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: 1002162
Sex: F
Age: 54
State: CA

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: fever headache pain down neck, shoulders and down to elbow couldn't lift arm

Other Meds:

Current Illness:

ID: 1002163
Sex: F
Age: 54
State: MO

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
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

Symptom List: Anxiety, Dyspnoea

Symptoms: Approximately 30 minutes after receiving the vaccine, she started feeling itchy, began developing a rash on her face, arms and trunk. Her lips started swelling and were tingly.

Other Meds: Vitamin D

Current Illness: None

ID: 1002164
Sex: F
Age: 72
State: AR

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/04/2021
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: IV Contrast Dye, aspirin

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

Symptoms: Patient received vaccine at approximately 9:30am. Around 9:40am patient stood up and complained of feeling nauseous and very hot. Patient asked to step outside to get some fresh, cool area. Patient stayed outside for approximately 5 minutes, returned inside and said she was feeling better. Out of precaution, during the remaining minutes on her 15 minute timer, we administered 25mg po liquid diphenhydramine. Patient remained seated for about 5 minutes and then complained of feeling even more nauseated and faint than before. We laid the patient down into the recovery position. No improvement in symptoms. Then administered 10mg IM of dexamethasone. Patient showed no signs of improvement nor worsening of symptoms. Administed 1 epipen into left outer thigh. Patient within 3 minutes began to feel better but chose to remain laying on the ground. EMS was called at 9:50am and were on scene to further evaluate patient at 9:58am. Patient was alert, responding, and reported feeling better. Moved to sitting position. Vitals were taken, Pulse of 77bmp, O2 Saturation of 100%, BP of 113/72. Vital signs were within normal limits. Patient had regained color in her face and her response to stimuli was back to normal when EMS were on scene.

Other Meds: Unknown

Current Illness: None

ID: 1002165
Sex: F
Age: 79
State: GA

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: PCN-rash

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pifizer BioNTech COVID-19 vaccine administered at 9:19am. At 0930 patient reports feeling lightheaded. Vital signs taken x3 -WNL. Patient given water. After 20 minutes client reports feeling dizzy, but wants to leave. AMA paper signed, left at 0956. Vital signs: 0938 BP 168/68, HR 62 RES 20 02 SAT 97% 0943 BP 158/73, HR 68, RES 20, 02 SAT 96% 0948 BP 152/73, HR 69, RES 20 02 SAT 97%

Other Meds: lisinopril

Current Illness: none

ID: 1002166
Sex: F
Age: 49
State: IN

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: Pcn, dilaudid

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

Symptoms: Chills and bodyache started first early the next morning. Fever of 101.5 started that evening lasting about 12 hours. Headache the whole time. Took Tylenol

Other Meds: Prilosec 40mg once a day

Current Illness: None

ID: 1002167
Sex: M
Age: 65
State: CA

Vax Date: 01/30/2021
Onset Date: 02/01/2021
Rec V Date: 02/04/2021
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: Pain in back, left arm, 8/10 pain, 10 being worst. Nausea, Dizziness, Fast heartbeat.

Other Meds: Atorastatin, Ibuprofen

Current Illness: None

ID: 1002168
Sex: F
Age: 31
State: CT

Vax Date: 01/10/2021
Onset Date: 02/02/2021
Rec V Date: 02/04/2021
Hospital: Y

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: 2nd pregnancy, at date of first dose (1/10/2021), 12 weeks 3 days gestation. on 2/2/2021 patient developed light vaginal bleeding. Ultrasound exam revealed no fetal heartbeat. Measurements showed gestational size 14 weeks 1 day (1/22/2021).

Other Meds: Magnesium, vit d, prenatal vitamin, vit c

Current Illness: None

ID: 1002169
Sex: F
Age: 49
State: OK

Vax Date: 01/30/2021
Onset Date: 01/31/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Reports waking around 2am 1/31/21 with extreme chills, fever 102. About 5 am chills continue with severe headache, body aches and joint pain. Same severity of symptoms persisted on 2/1/21, symptoms lessened on 2/2/21. Injection site with erythema, induration and warmth.

Other Meds:

Current Illness:

ID: 1002170
Sex: F
Age: 52
State: MD

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: mild allergy to soy, corn allergy to tylenol - tongue and facial swelling (but not in throat, so no issues with breathing)

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 2/2 10:30pm - extremely cold. hands and feet were like ice. 7 blankets to get warm. 3mg of melatonin. 2/3 2:30am - became hot and achy. hard to sleep. took another 3mg of melatonin. fell back to sleep a little after 4am 2/3 9:15am - woke. achy all day. continued to be hot and cold. extreme fatigue. slept much of the day. 2/3 8pm - headache began. took 40mg of Relpax and 6mg of melatonin. no other medication was taken 2/4 - felt much better.

Other Meds: possibly 3mg of melatonin the night before

Current Illness: none

ID: 1002171
Sex: F
Age: 41
State: MN

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
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: Iodine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Client presented for 1st dose of Pfizer Covid Vaccine. Patient's history was reviewed indicating history of anaphylaxis to iodine. 30 minutes after vaccination, client reported she had numbness of her tongue (anterior 1/3), some numbness of her lower cheeks/jaw. No difficulty breathing. BP120/85; HR 80. After a few minutes was reassessed and vitals were unchanged. Client felt anxious. No rashes, no breathing issues but continued anxiety and symptoms of numbness continued. 911 called. EMS assessed and vitals unchanged. Numbness lessened to just tip of tongue. Normal speech. EMS did not transport and father arrived to pick her up at 12:15 pm.

Other Meds: Unknown

Current Illness: Unknown

ID: 1002172
Sex: F
Age: 47
State: ME

Vax Date: 01/23/2021
Onset Date: 01/31/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: Hydrocodone Taxol Emend

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

Symptoms: On Day 2 the injection site was sore and itchy. On day 8 I woke with itching at the injection site, redness and a large lump. As the day progressed the itching got worse and the lump got bigger. By the end of the day the lump was the size of my palm and warm to the touch. I was concerned about it being cellulitis. The next morning the lump had mostly resolved with minimal itching. The arm is achy from time to time now.

Other Meds: Ibuprofen

Current Illness: None

ID: 1002173
Sex: F
Age: 55
State: CT

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/04/2021
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 known

Symptom List: Rash, Urticaria

Symptoms: I got my first Covid19 shot (Pfizer) at noontime on Wednesday January 27, 2021 12 hours later, about 12pm I start having side effect: Left Arm sore, hurt to lift (arm that was injected) Farting up a storm in my sleep Wednesday night, waking me up constantly, horrible weird smell, my poor husband, I moved to the couch and stunk up the first floor. Then diarrhea few hours later, about 4am, slight intestinal cramps, not bad. I was able to get ready and go to work for 6am. On Thursday January 28 Farting was over, thank goodness. As the morning went on I felt like I did when I originally had the Covid19 in May. I had to leave work at 10:30am due to: aches every where in body Especially neck hurt My left arm hard to lift or use (injection was in left arm), hard to think and concentrate (brain fog), chills Able to eat some soup Slept several hours at home, felt slightly better, than slept nine hours that night On Friday January 29th felt much better and arm hurt less to lift it. On Saturday January 30th Under my arm, glands are swollen and hurt to touch. All other symptoms have subsided Sunday January 31, glands under arm are better, much less sore Monday February 1st glands under arm, back to normal

Other Meds: Losartan 100mg , euthyox 88mg, hydrochlorothiazide 12.5mg

Current Illness: None

ID: 1002174
Sex: M
Age: 55
State: PA

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: PCN

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

Symptoms: Urticaria and pruritus of both hands and wrists. Denies dyspnea, chest pain, rhinorrhea, nausea, and dizziness.

Other Meds: Albuterol, Mometasone Furoate, Omeprazole, Triamcinolone

Current Illness: None

ID: 1002175
Sex: F
Age: 60
State: WA

Vax Date: 01/23/2021
Onset Date: 01/31/2021
Rec V Date: 02/04/2021
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: penicillin

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

Symptoms: rash - itching and redness on the arm where the vaccine was given, 1 week later treated with small amounts of benedryl, ice it comes and goes

Other Meds: atenelol, daily vitamin, vitamin D3, cranberry, vitamin C, probiotic

Current Illness: none

ID: 1002176
Sex: M
Age: 40
State: WI

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Tenderness at the site of injection, fever, chills, and headache. All signs and symptoms started about 6 hours after receiving vaccine and lasted about 18 hours. Felt back to baseline after 36 hours. Took ibuprophen 400 mg (morning of the 2/3 and evening of 2/3) for headache with relief and took Nyquil (night of 2/2) for chills and to help sleep with minimal relief. Symptoms were sever enough that I donot feel like I would have been able to go to work that day.

Other Meds: Chantix, Ibuprophen

Current Illness: None

ID: 1002177
Sex: F
Age: 36
State:

Vax Date: 01/22/2021
Onset Date: 01/29/2021
Rec V Date: 02/04/2021
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: NKA

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

Symptoms: Received 1st dose of Moderna vaccine on 01/22/21. On 01/29/21, noticed area of redness immediately inferior to injection site (Left upper arm). On 01/31/21, developed pruritic maculopapular rash primarily at bilateral upper arms, at area immediately inferior to injection site, inguinal areas, popliteal fossas, and milder across abdomen. Denies any other known potential causes.

Other Meds: none

Current Illness: none

ID: 1002178
Sex: F
Age: 66
State: WA

Vax Date: 01/08/2021
Onset Date: 01/10/2021
Rec V Date: 02/04/2021
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: Penicillin, Codeine

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

Symptoms: 7:00 PM onset of chills and fairly severe body aches - concentrated in lower back and hips. Went to bed early - slept to 8:00 PM. Woke up so got up to take evening meds and brush teeth. Had vertigo and moderate nausea. While brushing teeth, I fainted. Came around quickly - was on bathroom floor. Took only one of my medications - the one to prevent migraines and went back to bed. Continued with body aches and chills on and off through the night. In the morning I had worsened vertigo and nausea, but this is typical of my vestibular migraines and I think that was what was going on. I called in sick to work, took one of my pills for treating migraines and basically slept all day. I do not get migraines often - usually

Other Meds: Daily RX: Lisinopril, Levothyroxin, Topiramate, Mirtapine,

Current Illness:

ID: 1002179
Sex: F
Age: 59
State: CA

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
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: I was given the shot too early. My first shot was on 01/15/2021 and I received my second shot on 02/02/2021. I have since learned they need to be given 28 day apart with a four day window either way. When I was alerted by email that I could sign up for my second shot, I took the soonest slot I could get in fear of the county running out of vaccinations. There should have been some kind of default set up so that I was not able to sign up for the vaccine too early. Accounting for the four day window, I got the shot 6 days too soon. Will my vaccines work due to the fact that I received the second too early?

Other Meds:

Current Illness:

ID: 1002180
Sex: F
Age: 51
State:

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 100.6 temp Body aches Joint pain Headache No sleep

Other Meds:

Current Illness:

ID: 1002181
Sex: F
Age: 21
State: IN

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: penicillins

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

Symptoms: sore arm subsequent to vaccine; about 12 hours later chills began with no fever, fever developed around 14 hours after ad did vomiting and hypertension (160/100); tylenol relieved symptoms. Headache upon waking about 24 hours after but no fever. Nausea/heartburn continued for next 12 hours but relieved by antacid.

Other Meds: tylenol, doxycycline

Current Illness: none

ID: 1002182
Sex: F
Age: 30
State: PA

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 02/04/2021
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: Latex Amoxicillin

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

Symptoms: Rash at injection site, redness swelling and itch. Swelling decreased but redness remains 14 days after injection.

Other Meds: Metformin Levothyroxine Escitalopram

Current Illness: None

ID: 1002183
Sex: F
Age: 24
State: IN

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: Shrimp and dust mites

Symptom List: Unevaluable event

Symptoms: sore at the injection site, body ache(11am-01am) and fever (100.4 F, 6pm-9pm)

Other Meds: Naproxen 500mg as needed cetrizine 10mg/day

Current Illness: Hives

ID: 1002184
Sex: U
Age: 74
State: DC

Vax Date: 01/16/2021
Onset Date: 01/23/2021
Rec V Date: 02/04/2021
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: none

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

Symptoms: One week after injection itchy rash developed about 2" below injection spot. Over the next 24 hours rash grew to about 4" lone and 2" wide.

Other Meds: synthroid, olemesartin, calcium. vitamin D atorvastatin

Current Illness: none

ID: 1002185
Sex: F
Age: 56
State: TX

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
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: fever, body aches

Other Meds: Spironolactone, Vitamin C, Vitamin E, Zertec

Current Illness: Covid 1/19/21

ID: 1002186
Sex: U
Age: 29
State: MA

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: Regalin, Darvocet

Symptom List: Injection site pain, Menorrhagia

Symptoms: 1116 - c/o throat tightness, given Benadryl 25mg PO, VS 139/85, 104, 95, 18 1120 - VS 125/78, 98, 96, throat tightness improving at this time 1131 - talking, laughing VS 131/76, 97, 96, 16 1139 - VS 125/76, 94, 96, 16, No SOB observed 1148 - VS 120/80, 89, 97, 16, No acute distress noted 1151 - D/C to home. NAD observed.

Other Meds: IUD, Cymbalta, Trazodone

Current Illness: none

Date Died: 02/03/2021

ID: 1002187
Sex: M
Age: 77
State: TN

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
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:

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

Symptoms: PATIENT WAS IN CLINIC FOR 1ST CLINIC. WAS DISCHARGED BEFORE OUR 2ND CLINIC. HE CAME BACK TO OBTAIN HIS 2ND SHOT. WE WENT OUT TO THE CAR GAVE SHOT. THE NEXT DAY TO MY KNOWLEDGE, HE STARTED CODING AT HOME. AMBULANCE WAS CALLED AND HE CONTINUED TO CODE. THE AMBULANCE CREW TRIED CPR FOR 30 MINS WITH NO LUCK. PATIENT PASSED 2-3-21.

Other Meds:

Current Illness:

ID: 1002188
Sex: F
Age: 39
State: TX

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/04/2021
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: Sulfa drugs

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fever starting the night I received the vaccine with stong chills and body aches. Fever the next day that spiked to 101.5 degrees accompanied by chills and body aches. Treated with Tylenol. No further fever starting on 1/30/2021. Swelling, redness, and soreness on left arm around injection site. This subsided 2/2/2021.

Other Meds:

Current Illness:

ID: 1002189
Sex: F
Age: 69
State: WV

Vax Date: 01/21/2021
Onset Date: 01/29/2021
Rec V Date: 02/04/2021
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: I had a red rash on my arm that appeared about 8 days after I had the first vaccine. It was itchy and warm to the touch. It was about 2 inches high and wide. It lasted about 48 hours. No other adverse affects. I read in a magazine that the "COVID arm" rash was "annoying but harmless" so I didn't worry about it. I told the woman who vaccinated me about it, and she suggested that I report it.

Other Meds: Lisinopril 2.5 mg,, multivitamin gummy, magnesium citrate gummy, Vitamin D3, fish oil

Current Illness: None

ID: 1002191
Sex: F
Age: 62
State: IN

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
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: Cefzil, flu shot, corn

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

Symptoms: Sore Arm, cold chills, night sweats, extreme tiredness, joint pain, sore throat I took Tylenol and went to bed

Other Meds: levothyroxine, losartan, fluticasone, multivitamin, Vitamin B2

Current Illness: None

ID: 1002192
Sex: F
Age: 56
State: IN

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/04/2021
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; wheat Do not eat bananas; avocados; or mangoes Due to latex allergy

Symptom List: Nausea

Symptoms: Site of injection became sore upon injection Increased and painful soreness within 4 hours with other muscular involvement at shoulder and elbow joint? nerve and pain of forearm and hand by 2am 4/3/21?severe

Other Meds: Vitamin D

Current Illness: None

ID: 1002193
Sex: F
Age: 59
State: CT

Vax Date: 01/20/2021
Onset Date: 01/26/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin, Mollusks, Bee venom

Symptom List: Injection site pain

Symptoms: Immediately after gettint the injection on 1/20/21, I had typical response: muscle was sore x 2 days then nothing unusual. I awoke six days after the injection (1/26/21 feeling anxious, agitated, distracted. Poor appetite throughout the day. Later iin evening, I felt something a lot like a hot flash, I felt my face flusing, followed by hives on my chest and abdoman. The left deltoid muscle started to itch incessantly, and the deltoid muscle began to swell. A hard nodule at the injection site formed, initially the size of an m&m. It grew to the size of a golf ball, then to the size of a tennis ball over the next two days. It resolved on it's own over the next week.

Other Meds: Vitmains B, C, Ca+, Cranberry, D, E, Fish Oil, Glucosamine, Lysine, Mg+, Probiotic, Zn+

Current Illness: None

ID: 1002194
Sex: F
Age: 23
State: IA

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: allergy to sulfa latex and bee stings has used epi pen for bee sting 2013

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

Symptoms: shortness of breath. tingling in hands and lips hyperventilation. states similar to prior vaso vagal episodes that are triggered by stress

Other Meds: vitamins

Current Illness:

ID: 1002195
Sex: F
Age: 73
State: FL

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/04/2021
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: Wasp stings, erythromycin

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

Symptoms: Chills-overnight, pain and redness (3 inches) presently continues, headache-2 days, dizziness-2 days.

Other Meds: Ipratroprium bromide, Gabapentin, Esomeprazole, Multi, Magnesium Glycinate, COQ10, Fish Oil, Fiber, Trazodone

Current Illness:

ID: 1002196
Sex: F
Age: 29
State: IN

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/04/2021
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: None

Symptom List: Tremor

Symptoms: Chills, headache, whole body aches, nausea

Other Meds: Lexapro, prenatal vitamin, vitamin D3, probiotic

Current Illness:

ID: 1002197
Sex: F
Age: 72
State: AL

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/04/2021
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: PABA, bermuda grass/pollen, Insects, mold, erythromycin

Symptom List: Erythema, Pruritus

Symptoms: -Swelling and rash to injection site and face -Facial flushing -Bumps around injection sites -Injection site soreness

Other Meds:

Current Illness: None

ID: 1002198
Sex: F
Age: 86
State: VA

Vax Date: 01/20/2021
Onset Date: 01/31/2021
Rec V Date: 02/04/2021
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: unknown

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

Symptoms: Approximately 10 days post vaccination-Pink Large itchy area on left arm at vaccine injection site, clients reports slight swollen, raised 5 inches in length. No other symptom presents. advised to follow up with PCP and report any worsening symptoms.

Other Meds: unknown

Current Illness: unknown

ID: 1002199
Sex: F
Age: 38
State: NY

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 02/04/2021
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:

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

Symptoms: 1/6/21 Chills, body aches, fever101, headache and nausea that last about 48hours

Other Meds:

Current Illness:

ID: 1002200
Sex: F
Age: 52
State: WV

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/04/2021
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: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient initially received her first dose of Pfizer on 01/14/2021, lot number EK4176. Patient received her follow up vaccination today, which was provided as the Moderna dose, lot number identified above.

Other Meds: n/a

Current Illness: none

ID: 1002201
Sex: M
Age: 77
State: MD

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 02/04/2021
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: None

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

Symptoms: pt had rash from thigh up to waist. itching. He took a bath in the evening and had rash after that. He took one dose of Benadryl and got better

Other Meds: Benadryl 25mg for 2 times

Current Illness: None

ID: 1002202
Sex: M
Age: 72
State: WA

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
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: PENICILLIN

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

Symptoms: PATIENT SAID HE FELT LIKE FAINTING SENSATION FOR A FEW SECONDS AND TINGLING SENSATION IN HIS ARM FOR A FEW SECONDS. HE SAID HE WAS FINE AFTER THOSE FEW SECONDS.

Other Meds: SILDENAFIL

Current Illness: none

ID: 1002203
Sex: F
Age: 52
State: IN

Vax Date: 01/01/2021
Onset Date: 02/04/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Pain in extremity

Symptoms: Pain in right armpit unresolved

Other Meds: Iron Vitamin c

Current Illness:

ID: 1002204
Sex: M
Age: 46
State: OH

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/04/2021
Hospital:

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

Lab Data:

Allergies: Pcn, lactose intolerant, Heinz ketchup

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

Symptoms: Elevated BP 176/108 , shakiness, didn?t ?feel right?, several episodes of vomiting.

Other Meds: Lisinopril/hctz doxycycline

Current Illness: Covid diagnoses 2 weeks prior

ID: 1002205
Sex: F
Age: 27
State: KY

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/04/2021
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: Abx: keflex, clindamycine, Bactrum

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

Symptoms: Body aches ( lower leg pain) Chills Weak Mild Headache

Other Meds: Ibuprofen 800mg

Current Illness: Headache / migraine

ID: 1002206
Sex: F
Age: 54
State: HI

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/04/2021
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: NSAIDs, Benadryl, Zyrtec

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

Symptoms: 11:30 participant received vaccine; 12:10 pm she stated her tongue had a metallic taste and she felt lightheaded (stated symptoms started at 11:45 am. Vitals @12:15: BP 140/70, HR 80, RR 16, Temp 97.7F. Offered her bottled water. 12:30 pm stated she felt better Vitals: BP 140/70, HR 60, RR16, temp 97.5F, lungs CTA. Balanced gait. Conferred with EMS who stated that they are comfortable releasing her.

Other Meds: Elderberry

Current Illness:

ID: 1002207
Sex: F
Age: 52
State: CA

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/04/2021
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: chill body aches almost fainted in the bath tub

Other Meds:

Current Illness:

ID: 1002208
Sex: F
Age: 50
State: MD

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 02/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Starting the evening of the vaccine, the patient experienced fever, chills and body aches.

Other Meds:

Current Illness:

ID: 1002209
Sex: F
Age: 50
State: CA

Vax Date: 01/22/2021
Onset Date: 01/29/2021
Rec V Date: 02/04/2021
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: Raised rash bumps, particularly on extremities, mostly found on finger joints, elbows, knees , and to area of injection. Symptoms occurred approximately 1 week after vaccination

Other Meds: None

Current Illness: None

ID: 1002210
Sex: F
Age: 44
State: WI

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 02/04/2021
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: Allergic to Penicillen

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Within 5 minutes, I felt weird and light headed. My blood pressure spiked, temperature spiked to 101, heart rate was elevated and continued to be elevated for about 12 hours, and there was a rash across my chest and upper arms. On 1/14, I was extremely tired. On 1/15, I had a sore throat, headache, and still slightly tired. As the days went on, the cold symptoms got progressive worse. Extremely congested, runny nose, extremely painful headache, coughing up pflegm, sore throat, etc. On Wednesday, 1/20 I had a fever of 101. I had these cold symptoms for a week and a half and that was when I called my doctor. She gave me an antibiotic. I was on the antibiotic 1/26 - 1/30. Today is 2/4 and I'm still coughing. Something weird also happened, smells changed. My coffee smelled awful and other things seemed extremely strong.

Other Meds: Deblitane 0.35 Mg Women's One a Day Multivitamin

Current Illness: None

ID: 1002211
Sex: F
Age: 32
State: NJ

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
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: Tiredness, headache, muscle pain, chills, fever, body aches, injection site swelling, feeling unwell.

Other Meds:

Current Illness:

ID: 1002212
Sex: F
Age: 81
State: AZ

Vax Date: 01/31/2021
Onset Date: 02/02/2021
Rec V Date: 02/04/2021
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: None

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

Symptoms: 3 hours of Vomiting and Diarrhea for aprox 48 hours

Other Meds: Valstartin, glucosamine hci, Metoprolo, Levothyroxine, Lioythyronone, Simvastatin, adult asprin,

Current Illness: NONE

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm