gentimicin Zithromax Nuts Bees Tuna

Symptom List: Anxiety, Dyspnoea

Symptoms: Sever Headache, body aches, chills, Joint pain, Exhaustion, nausea for approximately 2 days. Still feeling extremely tired and rundown. I was told not to take Tylonel because my "immune system" needs to do its job. I have an Immune Deficiency (CVID) and infuse gamma globulin 2x weekly.. I believe that if I was able to take Tylonel at the onset my reactions wouldn't have been so severe. Immune Deficiency cannot fight off viruses.

Other Meds: none

Current Illness: Hypogammaglobulinemia Asthma Hypothyroidism

ID: 0991891
Sex: M
Age: 67
State: NJ

Vax Date: 01/14/2021
Onset Date: 01/15/2021
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: Statins, pollen

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

Symptoms: Pain in the arm. While sitting watching TV the pain started moving around to different joints. Out of nowhere his blood pressure went to 178/127. Took 2 aspirins. and one of his prescriptions. It started going down. It took a day to normalize. Still having the joint pain. Went to the doctor they are running test.

Other Meds: Carvedilol 25mg , Livalo 2mg, Eplerenone 50mg, Digoxin 125mg, Furosemide 20mg, Eliquis 5mg, Losartan Potassium 100mg, Montelukast SOD 10mg, Plavix 75mg, Amlodipine Besylate10mg, Trilogy, Vitamin D3, B2 400mg, Magnesium 500mg, Airborne, mu

Current Illness: no

ID: 0991892
Sex: F
Age: 77
State: MI

Vax Date: 01/27/2021
Onset Date: 02/01/2021
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: Simvastatin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient arrived in ED with new onset A-fib w/RVR

Other Meds: Amlodipine, vitamin D, vitamin E, hydrochlorothiazide, meloxicam, potassium

Current Illness: none

ID: 0991893
Sex: F
Age: 29
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Chills Body aches Fatigue Headache

Other Meds:

Current Illness:

ID: 0991894
Sex: F
Age: 75
State:

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

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

Symptoms: Chills, nausea, fever(102) Saturday except for temperature of 100 all symptoms were gone.

Other Meds:

Current Illness:

ID: 0991895
Sex: M
Age: 67
State: UT

Vax Date: 12/17/2020
Onset Date: 12/17/2020
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: Seasonal allergies multiple (ragweed, sagebrush, dogs, cats, many pollens

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Urticaria. Very mild about one week after first dose on December 17 (ignored and not linked to vaccine in retrospect. Went away after a week). More severe urticaria starting on January 29 ( with second vaccine on January 17. Urticaria, pruritic rashes on extremities, back, chest, behind ears. A sense of itching in throat. A sense of fullness in lips but no angioedema. Some fatigue and mild malaise

Other Meds: Celexa, Crestor, Zyrtec, Ocuvite, Mvi, Flonase, Monthly allergy shots,

Current Illness: Healthy.

ID: 0991896
Sex: F
Age: 60
State: MI

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Pharyngeal swelling

Symptoms: Patient developed temperature of 101 degrees, weakness, and fatigue.

Other Meds: Ativan 0.5mg BID; Duloxetine HCI delayed release 30mg daily;

Current Illness: none

ID: 0991897
Sex: F
Age: 17
State: MI

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Too Young for Vaccine

Other Meds:

Current Illness:

ID: 0991898
Sex: M
Age: 88
State: MT

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: PATIENT STATES HE HAS HAD SHORTNESS OF BREATH, AND NO ENERGY. PATIENT ALSO STATES HE FEELS WEAK.

Other Meds:

Current Illness:

ID: 0991899
Sex: M
Age: 62
State: TX

Vax Date: 01/30/2021
Onset Date: 01/31/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Fever, flu like symptoms

Other Meds: Lisinopril, synthroid, metformin, alogliptin

Current Illness: None

ID: 0991900
Sex: F
Age: 46
State: GA

Vax Date: 01/26/2021
Onset Date: 01/29/2021
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: Codeine/ Flexeril

Symptom List: Rash, Urticaria

Symptoms: Diagnosed with Bells Palsey

Other Meds: Lisinopril/HCTZ

Current Illness: Na

ID: 0991901
Sex: M
Age: 64
State: OH

Vax Date: 01/21/2021
Onset Date: 01/21/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Patient complained of diaphoresis and light headedness about 5 minutes after receiving 2nd dose of Moderna Covid vaccine. Patient was able to ambulate to cot. Blood pressure, heart rate, and respirations all within normal limits. Patient given water and observed for an additional 30 minutes. All symptoms resolved.

Other Meds:

Current Illness:

ID: 0991902
Sex: F
Age: 87
State: VA

Vax Date: 01/20/2021
Onset Date: 02/01/2021
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: none

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

Symptoms: Left upper arm has a large red raised area. Area measures 4.5 inches X 3 inches . Area is not painful and patient is not running a temperature. Patient is 12 days out from receiving her vaccine.

Other Meds: Melatonin, Magnesium, B12, Procrit, Zoloft, Tylenol, Keppra, Lipitor

Current Illness: Myelodysplasiac Disease

ID: 0991903
Sex: F
Age: 59
State: OR

Vax Date: 01/19/2021
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: Sulfa

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

Symptoms: Moderna COVID-19 Vaccine EUA Approximately 1 1/2 weeks after the initial vaccine the vaccination sight in my right upper arm started to turn red. It was hard and swollen. about the size of a baseball. Warm to the touch. Each day the red area is enlarging and still hard and warm to the touch.

Other Meds: Wellbutrin, Vitamin D, Allegra, Calcium, Magnesium, Tumeric

Current Illness: N/A

ID: 0991905
Sex: F
Age: 69
State: AZ

Vax Date: 01/01/2021
Onset Date: 01/22/2021
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: Woke up with severe chills, low fever, nausea, headache. Sick about 24 hours. 2 days later got very dizzy and shaky had to sit most of the day.

Other Meds: Vitamin C Calcium

Current Illness: None

ID: 0991906
Sex: F
Age: 58
State: KY

Vax Date: 01/06/2021
Onset Date: 01/13/2021
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: Methotrexate; ACE inhibitors; cephalosporins; PCN

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

Symptoms: Increased fluid in left eye with significant decreased vision started 1 week post immunization; and shingles started 1/29/2021

Other Meds: Lopressor; Wellbutrin; Lexapro; Entresto; Maxzide; Xeljanz; Horizant; Synthroid

Current Illness: None--Post vaccination Experienced increase fluid and significant vision change 1/13/2021 Experienced shingles 1/29/2021

ID: 0991907
Sex: M
Age: 66
State: NY

Vax Date: 12/31/2020
Onset Date: 12/31/2020
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: Unknown

Symptom List: Ear pain, Hypoaesthesia

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: 0991908
Sex: F
Age: 76
State: FL

Vax Date: 01/28/2021
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: Calcium, iron

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Injection site with redness, warmth, tender and hard

Other Meds: Yes

Current Illness: None

ID: 0991909
Sex: F
Age: 72
State: NY

Vax Date: 01/29/2021
Onset Date: 01/29/2021
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:

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

Symptoms: Headache, upset stomach, nausea and diarrhea, and her face was sunburn red and started Friday the 29th and still sick. throwing up every 15 to 20 mins. Called Dr. on Sunday and was told to take aspirin and Tylenol

Other Meds: Gabapentin 100 mg, trazadone 50 mg, certilene HQ 100 mg, vitamin B-12, oloppogrel 75 mg, farisolfate, mepoprolol SUCC 50 mg, amitropaline, antratrola

Current Illness:

ID: 0991910
Sex: F
Age: 20
State: CO

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

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

Symptoms: Fever 100, sore throat, body aches, warmth, tenderness and redness at injection site, approximately 3", increased in size overnight since onset. Recent hospitalization for CD. Tested negative at hospital discharged 1/19.

Other Meds: Venlafaxine 250mg, Topiramate, Gabapentin 100 mg

Current Illness: C. Diff.

ID: 0991911
Sex: F
Age: 47
State: GA

Vax Date: 01/06/2021
Onset Date: 01/16/2021
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: No known drug or food allergies

Symptom List: Unevaluable event

Symptoms: A delayed, large oval-shared rash at the injection site 10 days after vaccination with redness, itchiness, and mild irritation. Gradually diminished in size and redness in 2 weeks.

Other Meds: multi-vitamin

Current Illness: None

ID: 0991912
Sex: F
Age: 82
State: CA

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: LA

Lab Data:

Allergies: Codeine

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

Symptoms: At 0843, RRT was called at the post-vaccination area for an 82 y/o female C/O chest tightness after administration of the Pfizer vaccine at 0836. RRT RNs responded to scene with E-Kit, stethoscope, and pulse ox at hand. Initial vitals ? BP: 190/94, HR: 86, O2: 96% on RA. Client reports that chest tightness does not radiate anywhere else. Client denies N/V, vision changes, or difficulty breathing. Client appears in no acute distress, no sweats seen. Head-to-toe assessment done, all WNL. Client reports she took Metoprolol, Prilosec, a vitamin supplement, and Synthroid this AM. Has a history of macular degermation, thyroid dx, arthritis, and HTN. Throughout RRT, chest tightness improved. At 0855, BP was 182/92. At 0900, client?s head-to-toe assessment remained in WNL. She remained in no acute distress and was not SOB or had difficulty breathing. 911 assistance not needed at this time. Recommendation to client was to be monitored for an additional 15 minutes and that if symptoms worsen, she should contact her PCP and go to the nearest hospital/ER and/or call 911. Client verbalized understanding. At the end of additional 15-minute waiting period, client felt so much better. Symptoms improved. Client left AMA and left premises at 0915 via car.

Other Meds: None taken at the time of vaccination but on the AM of vaccination day, client took Metoprolol, Prilosec, a vitamin supplement, and Synthroid.

Current Illness: None

ID: 0991913
Sex: M
Age: 17
State: NE

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: No adverse events were reported. The vaccine was administered to the patient who is 17 year old.

Other Meds:

Current Illness:

ID: 0991914
Sex: F
Age: 75
State: CA

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

Lab Data:

Allergies: Shell Fish

Symptom List: Injection site pain, Menorrhagia

Symptoms: Day after the injection I experienced a red rash about the size of a tennis ball at the injection site. There was no pain or problems swallowing, no hives or headaches, just the rash. It lasted for two full days and was warm to the touch.

Other Meds: Losartin Zonisamide Metopolol Botox injections every three months in neck by neurosurgeon Fish Oil/Flaxseed Oil/ Vitamin C-E-D, Biotin, Cranberry pills, Preser Vision

Current Illness: n/a

ID: 0991916
Sex: M
Age: 40
State: ND

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

Lab Data:

Allergies: Anaphylaxis to bee venom

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

Symptoms: Pt developed throat constriction/pressure about 20 minutes after vaccine #2 of the COVID-19 series. He had no symptoms after the first dose. He denied any other symptoms. Denies SOB, cough, throat/tongue/lip swelling. Physical exam and initial vitals were normal. At 1100, he was given Benadryl 25mg po x1 dose. He reported symptoms were improving shortly after. At 1110, repeat vitals were still normal and physical exam was unchanged. Pt reported feeling better. He was discharged back to work in stable condition at 115.

Other Meds: Vitamin D

Current Illness: None

ID: 0991917
Sex: F
Age: 68
State: NC

Vax Date: 01/31/2021
Onset Date: 01/31/2021
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: caffeine, sufur-based, codeine

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: difficulty breathing, faintness, extreme weakness, unable to communicate

Other Meds: klor-con 20gm, claritin 10mg, amlodipine 10mg, aspirin, calcuim/vitmin D, multi-vitamin, pantoprazole 40mg

Current Illness: none

ID: 0991918
Sex: F
Age: 47
State: MN

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: Purpose: Sores in mouth and nose. Eye swollen, sores on nose and mouth jaw pain, headache and swollen glands after COVID-19 vaccine

Other Meds: Anastrozole clonazePAM Venlafaxine

Current Illness:

ID: 0991919
Sex: F
Age: 87
State: CO

Vax Date: 01/16/2021
Onset Date: 01/31/2021
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: Penicillin LisinOpril Lefofloxacin

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

Symptoms: Below injection site, 3 inch by 3 inch area red, slightly raised/swollen, itchy.

Other Meds: Probiotic-8 1x Olmesarton 20mg 1x Amlodipine 10mg 1x Triamterene 37.5-25 1x Loratadine 10mg 1x Advair 250/50 2x Rhinocort 32mcg as needed Oxygen 4 liter night/ 2-3 liter day Krill 500mg 1x CoQ-10 Essential Enzymes 500 mg 1x Omeprazole 10 mg

Current Illness:

ID: 0991920
Sex: F
Age: 97
State: PA

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Systemic: Other- Dizziness, lightheaded, rapid heart rate

Other Meds:

Current Illness:

ID: 0991921
Sex: F
Age: 72
State: IN

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Sulfa drugs

Symptom List: Injection site pain

Symptoms: On day following shot, I became achy all over, had a headache and slight fever. I went home from my shopping trip, took a 3 hour nap. I felt worse so I went to bed and slept 14 hours. I felt better Saturday morning. That evening I noticed a rash on both legs, from ankles to my knees. It is still there, though it doesn't itch or make me feel sick.

Other Meds: Synthroid, Atorvastatin, Losartan, Amlodipine Fish oil, multivitamin, vitamin c, coq10, magnesium, GNC hair, skin & nails, cranberry, Juice Plus fruits and vegetables,.

Current Illness: None. I was recovered from COVID just before the end of December

ID: 0991922
Sex: F
Age: 79
State:

Vax Date: 01/22/2021
Onset Date: 01/31/2021
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: Started with stinging and then itching in her arm on 1/31/21. Deep red rash noted to area on this day as well, very itchy if she touches this at all. Arm was so sore after injection she could barely move her arm. She was also extremely tired for two days after getting the vaccine.

Other Meds:

Current Illness:

ID: 0991923
Sex: F
Age: 30
State: AZ

Vax Date: 01/13/2021
Onset Date: 01/13/2021
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: vicodine

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

Symptoms: warm feeling on chest, increase heart beat, pulse 125, going down to 60 up to 120s, was told i was nervous, i felt this 5-8 minutes after vaccine.

Other Meds: none

Current Illness: none

ID: 0991924
Sex: M
Age: 48
State: KS

Vax Date: 01/25/2021
Onset Date: 01/26/2021
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: Codeine, Phenobarbital, Influenza Vaccine

Symptom List: Tremor

Symptoms: fatigue, decreased mobility, minimal swelling of feet, O2 dips, lethargy

Other Meds: See PO

Current Illness: N/A

ID: 0991925
Sex: F
Age: 60
State: WA

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:

Symptom List: Erythema, Pruritus

Symptoms: Pt came in for Dose 2 of covid vaccine and did not have her card with first vaccine. Moderna was administered. Upon entering information into the state immunization registry, it was determined that the patients first dose had been Pfizer on 12/31/2020. Contacted CDC who indicated that no further dose is necessary.

Other Meds:

Current Illness:

ID: 0991926
Sex: M
Age: 26
State:

Vax Date: 01/24/2021
Onset Date: 01/24/2021
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: animal dander

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

Symptoms: chest tightness, overall itching, no rash

Other Meds: Truvada

Current Illness:

Date Died: 01/12/2021

ID: 0991927
Sex: M
Age: 86
State: ND

Vax Date: 01/05/2021
Onset Date: 01/12/2021
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: No known defined allergies.

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

Symptoms: Patient was found deceased at Nursing Home in his room 01/12/2021 at 5:25 AM.

Other Meds: Diphenhydramine HCl, atorvastatin, furosemide, gabapentin, Healthy Eyes (vitamin A, C, & E with lutein minerals), Imodium, Isosorbide mononitrate, Jantoven, Potassium Cl, Metoprolol succinate, Nitroglycerin.

Current Illness:

ID: 0991928
Sex: F
Age: 38
State: IL

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

Lab Data:

Allergies: amoxicillin, erythromycin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Was drawing up doses from Moderna vial. Pulled a needle back for 0.5ml of air to equalize the pressure once in the vial. Had to stop what I was doing as customers came up to the counter to drop off and pick up along with multiple calls ringing (pharmacy has only 1 person at all times - 1 pharmacist, no techs, no other pharmacists). After finishing up with all of the customers and calls, my Covid-19 vaccine appointment showed up. Instead of grabbing a pre-drawn needle with Moderna in it, I grabbed the needle pulled back to 0.5ml with just air in it. I noticed the mistake as I pierced the needle into the patient's deltoid muscle. I explained what happened and the patient was completely understanding. She received the Moderna vaccine immediately right after. She was stuck with a needle twice, one time air and one time with Moderna in it. Patient had no issues or adverse events. Patient has not called back for any problems to report.

Other Meds: Unknown

Current Illness: Unknown

ID: 0991929
Sex: F
Age: 58
State: TN

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient immediately started experiencing a "fullness" in back of throat. No breathing difficulty. Adenoid was very swollen.

Other Meds: Vitamins, calcium, Armour thyroid

Current Illness: None

ID: 0991930
Sex: M
Age: 76
State: IN

Vax Date: 01/23/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

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

Symptoms: TOTAL BODY SEVERE PAIN OF ALL JOINTS AND MUSCLES (FROM HEAD TO TOE, PLUS PAIN BEHIND BOTH EYES

Other Meds: HEART, CHOLESTEROL, DIETARY (POTASSIUM,ZINC,VITAMINS C,B-12,D-3, TERBINAFINE HCL,LOW DOSE ASPIRIN.

Current Illness: COVID-19 POSITIVE TEST ON JAN. 7, 2021.

ID: 0991931
Sex: F
Age: 78
State: LA

Vax Date: 01/23/2021
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:

Symptom List: Pain in extremity

Symptoms: Six days after vaccination she developed a round red circle around injection site. Site is itchy and warm to touch. No other symptoms are apparent.

Other Meds:

Current Illness: NONE NOTED

ID: 0991932
Sex: F
Age: 86
State:

Vax Date: 01/22/2021
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: No symptoms noted until 2/1/21 where resident noted redness around the injection site. No other symptoms.

Other Meds:

Current Illness:

ID: 0991933
Sex: M
Age: 59
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

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: 0991934
Sex: F
Age: 56
State: MI

Vax Date: 01/25/2021
Onset Date: 01/26/2021
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: Aspirin

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

Symptoms: 1/26/2021 at about 1pm I began getting chills and was very cold. Later on the night I got a bad headache. This went on for 2 more days. The headache was so bad I couldn't eat, drink, or lift my head and I was so cold I had a heater, heating pad and several blankets.

Other Meds: Omeprazole

Current Illness:

ID: 0991935
Sex: M
Age: 70
State: CA

Vax Date: 01/25/2021
Onset Date: 01/29/2021
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: Patient was given vaccine on 1/25/2021, he was observed for 30 minutes, and did well. The patient then called 1/29/2021, and spoke with the receptionist. He stated he had a rash on thigh prior to the vaccine that seems to have worsened after getting the vaccine. I attempted to called the patient back 1/29/2021 at 1:17 pm, and again at 4:00pm he did not answer so I left a message. He returned my call 2/1/2021 and states he now has a blister like rash on his back, chest, arms, and thighs that is itchy. I advised the patient I would be reporting this to VARES, however if he develops any shortness of breath, trouble swallowing, or severe hives to go to the ER. He is not a patient of this clinic and stated he called his PCP who referred him back to us.

Other Meds: Blood thinner

Current Illness: Unknown

ID: 0991936
Sex: F
Age: 42
State: NY

Vax Date: 01/05/2021
Onset Date: 01/12/2021
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: none but have strong reactions to insect bites

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: one week after injection, injection site became inflamed, this went away in a few days. however, fingers and toes became very red and itchy that same day & has not gone away yet (3 weeks). also developed red itchy bumps on right side beneath under arm.

Other Meds: none

Current Illness: none

ID: 0991937
Sex: M
Age: 92
State: FL

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 02/01/2021
Hospital: Y

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: Sulfa

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

Symptoms: weakness in legs, difficult to get out of chair, fell and could not get up. fever loose stool Went into AFIB and it snowballed from there. Was taken to Emergency.

Other Meds: Coreg, Eliquis Vitamin D

Current Illness: N/a

ID: 0991938
Sex: F
Age: 45
State:

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Sulfa

Symptom List: Injection site swelling, Limb discomfort

Symptoms: c/o feeling warm on left side going down the throat. Same feeling with first dose, this time not as severe as the first time. Denies chest pain, SOB, fatigue, lightheaded, rash, throat pain. No acute distress BP: 157/92 HR: 90 Sp02: 98% room air Seen and cleared by EMS

Other Meds: metformin. lisinopril. levothyroxine

Current Illness:

ID: 0991939
Sex: M
Age: 16
State: NM

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

Lab Data:

Allergies:

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

Symptoms: Error: Too Young for Vaccine

Other Meds:

Current Illness:

ID: 0991940
Sex: M
Age: 27
State: FL

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKDA

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

Symptoms: Fever, chills, fatigue, headache developed on 1/28/21 after receiving 2nd Moderna vaccine. 1/29/21 began vomiting. 1/29/21 treated in the emergency department for dehydration and hypotension.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm