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: 0992093
Sex: F
Age: 43
State: WV

Vax Date: 01/29/2021
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: adhesives,vicodine, steri strips,

Symptom List: Dysphagia, Epiglottitis

Symptoms: have a knot in the injection site and it has redness in that area. Also have a knot in the arm pit that is as big as fist. no redness to it.

Other Meds: ,tummeric,tylenol,vitamin c, Prilosec, b,zinc, vitamin d, multivitamin, topiramate,norethindrone,

Current Illness: none

ID: 0992094
Sex: M
Age: 34
State: MI

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

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Headache, chills, body aches, nausea and the started to have drooping on the left side of his face.

Other Meds: none

Current Illness: None

ID: 0992095
Sex: F
Age: 77
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA, denies any allergies

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

Symptoms: Patient arrived at shot table in TCPH w/c, short of breath. Taken straight back to private observation from shot table. EMT on site in attendance. Upon assessment; patient having suprasternal, substernal, intercostal retractions. Patient on home O2 at 2 L/M per NC. Per EMT auscultation patient has inspiratory and expiratory wheezing. Patient has a loose congested cough. Pt's nail beds dusky, no blanching. Hands are cold. Unable to initially obtain O2 sat reading. Patient does not have inhalers with her. Pt. can't recall names of meds. 9:30 BP 132/62; HR 68 strong and regular per palpation. RR 30. 9:40 O2 sat 82% after hands warmed. Patient increased her own O2 to 3 L/m . EMS activated 9:45 O2 sat 84% with 3 L/m per NC. Still having deep retractions. 9:50 EMS arrived along with FWFD. Patient alert/oriented x 4, still labored breathing. Patient denies feeling badly. Med star team evaluating. 0957 O2 97% on 3 l/m per nc. HR 72; BP 104/58; ETCO2 41 1007 O2 97% on 3 L/m per NC; ETCO2 43; HR 112; BP 96/56. EMS recommends transport. Patient refused. Pt. states she will go home and take her own nebulizer treatment. Patient called brother for ride Patient left AMA, patient remains A/O x 4, taken via w/c to brother's car for transport home.

Other Meds: Takes meds for COPD, Afib, CHF, Emphysema but can't recall names of any of the meds.

Current Illness: denies

ID: 0992096
Sex: F
Age: 73
State: IN

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: Tuna, cats

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient developed a rash and itching about 15 minutes after receiving the Moderna vaccine. Patient was given 25 mg of Diphenhydramine HCI

Other Meds: Lisinopril 10 mg a day

Current Illness: N/A

ID: 0992097
Sex: F
Age: 39
State: PA

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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Arm, pain, Fever 10.3-101, chills, body aches, shakes fatique, peristent nausea and one episode of vomiting

Other Meds:

Current Illness:

ID: 0992098
Sex: F
Age: 51
State: TX

Vax Date: 12/31/2020
Onset Date: 12/31/2020
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: Albuterol Environmental Allergies

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

Symptoms: About 10-12hrs later, my right shoulder started hurting and got worse. The night of the 31st it was excruciating, it felt like someone was breaking my bones, it was a 10/10 pain, I wanted to cry the pain was so bad. I took two Advil and put ice on it and I got to where I couldn't move my arm. I had difficulty sleeping as well. In the morning it was just as bad and I couldn't raise my arm it hurt so bad. My husband had noticed the shot given so high in my arm. The next two days is didn't get much better, I tired to move it and lift it up but hard. The 5th day after the shot I called to get into the Orthopedic Dr to see that was going on. it was a little better but still a lot of pain. The Dr. had told me to try to keep moving it, he did an xray and nothing was broken but told me to follow up with him if it didn't get better. He did say to ask to have the second dose injection given a little lower in my arm. It wakes me up once or more at night, I'm not able to do what I use to do. I can move it a little better but my shoulder still hurts, I'm not using it as much. I'm not sure if it's related to the vaccine.

Other Meds: MP Thyroid

Current Illness:

ID: 0992099
Sex: F
Age: 48
State: TX

Vax Date: 01/21/2021
Onset Date: 01/26/2021
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 drugs

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: had pain in arm 12 hours after initial shot, then several days now have noticed a red raised circular area with pinkish red rash. still present on arm.

Other Meds: Anastrozole 1 mg, aspirin 81 mg, Claritin, Vitamin D, C, Zinc

Current Illness:

ID: 0992100
Sex: F
Age: 67
State: IN

Vax Date: 12/04/2020
Onset Date: 12/04/2020
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: Demurral, Macrobid

Symptom List: Pharyngeal swelling

Symptoms: Ringing in my ears that started the night of my injection and still ringing now. I have gone to my primary Dr , and , Went to allergy Dr. twice.

Other Meds: Thyroid pill, cholesterol pill

Current Illness:

ID: 0992101
Sex: F
Age: 59
State: KS

Vax Date: 01/08/2021
Onset Date: 01/17/2021
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: latex, Neosporin, and hydrocodone

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: patient developed redness at the injection site 1 week after immunization followed by an L-shaped rash few centimeters distal to the injection site which lasted for 4 days and required a steroid injection 2 days after appearance. Currently, patient doesn't have any rash and her symptoms have resolved

Other Meds: vitamin C 250 mg, one tablet every other day Vitamin D 50 ?g, one capsule every day Tylenol 500 mg, 2 tablets 3 times daily as needed

Current Illness: none

ID: 0992102
Sex: U
Age: 31
State: OH

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Vaccine administered 23 days after first dose. Headache, fatigue, chills, body aches

Other Meds:

Current Illness:

ID: 0992103
Sex: F
Age: 65
State: NY

Vax Date: 01/31/2021
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: Shrimp Cantaloupe Horseradish Portabella mushrooms Clindamycin Penicillin

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

Symptoms: Lump/swelling in throat no problem breathing or eating Started immediately after the vaccine was administered thought it was my nerves but it hasn't gone away it's a day later

Other Meds: Hctz, Probiotics, Amlodipine, Vitamin D, Aspirin, Fish oil, Losartan Potassium, Lipitor, Magnesium, Vitamin C,

Current Illness: None

ID: 0992104
Sex: F
Age: 51
State: MT

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Diarrhea & Nausea

Other Meds:

Current Illness:

ID: 0992106
Sex: F
Age: 41
State: CA

Vax Date: 01/29/2021
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: latex, shellfish, iodine, adhesives

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

Symptoms: Facial swelling and pain at site of previous facial filler. Woke me up around 3am 1/30/21. Treatment: watch and wait, no meds. Outcome: Swelling and tenderness is almost gone as of 2/1/21 12pm.

Other Meds: prenatal vitamins, Vit D3, (Standard Process) Thymex, (Standard Process) Drenamin

Current Illness: None

ID: 0992107
Sex: F
Age: 33
State:

Vax Date: 12/31/2020
Onset Date: 12/01/2020
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: Patient came in for her second dose, and reported that she had terrible arm pain after 1st dose. Also stated she had terrible pain over body since vaccination 3 weeks prior. Stated that on a pain scale of 1-10 (10 being the highest), that her pain was over a 10. This had been intermittent over the past 3 weeks. She stated that she would take Tylenol, and after the Tylenol would wear off the pain would come back greater than before. I told her she needed to see her primary care provider before the second dose would be administered due to her pain being higher than a 10 after 3 weeks of 1st dose.

Other Meds:

Current Illness:

ID: 0992108
Sex: F
Age: 36
State: MN

Vax Date: 01/19/2021
Onset Date: 01/27/2021
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: Penicillin, azithromycin

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

Symptoms: Developed swelling, redness and itchiness around injection site 8 days post shot. Resolved within 2 days (1/29/21).

Other Meds:

Current Illness: None

ID: 0992109
Sex: F
Age: 50
State: MI

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

Lab Data:

Allergies: codeine, lidocaine

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

Symptoms: I became increasingly sick within 24 hours after the shot. I was very tired, felt feverish, very cold, coughing, headache and diarrhea. 36 hours after the shot I began to notice a loss of taste and smell. 48 hours I was very weak and needed to sleep for the next 3 days. Overall loss of appetite, diarrhea and very bad cough continued for at least 1 week.

Other Meds: Estradiol 1mg x 2 per day Atorvastatin 10mg Alprazolam .25 as needed imitrex 50mg as needed

Current Illness: Common cold, seasonal allergies

ID: 0992110
Sex: F
Age: 33
State: FL

Vax Date: 01/22/2021
Onset Date: 01/31/2021
Rec V Date: 02/01/2021
Hospital: Y

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None

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

Symptoms: Uncomplicated pregnancy but mother has type 1 diabetes and hypothyroidism monitored by regular OB and high risk MFM. On 1/31/21, I developed discharged of clear vaginal fluid later diagnosed at the hospital with preterm premature rupture of the membranes.

Other Meds: Levothyroxine Humalog Aspirin Prenatal vitamins Prenatal DHA

Current Illness: None

ID: 0992111
Sex: F
Age: 28
State: MD

Vax Date: 12/19/2020
Onset Date: 12/30/2020
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: Sulfur, Penicillin, apple juice, pollen, dust mites, dogs, cats and other various allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: On 12/30 I developed neck pain, a headache, chill and shaking but no fever, diarrhea, ear pain and nasal congestion. I had a virtual visit with the NP and was advised if the symptoms got worse to take tylenol and ibprophen. I was advised I could take mucinex and recommended a COVID test. It was performed on 12/31 which was negative so I took mucinex for the congestion and after 2 or 3 days I began to feel better.

Other Meds: Prozak, Birth Control, Ibuprohen

Current Illness: no

ID: 0992112
Sex: F
Age: 53
State: NY

Vax Date: 01/21/2021
Onset Date: 01/21/2021
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: pcn , flu vaccine teatnus toxoid clindamycin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Severe headaches , dizziness , diarrhea with in 2 hrs of vaccine arm sorness , fatigue for 36 hrs later developed severe RT TMG , TGN , RT EAR INFECTION than week later developed on and off painful paraesthesia all 4 limbs more marked both legs , RT leg on and off weakness feeling but no trouble walking , running , muscle fasiculation on and off b/l eyes and limbs t\TGN symptoms worsened over days , entire RT side of face is very sensitive to touch . no rashes , RT ear is blocked feel decrease hearing RT EAR , had mild vertigo for short duration self resolved

Other Meds: none

Current Illness: none

ID: 0992113
Sex: F
Age: 61
State: NY

Vax Date: 01/23/2021
Onset Date: 01/23/2021
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: no known allergies

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

Symptoms: Began with pain to injection the same evening of injection on Sat 1/23/21, then 2 days later on Mon 1/25/21 with some redness around injection, no drainage or fevers.

Other Meds: denies any meds or otc

Current Illness: denies

ID: 0992114
Sex: M
Age: 28
State: WA

Vax Date: 01/20/2021
Onset Date: 01/22/2021
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: Eggs and legumes

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

Symptoms: I am an RN in Washington state and qualified to assess my son's injection site. I noted January 28, 2021 approximately 8 days post vaccination, that my son has a 5" x 3" area of erythema and induration over his left deltoid. He doesn't complain of any pain or other signs of illness at this time. This area has not enlarged nor has it reduced since I've begun to monitor him.

Other Meds: Ethosuximide

Current Illness: No known

ID: 0992115
Sex: F
Age: 61
State: MT

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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Chills & Vomiting

Other Meds:

Current Illness:

ID: 0992116
Sex: F
Age: 41
State: MD

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

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

Symptoms: Starting the day after the injection she began having a fever as high as 102.4, severe chills, joint pain, headache, nausea, vomiting, body aches

Other Meds:

Current Illness:

ID: 0992117
Sex: M
Age: 51
State: MD

Vax Date: 01/15/2021
Onset Date: 01/24/2021
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: no

Symptom List: Injection site pain, Pain

Symptoms: chest tightness, shortness of breath and chest pain.All this symptoms occur during physical activity.

Other Meds: metoprolol,metformin

Current Illness: Diabet,Hypertension ,psoriasis

ID: 0992118
Sex: F
Age: 57
State: PA

Vax Date: 01/28/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Headaches with Chills and Nausea. Fatigue Tylenol Helpful for a short duration.

Other Meds: Multi Vitamin Occuvite Crestor Co-Q 10

Current Illness:

ID: 0992119
Sex: F
Age: 38
State:

Vax Date: 01/24/2021
Onset Date: 01/30/2021
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: no known allergies

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

Symptoms: Moderna Covid-19 Vaccine EUA Same day as injection and one day post injection, experienced extreme fatigue and brain fogginess. Six days post injection, injection site is red, hard and itchy. Injection site is also warm to the touch. No fever. No other side effects at this time.

Other Meds:

Current Illness: none

ID: 0992120
Sex: F
Age: 68
State: PR

Vax Date: 01/28/2021
Onset Date: 01/29/2021
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: Aspirin and Seafood

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fever, chills, throat pain, weakness

Other Meds: Synthroid 88mg , Candersartan 4mg, Amlodipine 5mg, Crestor 10 mg, Vitamin D3 5000

Current Illness: Cold Flu

ID: 0992121
Sex: F
Age: 62
State: GA

Vax Date: 01/23/2021
Onset Date: 01/24/2021
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: Erythromycin - Gastric Upset

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Moderna COVID-19 Vaccine EUA Sunday, Jan 24 2021 Afternoon - Chills, Achiness Dinnertime - Addition of Nausea Evening - Addition of Joint Pain, Muscle Pain and Fatigue Monday, Jan 25 2021 Basically out of it all day with extreme fatigue, headache similar to a migraine where it hurt to even move my head, stiff neck, chills, nausea, muscle and joint pain. Did not take temperature as I was sleeping most of the day, made it to the bathroom but that was it. Tuesday, Jan 26, 2021 Less fatigued, headache and stiff neck was there but not nearly as bad. Still had the chills, nausea, muscle and joint pain. Temp was 99.4 when taken Wednesday & Thursday (Jan 27 & 28, 2021) - Each day felt a bit better but still seemed to tire easily and gradually got back to feeling like eating something. Friday, Jan 29, 2021 - Felt pretty much back to normal but tire easily. Sat Jan 30 - Monday Feb 1, 2021 - Still feel I am tiring easy but each day gets better. Monday Feb 1, 2021 - Afternoon - Have tingling in throat and right ear. Typical of reaction to IGG Infusion. Have taken Benadryl 25. If continues will call PCP.

Other Meds: Hyzaar-DS - 1 QAM Amiodipine 5mg - 1 QHS Tramadol 300mg - 1 QAM Rheumatoid Pain Tylenol #3 BID PRN - Post op Total Knee Replacement Pain Trazodone 100mg 1 QHS Gabapentin 300 1 QID Multivitamin 1 OD B-Complex 1 OD B6-100 1 OD Zinc 50mg 1 OD

Current Illness:

ID: 0992122
Sex: F
Age: 73
State: FL

Vax Date: 01/24/2021
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: PCN--- hives pt states allergy to spicy foods but questionable history

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

Symptoms: Approximately 48 hours after first dose given, pt developed generalized urticaria (hives) There was no angioedema, no anaphylaxis. Symptoms resolved with antihistamine, but recurred on 2/1/21 when she stopped- although very mild recurrence. Pt has h/o hives, intermittent, she describes as related to spicy foods, but more likely idiopathic hives by her history.

Other Meds: Atorvastatin, Glucosamine-chondroitin, Vit B complex, Vit D3, Pepcid

Current Illness: none

ID: 0992123
Sex: M
Age: 20
State: MA

Vax Date: 01/26/2021
Onset Date: 01/30/2021
Rec V Date: 02/01/2021
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: Egg, Peanut, Treenut

Symptom List: Nausea

Symptoms: Acute myocarditis with chest pain and elevated troponin with EKG ST segment changes, muscle aches

Other Meds: Dupixent, Albuterol, Zyrtec, Montelukast, Symbicort

Current Illness: None

ID: 0992124
Sex: M
Age: 31
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Injection site pain

Symptoms: Symptoms started 14 hours after 2nd shot. Cold chills, low grade fever, cold chills, severe head ache, body aches, restlessness, tiredness. That lasted for 7 hours. All symptoms subsided 7 hours later except body aches and severe head ache which lasted another 8 hours. All symptoms subsided after 24 hours.

Other Meds: Multi vitamin, coq 10, ibuprofen

Current Illness: Low grade fever, cold chills, body aches, severe headache, tiredness, restlessness, clogged ears

ID: 0992125
Sex: F
Age: 58
State: MT

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Nausea

Other Meds:

Current Illness:

ID: 0992126
Sex: F
Age: 42
State: IL

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: RA

Lab Data:

Allergies: Dust

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

Symptoms: Left neck pain/spasm with left arm deltoid pain and left hand tingling. Lasted for 4 hours until I self massaged with a tennis ball to the back of the neck/upper back. Then left lateral hip pain started immediately for 72 hours. After 24 hours difficulty walking started then after 30 hours inability to ambulated stairs with the left leg and inability to squat started. At 48 hours pain lessened mildly as walking returned to normal gait but pain persisted. At 72 hours able to resume all activity with very mild pain. All pain resolves by 96 hours after onset.

Other Meds: Multivitamin, Omega 3, Omega 6, Nutriferon, Vitamin D, Votamin C, zinc, probiotic, alfalfa

Current Illness: None

ID: 0992127
Sex: F
Age: 25
State: OH

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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: Lidocaine-unknown type

Symptom List: Tremor

Symptoms: got sweaty, pale and felt faint immediately following injection of her Moderna COVID-19 vaccination, which required additional monitoring. Prior to the injection- patient reported an allergy to lidocaine and when writer inquired about the reaction- she reported getting sweaty and feeling faint when she received a local injection.

Other Meds: N/A

Current Illness: N/A

ID: 0992128
Sex: F
Age: 81
State: PR

Vax Date: 01/18/2021
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: Aspirin

Symptom List: Erythema, Pruritus

Symptoms: Redness, fever on injection site, inflammation, swelling, hardness

Other Meds: lisinopril 10 mg tab, fluoxetine 20 mg cap, folic acid 1mg tab., memantine 5 mg tab., buspirone 10 mg tab., Vitamin b 12 1000mcg tabb, Caltrate +vit D3, Colace 50 mg cap, simvastatin 10 mg tab., donepezil 23 mg , quetiapine 50 mg tab., A

Current Illness:

ID: 0992129
Sex: F
Age: 70
State:

Vax Date: 01/23/2021
Onset Date: 01/26/2021
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: None

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

Symptoms: Shingles

Other Meds: Vit D3, 5000 IU

Current Illness: None

ID: 0992130
Sex: F
Age: 84
State: TX

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: LA

Lab Data:

Allergies: sulfa, keflex, phenergan,

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

Symptoms: headache off and on, severe coldness and some chills, diahrrea for 48 hours

Other Meds: allopurinol, ezetimibe, levoxyl, metformin, hydrocodone-apap, neupro, ramipril, ropinerole, spironolactone-hydrocholothiazide, vascepa, horizant, aspirin81, calcium, iron, magnesium, melatonin, selenium, vitamin c, vitaminD3, zinc

Current Illness: none

ID: 0992131
Sex: F
Age: 38
State: AL

Vax Date: 01/15/2021
Onset Date: 01/17/2021
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: penicillin and prednisone the pill form

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Around the 2nd night/3rd morning, my arm began to swell. It was hot to the touch and feels like a knot. The knot and size keeps increasing for nearly a full week-still has a fever, hot to the touch, and very hard. The injection site is not sore. I'm now at day 17 and I still have a golf ball size knot that I'm very concerned about. It does not have a fever and the red swelling has gone away.

Other Meds: welburtrin, alphrazolam, zyrtec

Current Illness:

ID: 0992132
Sex: F
Age: 29
State: PA

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

Lab Data:

Allergies: Advil, cantaloupe

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

Symptoms: Swollen arm in a circular form, hot to the touch, itches, painful to touch

Other Meds: None

Current Illness: none

ID: 0992133
Sex: F
Age: 74
State: KY

Vax Date: 01/28/2021
Onset Date: 01/28/2021
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: pt states when she went to bed the day of her vax that her heart raced for about 30 minutes and she had severe chills for at least 12 hours. She said she felt so sick she got up to call an ambulance but did not. Pt stated she was very weak the next day after the vax. Pt has not contacted her PCP but is wakes up every day weak and shaky.

Other Meds: diltiazem 180mg once daily, low dose aspirin

Current Illness: none

ID: 0992134
Sex: F
Age: 41
State: MT

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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Fever, Nausea, Body Aches, Headache

Other Meds:

Current Illness:

ID: 0992135
Sex: F
Age: 60
State: CT

Vax Date: 01/29/2021
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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: Possible Morphine rx-facial swelling post cx birth in 1988.

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

Symptoms: Within 8hrs of injection on Fri 1/29-very sore arm and body aches setting in. Slept thru night feeling hot and strong headache requiring 2 Tylenol in am. No fever upon check in am. No cough. Body aches, chills, and woozy/dizziness all day. Sept on/off most of next day(Sat 1/30) 2 Tylenol taken in afternoon helped with lingering headache/body aches. General dizziness on/off low grade headache persists thru Mon 2/1 requiring call out from work double shift..3pm-11;30pm 2/1/21 and 11:30pm-7:30am 2/2/21 . Sleep and hydration helping with reaction symptoms.

Other Meds: Ezetimibe, Rosuvastatin, Advair, Citalopram40 mg for sleep,Natures Way Once daily Womens Vitamin Supplement.

Current Illness: none

ID: 0992136
Sex: F
Age: 70
State: OH

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: morphine compazine

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

Symptoms: fever, chills, severe muscle aches, severe migraine head ache, nausea lasting from 3 hours after injection until 36 hours later

Other Meds: omeprazole 40mg, folic acid 1mg, propanol 10mg, low dose aspirin , calcium 600mg, vitamin d 50 mcg,

Current Illness:

Date Died: 01/31/2021

ID: 0992137
Sex: M
Age: 74
State: SC

Vax Date: 01/19/2021
Onset Date: 01/25/2021
Rec V Date: 02/01/2021
Hospital: Y

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

Symptoms: 6 days after vaccine developed bloody diarrhea. Thought to have ischemic colitis but negative evaluation. became hypotensive bradycardic placed on ventilator. Subsequently was poorly responsive and eventually coded once more and succumbed

Other Meds: oxymorphone ,mertazapine,medical marijuana , duloxetine , lisinopril , monolucast, hydocortisone, simvastatin amlodipine famotidine

Current Illness:

ID: 0992138
Sex: F
Age: 47
State: AZ

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

Symptom List: Vomiting

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 0992139
Sex: M
Age: 75
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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Hydrocodone

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Increase in anger and agitation. He is unable to tell us what is wrong, but it occurred the day after the vaccine was administered. Not acting like himself.

Other Meds: Atorvastatin Calcium 10mg daily; Carvedilol 3.125mg BID;

Current Illness: none

ID: 0992140
Sex: F
Age: 60
State: GA

Vax Date: 01/29/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Chills, low grade fever, headache, stomach ache, muscle pain

Other Meds: 2.5 mg letrozole 20 mg doxycycline Centrum Silver for women 100 mg Spironolactone 4 mg chlorpheniramine maleate

Current Illness: None

ID: 0992141
Sex: F
Age: 56
State: MO

Vax Date: 01/18/2021
Onset Date: 01/21/2021
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: petechiae bilateral lower legs

Other Meds: levothyroxine, duloxetine, MVI, vit D, calcium, tylenol, benadryl, ibuprofen

Current Illness: n/a

ID: 0992142
Sex: F
Age: 87
State: WI

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

Lab Data:

Allergies: Latex (Environmental)PRURITUS, Other (See Comments) PenicillinsRASH TalcRASH

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

Symptoms: After receiving vaccine (within 30 minutes), pt presented with diaphoresis and palpitations. Rapid response was called and pt was sent to emergency room for further workup.

Other Meds: potassium chloride (KLOR-CON) 10 MEQ ER tablet furosemide (LASIX) 40 MG tablet metoPROLOL succinate (TOPROL-XL) 100 MG 24 hr tablet atorvastatin (LIPITOR) 40 MG tablet omeprazole (PriLOSEC) 40 MG capsule blood glucose meter bloo

Current Illness: Unknown

ID: 0992143
Sex: F
Age: 53
State: WI

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: IM
Vax Site: RA

Lab Data:

Allergies: SULFA

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

Symptoms: GOT EXTREME CHILLS, FEVER AND BODY ACHES FOR A GOOD 30 HOURS AFTER THE VACCINE.

Other Meds: MULTIVITAMIN, CITOLOPRAM, OMEPROZOL

Current Illness: NONE

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm