VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 1002048
Sex: F
Age: 27
State: MI

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

Lab Data:

Allergies: none

Symptoms: Moderna COVID-19 Vaccine EUA Around 3am on 2/3/21 had nausea, body aches, headache, fluctuating body temperature (fever unknown). Pain at injection site started a few hours after administration and increased in severity, but still mild as of now 2/4/21. Noticed swelling at injection site sometime 2/3/21. Nausea subsided late morning/early afternoon 2/3/21, with headache, body aches, fluctuating body temperature lasting until approximately 12am 2/4/21. No medical treatment was sought, no otc medications taken, only rested.

Other Meds: Pimtrea birth control, women's multivitamin, probiotic, fluoxetine 20mg

Current Illness: none

ID: 1002049
Sex: F
Age: 34
State: MS

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

Lab Data: none

Allergies: Uristat

Symptoms: Severe chills and shaking, fever up to 101.8. Started at 1130pm took ibuprofen at 0230am and rotated tylenol and ibuprofen every 4 hours no other issues

Other Meds: MVT, Zoloft 100mg

Current Illness: none

ID: 1002050
Sex: U
Age:
State: MD

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

Lab Data:

Allergies:

Symptoms: patient received the fisrt dose at 14 years old / The patient is now 22 and did not complete the series of vaccinations / patient wants to continue vaccination; No additional AE; This spontaneous report was received from a nurse practitioner, referring to a 22 year old patient of unknown gender. The patient's historical drugs, medical history, concomitant therapies and concurrent conditions were not reported. On an unknown date, the 14 year old patient was vaccinated with HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast) (GARDASIL 9) 0.5 ml, for prophylaxis (strength, route, frequency, lot# and expiration date were not reported). At the time of reporting, the patient was 22 year old and did not complete the series of vaccinations. The patient wanted to continue with vaccination. No additional information provided.

Other Meds:

Current Illness:

ID: 1002051
Sex: F
Age: 36
State: ND

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

Lab Data: None

Allergies: ibuprofen

Symptoms: Pregnancy = 16 weeks EDD: 7/15/21 Swollen axillary node on 2/2/21- still present on 2/4. Developed 2x2 area of erythema at injection site on 2/4/21

Other Meds: ondansetron, famotidine, prenatal vitamin, calcium, albuterol, Zyrtec, Symbicort, escitalopram, fluticasone nasal spray, singulair

Current Illness: None

Date Died: 01/20/2021

ID: 1002052
Sex: F
Age:
State: OH

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Passed away yesterday, found deceased in her apartment; This spontaneous report was received from a consumer which refers to a 91-year-old female patient who received the Moderna COVID-19 vaccine (mRNA-1273) and next day the patient passed away. The patient's medical history was not provided. Concomitant medications were not reported. On 19 Jan 2021, the patient received her first of two planned doses of mRNA-1273 intramuscularly (Lot number: not provided) for prophylaxis of COVID-19 infection. On 20 Jan 2021, the patient passed away and she was found deceased in her apartment. No treatment medication was provided. Action taken with mRNA-1273 in response to the events was not applicable as the patient passed away. On 20 Jan 2021, the patient died, cause of death was unknown. Autopsy result was unknown. The reporter assessed the causality as related between the event and Moderna COVID-19 vaccine.; Reporter's Comments: This case concerns a 91-year old female patient. The medical history and concomitant medication is not provided. The patient experienced Death. The event occurred approximately one day after receiving their first of two planned doses of mRNA-1273 (Lot unknown). Very limited information regarding this event has been provided at this time. Based on temporal association between the use of the product and the onset of the event, a causal relationship cannot be excluded and the event is considered possibly related to the vaccine.; Reported Cause(s) of Death: Unknown Cause of Death

Other Meds:

Current Illness:

ID: 1002053
Sex: U
Age:
State: KY

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

Lab Data:

Allergies:

Symptoms: UTI; A spontaneous report was received from a consumer (Unknown age and gender) who received Moderna's COVID-19 vaccine and experienced urinary tract infection (UTI). The patient's medical history was not provided. No relevant concomitant medications were reported. In Jan 2021 prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On Unknown date, she experienced Urinary tract infection. Treatment: HCP provided antibiotics. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The outcome for the event UTI is Unknown.; Reporter's Comments: This case concerns a patient, who experienced a serious unexpected event of urinary tract infection. The event of urinary tract infection occurred on an unspecified date after first dose of mRNA-1273, lot # unknown. Treatment included antibiotics (not specified). Based on the current available information and temporal association between the use of the product and onset of the events a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1002054
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: Diabetic ketoacidosis; A spontaneous report was received from a physician concerning a unknown patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced diabetic ketoacidosis. There was no medical history provided. Concomitant medication included ixekizumab for unknown indication. On an unspecified date, the patient received her first of two planned doses of mRNA-1273 (Batch # unknown) intramuscularly, for prophylaxis of COVID-19 infection. On an unspecified date, the patient experienced diabetic ketoacidosis. The patient was sent to intensive care unit (ICU) and the ICU physician determined, event may have been cause by a combination of the vaccine and concomitant mediation. The patient was treated for diabetic ketoacidosis at the ICU. The patient was better at the time of this report and physician wanted more information prior to second dose. It was not confirmed if the patient was still hospitalized at the time of this report. Action taken with mRNA-1273 in response to the event diabetic ketoacidosis was not provided. The outcome for the event diabetic ketoacidosis was unknown. The reporter causality assessed as probably related between the event and Moderna's COVID-19 vaccine.; Reporter's Comments: This case concerns a patient, who experienced event of diabetic ketoacidosis. The event occurred on an unknown date after the first and last dose of mRNA-1273 vaccine administration. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded and the event is assessed as possibly related. Concomitant medication ixekizumab is a confounding factor. Further information have been requested.

Other Meds: TALTZ

Current Illness:

ID: 1002055
Sex: M
Age: 50
State: AZ

Vax Date: 01/14/2021
Onset Date: 01/31/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: CPK 5070 U/L (normal range <308 U/L) on Feb 3, 2021.

Allergies: NKDA

Symptoms: Rhabdomyolysis, CPK 5070 U/L (normal range <308 U/L) on Feb 3, 2021. Diffuse sore muscles after extreme work out on both 1/30 & 1/31.

Other Meds: Interferon alpha-2b subcutaneous 250mcg q14days. Aspirin 81 mg po daily

Current Illness: None

ID: 1002056
Sex: F
Age: 44
State: CO

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

Lab Data:

Allergies:

Symptoms: Anaphylaxis reaction; Angioedema; Shortness of breath; Wheezing; Fast heart rate; A spontaneous report was received from a physician concerning a 44-year-old, female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced an anaphylaxis reaction, angioedema, shortness of breath, wheezing, and increased heart rate. The patient's medical history was not provided. No relevant concomitant medications were reported. On 20 Jan 2021 at 18:00, approximately 10 minutes prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 041L20A) intramuscularly for prophylaxis of COVID-19 infection. On 20 Jan 2021, approximately 10 minutes after receiving her injection, the patient began to have tongue swelling. She was given diphenhydramine and epinephrine by epi pen. She went to the emergency room where she displayed symptoms including a fast heart rate, wheezing, and shortness of breath with an angioedema or anaphylaxis like appearance. She was given more epinephrine, famotidine, scheduled diphenhydramine at 50 QAs intravenously (IV), IV steroids, was intubated and placed on a ventilator. She was on the ventilator for approximately 18-20 hours following admission. She eventually responded to a high dose of dexamethasone. She was also given duonebs for her shortness of breath, regular sedation for the ventilator, and a dose of ketorolac. Consent was given for Safety to follow up. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the events were unknown at the time of this report.; Reporter's Comments: This case concerns a 44 year old female patient who experienced a serious unexpected event of Anaphylactic reaction. The event occurred approximately 10 minutes after first dose of the study medication administration. She was treated with epinephrine, famotidine, diphenhydramine, IV steroids, intubated and placed on a ventilator. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

Date Died: 02/04/2021

ID: 1002057
Sex: F
Age: 80
State: CA

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

Lab Data: None

Allergies: Baclofen, Sulfa antibiotic

Symptoms: Sudden death

Other Meds: Percocet 5/325 mg, Vitamin B12, Ventolin HFA, Amiodarone, Apixaban, Atorvastatin, Carvedilol, Iron sulfate, Lasix, Gabapentin, Insulin Glargine, Insulin Lispro, Levothyroxine, Lidocaine patch, Protonix, Sertraline,

Current Illness: 1) Deconditioning 2) Osteoporosis with acute T4 compression fracture from coughing in 12/15/20 3) Chest wall pain 4) Anemia due to GI bleed 5) HTN 6) DM 2 7) HFrEF 8) Hyperlipidemia 9) Paroxysmal atrial fibrillation 10) PVD 11) CAD 12) Aortic stenosis 13) Hypothyroidism 14) Anxiety disorder

ID: 1002058
Sex: F
Age: 26
State: MN

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

Lab Data: Unknown

Allergies: None Listed

Symptoms: Client received Moderna vaccine at about 2:45 pm. At 3:04 observed to be vomiting. Reported headache, feeling weak and nauseated. Pulse 100. BP 80 (systolic). Had client lie down on floor with feet up on chair. After 30 minutes BP improved to 120 (systolic). Sat on chair and BP held with systolic of 120. Drank juice and vomited a small amount after that. After 15 minutes drank 6 oz juice, ate crackers, no nausea reported, headache eased. Felt clear and able to leave at 4:15 pm. Able to state medical resources she could contact if symptoms returned.

Other Meds: Unknown

Current Illness: Unknown

ID: 1002059
Sex: F
Age: 60
State: LA

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

Lab Data:

Allergies: Red Dye, Sulfa medications,

Symptoms: Patient states felt skin was burning on eczema rash. She had a previous ruptured aneurysm in brain, and she stated she felt piercing pain in her ears for a few hours. She also experienced back pain. She has called her physician and is waiting for a return call. She stated she felt better today.

Other Meds:

Current Illness:

ID: 1002060
Sex: M
Age: 68
State: FL

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

Lab Data:

Allergies: None

Symptoms: After 34 hours I now have a massive, stabbing headache. Do not get headaches ever.

Other Meds: Levine's, janumet, Plavix, sotalol, metformin.

Current Illness: None

ID: 1002061
Sex: M
Age: 48
State: WA

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

Lab Data: None

Allergies: Penicillin

Symptoms: Rapid Heart rate for about 30 seconds, rise in blood pressure

Other Meds: Vitamin C 1000mg, Vitamin B3, Multi Vitamin, Stool Softener, Losartan 50 Mg x2

Current Illness:

ID: 1002062
Sex: F
Age:
State: VA

Vax Date: 01/13/2021
Onset Date: 01/17/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Episode of atrial fibrillation; This is a spontaneous report from a contactable physician (patient). A 60-years-old female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number EK4176), via an unspecified route of administration at Left arm on 13Jan2021 09:15 at SINGLE DOSE for COVID-19 immunization. The patient was not pregnant. Medical history included scoliosis and depression. Concomitant medications in two weeks included duloxetine hydrochloride (CYMBALTA), estradiol/norethisterone acetate (COMBIPATCH). Historical vaccine included first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number, EH9899) received on 20Dec2020 05:00 PM at left arm for COVID-19 immunization. The patient previously took codeine and experienced drug allergies. The patient experienced episode of atrial fibrillation on 17Jan2021 at 05:45 AM. No treatment received, no COVID prior vaccination. The outcome of the event was unknown.; Sender's Comments: Based on a compatible temporal relationship, causality between event episode of atrial fibrillation and BNT162B2 vaccine cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.

Other Meds: CYMBALTA; COMBIPATCH

Current Illness:

ID: 1002063
Sex: M
Age: 71
State: FL

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

Lab Data: NONE

Allergies: NONE

Symptoms: ARM PAIN AT INJECTION SITE, LIGHT-HEADNESS, DRY-MOUTH, TIREDNESS/WEAKNESS.

Other Meds: SERTRALINE, MOEXPRIL, FLOWMAX, SYNTHROID,RYTHMOLL, REMERON

Current Illness: NONE

ID: 1002064
Sex: M
Age:
State: NY

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 02/04/2021
Hospital: Y

Lab Data: Test Date: 20210119; Test Name: Temperature; Result Unstructured Data: Test Result:Unknown result; Test Date: 20210119; Test Name: Heart rate; Result Unstructured Data: Test Result:Increased; Test Date: 20210120; Test Name: Checked everything; Result Unstructured Data: Test Result:All negative; Comments: went to the hospital and they checked everything and they were all negative

Allergies:

Symptoms: Increase heart rate; Very weak; Chills; A temperature; This is a spontaneous report from a contactable consumer (patient). A male patient of an unspecified age received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, batch/lot number and expiration date were unknown), via an unspecified route of administration on 19Jan2021 at single dose for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. The patient reported that he took the Pfizer vaccine on Tuesday 19Jan2021 and that same night he had a reaction. He had to go to the hospital on Wednesday/the next morning on 20Jan2021. He went to the hospital and they checked everything, and they were all negative. The patient reported that he had increase heart rate, chills, a temperature and very weak. While he was at the hospital, he saw a gentleman who works there who told him he took a vitamin combination/package before getting the vaccine and it helped him. The patient asked whether he can take it to prevent the side effects. The patient reported that it was his first vaccine with Pfizer and new he is going to get another one in 3 weeks, and the patient asked if there was anything he could take to help him as far as the after effects. The outcome of the events was unknown. Information about lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1002065
Sex: F
Age: 43
State: KS

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

Lab Data:

Allergies: Nuts, morphine, microbid, mucinex

Symptoms: Fever of 101 last 48+ Hours Swelling of lymph nodes 48+hours Body aches 48+hours Headaches 48+ hours

Other Meds: Tylenol ,multi-vitamin

Current Illness: Pneumonia

ID: 1002067
Sex: F
Age:
State: TX

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

Lab Data:

Allergies:

Symptoms: Guillain Barre syndrome; This is a spontaneous report from a contactable consumer. A female patient (sister) of an unspecified age received BNT162B2 (Pfizer-BioNTech Covid-19 vaccine) at a single dose on an unspecified date for Covid-19 immunization. The patient's medical history and concomitant medications were not reported. The patient had a very serious adverse event that now had Guillain Barre syndrome. She was hospitalized 6 days ago. The outcome of the event was unknown. Information on the Batch/Lot number has been requested.

Other Meds:

Current Illness:

ID: 1002068
Sex: F
Age:
State: GA

Vax Date: 01/12/2021
Onset Date: 01/01/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data:

Allergies:

Symptoms: left arm was blue from her shoulder to her elbow almost whole circumference going under arm /left arm discoloration is what she calls "puce", clarifying hers is a purple, black, and blue color; slight left arm swelling; left arm discomfort; This is a spontaneous report from a contactable nurse (patient). An 84-year-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number: EK9231, expiration date: Apr2021), via an unspecified route of administration in the left deltoid on 12Jan2021 14:45 at single dose for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. On Jan2021, her left arm was blue from her shoulder to her elbow and almost the whole circumference going under her arm. On Jan2021, she has a slight left arm swelling and left arm discomfort. The discomfort was bearable. The discoloration of her left arm has become bad. She was at the COVID-19 vaccine clinic, some nurses looked at her arm, and insisted she contact Pfizer and her doctor to report what happened to her arm. She has an appointment with her doctor the afternoon of 20Jan2021. Her second COVID-19 vaccine dose is scheduled on 02Feb2021. Her left arm swelling and discomfort is the same now, but her left arm discoloration is awful. Her left arm discoloration is the only change she has experienced since her first report. Her left arm discoloration is what she calls "puce", clarifying hers is a purple, black, and blue color. The discoloration of her left arm is uncanny. The discoloration stops before her left elbow like a completely straight line drawn by a ruler. The discoloration continues from her left elbow up to her left shoulder for which the discoloration spreads out unevenly. Outcome of the events was not recovered.; Sender's Comments: A possible contributory role of the suspect products cannot be excluded for the reported events based on the known safety profile and temporal association The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators as appropriate.

Other Meds:

Current Illness:

ID: 1002069
Sex: F
Age: 34
State: TX

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

Lab Data: None - I did not seek medical attention.

Allergies: None

Symptoms: I received my first dose of the Moderna COVID-19 vaccine at approximately 10:25AM on 2/2/21. By about 6PM that evening, I was running a low grade fever of 100.8F, had a headache, and my neck was abnormally stiff and painful on the left side. Throughout the night, my fever increased to 101.6F, my body aches and headache intensified, and my neck pain became so intense that I could no turn my head fully to the left. My throat was also very sore to the point where I could no longer speak normally. On 2/3/21, I was so ill that I missed work and slept most of the day, taking Tylenol and drinking water to ease my symptoms. Later in the afternoon of 2/3/21, I developed a productive cough with very thick, dark colored mucus discharge. By the morning of 2/4/21, I felt mostly better. The cough is still present along with the mucus, but the fever, body aches, headache, neck pain, and sore throat have stopped. The extreme fatigue I was feeling on 2/3/21 has also subsided.

Other Meds: Zoloft, 50mg, 1x/day

Current Illness: None

ID: 1002070
Sex: M
Age: 0
State: NY

Vax Date: 05/02/2017
Onset Date: 01/21/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: Test Date: 20210117; Test Name: a respiratory culture; Result Unstructured Data: the diagnosis of Haemophilus B was confirmed; Test Name: Haemophilus B; Test Result: Positive; Result Unstructured Data: positive for Haemophilus B Influenza

Allergies:

Symptoms: presented with thick runny nose; chronic inflammation of tonsils; positive for Haemophilus B Influenza and Haemophilus B confirmed by respiratory culture; positive for Haemophilus B Influenza; Initial information regarding an unsolicited valid serious case was received from another health professional (nurse) via Agency (Reference number- 00440310) and transmitted on 21-Jan-2021. This case is linked to case 2021SA032915. This case involves a 3-year-old male patient who was found positive for Haemophilus B influenza and presented with thick runny nose with chronic inflammation of tonsils (Haemophilus infection with symptoms of rhinorrhea and tonsillar inflammation), after he received PENTACEL. Medical history, medical treatment, vaccination and family history were not provided. List of concomitants were reported as no other vaccine. The patient received 4 doses of suspect of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE (1 dosage form, 0.5 mL, lot number: C5316AA, C5308AA, C5342AA and C5506AA, the expiration dates were unknown due to reporter not being able to access that information) via an intramuscular route at an unknown administration site on 02-MAY-2017, 22-JUN-2017, 17-OCT-2017 and 29-AUG-2018 respectively. (reported as: Immunization). On an unknown date, the patient presented with serious thick runny nose with chronic inflammation of tonsils (Rhinorrhea and Tonsillar inflammation) (unknown latency) following the administration of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE. On 17-Jan-2021, a respiratory culture was collected and on 21-Jan-2021, the diagnosis of Haemophilus B was confirmed as patient was found positive for Haemophilus B influenza (Haemophilus infection), 3 years 8 months 19 days following the administration of first dose, 3 years 6 months 30 days following the administration of second dose, 3 years 3 months 4 days following the administration of third dose and 2 years 4 months 23 days following the administration of fourth dose DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE. All the reported events were assessed as medically significant. This was also a case of vaccination failure (unknown latency) as the patient was positive for Haemophilus B influenza, despite being vaccinated with PENTACEL. Relevant laboratory test results included: Culture - On 17-Jan-2021: the diagnosis of Haemophilus B was confirmed Haemophilus test - On 17-Jan-2021: Positive [positive for Haemophilus B Influenza] The patient was treated with AMOXIL, but the patient was not responding then he was prescribed a CEFDINIR. At the time of reporting, the outcome was unknown for all the events. The reporter also wanted to know if vaccine was resistant to their strain of the virus and would like a call back as soon as possible. Sender's Comments: This case involves a 3-year-old male patient who presented Haemophilus infection with symptoms of rhinorrhea and tonsillar inflammation, after vaccination with PENTACEL. The time to onset is compatible with the Haemophilus infection and unknown with the other reported events. It was also a case of vaccination failure. A respiratory culture confirmed the diagnosis of Haemophilus B. However, no information regarding patient's condition at time of vaccination and immune status was provided. Based upon the reported information, the role of an individual vaccine and vaccination failure cannot be assessed.

Other Meds:

Current Illness:

ID: 1002071
Sex: F
Age: 60
State: OH

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

Lab Data:

Allergies: Shel fish

Symptoms: Tired soreness, fever, pins and needles skin sensation

Other Meds: Lansoprazole Potassium Ropinirole Venlafaxine levothyroxine vitamin d multi vitamin Calcium

Current Illness: None

ID: 1002072
Sex: F
Age: 52
State: CO

Vax Date: 01/23/2021
Onset Date: 01/26/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: During emergency department encounter: Complete blood count: within normal ranges except white blood cell count 3.5 x 10*9/L Serum electrolytes: within normal ranges

Allergies: codeine, sulfonamides, topiramate, valacyclovir, azithromycin, latex, pregabalin, gabapentin, dapsone

Symptoms: Moderna COVID- 19 Vaccine EUA: Three and four days after vaccination patient presented to the emergency department and primary care provider, respectively, for right upper arm inflammation, swelling, tenderness, warmth, pain, lymph node swelling, and erythema. Patient reported fever and chills initially soon after vaccination that resolved prior to right arm symptoms. Vital signs all within normal ranges. Patient diagnosed with cellulitis and prescribed antibiotics.

Other Meds: albuterol, amitriptyline, ascorbic acid, calcium carbonate, cholecalciferol, diazepam, domperidone, lisinopril, multivitamin, tizanidine, triamcinolone

Current Illness: asthma, vertigo, cholelithiasis, fibromyalgia, gastroesophageal reflux disease, gastroparesis, hypertension, migraines, hypersensitivity pneumonitis attributed to mold exposure

ID: 1002073
Sex: F
Age: 73
State: TX

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/04/2021
Hospital: Y

Lab Data: CT scan, MRI, TEE, EKG, blood work, PT/OT, Speech, neurology, and follow-up visit with Dr. Patient spent Saturday 1/30/21-2/2/21 in Hospital.

Allergies: Codeine Phosphate, Penicillin V Potassium, Sulfa

Symptoms: Extreme pain in L arm injection site immediately after injection, followed by extreme fatigue, constant L arm pain, ache in body, on Tuesday-Friday, Saturday felt weak and extremely nauseous, at 2:00 pm experienced a embolic stroke on the right side of the brain and paralysis on the left side of body, rushed to ER, administered TPA clot buster and had a removal of the clots by Dr.

Other Meds: MethylPrednisolone USP 4 mg (last day of dose pack), Spironolactone 50mg, Finesteride1mg, Zyrtec 10mg, Estradiol oral 1mg, rosubastatin 10mg, Tylenol, hydroxyzine 10 mg, biotin 1,000 mg, nasonex 50 mcg, Vitamin E 1,000, Vitamin D 2,000,

Current Illness: None.

ID: 1002074
Sex: F
Age: 55
State: MI

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

Lab Data:

Allergies: None

Symptoms: Projectile vomiting for 2 hours. Extreme diareah for 8 hours. Fever and chills over a duration of 24 hours.

Other Meds: None

Current Illness: None

ID: 1002075
Sex: F
Age: 32
State: GA

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 02/04/2021
Hospital:

Lab Data: No

Allergies: No

Symptoms: I had a 100.0 degree fever that lasted a few hours, fatigue.

Other Meds: I take Lamotrigine, Rosuvastatin Calcium, Fish Oil, Nexum, Claratin.

Current Illness: No

ID: 1002076
Sex: F
Age: 20
State: IN

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

Lab Data:

Allergies: None

Symptoms: Grogginess, sore arm, nausea, migraine

Other Meds: Biotin supplement, birth control, lexapro

Current Illness: Cold

ID: 1002077
Sex: F
Age: 84
State: AZ

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

Lab Data:

Allergies: Had a problem being able to take allergy injection and finally discontinued. Most allergic to grasses, weeds and flowers.

Symptoms: Sore arm, red injection site, itching, burning. Not as sore after about 48 hours but still red and hot injection site. Today is 02/04/2021 and arm is still red and a little itchy. and warm. This is 2 weeks later. No other side effects.

Other Meds: Xtampza ER 9mg, BupropionSR 200mg, metoprolol ER 50mg, Oxycodone 5mg, Oxycodone/acetamine5-25, Rosuvastin 10mg, Gabapentin600mg, Tylenol, Vitamin D

Current Illness: None

ID: 1002078
Sex: F
Age: 28
State: CA

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

Lab Data: none

Allergies: Diclofenac

Symptoms: Fever 100.2, chills, severe body ache, vomiting, nausea ,severe headache, injection site is really sore , painful, swelling and not able to lift arm.

Other Meds: nill

Current Illness: none

ID: 1002079
Sex: M
Age: 35
State: PA

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

Lab Data: None

Allergies: None

Symptoms: 10 minutes after dose #2: Mild Facial flushing, parasthesias in bilateral fingers, mild lightheadedness. Observation only

Other Meds: None

Current Illness: None

ID: 1002080
Sex: F
Age: 62
State: TX

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

Lab Data:

Allergies: none

Symptoms: The next day I was so sleepy , chill's and severe headache I had to leave work. Around 2:00 I was running a low grade fever of 101. I went to sleep for until the next morning at 6:00am When I woke up my arm was very red and swollen below where I was given my injection. Today I'm still having headaches and feel very sleepy and very nausea.

Other Meds: none

Current Illness: none

ID: 1002081
Sex: F
Age: 58
State: TX

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

Lab Data:

Allergies:

Symptoms: Patient reports flushing and feeling her heart racing a little bit. Patient was seen by Nurse Practitioner; she refused to be seen by EMS. Reported feeling okay and wanted to go home. Signed refusal form (Refusal of Ambulance Transport Against Medical Advice)

Other Meds:

Current Illness:

ID: 1002082
Sex: M
Age: 55
State: CA

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

Lab Data: None

Allergies: TDap

Symptoms: Hives in the same area where vaccine was administered

Other Meds: Allopurinol 300 mg Losartan 50 mg Atorvastatin 20 mg Folic acid 1 mg Zinc picolinate 50 mg

Current Illness: None

ID: 1002083
Sex: F
Age: 44
State: OK

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: no

Allergies: soy, dairy, sunflower, cottonseed, lentil, vit e, chickpea

Symptoms: Arm mildly sore evening after vax but no other symptoms. Following morning, started have mild muscle aches and fever. Tylenol kept fever down to around 100.5. By the evening, I had 103.2 temp even while taken tylenol and was advised by on-call RN to alternate tylenol and motrin for 3 hours until it decreased. Fever came down after 2-3 hours to 102.3. Fever down to 101.5 by next morning. Had mild headache, dizzyness and fever for next several days.

Other Meds: Vit d, Vit c

Current Illness: Had been running mild fever along with headache for about one week prior to 2nd vaccine, tested negative with rapid COVID test, however family member who also tested negative with similar symptoms plus fatigue lost taste and smell during this time frame

ID: 1002084
Sex: F
Age: 77
State: CA

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

Lab Data: None

Allergies: Lamisil, Polysporin

Symptoms: Hives rash over body No treatment

Other Meds: Fluconazole 200 mg, Losartan 25 mg, Magnesium 350 mg, Vitamin De 2,000 units, Vitamin B complex, Multivitamin, Fish Oil, Glucosamine 1500 mg, Calcium 950mg, Loratadine 10 mg, Diclofenac Sodium Topical Gel, 1%,

Current Illness: "Valley Fever" a fungal infection,

ID: 1002085
Sex: F
Age: 32
State: GA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: No

Allergies: No

Symptoms: I had a fever of 101.0 fever that lasted for two days, shivering, body aches and fatigue.

Other Meds: I take Lamotrigine, Rosuvastatin Calcium, Fish Oil, Nexum, Claratin.

Current Illness: No

ID: 1002086
Sex: F
Age: 26
State: IN

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

Lab Data:

Allergies: Tree nuts

Symptoms: Fatigue, chills, headache, injection site pain

Other Meds: Synthroid

Current Illness:

ID: 1002087
Sex: F
Age: 42
State: TN

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: See above statement from patient

Allergies: NKDA

Symptoms: Per patients email..."Vaccinated on 1/13/21 with Moderna #1. Shortly after, my entire upper arm was swollen and redness in entire left arm. 24 hours later I started having body aches, headache and fever of 100.1. 1/15/21 brain fog, left side facial tingling, nausea, diarrhea, and fatigue. 1/16/21 had severe headache with nausea, continued fatigue and nausea. 1/18/21 bilateral lower ext?s aching and tingling from knees down. 1/19/21 woke with severe headache with blood pressure 143/123, tingling legs and generalize weakness. One hour later. Several labs were done, ultrasound of bilateral lower ext, chest xray, which were all normal. The ER physician strongly felt all of my symptoms were related to the vaccine. He prescribed Zofran, meclizine and fioricet. Advised me to return if symptoms persist or worsen. 1/25/21 facial twitching on left upper lip and below eye. I have had daily headaches and joint pain since the vaccine. All other symptoms have subsided"

Other Meds: none ( patient only reports prescription for Alprazalam 0.5mg PRN that is rarely taken.)

Current Illness: none

ID: 1002088
Sex: F
Age: 23
State: OK

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data:

Allergies: N/A

Symptoms: Headache pain scale of 1-10, it was a 7. Tylenol did not relieve pain. Had to leave work early. With rest, it got better the next day. Estimated gestation that day, 1/13/2021, was 27 weeks and 6 days. Estimated date of delivery will be 04/08/2021. No expected complications with fetus.

Other Meds: Zofran, prenatal, docolace, famotidine

Current Illness: N/A

ID: 1002089
Sex: F
Age: 72
State:

Vax Date: 01/22/2021
Onset Date: 01/28/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient called PCP on 2/1/21 after complaint of rash for the past 3-4 days. Then, patient was also seen in person at urgent care 2/1/21 for rash. She had received Moderna vaccine dose 1 on 1/22/21. Per her report to urgent care provider, she reported feeling "feverish and chills" on the 27th and then subsequently developed rash after that. Denies itchiness and had not taken any medications. Rash started on belly and legs and then on arms and chest. Rash is better on arms/chest. Patient was prescribed hydroxyzine 25mg and TAC 1% cream by PCP on 2/1/21. Repeat COVID test done on 2/2/21 resulted as COVID negative. Patient was followed up 2 days later on 2/3/21 via telephone and patient reported to provider rash symptoms have improved.

Other Meds:

Current Illness:

ID: 1002090
Sex: M
Age: 68
State: CA

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

Lab Data: Unknown, pt transferred to local ER and no records have been received yet.

Allergies: None

Symptoms: During welfare checks pt was found to have ALOC and swollen lymph nodes. Pt's VS 200/107 P 144 R 16 T 98.1 O2 sat on RA 99

Other Meds: ACETAMINOPHEN (TYLENOL)500MG 1 TAB [PO] By Mouth QID MIRTAZAPINE (REMERON)15MG TAKE 1 TABLET BY MOUTH EVERY EVENING *MAY CAUSE DROWSINESS* NOVOLIN 70/30 10ML70/30 U/ML 27 UNIT(S) [SC] SUBCUTANEOUSLY FSBG TWICE DAILY LEVOTHYROXINE (SYNTHROID

Current Illness:

ID: 1002091
Sex: M
Age: 31
State: LA

Vax Date: 12/21/2020
Onset Date: 01/01/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: COVID-19-positive

Allergies: no

Symptoms: On 1/1 I woke up with a fever of 100.3 which went away on its own within an hr. I had a headache, congestion, a mild running cough and lost my sense of smell, but no more fever which all lasted for about 3 days. 1/3 I went to Urgent Care because I was feeling so bad and had a COVID test which came back positive and advised if symptoms got worse to return.

Other Meds: Vivance

Current Illness: no

ID: 1002092
Sex: M
Age: 23
State: TX

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

Lab Data:

Allergies:

Symptoms: Insomnia, severe headache, lasted 24 hrs

Other Meds:

Current Illness:

ID: 1002093
Sex: F
Age: 49
State: OH

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 02/04/2021
Hospital:

Lab Data: Covid test

Allergies: Percocet, Tetracycline

Symptoms: 12-31-20, I developed a headaches, had malaise and a fatigue with a fever. I do have history of migraine headaches. I took Motrin after my first dose injection. On Saturday 01-02-2021, I got a fever of 99.3F. I also had bilateral rib pain, R>L with associated low back pain. i got tested for Covid-19 on 12-22-2020 which was negative.

Other Meds: Motrin, Metoprolol 12.5mg a day, Vertec daily, Flonase nasal spray, Lisinopril 5mg

Current Illness:

ID: 1002094
Sex: F
Age: 59
State: TX

Vax Date: 12/04/2020
Onset Date: 12/05/2020
Rec V Date: 02/04/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient described a rash that covered injection site and spread down left arm. Patient did not state any treatment was done for it and let the rash heal on its own.

Other Meds:

Current Illness:

ID: 1002095
Sex: F
Age: 73
State: LA

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data:

Allergies: PENICILLIN, CONTRAST USED TO DO CT SCANS

Symptoms: PAIN, TENDERNESS AND SWELLING OF LYMPH NODES IN SAME ARM AS INJECTION- LASTED 4 DAYS., FATIGUE,HEADACHE, AND NAUSEA FOR 24 HOURS.

Other Meds: PRAVASTAIN 20 mg, AMLODIPINE 5 MG, XYZAL, ALBUTEROL INHALER

Current Illness: NONE

ID: 1002096
Sex: F
Age: 34
State: CA

Vax Date: 12/28/2020
Onset Date: 01/03/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: No

Allergies: Penicillin - get hives

Symptoms: When I first got the injection - I got the typical sore arm and headache and that resolved within 48 hours. Night of Jan3, I developed red, hive like rash around the injection - painful; swollen and my lymph nodes were swollen in my armpit as well. It progressively spread through my whole arm within 24 hours and looked like a "poison oak" rash. I took Benadryl. I emailed my doctor about (PCP). I missed a day of work on January 5th. The rash got three days progressively. The lymph node pain was gone about a week after. I did have the dr write a prescription for the second dose for an epi-pen but didn't have to use it.

Other Meds: Multi-vitamin; Omega 3 supplement; magnesium

Current Illness: no

ID: 1002097
Sex: F
Age: 42
State: MN

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

Lab Data: No

Allergies: Latex

Symptoms: Metallic taste in mouth immediately , 30-60 min later face and hand on left side became numb, next day felt heavy on left side and body aches, by sunday symptoms resolved

Other Meds: Amitriptyline, Allegra, Vit D, Calcium Magnesium, Potassium Citrate, Natalol, Nasacort, Rizatriptan

Current Illness: None

ID: 1002098
Sex: F
Age: 84
State: TX

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

Lab Data: EKG abnormal - ST elevation

Allergies:

Symptoms: Patient reports shortness of breath ad her heart racing. EMS performed EKG which was abnormal - ST elevation. Patient was transported to ER. Daughter of patient reports that patient was at the ER 2 days prior due to blood pressure.

Other Meds: lisinophil

Current Illness: hypertension - patient was at the ER 2 days ago for her blood pressure

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm