VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1006209
Sex: F
Age: 24
State: MD

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/05/2021
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: Not aware of any.

Symptom List: Dysphagia, Epiglottitis

Symptoms: Muscle and joint soreness over entire body beginning approximately within an hour after injection and lasting approximately 12-24 hours in total duration.

Other Meds: Biotin, Zyrtec

Current Illness: None

ID: 1006210
Sex: F
Age: 27
State: TX

Vax Date: 01/08/2021
Onset Date: 01/15/2021
Rec V Date: 02/05/2021
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: Rocephin, Vancomycin

Symptom List: Anxiety, Dyspnoea

Symptoms: The Moderna vaccine administration was painful at the time the shot was received. I experienced symptoms of fatigue and body aches for 24 hours after receiving the vaccine. My left arm was extremely sore and knotted for over a week after administration. The vaccine site was red and splotchy for the first 7 days after getting the shot. By the early morning of the 8th day (01/16/21), the splotches had joined together to make a large red area surrounding the vaccine site, that was raised and hot to the touch. During that entire day, pain was shooting down my left arm to my fingers (particularly the left middle finger) in a manner that felt like how severe arthritis pain is described. The pain became worse as the day went on. I texted a picture of my arm to my boss, who is a physician, to see what he thought I should do. He stated that from the photo, it looked like Cellulitis, and offered to send in an antibiotic to my pharmacy. Soon after, the pain was so intense (especially with movement of the arm) that I had someone drive me to ER & Urgent Care around 8:30pm. The physician there marked my arm and prescribed 2 antibiotics to begin taking immediately (Bactrim & Amoxicillin) with the instructions to come back in 48 hours. By the next day, the redness was spreading by the hour, which was marked & tracked via photos that documented the progression. By Monday morning, the redness had continued to spread & take up most of my left upper arm. The skin was hot to the touch and swollen. I had my boss look at my arm in the morning and mark the redness, then I had another physician at my office look at it in the afternoon and do the same. Their analysis was that the antibiotics were not working, and I went back to ER after I got off work at 5pm, which was around the 48-hour mark when I was supposed to return. ER gave me several IV antibiotics and ordered an Ultrasound of the left arm to make sure there was no blood clot hidden beneath the swelling. They also took several different lab and blood culture samples. I ended up having a reaction to one of the IV antibiotics (Vancomycin), where they had to counteract the reaction with IV steroids & antihistamines, and decided to hold off on giving me the third IV antibiotic that was initially planned. I was sent home with Clindamycin 900mg, a Medrol dosepack, and told to discontinue the Bactrim, but continue the Amoxicillin. I continued to check back over the following days, and ended up receiving another IV antibiotic (Clindamycin) and more lab tests. The provider that saw me on Monday said that she was close to admitting me to the hospital, and if I did not improve by the following day, she would proceed with sending me. By the 5th/6th day, the redness seemed to be improving and becoming smaller.

Other Meds: Vyvanse 60mg oral capsule

Current Illness: None

ID: 1006211
Sex: F
Age: 26
State: AZ

Vax Date: 01/12/2021
Onset Date: 01/18/2021
Rec V Date: 02/05/2021
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: NONE

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

Symptoms: Patient showed a picture of injection area and was large red and swollen. Patient stated it appeared approximately 1 week following 1st dose for Moderna. Redness lasted a few days and went away.

Other Meds: nONE

Current Illness: NO

ID: 1006212
Sex: F
Age: 38
State: IN

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fever 99.7 degrees F for 24 hours; hamstrings painful enough I couldn?t sleep for 10 hours; ankles, knees and hips very tight and sore for 24 hours

Other Meds: Lamotrigine 200 mg, Aimovig injection 140 mcg, bupropion XL 150 mg, Vitamin D3 50 mcg (2000 IU), Iron 65 mg, Magnesium Complex 400 mg

Current Illness: None

ID: 1006213
Sex: F
Age: 25
State: OR

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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

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

Symptoms: Chills, a fever of 100.4, and headache

Other Meds: topical Clindamycin daily for acne

Current Illness: none, but I did have Covid in December of 2020, and symptoms of covid ended on 12/24/2020

ID: 1006214
Sex: F
Age: 25
State: TN

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Patient arrived at our COVID vaccination site for her scheduled "first dose" appointment. A Pfizer assessment sheet was filled out, and the patient answered "No" to all assessment questions. When asked "Has the person to be vaccinated ever received a COVID-19 vaccine" the pt stated "no". The pt was also asked " has the person to be vaccinated received any vaccine in the past 14 days" and the pt stated "no". Based upon the pts responses to the standard questions asked on the assessment sheet, a Pfizer vaccine was administered to the pt. The pt never let on that she had previously received a COVID vaccine. Upon entering the pt vaccination information into the system, it was discovered that the pt had in fact already received a dose of the Moderna vaccine on 1/06/2021.

Other Meds: Unknown

Current Illness: Unknown

ID: 1006215
Sex: F
Age: 48
State: KY

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Fever, chills, headache, joint pain, muscle pain, pain at injection site Fever lasted 2 days all other symptoms except pain at injection site lasted 3 days. Injection site pain is on going

Other Meds: Cymbalta, Buspirone

Current Illness:

Date Died: 02/03/2021

ID: 1006216
Sex: F
Age: 100
State: SC

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

Symptom List: Pharyngeal swelling

Symptoms: Notes of the checks/events with resident: 18:36 2/2/21 Resident had no complaint of pain, swelling, redness or warmth to vaccine site. No signs and symptoms of fever, chills, tiredness or headache. T 97.2 02:50 2/3/2021 Resident received 2nd COVID vaccine. No complaint of pain, swelling, redness or warmth to vaccine site. No signs and symptoms of fever, chills, tiredness or headache. T 98.1 07:15 2/3/2021 Resident was observed not breathing. 911 was contacted along with the doctor. Resident was confirmed having passed away.

Other Meds: Medications the resident was currently recieving: AmLODIPine Besylate Tablet 5 MG Losartan Potassium Tablet 50 MG Melatonin Tablet 5 MG Povidone-Iodine Solution 10 % Remeron Tablet 15 MG (Mirtazapine) Tamsulosin HCl Capsule 0.4 MG Lactobaci

Current Illness: None

ID: 1006217
Sex: F
Age: 49
State: ME

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/05/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Red rash that appeared on the back of her neck the evening after the vaccine. The rash then expanded to the front of her neck as well.

Other Meds:

Current Illness:

ID: 1006218
Sex: F
Age: 44
State:

Vax Date: 01/09/2021
Onset Date: 01/21/2021
Rec V Date: 02/05/2021
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: Staff member received COVID vaccine on 1/9/21. Initially post injection, noted swelling and itching at injection site which lasted approx. 48 hours. Contacted manager today (1/22/21 with report of nausea and headache on 1/20/21 and return of swelling, itching, and hives at injection site on 1/21/21.

Other Meds:

Current Illness:

ID: 1006219
Sex: F
Age: 30
State: OH

Vax Date: 12/31/2020
Onset Date: 01/04/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: Codeine Morphine Latex

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

Symptoms: Swollen lymph nodes left side neck after 1st vaccine Swollen lymph nodes on right side neck Continues to be enlarged & under going further testing as this has not been listed as a possible side effect.

Other Meds: Nexplanon

Current Illness: None

Date Died: 02/12/2021

ID: 1006220
Sex: M
Age: 93
State: KY

Vax Date: 01/24/2021
Onset Date: 01/31/2021
Rec V Date: 02/05/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Rash, Urticaria

Symptoms: Pt from home via EMS. Pt reports increased weakness since getting the covid vaccine on the 24th. Pt is normally ambulatory at baseline, but has not been able to get around his house. Pt was found to be 83% on RA and was audibly wheezing per EMS. No history of respiratory issues. Denies fever, but has had a productive cough. A&O x4. Pt received Duoneb treatment in route. Acute respiratory failure with hypoxia , Pneumonia due to COVID-19 virus , Elevated LFTs. Patient admitted to hospital on 2/3 and is still inpatient

Other Meds: Hime Meds: Tylenol Arthritis tablets, Lipitor, Baclofen, Celexa, Cardizem CD, Claritin-D, Myrbetriq, Remeron and Rhythmol

Current Illness: PMH: Former smoker, paroxysmal atrial fibrillation, sleep apnea, hypertension and osteoarthritis. Admitted to the hospital on 2/3/21 with complaints of non-productive cough for 2-3 days prior to admission and generalized weakness. His O2 sats upon admission was 83% and he was wheezing upon exam. He walks with a walker at baseline and does not use oxygen at home.

ID: 1006221
Sex: F
Age: 50
State: AR

Vax Date: 01/31/2021
Onset Date: 02/01/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Redness, swelling and warmth at injection site. Lasted 4 days and then went away. No other reactions.

Other Meds: Lisinopril 10 mg 1x a day OTC: Vit C 1x a day Vit D3 1x a day Probiotics 1x a day

Current Illness: None.

ID: 1006222
Sex: F
Age: 49
State: PA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/05/2021
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: Cipro, Tree nuts, Pine nuts

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

Symptoms: 5:15P Received Moderna vaccine-2nd dose 5:30P-Developed "tickle in back of throat" and need to "clear throat. Given Benadryl 25MG oral and Famotidine 40 mg oral by PA 5:35P Examined by Dr.. Patient did not want to go to ER 5:50P- Pt states symptoms resolved. Remains in vaccine clinic 6:30P re-examined by Dr. . Remained asymptomatic. Allowed to leave clinic

Other Meds: Tapazole, Lisinopril, Protonix

Current Illness: None

ID: 1006223
Sex: F
Age: 29
State: MA

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: amoxicillin, rash

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

Symptoms: Severe fever chills shakes numbness of face headache weakness left arm heaviness unable to get up for 2 hours. Took acetaminophen shaking improved, fever/chills persisted through the night with nausea, stomach cramps.

Other Meds: spironolactone 100mg daily

Current Illness: none

ID: 1006224
Sex: F
Age: 25
State:

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 02/05/2021
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:

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

Symptoms: "Patient received first COVID vaccine dose (Pfizer, Lot # EL1283, exp. 4/30/2021). Two minutes after administration, patient reported feeling dizzy, flushed, and short of breath. VS: BP 67/49 HR 83 100% oxygenation on room air. Patient felt like her throat was closing and had heaviness on her chest, EPI available but not given, a rapid response was called as her BP remained at 64/36, then RR team here, BP came up to 100/67. Patient maintained 100% oxygenation throughout, she taken to ED for further evaluation and monitoring. Patient leader was contacted to let them know she would not be returning to work at this time. In ED... patient receiving fluids, being worked up for hypotension and elevated WBC's. Disposition has not been determined as of 1615.

Other Meds:

Current Illness:

ID: 1006225
Sex: F
Age: 69
State: CA

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Walnut Trees, Scallops

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

Symptoms: Almost immediately a bright red rash appeared from injection site to the wrist. Also left side of tongue swollen. It was suggested that my husband purchase and administer benadryl which we did - 2 tablets. After 30 minutes we went to the car. My face was bright red (cheeks) and swollen. Within 20 minutes of taking the benadryl symptoms subsided.

Other Meds: Synthroid, citalopram, cytomel, D3, Ultimate Omega, Multiple

Current Illness: None

ID: 1006226
Sex: F
Age: 30
State: IA

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Head ache; sweaty; Got into elevator to go back to work and passed out. Assessed by physicians assistant and was released, sent home for the day.

Other Meds:

Current Illness:

ID: 1006227
Sex: F
Age: 39
State: CA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient reported dizziness, nausea and cramping 30 minutes after vaccination administration. Pt reports that dizziness was gone after 30 minutes, but continued to have intermittent nausea. Site of injection site clear, no redness or swelling.

Other Meds:

Current Illness: n/a

Date Died: 02/03/2021

ID: 1006228
Sex: F
Age: 88
State: ND

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

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

Lab Data:

Allergies: cephalosporins, codine, diazepam, morphine, penicillins, phenobarbital, sulfailamide, clindamycin

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

Symptoms: 2/2/21-1000-patient presented to the local emergency room with complains of fever, shortness of breath and decreased oxygen sats. temp 101.7, pulse 102, respirations 36, BP 141/92, oxygen 94%. Lung sounds crackles bilaterally with rhonchi on the left. patient worked up for sepsis, CXR shows mild atelectasis. blood pressure dropped, and continued to drop through treatment requiring levophed drop to be initiated. Patient POA determined that this would not be her sister's wishes and made the decision to make patient comfort care status. 2/3/21- patient lethargic throughout night. 0640-patient demise.

Other Meds: desmopressin 0.01% nasal spray 1 spray NS BID, dezlansoprazole 60 mg PO Daily, Escitalopram 10mg PO Daily, folic acid 1mg PO daily, furosemide 20mg PO daily, lorazepam 1mg PO TID PRN MDD 3mg in 12H, losartan potassium 100mg PO daily, macula

Current Illness: none known.

ID: 1006230
Sex: F
Age: 35
State: ME

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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:

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

Symptoms: injection site was red and itchy. Benadryl was given

Other Meds: 50mg Benadryl given PO

Current Illness:

ID: 1006231
Sex: F
Age: 65
State: NY

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Unevaluable event

Symptoms: Severe headache; chills; fatigue; muscle aches. These symptoms lasted through the following day but abated within 48 hours.

Other Meds: Levothyroxin

Current Illness: None

ID: 1006232
Sex: F
Age: 29
State: OH

Vax Date: 01/08/2021
Onset Date: 02/02/2021
Rec V Date: 02/05/2021
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: Na

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

Symptoms: Iritis

Other Meds: Steroids for eye and seduo fed

Current Illness: None

ID: 1006233
Sex: F
Age: 60
State:

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 02/05/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Discovered a vaccine site reaction. Site is red, swollen, and itches, with hard lump about 6 cm in diameter. Self-treatment: Taking ibuprofen every six hours and using hydrocortisone 1% cream for itching.

Other Meds:

Current Illness:

ID: 1006234
Sex: F
Age: 82
State: KS

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: Ace inhibitors

Symptom List: Injection site pain, Menorrhagia

Symptoms: Shortness of Breath, Tingling of Tongue

Other Meds: Amlodipine Besylate, Indomethacin, Metoprolol, Simvastatin, Ezetimibe, Furosemide, Levothyroxin, 81 Aspirin, Zertec Generic, Lutein, Multi vitimin, vitimin D3,

Current Illness:

ID: 1006236
Sex: M
Age: 76
State: CA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: None known. Allergic rhinitis from dust, mold, pollen, petroleum products

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

Symptoms: Muscle and joint aches, shot site ache, headache, chills, fatigue, no appetite Treating with Tylenol. No abatement yet (9 hours later)

Other Meds: Metoprolol, Lisinopril, HCTZ, Terazosin.

Current Illness: HBP

ID: 1006237
Sex: F
Age:
State: IN

Vax Date:
Onset Date:
Rec V Date: 02/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: With the second dose I had chills, body aches and felt light headed. After 24 hours I woke up fine.

Other Meds:

Current Illness:

ID: 1006238
Sex: F
Age: 68
State: CA

Vax Date: 01/28/2021
Onset Date: 02/01/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Starting on the 4th day, itchy in the injection site and pale small light pinkish area was noted; light swelling also behind the injection site. On the 7th day, very very itchy and Benedryl cream helped; Redness area got bigger and color intensity increased. Today is the 8th day and still itching and red.

Other Meds: 1) Levothyroxine, 2) Calcium Citrate, 3) Vit D3, 4) Kirkland Triple Action Joint Health, 5) Omega 3, 6) Tumeric Supplement

Current Illness: None

ID: 1006239
Sex: M
Age: 36
State: PA

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: High fever of 102.4, severe chills, aches, stomach pain, pain in left eye and testicles.

Other Meds: Vitamin D, B12, multivitamin, fluticasone.

Current Illness: None.

ID: 1006240
Sex: F
Age: 48
State: CA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Pt became lightheaded 15 min after dose that was better upon lying down. BP 156/82, 99% o2sat, 92 HR. Attempted several times to sit up but became lightheaded again. Reported headache 5/10 at back of the head at 09:45am and tension in the neck (stiff). At 10am, pt vomited and vomited several times more afterwards. At 10:07am, pt was cleared for d/c home by NP. Pt told to take rest of day off and at 10:30am, pt was escorted via WC to car, husband driving. Pt still was lightheaded, nausea was improved, still had HA and stiff neck. Pt and husband given ER precautions.

Other Meds:

Current Illness:

ID: 1006241
Sex: M
Age: 59
State: MI

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: PCN- anaphylaxis

Symptom List: Injection site pain

Symptoms: presented to healthcare alert with mild confusion and hypotensive. Temp 100.4 IV fluids started and sent to ER for further evaluation.

Other Meds: Acetaminophen, ASA, Benztropine mes, celecoxib, divalproex sodium, fluoxetine hcl, midodrine hcl, multi-vitamins, risperidone, simvastatin, nasal spray, sodium chloride 1 gm

Current Illness: COVID (+) 12-28-2020

ID: 1006242
Sex: F
Age: 17
State: ND

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received moderna vaccine at 17 years of age.

Other Meds:

Current Illness:

ID: 1006243
Sex: F
Age: 64
State: GA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: Sulfa

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

Symptoms: 12 hr post - chills and fatigue, 24 hrs - fatigue, generalized aches preceded syncopal event while seated with sweating , blurred vision then loss on consciousness for 15 seconds. Revived on floor with tachycardia, sweating then nausea and vomiting x 1.

Other Meds: Levothyroxin, Vitamin D , Flonase

Current Illness: No

ID: 1006244
Sex: F
Age: 52
State:

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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:

Symptom List: Tremor

Symptoms: chills, fever, body aches and headache

Other Meds:

Current Illness:

ID: 1006245
Sex: F
Age: 25
State: OH

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Latex, Zithromax, contrast dye

Symptom List: Erythema, Pruritus

Symptoms: Starting 30 minutes after receiving the Moderna vaccine, I experienced fatigue, achy muscles, and chills.

Other Meds: n/a

Current Illness: Covid-19 from 1/12/2021 - 1/22/2021

ID: 1006246
Sex: F
Age: 32
State: OR

Vax Date: 01/10/2021
Onset Date: 01/17/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: None

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

Symptoms: Had initial redness, pain and swelling that mostly went away within 24-48 hrs. Am reporting return of redness, swelling, tenderness and itchiness 8 days after vaccination administration. Then that also went away within 48 hours of reappearing.

Other Meds: Flexaril, hydrochlorothiazide

Current Illness: None

ID: 1006247
Sex: M
Age: 40
State:

Vax Date: 02/01/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: N/A

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

Symptoms: Maculopapular rash involving entire trunk front and back, neck, and arms.

Other Meds: Omeprazole

Current Illness: N/A

ID: 1006248
Sex: F
Age: 76
State: CA

Vax Date: 01/31/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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: Chronic and debilitating head ache for 3 days (still continuing). Taking ibprofin (400 mg) every 4 hours.

Other Meds: Vesicare, Amlodipine, carvediol,ezetimble, losartan, mycophenolate, prednisone, omneprazole, multivitamin, fish oil

Current Illness: none

ID: 1006250
Sex: M
Age: 60
State: CA

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: CHILLS, FEVER UP TO 105.5, FATIGUE, ANOREXIA,

Other Meds: Metoprolol, Fenofibrate, Vit D., baby aspirin

Current Illness: None

ID: 1006251
Sex: F
Age: 27
State: IN

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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:

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

Symptoms: Fatigued, body aches, chills,

Other Meds:

Current Illness:

ID: 1006252
Sex: F
Age: 38
State: MI

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: Seasonal/outdoor allergies.

Symptom List: Pain in extremity

Symptoms: Cough , shortness of breath and dizziness. Personal albuterol inhaler used without relief of symptoms so was taken to the emergency room.

Other Meds: Albuterol inhaler and Lisinopril

Current Illness: Asthma.

ID: 1006253
Sex: F
Age: 67
State: VA

Vax Date: 01/27/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: I have eosinophilic esophagitis I am allergic to food and have environmental allergies

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

Symptoms: None stated.

Other Meds: Synthroid effexor previcid triamterine ( for Meniere's disease) singular

Current Illness: UTI and I had to have an endodontic procedure

ID: 1006254
Sex: F
Age: 52
State: ME

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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:

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

Symptoms: Arm, numb and tingling radiating into the L jaw, 50mg Benadryl given

Other Meds:

Current Illness:

ID: 1006255
Sex: F
Age: 32
State: IL

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: alupent syrup (seizure as baby)

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

Symptoms: 5 minutes after shot, patient passed out for 10-15 seconds. Nurse woke up patient. Patient reports vomiting about 1 minutes later. Patient states they had a migraine before getting the vaccine today. Patient reports a history of getting anxious and passing out with shots or blood draws.

Other Meds: Probiotic; multivitamin, citalopram 10mg daily.

Current Illness: None

ID: 1006256
Sex: F
Age: 43
State: NY

Vax Date: 01/28/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: Berries, apples, pears, seamen

Symptom List: Vomiting

Symptoms: I'm having a terrible reaction to my first covid shot that I got on 1/28. It's itchy, hot to the touch, hard, the swelling is the size of a baseball. I have headache, I'm super tired, my pinky finger is hot and numb And my neck hurts. I saw the dr this morning and she says it's called "covid arm" it will most likely spread down my arm and up to my neck. I have to be careful that it doesn't turn into cellulitis

Other Meds: None

Current Illness: Nond

ID: 1006258
Sex: F
Age: 74
State: FL

Vax Date: 01/15/2021
Onset Date: 01/22/2021
Rec V Date: 02/05/2021
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: sulfa, lactose, vicadin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: rash on arm, site of vaccination, itchy, red, swollen, hot to touch, painful, lasted 3 days, then residual redness for 3 more days

Other Meds: carbidopa-levodopa, pantoprazole, lexipro, miralax, calcium + D, B-12, melatonin

Current Illness:

ID: 1006259
Sex: F
Age: 28
State: CA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: n/a

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

Symptoms: @ 10:10 patient reports feeling nauseated, she reports that it lasted for 10 minutes. She was monitored for 30 minutes and was asked to return to clinic if any changes occur.

Other Meds: n/a

Current Illness: n/a

ID: 1006260
Sex: F
Age: 59
State: TX

Vax Date: 01/30/2021
Onset Date: 01/31/2021
Rec V Date: 02/05/2021
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: - None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: went 2d ago for covid vaccine #1 (Moderna) at 5:30pm; LT upper arm - no rash around injection site - yesterday at noon felt feverish, then rash on torso in the evening ~5pm

Other Meds: Losartan, Atorvastatin, Nature throid, Progesterone; also taking B complex, Vit C, zinc, Vit D 1000IU/d

Current Illness:

ID: 1006261
Sex: M
Age: 79
State: PA

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
Hospital: Y

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

Lab Data:

Allergies: Varencicline ?weird dreams?

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

Symptoms: Fever to 103.4, malaise,weakness; treatment tylenol supportive care, O2 to 3L

Other Meds: Prn nitro sublingual 0.4 mg Trazodone 50 mg po hs Advair 45/21 2 puffs bid Asa 81 mg qday Atorvastatin 20 mg qpm Metformin 1000 mg bid Flomax 0.8 mg qhs Proair 2 puffs q4 prn Glucosamine- chondroitin 1 tab qday unknown dose Diltiazem xr 24

Current Illness: Severe covid-19 with hypoxemic respiratory failure hospitalized dec 9 2020 to dec 30 2020 (two months ago)

ID: 1006262
Sex: F
Age: 65
State: GA

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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: Allergic to shellfish

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

Symptoms: Severe swelling of face around eyes nose and cheek area. Tingling of tongue, pressure at lymp node areas.

Other Meds: Simistatin Bayer Low Dose Aspirin

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm