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: 1002851
Sex: F
Age: 66
State: MI

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

Lab Data:

Allergies: sulfa,septra,penicillin,lactose,fish,,mold,mildew,seasonal allergies,adhesive

Symptoms: sever itching flushed face raised blood pressure

Other Meds: albuterol,aspirin 81mg,atorvastatin,gabapentin,norco,claritin,meloxicam,,metformin,omeprazole,singular,spiriva,symbicort,prednisone,proventil,flonase.

Current Illness:

ID: 1002852
Sex: F
Age: 77
State: GA

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

Lab Data:

Allergies: Penicillin, ibuprofen

Symptoms: Weakness, confusion

Other Meds: Losartan, Amlodipine, Metoprolol, Hydrazaline, Lortab, elderberry, gabapentin

Current Illness: None

ID: 1002853
Sex: F
Age: 58
State: NY

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

Lab Data: none

Allergies: chlorthalidone, hydrochlorothiazide, morphine, penicillins, topamax, triamterene, wellbutrin

Symptoms: Patient received COVID Moderna second dose of vaccine on 2/2. Reports abdominal pain, body aches, fever, headache and congestion that started several hours later that continues into 2/4 Per PCP, rest, hydration and Tylenol for treatment

Other Meds: celecoxib, Chantix, estradiol, lotemax, nitro, omeprazole, Sexenda, valacyclovir, venalfaxine, vyvanse, zolpidem

Current Illness: na

ID: 1002854
Sex: F
Age: 27
State: IN

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

Lab Data:

Allergies: Sulfa

Symptoms: Fever, Joint and muscle soreness, headache, nausea and tiredness

Other Meds:

Current Illness:

ID: 1002855
Sex: F
Age: 40
State: MI

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: See above, item 18.

Allergies: NKA

Symptoms: 12/30/2020: COVID Vaccine Pfizer-BioNTech dose 1 of 2 left arm. Acute onset left shoulder/arm pain 1-2 days later without inciting event (no trauma, no sports/weights), progressively worsening to severe next 2 days with onset of numbness and paresthesias in left upper arm and hand by 1/5/2021 seen at urgent care with dx: Cervical Neuropathy. Follow-up cervical MRI 1/22/21 without significant canal or foraminal impingement. Seen by Neurologist 2/3/2021, at that time pain improved and localized to left shoulder joint area radiating under scapula and paresthesia resolved to numbness. Physical exam findings: Absent triceps reflex, Left FDI atrophy, left hand finger extensor weakness, left abduction limited to 90 degrees. Dx: Neurologic Amyotrophy (Parsonage Turner Syndrome); Complication of COVID vaccination. Plan: EMG, NCS, Left shoulder MRI, labs pending. PT OT ordered. Rx: Nortriptyline, Medrol Dosepak. F/U 2-3 months with neurology.

Other Meds: Synthroid 150MCG QD.

Current Illness: 12/03/2020: Upper Respiratory Infection

ID: 1002856
Sex: F
Age: 48
State: MI

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

Lab Data:

Allergies:

Symptoms: Patient states she was waiting in post vaccination area when she began to become very anxious. Her heart was racing, felt hot, rash on chest, and felt throat feel thick. EMS was on site and took vital signs. Transported patient to Emergency Department via ambulance. Benedryl and Prednisone were administered IV. Patient was monitored for 4 hours at Emergency Department. Followed up with patient today. She is continuing to take Benedryl. Feels much better.

Other Meds:

Current Illness:

ID: 1002857
Sex: F
Age: 78
State: IL

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

Lab Data: Patient was monitored by daughter at home after being released from the hospital/vaccine site.

Allergies: Reaction to Epinephine (cannot have Novocain with Epinephrine); Reaction to foods and medications with histamine and tyramine

Symptoms: About 7-10 minutes after receiving the shot, patient started to feel extremely shaky and warm. Her face turned red and hands were shaking. Patient felt her heart skipping with irregular heart beats. The nurse measured the patient's blood pressure and it was 183/95 with a pulse of 104. The patient was observed for an hour.

Other Meds: Toprol XL; Amlodipine Besylate; LevoThyroxoine; Atorvastatin; Lumigan; Dorzolamide-Timolol; VitaFusion MultiVitamin; Nature's Bounty Biotin; VitaFusion Calcium

Current Illness: None

ID: 1002858
Sex: F
Age: 33
State: IN

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

Lab Data:

Allergies: Penicillin

Symptoms: Patient reported difficulty breathing, feeling warm, hands sweaty approximately 15 minutes after receiving second COVID-19 vaccine (Moderna) dose. VS stable BP 127/74, HR 86, O2 sats 100%, RR 14. Referred to ED staff/provider (physically located in same building) for further evaluation and management due to patient report of difficulty breathing. Patient walked over to ED location and ED nurse assumed care for patient.

Other Meds: Prednisone

Current Illness:

ID: 1002859
Sex: F
Age: 83
State: CA

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

Lab Data: none

Allergies: None

Symptoms: Starting at 11:30a on Feb 3, 2021 my mom had her first fall. For the next 24 hours she had 3 more falls and several close calls. She started feeling very weak and dizzy. This was very sudden. Up to the first fall, she was strong enough to go up and down the stairs several times a day with no assistance, and she could walk about a mile with her walker.

Other Meds: Protonix Sertraline Calcium supplement Miralax

Current Illness: Dementia

ID: 1002860
Sex: F
Age: 57
State: AR

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

Lab Data: No tests done

Allergies: Alpha Gal: Allergic to mammal meat dairy and medicines made from mammal and dairy. Get Hives and severe stomach pains. Latex: Hives CT contrast dye: Hives Pepto Bismol: Hives

Symptoms: Received my 1st Pfizer vaccine 1/10/2021. Did great! Received my 2nd Pfizer vaccine 1/31/2021 1130 am 6 hours later at 6:30 pm ate packaged veggie dumplings and 15 min later my tongue swelled and my face felt swollen and itchy. Took Benadryl 25mg, Allegra 180mg and Pepcid 20mg with relief. 6 hours later, awoke with itchy throat and face and took Benadryl 25mg with relief. Next morning, 2/1/2021: 8 am ate my regular breakfast of peanut butter on toast and 15 minutes later my face started itching. Took Allegra 180mg with relief. 11:30 ate pretzels and face started itching `15 minutes later. Everything I ate that day caused me to itch 15 min afterwards just like when I would have food reactions when first diagnosed with Alpha Gal and my IGE histamine levels with 3x normal. I increased my Allegra 180mg to 3x a day for 24 hours and Pepcid 20mg to 2x a day for 24 hours. 48hours after vaccine I was able to decrease Allegra 180mg to 2x a day with Pepcid 20mg to 2x a day and was able to eat bland food without itching afterwards. My allergist felt the 2nd vaccine may have caused an inflammatory response and flared up my alpha gal symptoms.

Other Meds: Monthly Xolair for the last 6 months without problem. Had Xolair 5 days prior. Trazodone 12.5mg at night Lipitor 5mg at night Allegra 180mg at 10 pm Pepcid 20mg at 10 pm Colace 100mg 8 am and 10 pm Methylfolate 15mg 8 am Fish Oil 10

Current Illness: Being treated for Alpha Gal hives and stomach pains for 6 months with high IgE 6 months ago at time of alpha gal diagnosis. . Controlled with Xolair, Allegra, Pepcid/ No hives in a month prior to vaccine. No problems after first Pfizer vaccine except mild sore arm. Problems after 2nd Pfizer vaccine, received 21 days later.

ID: 1002861
Sex: F
Age: 38
State: ND

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

Lab Data: No medical tests.

Allergies: Ambien, Naproxen, Yellow dye; Zolpidem, Ibuprofen, Sulfa drugs, Ciprofloxacin

Symptoms: Patient received her second dose of Moderna COVID-19 vaccine at approximately 11:00 a.m. She had no reaction within the first 15 minutes of recieveing the vaccine and went back to work. She is a worker in our facility and presented to the hospital floor at 12:20 complaining of itching to her chest and arms and redness to chest, arms, and abdomen. On-call health care provider was contacted and informed of situation and orders for 50 mg PO benadryl were carried out by nursing staff. Health care provider states patient could return to work if she feels able and report back to the hospital floor if her symptoms worsen.

Other Meds: Relpax, Flonase; Prilosec,

Current Illness: None

ID: 1002862
Sex: M
Age: 39
State: HI

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

Lab Data:

Allergies:

Symptoms: On the day of vaccination, the employee described pain and tenderness at the injection site 6 hours after receiving the vaccination. The next day (1/29/21), the employee became lethargic and had generalized aches in lower and mid-back. He reported taking Tylenol 1000 mg on 1/28/21 for the injection site pain, and again on 1/29/21 for the aches and pains.

Other Meds:

Current Illness:

ID: 1002863
Sex: F
Age: 72
State: CA

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

Lab Data:

Allergies: ibuprofen, naproxen sodium, aspirin, atorvastatin, ezetimibe-

Symptoms: Got the shot and while we were waiting i just realized at my collar bone and my breast it felt really tight. and around 2 pm i felt a little burn at my color bone there was two little spots that looks like bites and went and took nap and when i woke up i was fine. do have sore arm and not able to lift it high.

Other Meds: multivitamin for woman , calcium citrate with vitamin D 500 2

Current Illness: 100.1 temperature in early jan. and loose bowels for about a d

ID: 1002864
Sex: F
Age: 74
State: GA

Vax Date: 01/25/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: N/A

Allergies: Black Walnuts Penicillin

Symptoms: Hard raised rash 4 x 4 ?

Other Meds: Levothyroxine 50 MCG Hydrochlorothiazide 25MG Ibuprofen 400 MG ESTRADIOL 0.0375 mg/ 24 hr

Current Illness: None

ID: 1002865
Sex: F
Age: 57
State: CA

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

Lab Data:

Allergies: No

Symptoms: I experienced dizziness and nausea.

Other Meds: No

Current Illness: No

ID: 1002866
Sex: F
Age: 45
State: KY

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

Lab Data:

Allergies:

Symptoms: Left arm remained sore and warm to touch for several days. On 1/31/21 started having extreme pain with ROM of left should. Went for evaluation on 2/1/21, was diagnosed with left shoulder deltoid myositis after injection.

Other Meds:

Current Illness:

ID: 1002867
Sex: F
Age: 58
State: IN

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

Lab Data:

Allergies:

Symptoms: Patient reported neck pain, chest tighness approximately 15 minutes after receiving second COVID-19 vaccine (Moderna) dose. VS stable BP 146/95, HR 70, O2 sats 99%. Referred to ED staff/provider (physically located in same building) for further evaluation and management due to complaints of neck and chest pain. Walked with patient over to ED location and ED nurse assumed care for patient.

Other Meds:

Current Illness:

ID: 1002868
Sex: F
Age: 35
State: IL

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

Lab Data:

Allergies: None

Symptoms: Fever up to 102.3 deg F, chills, body aches, fatigue, headache.

Other Meds: Multivitamin

Current Illness: Fever for one day, 7 days post first dose COVID vaccine.

ID: 1002869
Sex: F
Age: 35
State: OH

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

Lab Data: blood work , Creatinine kinase level of 1303

Allergies: no known allergies

Symptoms: possible rhabdomyolysis

Other Meds: biotin, magnesium, multi vitamin

Current Illness: none known

ID: 1002870
Sex: F
Age: 83
State: CO

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

Lab Data:

Allergies:

Symptoms: Due to mis-communication with pharmacist 1.0 mL doses was administered instead of 0.5 mL dose - no reaction noted

Other Meds:

Current Illness:

ID: 1002871
Sex: F
Age: 70
State: MI

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

Lab Data: No testing

Allergies: PENICILLIN SULFA CODEINE TETRACYCLINE ERYTHROMYCIN

Symptoms: Injections site reaction: Hot, hard and red upon waking in the morning.

Other Meds: HCTZ ATORVASTATIN OMEPRAZOLE AIRBORNE ASPRIN

Current Illness: NONE

ID: 1002872
Sex: F
Age: 41
State: MA

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

Lab Data:

Allergies: None

Symptoms: Fever, headache, muscle and joint aches

Other Meds: Vitamin D

Current Illness: None

ID: 1002873
Sex: M
Age: 69
State:

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

Lab Data:

Allergies:

Symptoms: Caller stated that she received her vaccine on 01/25/2021 and a week later she got hives, the site of injection became red and swollen. She contacted her PCP who advised her to take antihistamine. She took zyrtec as advised and the hives went away, but redness is still there, but not sore.

Other Meds:

Current Illness:

ID: 1002874
Sex: F
Age: 86
State: MD

Vax Date: 01/19/2021
Onset Date: 01/25/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data:

Allergies: PCN Demerol

Symptoms: Redness, a big hard ump that resolved already & itchiness

Other Meds: Omeprozole Lotoporol Lasix Lasartan Fenofibrate Pretrovision Tumeric Vit C, Magnesium, D3, B12 B, complex, Potassium, Metamucil

Current Illness: None

ID: 1002875
Sex: F
Age: 27
State: IN

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

Lab Data:

Allergies: Penicillin, amoxicillin, Augmentin, Clindamyacin, keflex

Symptoms: Fever, chills, body aches, blotchy skin, fatigue, nausea, headache, arm pain

Other Meds:

Current Illness:

ID: 1002876
Sex: F
Age: 43
State: RI

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

Lab Data: none-reported

Allergies: NKDA

Symptoms: Pt experienced Arm numbness/tingling sensation on Left Arm, as well as a hot flash episode resulting in a brief episode of general weakness/malaise

Other Meds: Metoprolol

Current Illness: None-reported

ID: 1002877
Sex: M
Age: 56
State: FL

Vax Date: 01/13/2021
Onset Date: 01/15/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: Uveitis (underlying condition occurring once every 2-3 years, I was NOT in a flare up at the time of the injection), and mouth ulcers (underlying condition occurring 2-3 times a year, I was NOT in a flare up at the time of the injection). For the Uveitis I went to my eye doctor and started a prednisolone regimen and am still on it. I received the 2nd does (lot EL9264) yesterday on 3 Feb at 09:00am. The mouth ulcers were treated with oral medication-Valtrex. 2nd dose does not seem to have aggravated the above noted reactions. Other symptoms common to the injection are occurring but seem more intense after the 2nd dose (aches, low energy, some minor coughing)

Other Meds: Humira, Sulfasalazine, Chlorthalidone, Potassium CL, Metformin, Atenolol, Montelukast, Fluticasone, Leflunomide, Concerta, Amlodipine, Atorvastatin, Diclofenac, loratadine, Losartan, Omeprazole

Current Illness:

ID: 1002878
Sex: F
Age: 70
State: WY

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

Lab Data:

Allergies: pencillin

Symptoms: approx 16 hours after I received the vaccine I awoke in excruciating pain. My back hurt so badly I was having trouble walking and both upper arms felt as though they were in a vice. I had been warned that side effects might be significant but this was like nothing I had ever experienced. I spent the next 15 hours in pain and at first I worried that somehow I had gotten the virus. At about 4:30 am the pain disappeared and it was like I had never even experienced it. I am reporting this because of the extreme pain I had and the odd way it just disappeared with no after effects. I did not seek medical attention because I felt fine by the time doctors offices would have been open.

Other Meds: calcium 600 mg plus vitamin d 20mg 2 daily/ vitamin D3 50 mg 2000IU 1 daily/magnesium 250 mg 1 daily/ leflunomide 20mg 1 daily/metoprolol 25 mg 2 daily/spironolactone 25 mg 1 daily/alendronate 70mg 1 weekly

Current Illness: RA

ID: 1002879
Sex: F
Age: 75
State: LA

Vax Date: 01/07/2021
Onset Date: 01/19/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data:

Allergies: Aspirin

Symptoms: Painful red rash appeared on both arms( under arm near glands), lower back, and under both breast.

Other Meds: Metoprolol, Fluid Pill

Current Illness: None

ID: 1002880
Sex: F
Age: 30
State: IN

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

Lab Data: N/A

Allergies: Non-respiratory reactions to mangos (nausea, vomiting, diarrhea) and strawberries (itching on tongue and mouth)

Symptoms: Nausea, lightheadedness, Skin-crawling feeling, Headache, Symptoms began after eating a meal, around 7:30 PM and continued until about 2:00 AM. Symptoms minorly alleviated with weighted blanket, rest, and tylenol.

Other Meds: Fluoxitine, Sprintec, Zyrtec

Current Illness: N/A

ID: 1002881
Sex: F
Age: 42
State: SC

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

Lab Data:

Allergies:

Symptoms: During 15 minute wait period after vaccine she reported her hands itching; she notified the observation nurse. Within the hour her right arm felt heavy, then progressed to her entire right side feeling heavy with numbness. Later she developed a migraine and noticed a rapid heart rate. By 1/31/2021 the symptoms began to lessen. Again on 2/3/2021 she experienced itching of her hands that progressed to itching all over her body, resolving after about 1 hour.

Other Meds:

Current Illness:

ID: 1002882
Sex: F
Age: 41
State: AZ

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

Lab Data: 2 Emergency room visits and 3 doctors office visits 20mg corticosteroids daily for 30 days, albuterol breathing treatments 4x daily, in addition to diphenhydramine 50mg 4x times daily

Allergies: Gluten intolerance

Symptoms: Anaphylactic reaction to COVID-19 booster (2nd shot) Refractive Asthma brought on due to anaphylaxis

Other Meds: Albuterol Tumeric Colostrum Vitamin D-3 Benadryl

Current Illness: colitis flare up due to food poisoning December 2nd 2020; er visit

ID: 1002883
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: Allergic to dairy products, animal dander, pollen, dust, grass

Symptoms: Symptoms started 15.5 hours after injection, I woke up with extreme joint pain and muscle aches all over my body, particularly my left arm (injection site). Every joint in my body was painful even while resting, I was extremely fatigued and could hardly move. I took Tylenol and Advil around the clock for 24 hours and it made the pain bearable, and when I woke up on 02/04/21 I was completely fine, only a slight ache in the middle of my shoulders.

Other Meds: NuvaRing hormonal birth control, women's multivitamin, ferrous sulfate (iron) supplement

Current Illness: Sinus infection January 2021

ID: 1002884
Sex: F
Age: 39
State: TX

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

Lab Data: None

Allergies: Cats

Symptoms: Body aches, chills, fever, nausea, insomnia

Other Meds: Adderall 20 mg

Current Illness: None

ID: 1002885
Sex: F
Age: 70
State: CO

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

Lab Data:

Allergies:

Symptoms: Due to mis-communication with pharmacists 1.0 mL dose was administered instead of 0.5 mL dose - no reaction noted

Other Meds:

Current Illness:

ID: 1002886
Sex: M
Age: 80
State: FL

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

Lab Data: PT went to PCP office and was tested 2/4/21 for COVID-pt is POSITIVE

Allergies:

Symptoms: cough, fatigue, flu like symptoms

Other Meds: Valsartan 160 mg once daily, Atenololchlorhlorside 5025 mg, Atorvastin 20 mg, Eliquis 5 mg twice daily, Flecainide 50 mg twice daily, Silodosin 8 mg, Clonazepam .5 mg, Vitamin D, Vitamin B3, Aredes Gummy Vitamin

Current Illness:

ID: 1002887
Sex: F
Age: 61
State:

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

Lab Data: DID NOT SEEK MEDICAL HELP

Allergies: LEVAQUIN, FLAGYL

Symptoms: SEVERE FATIQUE, NAUSEA, JOINT AND MUSCLE ACHES, FEVER OF 102.5, HEADACHE FOR APPRX 32 HRS

Other Meds: BABY ASPRIN, MULTIVITS, VYVANCE, FOCALIN, DEXILANT, LEXAPRO, WELLBUTRIN, EZETIMIBE, AZELASTINE, MIRALAX, XIIDRA, SYMBICORT,IPRATROPIUM BROMIDE NASAL SOLUTION 0.06%

Current Illness: REACTION TO FIRST DOSE OF MEDERNA COVID VACC

ID: 1002888
Sex: F
Age: 42
State: OR

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

Lab Data: cbg 75 @ 0943

Allergies: bee venom

Symptoms: (This RN was not direct observer of initial incident. Initial events as reported by initial responding RNs). Pt had just received Pfizer vaccination and was seated in observation area. Was observed to be "not looking well" and approached by staff. Pt began to hyperventilate, exhibit repetitive jerking motions to upper body/"pseudo seizure-like activity", and reported feeling nauseated. Began to slide out of chair, x2 RNs assisted pt to floor. Pt then placed in wheelchair and taken to Triage tent A. Pt remained alert and oriented throughout duration of event. VS @0915- BP 128/77 HR 131 Sats 100% on RA. 0.3mg IM epinephrine given at 0919. VS @ 0920 HR 108 0938 O2 sats 87% on RA, applied 0.5L O2 via nonrebreather mask. Sats back up to 100% @ 0939. Pt remains alert, intermittently exhibits periods of jerking actions and hyperventilation between periods of calm. With staff assist, called husband who was en route. VS @ 0940- HR 101, Sats 100% on 0.5L via nonrebreather. 50mg IM Benadryl given at 0940. VS @ 0950 HR 109 sats 100% on RA. Husband, to bedside. Pt remains alert. 1007 EMS arrives for transport to Emergency Department

Other Meds: UTA

Current Illness:

ID: 1002889
Sex: M
Age: 56
State: CA

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

Lab Data:

Allergies:

Symptoms: Medication error 0.3ml was administered when 0.5ml was the recommended dose per manufacturer. Per CDC and the manufacturer no treatment, facility advised to follow up with 2nd dose of 0.5ml of Moderna 28 days post 1st dose administration.

Other Meds:

Current Illness:

ID: 1002890
Sex: M
Age: 64
State: FL

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

Lab Data: COVID test - positive

Allergies:

Symptoms: The next day in the evening I experienced fever of 102 and I had chills, achiness in my body. I couldn't sleep, my thinking patterns were little confused, I was confused. I was also having adverse dreams. By Monday the fever went down, and the body aches and tiredness went down some. On Monday I went and got a COVID test and got a positive. Up to time of vaccination I have tested negative. The place that gave me the COVID test said it could be a false positive due to recently being vaccinated. The person from the COVID test said it was safe to get the 2nd dose. I feel okay right now and I am out and about.

Other Meds: Blood pressure Amlodipine 5 MG daily, Vitamin D and Zinc,

Current Illness:

ID: 1002891
Sex: F
Age: 36
State: OH

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

Lab Data:

Allergies: nubain

Symptoms: within an hour after getting vaccine severe headache started. continued thoughtout rest of day. by evening my left eye swollen red couldn't see out of it, severe headache, severe body aches, chills, low grade fevers off and on extreme fatigue, unable to get out of bed without being dizzy and nausea

Other Meds: celexa Wellbutrin

Current Illness: none

ID: 1002892
Sex: F
Age: 30
State: IL

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

Lab Data:

Allergies: Sulfa

Symptoms: Ongoing headache, moderate sinus pressure and congestion, drowsiness; took an Advil Sinus Congestion & Pain tablet (200mg ibuprofen, 10mg phenylephrine HCI)

Other Meds: Bupropion, 150mg; sertraline, 50mg

Current Illness:

ID: 1002893
Sex: F
Age: 70
State: WA

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

Lab Data: None

Allergies: none

Symptoms: chills, fever 101, nausea, aching, Symptoms remitted within 24 hours

Other Meds: Qvar Flonase Aspirin 81 mg Lamictal 150 mg bid Diltiazem 60 mg bid Rosuvastatain 20 mg Zytrec 10 mg Singulair 10 mg Tylenol as needed

Current Illness: none

ID: 1002894
Sex: F
Age: 46
State: IN

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

Lab Data: none

Allergies: unknown

Symptoms: Vaccine was not administered d/t error drawing up vaccine from vial. Needle was pushed through vaccine into air space of vial and injected into patient. No injuries reported from vaccine recipient and have been rescheduled to receive their vaccine.

Other Meds: unknown

Current Illness: unknown

ID: 1002895
Sex: F
Age: 43
State: NC

Vax Date: 01/26/2021
Onset Date: 02/03/2021
Rec V Date: 02/04/2021
Hospital:

Lab Data: Office visit on 02-04-2021

Allergies: Cefzil

Symptoms: Swelling, redness, hives, hot to the touch, sore, and itchy. Began taking oral Benadryl after I called the nurse line and scheduled an appointment to see my doctor the following day. Doctor recommended continuing with topical Benadryl during the day and oral Benadryl at night along with ibuprofen and ice packs on 20 minutes and off 20 minutes.

Other Meds: Flecainide Acetate 100 MG - 2 x's daily Multi-Vitamin Oral Table Probiotic Oral Table Lopid 100 MG - 2x's daily Spironolactone35 MG - 3 in the morning Trintellix 10 MG Oral Table Zyrtec Allergy 10 Mg Oral Zyrtec

Current Illness: None

ID: 1002896
Sex: M
Age: 61
State:

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

Lab Data:

Allergies:

Symptoms: The patient received his vaccine on Monday 2/1/21. The patient did not complain of any ADRs or fever immediately following the injection. However, the next day he had a temperature of 99.1 F. Since the patient was febrile, he was given rapid COVID tests, which was negative. Patient was not in distress.

Other Meds:

Current Illness:

ID: 1002897
Sex: F
Age: 47
State: GA

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

Lab Data: None

Allergies: None

Symptoms: 45 minutes after receiving the vaccine I felt a slight swelling in the throat, it went away in about an hour. Did not have to go to the hospital, it went away. Later the arm area where the shot was administered became swollen, red, warm and enlarged. It stayed that way for 2 weeks.

Other Meds: None

Current Illness: None

ID: 1002898
Sex: M
Age: 61
State: HI

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

Lab Data:

Allergies:

Symptoms: Employee described malaise and body aches the day after receipt of the vaccination (1/13/21). The symptoms were bothersome enough to keep the the employee out of work for one day.

Other Meds:

Current Illness:

ID: 1002899
Sex: F
Age: 75
State: CO

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

Lab Data:

Allergies:

Symptoms: Due to mis-communication with pharmacist 1.0 mL dose was administered instead of 0.5 mL dose - no reaction noted

Other Meds:

Current Illness:

ID: 1002900
Sex: F
Age: 61
State: AZ

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

Lab Data: Blood Tests ECO Cardiogram Blood Sugar Test I-V Chest X-Ray IV for Zofran

Allergies: Codeine, Epinephrine, Milk,

Symptoms: Extremely sore left arm for days 1-3, On third day awoke with debilitating dizziness, nausea and headache. Dizziness was so extreme any movement sent my head spinning and I began sweating and experienced nausea. Had to go to the hospital for treatment. Dizziness continued on the fourth morning but subsides after taking 25mg of Meclizine HCL. headache continues as well. Other side effects: Complete loss of appetite Blurred vision in right eye

Other Meds: None

Current Illness: Irritable Bowel Syndrome

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm