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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1003232
Sex: F
Age: 51
State: WA

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

Lab Data:

Allergies: PCN

Symptom List: Dysphagia, Epiglottitis

Symptoms: First vaccine: site pain and swelling, headache, muscle aches, fatigue Second vaccine: site pain and swelling, headache, muscle aches, fatigue, chills fever of 100.5

Other Meds: Motrin 800 mg

Current Illness: none

ID: 1003233
Sex: F
Age: 50
State: RI

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

Lab Data:

Allergies: diamax

Symptom List: Anxiety, Dyspnoea

Symptoms: 50 yr old female felt dizzy and lethargic after receiving first covid 19 vaccine. pt started feeling symptoms immediately aster entering the observation area. pt was wheeled to medical room via wc and was assessed. pt vs were taken and bp was elevated at 157/92, pt hr was 88, resp 18, so2 98% ra and ls clear bil. pt wanted to lie down on stretcher flat and rest. pt states she had a similar experience after giving platelets and had to be t/p to emergency room and was d/c after receiving iv fluids and a sandwich. pt was monitored for her bp every 10mins and was given water to drink due to pt denying n/v. pt bp remained stable but elevated around 145 systolic. pt could shake feeling dizzy and requested to be t/p to emergency room. 911 was notified and fire dept was enroute to t/p pt to hospital upon pt request. pt received a 500ml of 0.95 ns running kvo in int establishments in rt hand via 20g catheter. pt bel was 135 mg/dl and pt vs were taken and final set was 152/102, hr 86, resp 18, spo2 99% ra and ls were clear bil. pt was t/f to stretcher and report was given to crew for transfer of care. pt was t/p to er w/o further incident.

Other Meds: lisinopril, zyrtek, celexa

Current Illness: no illness at time of vaccine or 1 month prior

ID: 1003234
Sex: M
Age: 42
State: AZ

Vax Date: 02/03/2021
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:

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

Symptoms: Fever (37? - 38?C) and chilling, nausea, muscular pain, joint pain, weakness, urine burn.

Other Meds:

Current Illness:

ID: 1003235
Sex: M
Age: 65
State: IN

Vax Date: 02/01/2021
Onset Date: 02/02/2021
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: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Bone/muscle aches, nausea, 102.2?, fatigue, diarrhea, no appetite.

Other Meds: Sertraline, simvastatin, prilosec otc

Current Illness: N/A

ID: 1003236
Sex: M
Age: 43
State: OR

Vax Date: 01/29/2021
Onset Date: 01/30/2021
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: None known

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

Symptoms: Extreme fatigue, foggy thinking, and malaise that was intense for 36 hours. Symptoms gradually decreased from hour 36 to hour 72. Still feeling more tired than usual, but it's mild and I obviously cannot pinpoint the cause.

Other Meds: Fluvoxamine 200mg a day. Clonazepam .5mg as needed. Typically several times a week. Esomeprazole 22.25mg a day

Current Illness: None

ID: 1003237
Sex: F
Age: 51
State: SD

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

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

Symptoms: On the day of the vaccine did have arm soreness 4 hours after the vaccine. Started to get chills and aches around 8:30. Then went to sleep and woke up around around midnight with the worse chills, teeth chattering. Had this feeling all through the night and could not calm down from the aches, temp was 99. As the next morning progressed, she calmed down and was exhausted. The fever started to elevate and went up to 101.5 all the next day, really exhausted and was sleeping most of that day. It took probably about 4 days to recover from that with low energy level. She felt that she had gone through a shortened COVID. They had already had COVID at the end of September, and it took 2 1/2 weeks for that to resolve. The following Thursday 1/7/21 started having diarrhea that lasted 4 days. Then she finally felt better. She also spoke with a friend who took the Pfizer vaccine and had the same reaction to her vaccine as well. Called doctor and he advised her to wait it out.

Other Meds: Atenolol, Claritin, Pepcid AC. Emergen-C.

Current Illness: None.

ID: 1003238
Sex: F
Age: 56
State: CA

Vax Date: 01/28/2021
Onset Date: 01/29/2021
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: no

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Got really nauseous the first night and headache along with aches and pains. By the end of evening on 29th, I was running a fever. Fever on 30th - nauseous; aches; and pains. On 31st, the fever broke. I still had aches, pains, fatigue. Had chest tightness - harder to breathe. Each day a couple of symptoms would go away or get better. By Monday, I was mostly just tired. Tuesday I was back at work.

Other Meds: no

Current Illness: January 2021 COVID after first dose of Moderna vaccine

ID: 1003239
Sex: M
Age: 33
State: IN

Vax Date: 12/22/2020
Onset Date: 12/29/2020
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: Possible penicillin almost

Symptom List: Pharyngeal swelling

Symptoms: I started having vertigo every once in a while. It was frequent, but short. Like if you stand up really fast and it goes away, but it happened when I was sitting down. Around the 7th, it got worse and I sought treatment at ER. They gave me fluids, but couldn't find out why it was happening. It's been gradually getting better.

Other Meds: Vitamin D Tramadol Ibuprofen Zyrtec

Current Illness:

ID: 1003240
Sex: F
Age: 37
State: MN

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: No Known allergies

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient complained of uticaria with rash on chest and throat

Other Meds: No known medications

Current Illness: None

ID: 1003241
Sex: M
Age: 33
State: MI

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient was administered the COVID-19 Vaccine on 1/26/21. Patient received Varicella on 1/25/21. You are supposed to wait 14 days before you can get the COVID-19 vaccine

Other Meds:

Current Illness:

ID: 1003242
Sex: F
Age: 33
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: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Headache, chills, fatigue, low grade fever

Other Meds: Levetiracetam- 250 mg twice a day Magnesium oxide-500 mg once a day Prenatal Multi Vitamin- once per day

Current Illness: Colonoscopy- polyp removal- December 4 Diagnosed with PCOS- December 18

ID: 1003243
Sex: F
Age: 59
State: NJ

Vax Date: 01/30/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies: Gluten

Symptom List: Rash, Urticaria

Symptoms: Severe case of herpes simplex on oral mucosa Treatment: Denivir

Other Meds: Flecainide, cardizem, aspirin

Current Illness: Afib

ID: 1003244
Sex: F
Age: 52
State: AL

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:

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

Symptoms: 3:45pm pt stated throat feels funny; rechecked in 15 minutes; 4pm patient stated he feels fine and wants to leave; instructed to go to er if it occurs again; also instructed to take benadryl and pepcid fi okay with hx.

Other Meds:

Current Illness:

ID: 1003245
Sex: F
Age: 32
State: AK

Vax Date: 01/29/2021
Onset Date: 01/30/2021
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: latex, grapes

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

Symptoms: I started to develop a reaction the first evening after receiving the vaccine. My arm was incredibly sore, I had neurological slip ups-i could not think thoughts fully all the way through and my tongue swelled overnight and I woke up to me frantically rubbing my tongue on my back teeth, which is extremely abnormal for myself. the first night back started aching (I have never felt this pain before now), Developed swollen lymph nodes in my armpit and in my neck and chin on my right side of my body, was extremely lethargic. and this continued for 3 days when the lymph nodes started to go down, and then an outbreak happened inside the right side of my throat, which is still in place today, seems to be healing now, but continued to get worse for 3 days before starting to heal. I am finally back to a normal level of energy and my mind seems to be working normally again, but my back is still in incredible pain.

Other Meds: Daily multivitamin

Current Illness: none

ID: 1003246
Sex: M
Age: 68
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: had a spike in blood pressure noticed the day after the vaccine at a medical check-up appointment. Came down the following day. Doctor prescribed increase in blood pressure meds before it came down the following day.

Other Meds: omeprazole sertraline (Zoloft) losartin B-complex vitamin certerazine

Current Illness: none

ID: 1003247
Sex: M
Age: 81
State: CA

Vax Date: 01/26/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: NO KNOWN MEDICATION ALLERGIES

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

Symptoms: REDNESS, SWELLING, PRURITIS AT INJECTION SITE

Other Meds: MELATONIN, SERTRALINE, ATORVASTATIN,SILDENAFIL, FLUDROCORTISONE, PANTOPRAZOLE

Current Illness:

ID: 1003248
Sex: F
Age: 43
State: CA

Vax Date: 01/08/2021
Onset Date: 01/13/2021
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:

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

Symptoms: muscle twitching all over body

Other Meds:

Current Illness:

ID: 1003249
Sex: M
Age: 39
State: AK

Vax Date: 02/01/2021
Onset Date: 02/01/2021
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: Clindamycin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Approximately 20 minutes after vaccine administered, pt reported feeling flush, heart racing, then dizzy. Became tachycardic and tachypnic and reported headache. Rapid Response called and patient transported to Emergency Department (ED). Cardiac workup, CT of head done. No acute process found. Given Ativan, fentanyl without improvement. Then given droperidol, Beandryl and Toradol and had complete resolution of headache. Other symptoms resolved. Discharged from ED at 2:22pm 2/1/2021.

Other Meds:

Current Illness:

ID: 1003250
Sex: F
Age: 32
State: FL

Vax Date: 02/04/2021
Onset Date: 02/04/2021
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: latex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Initially approximately 5 minutes following injection hot flashes occured, continued intermittently, around 1:30pm Tingling started in right jaw in close proximity to ear, spread to approximately half way across right cheek from below eye to lower jaw, tingling sensation to base of right side of tongue that felt similar to that when you get a novicane injection, progressed to numbness to same area, tingling started to subside a few hours following, however, when touching/ applying light pressure to that area of face and progressing toward R side of top and bottom lip the feeling of pins and needles occurs, pressure sensation is felt to the right side of the face, with new addition of numbness/tingling to right side of top and bottom lip.

Other Meds: tylenol

Current Illness: none

ID: 1003251
Sex: M
Age: 95
State: CA

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

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

Symptoms: Pain in injected arm and shoulder from Jan 19 to the present Feb4 2021

Other Meds: Too mny to list: Primary are Testosterone, HGH, Vitamin B

Current Illness: None

ID: 1003252
Sex: F
Age: 68
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Iodine, chlorine, adhesive tapes, beta blockers, Losartan

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

Symptoms: Pt had angio-edema within 15 min of receiving Covid-19 vaccine. Reports having tingling in her mouth. Denied shortness of breath/wheezing. Alert and Oriented X4. Pt's tongue was swollen/bumpy. EPI auto-ject was given, EMS called to take pt to ER.

Other Meds: Pt currently takes: Clobetasol 0.05% cream: apply twice daily to affected areas Valium: Take 1 tab PO 2x daily PRN motion sickness Diclofenac 1.3% patch: Pleace 1 patch onto the skin 2x daily Diclofenac 1% gel: Apply 4g topically 4x daily

Current Illness: none

ID: 1003253
Sex: M
Age: 43
State: WI

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Patient stated he could feel his lip was swollen. The RN was unable to see swelling. He was observed eating and drinking after his vaccine. She asked him to stay past is 15 minutes and he chose not to. Back in his unit he stated his tongue was swelling. His co-workers gave him Benadryl and Claritin. He saw the physician who was unable to determine any issues. Patient was very sleepy due to the Benadryl and Claritin.

Other Meds:

Current Illness:

ID: 1003254
Sex: M
Age: 39
State: MD

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

Lab Data:

Allergies: None

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

Symptoms: Dose 1 - Sore arm Dose 2 - Sore arm, headache, general malaise (Took about 24 hrs to recover - took 3 doses of 600mg ibuprofen 6 hrs apart (total 1800mg over the course of 18hrs

Other Meds: Ibuprofen - 600mg

Current Illness: None

ID: 1003255
Sex: F
Age: 70
State: CA

Vax Date: 01/30/2021
Onset Date: 02/02/2021
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: Adhesive TapeRash Amlodipine Casein Cat Dander Dolophine [Methadone]Hives FentanylRash Fruit Gabapentin Grass Pollen LatexRash MethotrexateOther. Opioid - Non-pharmaceuticalHives ProcainamideRash Rabbit Dander Stadol [Butorphanol Tartrate]Rash TramadolHives Yellow Jacket Venom Protein [Hymenoptera Allergenic Extract]

Symptom List: Injection site pain, Pain

Symptoms: Possible TIA. Patient had slurred speech and disorientation on Tuesday morning

Other Meds: Temazepam (RESTORIL) 15 mg Oral Cap Diclofenac Sodium (VOLTAREN) 1 % Top Gel tiZANidine (ZANAFLEX) 4 mg Oral Tab Atenolol (TENORMIN) 25 mg Oral Tab DULoxetine (CYMBALTA) 20 mg Oral CPDR SR Cap K-Tab 10 mEq Oral SR Tab Lisinopri

Current Illness: URI (COVID NEGATIVE)

ID: 1003256
Sex: F
Age: 33
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: SYR
Vax Site: LA

Lab Data:

Allergies: Gluten allergy

Symptom List: Injection site pain, Menorrhagia

Symptoms: Extreme inflammation, nausea, dizziness, fever reaching 101.9 lasting an entire day impacting ability to work, fatigue first day after shot. Mild pain and inflammation over whole body with low grade temp on day two.

Other Meds:

Current Illness:

ID: 1003257
Sex: F
Age: 63
State: NY

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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: Sulfa Amoxicillin

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

Symptoms: Sore arm at injection site, no treatment, resolved in 24 hours

Other Meds: Lexapro 10 mg daily Atorvastatin 40 mg daily Losartan 50 mg daily Daily baby aspirin 80 mg Probiotic CBD gummies 25 mg

Current Illness: None

ID: 1003258
Sex: M
Age: 73
State: AZ

Vax Date: 02/02/2021
Onset Date: 02/02/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Injection site soreness starting 1 hr. after injection, then chills, fever, body shuddering,generalized myalgias, feeling cold all over starting 10-11 hrs. after injection, then night sweats on second night after injection. All symptoms have resolved after 48 hours.

Other Meds: Insulins, perindopril, atorvastatin, levothyroxine,primidone, valacyclovir, multivitamin

Current Illness: none

ID: 1003259
Sex: M
Age: 17
State: TX

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

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 17 Y.O. Male inadvertently administered moderna cov-19 vaccine.

Other Meds: unknown

Current Illness: none

ID: 1003260
Sex: F
Age: 46
State: CA

Vax Date: 01/07/2021
Onset Date: 01/07/2021
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: Adhesive tape, precocet

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

Symptoms: metallic taste to mouth, thickening of saliva, itching on neck. Benadryl 50 mg PO, transferred to Urgent Care. Monitored and discharged with no further incident

Other Meds:

Current Illness: peripheral neuropathy

ID: 1003262
Sex: F
Age: 53
State: ID

Vax Date: 01/29/2021
Onset Date: 01/30/2021
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: Penicillin

Symptom List: Nausea

Symptoms: Flu-like symptoms, migraines, 101 fever, rash and hives. Took over the counter medication. Started day after vaccination, symptoms cleared by day five, still having occasional headaches

Other Meds: None

Current Illness: None

ID: 1003263
Sex: F
Age: 55
State: TX

Vax Date: 01/28/2021
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: LA

Lab Data:

Allergies: Sulfa

Symptom List: Injection site pain

Symptoms: Light headache and light body ache. I took Tylenol and put ice bag. It last 1 day 1/2.

Other Meds: Metoprolol

Current Illness: None

ID: 1003264
Sex: F
Age: 44
State: TX

Vax Date: 02/01/2021
Onset Date: 02/01/2021
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: Ibuprofen Seasonal allergies

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

Symptoms: Swollen arm Itchy arm Chills Uncontrollable shivering Fever Sweating Extreme fatigue Bad dreams Remained at hospital for 30 minutes after injection for observation due to history of asthma and ibuprofen allergy. No reactions that that time. Symptoms started approximately 12 hours after injection. Gradually went away and almost gone after 72 hours.

Other Meds: Dupixent Zoloft Singulair Symbicort Vitamin D

Current Illness: Mild asthma Nasal polyps Sensitivity to NSAIDS

ID: 1003265
Sex: M
Age: 79
State: VT

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: upon administering the vaccine the needle malfunctioned and it is unsure how much was given. it was decided with permission of the patient and guidance from my district manager and patient care coordinator to re administer the dose.

Other Meds:

Current Illness:

ID: 1003266
Sex: M
Age: 38
State: AL

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

Lab Data:

Allergies: No known allergies

Symptom List: Tremor

Symptoms: No history of severe allergic reactions. Observed for 15 minutes following vaccine injection. Felt fine at that point so I was told that I could leave. About 10-15 minutes after leaving (about 25-30 minutes after vaccine injection), I started to feel tingling in the bottom half of my face (most noticeable in the bottom lip and chin area), slight swelling on back sides of tongue, and slight swelling of area under chin at the top of the throat (right side only). I could still breathe, drink, and talk normally. Although symptoms did not seem to be intensifying, I decided to seek care at a nearby urgent care out of caution. I arrived at the urgent care about 10 minutes after the onset of symptoms (about 45 minutes after vaccine injection). Provider evaluated me, administered pepcid and a Benadryl shot, and notified me that if I went into anaphylactic shock that they would administer an epipen and call an ambulance. Vitals were normal and remained normal throughout observation. Symptoms began to abate about 15 minutes after Benadryl injection. Tongue swelling abated first about 15 minutes after Benadryl injection. Active tingling in the chin abated about 30 minutes after Benadryl injection, although light numbness remained. Swelling under chin abated about 45 minutes after Benadryl injection. Provider or staff checked on me every 15-20 minutes. Provider released me from observation after about 2 hours. At that point all symptoms had abated with the exception of slight numbness on bottom half of face, which persisted for several more hours.

Other Meds: Protonix (acid reflux), Zyrtec (mild seasonal allergies), Sulfasalazine (seronegative arthritis), Folic Acid, Align (probiotic), multivitamin, vitamin D, Fish oil

Current Illness: None

ID: 1003267
Sex: F
Age: 34
State: CA

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

Lab Data:

Allergies: DENIES

Symptom List: Erythema, Pruritus

Symptoms: AT APPROXIMATELY 12:00, TWO HOURS AFTER RECIEVING HER SECOND MODERNA VACCINE DOSE SHE COMPLAINED THAT HER LOWER LIP STARTED TO SWELL. SHE WAS TAKEN TO THE TREATMENT AND TRIAGE AREA ON WORK GROUNDS WHERE THE DOCTOR THERE TREATED HER WITH BENADRYL AND DEXAMETHASONE. AFTER SHE WAS OBSERVED AND WAS FEELING BETTER SHE LEFT WORK TO GO HOME AND GET SEEN AT A LOCAL URGENT CARE FOR FOLLOW UP.

Other Meds: DENIES

Current Illness: DENIES

ID: 1003268
Sex: M
Age: 75
State: TX

Vax Date: 02/04/2021
Onset Date: 02/04/2021
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: knda

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

Symptoms: dose was given on day 14 at patient request b/c he was moving, employee who scheduled did not confirm date of prior dose and proceeded to schedule. vaccinator did not confirm date of prior dose to ensure it was within the acceptable time frame. it was 3 days too early.

Other Meds: HCTZ Rosuvasattin Selenium sulfide Valacyclovir lisinopril Triamcinolone acetonide 0.1% ointment propylene glycol asa naproxen

Current Illness: none

ID: 1003269
Sex: F
Age: 34
State:

Vax Date: 01/31/2021
Onset Date: 02/03/2021
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: Rash at injection sight. Covers most of left upper arm.

Other Meds: Singular, Zyrtec

Current Illness:

ID: 1003270
Sex: F
Age: 74
State: FL

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

Lab Data:

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Temp 101.4, chills, dizzy and aching all over. I did not seek medical attention. just took Tylenol and rested.

Other Meds: Hydrochlorothiazide, Omeprazole, Metoprolol, Meloxicam , Atorvastatin, Zolpidem, Bayer low dose aspirin, Biotin and Citracal calcium supplement

Current Illness: none

ID: 1003271
Sex: F
Age: 63
State: MN

Vax Date: 01/29/2021
Onset Date: 01/30/2021
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: Sulfa drugs, dust, animal dander, mold

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

Symptoms: Body aches, fatigue, headache, feverish; lasted about 40 hours; felt like I had COVID again

Other Meds: Buproprion, estradiol, progesterone, lisinopril, hydroxyzine

Current Illness: None

ID: 1003272
Sex: F
Age: 66
State: GA

Vax Date: 01/30/2021
Onset Date: 01/30/2021
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, sulfur, latex gloves

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

Symptoms: None stated.

Other Meds: Advair HFA 230/21, Ventollin HFA

Current Illness: No

ID: 1003273
Sex: F
Age: 66
State: TX

Vax Date: 01/07/2021
Onset Date: 01/13/2021
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:

Symptom List: Pain in extremity

Symptoms: rash on lower back at the same time of injection site rash showed up within a week and lasted about 3 or 4 days

Other Meds: Lisinopril Levothyroxine Alive multi-vitamin Vitamin D3 Ester-C Red mineral algae-vegetarian calcium MegaRed

Current Illness:

ID: 1003274
Sex: F
Age: 54
State: AZ

Vax Date: 02/01/2021
Onset Date: 02/01/2021
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: Penicillin, codeine, and anesthesia make me vomit...not necessarily allergic reactions.

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

Symptoms: 1) Immediately noticed that I was light-headed or dizzy upon receiving shot. 2) My face started to feel numb on the left side (below the eye to the jawline and from below my left ear to my nose area. I was worried about a stroke, so I made sure that I was able to smile in my rear-view mirror. The numbness began to clear up around 8 hours later without any muscular drooping of eye or mouth. I still have tingling or a numb feeling in areas but it is not significant at this time. 3) fatigue, slight nausea, pain in right collar bone area has been present since Monday. All seem to be minor side effects.

Other Meds: None

Current Illness: None

ID: 1003275
Sex: F
Age: 17
State: TX

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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: unknown

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

Symptoms: 17 Y.O. inadvertently administered moderna cov 19 vaccine

Other Meds: unknown

Current Illness: unknown

ID: 1003276
Sex: M
Age: 65
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No

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

Symptoms: At approximately 20 hours following injection developed high fever (102+) rapidly. Fever ceased at 12:00 pm. Accompanied by severe body aches and uncontrollable shivering. Today I have extreme muscle soreness in mid to lower back and in joints of my limbs. Also severe headache that ibuprofen could help. I had covid in July of 2020 with moderate symptoms.

Other Meds: Lipitor

Current Illness: No

ID: 1003277
Sex: F
Age: 30
State: CA

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Vomiting

Symptoms: ONE FOREARM DEVELOPED AN ITCHING RASH ABOUT 5 INCHES WIDE. BENADRYL 50MG PO GIVEN WITH GOOD RESULTS.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1003279
Sex: F
Age: 22
State: NY

Vax Date: 01/28/2021
Onset Date: 01/29/2021
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: Penecillin, Peanuts, Dairy

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Day 2 - Extreme fatigue, injection sight soreness, nausea, loss of appetite, chills, low fever, muscle aches, he ache Day 3 - fatigue Day 4 - fatigue, sore throat Day 5 - Sore throat, congestion, fatigue Day 6 - Extreme fatigue, migraine, vertigo/dizziness Day 7 - Extreme fatigue, vertigo/dizziness, sore throat

Other Meds: Biotin, Vitamin C, Vitamin D, Calcium Magnesium

Current Illness: N/a

ID: 1003280
Sex: M
Age: 63
State: CA

Vax Date: 12/29/2020
Onset Date: 12/29/2020
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: Shellfish (crab) if he over indulges - develops hives

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

Symptoms: Itching behind knee caps, both legs, ribs under armpits, whole back itching and redness all over body and got really bad itchy when he got home but it went away after a few hours with no treatment.

Other Meds: Multi Vitamins

Current Illness: None

ID: 1003281
Sex: F
Age: 42
State: KS

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

Lab Data:

Allergies: aspirin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Severe muscle aches and pains prohibiting sleep. Arm pain at injection site hard and sore preventing sleep as well. Muscle aches and pains subsided within 48 hours.

Other Meds: iud

Current Illness: cold in between vaccines

ID: 1003282
Sex: F
Age: 65
State: CA

Vax Date: 01/26/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Environmental allergies

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

Symptoms: Initial injection site swelling with redness and itching. Beginning to resolve after three or four days then coming back with a more pronounced reaction on day number eight. Current delayed reaction is more pronounced than the initial reaction.

Other Meds: Olmesartan, rosuvastatin, levothyroxine

Current Illness: None

ID: 1003283
Sex: F
Age: 77
State: GA

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

Lab Data:

Allergies: corn syrup, chocolate

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

Symptoms: On 2/3 upon rising my vision was blurry for awhile. At 8PM I had Kaleidoscope Auras in both eyes. I have never experienced either of these events.

Other Meds: Letrozole 2.5mg Calcium 1250mg D3 2000 units Vitamin C 1000mg Pepcid Complete

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm