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

Incidents per State

State Total
92,076
AK1,880
AL6,345
AR4,151
AS46
AZ14,991
CA66,887
CO12,550
CT8,943
DC1,795
DE2,009
FL42,724
FM4
GA17,031
GU124
HI2,580
IA4,919
ID2,892
IL22,128
IN24,197
KS5,047
KY9,111
LA5,500
MA15,718
MD13,434
ME3,351
MH8
MI20,971
MN13,585
MO10,747
MP30
MS3,198
MT2,477
NC18,051
ND1,501
NE3,109
NH3,218
NJ20,216
NM4,218
NV4,728
NY37,667
OH20,793
OK6,692
OR9,244
PA25,607
PR2,588
QM2
RI2,163
SC7,261
SD1,282
TN10,445
TX39,890
UT4,618
VA15,980
VI67
VT1,830
WA16,071
WI12,042
WV2,571
WY926
XB5
XL1
XV2

ID: 1007055
Sex: M
Age: 78
State: IA

Vax Date: 01/30/2021
Onset Date: 02/02/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type:
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Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient had discoloration of skin/bruising at the injection site

Other Meds: None

Current Illness: Unknown

ID: 1007056
Sex: F
Age: 65
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: PCN, CIPRO, OCEPHIN, JACK FRIUT, HIBISCOUS, JUJUBEES, LATEX

Symptom List: Anxiety, Dyspnoea

Symptoms: RASH, REDNESS INNECK AREA, STARTED AT 7PM ON DATE OF VACCINE. C/O PAIN IN LEFT EAR, REDNESS THAT LASTED 5 DAYS, EAR PAIN LASTED 24 HOURS

Other Meds: OLAIR/ ING 150MG ., LISINOPRIL, CRESTOR, TIMOLOL, ALBUTEROL INHALER , CQ10, FISH OIL, CA , D3, MAGNESIUM

Current Illness: RECEIVED SOLUBMEDROL 150MG. INJECTABLE.

ID: 1007057
Sex: F
Age: 73
State: CA

Vax Date: 01/22/2021
Onset Date: 01/28/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Lab Data:

Allergies: Penicilin Amoxycilin probably all cillins Bactrim Antihistamines

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

Symptoms: Itching at site of vaccine injection on my right arm 6 days after injection, I noticed a rash red and itching, then blotches combined into an "angry" red blotch that grew larger over the next 6 days, was sore, hot to the touch and itchy. Today, 2-5-21, the red blotch is faded but still visible. It no longer hurts, and itches intermittently and much less severely. Treatment: Tylenol mostly at night as pain disrupted sleep, ice on the red patch, and I took Benadryl. First time was helpful, stopped the itching and discomfort. Second time I had a reverse reaction and was jittery with more itching and discomfort. The outcome is that the redness has faded, no pain, not hot and itching is very low level. I expect this redness will disappear completely soon. My sister on east coast, had 1st Moderna shot 2 days before me and had the same experience, a little less severe.

Other Meds: Cytomel Avorstatin Evista Zetia Prilosec

Current Illness: none

ID: 1007058
Sex: F
Age: 43
State: MI

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Sore right arm after injection. Jaw pain right side, unable to open mouth or eat for over 24 hours. Right arm 2 weeks later still has a red rash like area and warm to the touch and painful.

Other Meds:

Current Illness:

ID: 1007059
Sex: F
Age: 42
State: FL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies: CODEINE MORPHINE

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

Symptoms: PT COMPLAINED OF REDNESS AND ITCHING OF RIGHT UPPER ARM FOR 10 MINUTES. AFTER 10 MINUTES, THE RASH AND REDNESS BEGAN TO SPREAD DOWNWARD TOWARD ELBOW WITH INCREASED ITCHING THAT EXTENDED INTO THE AXILLA AREA. WAS TRANSPORTED TO URGENT CARE FOR FURTHER TREATMENT AND EVALUATION. URGENT CARE - 9:00 AM

Other Meds: albuterol sulfate 90 mcg/actuation INHALE TWO PUFFS BY MOUTH EVERY 4 HOURS AS NEEDED FOR SHORTNESS OF BREATH alprazolam 0.5 mg oral Every 8 hours PRN butalb/acetaminophen/caffeine 50-300-40 mg TAKE ONE TO TWO CAPSULES BY MOUTH AS NEEDED -

Current Illness: N/A

ID: 1007060
Sex: F
Age: 63
State: KY

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

Vax Type:
Manufacturer:
Vax Name:
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Lab Data:

Allergies: None

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

Symptoms: Had vaccine#2 at noon on the 4th. Woke up with 101 temp and body aches at 4:30 the next morning. Temp is down with tylonol but back, neck, eyes... Especially back are extremely sure and achy. Slept at day with no energy

Other Meds: Effexor, simvastatin,aspirin,klorcon,metformin hcl,pramipexole,gnc women's offer 50 vitamins

Current Illness: None

ID: 1007061
Sex: F
Age: 26
State:

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies: INH- dizziness, hypotension, nausea

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Signs/Symptoms: fever 102.7, chills, headache, tiredness, restlessness, pain in arm, loss of appetite, malaise. Time: midnight 01/15- 12pm, administered theraflu relieved most symptoms and slept for 4 hours, headache, malaise, and fever 100.9 returned at 5pm, took another theraflu at 9pm. All symptoms resolved overnight.

Other Meds: Prenatal vitamins, nexplanon implant

Current Illness: None

ID: 1007062
Sex: F
Age: 57
State: AL

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

Vax Type:
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Lab Data:

Allergies: Sulfa drugs

Symptom List: Pharyngeal swelling

Symptoms: Rash, swelling, redness and pain upper right arm one week after injection

Other Meds: Metoprolol , lexapro, amlodipine

Current Illness: None

ID: 1007063
Sex: F
Age: 54
State: CA

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 02/05/2021
Hospital:

Vax Type:
Manufacturer:
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Lab Data:

Allergies: Ace inhibitors Aspirin Latex

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I had a severe headache daily. I had fatigue and chills that eventually went away. On Jan 1st, the symptoms returned with a fever of 104, muscle aches and achy joints. Tylenol and Ibuprofen would only help it to go down to 101 or 102, but it would go back up. I went to urgent care around the 3rd, where they tested me for COVID but it was negative. I was still having symptoms days later, so I called my PCP. My doctor decided to do another COVID and a flu test, but both were negative. I gradually improved and then once I was fever free for 72 hours, I returned to work. I still had the headache, though. I am continuously completing my vsafe checks, but I was scared about getting the 2nd dose. I went ahead and got it. I had fever, chills, body aches and joint pains, but it only lasted two days.

Other Meds: Diabetes meds

Current Illness:

ID: 1007064
Sex: F
Age: 51
State: NM

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

Vax Type:
Manufacturer:
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Lab Data:

Allergies: Codeine and topamax

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient recieved vaccine at 1312 and by 1315 patient started to complain of burning in the chest. Patient denied shortness of breathe at that time. vitals were taken and were within normal ranges. RN contacted provider and antacids were ordered for patient. Medication was administered by 1323 and patient verbalized relief at 1333. Patient was assessed for 15 minutes and was released to return home.

Other Meds: Loratadine, magnesium oxide, aloh/mgoh/simethicone, albuterol/ipratropium, metformin hcl, losartan, nystatin, carbamazepine, furosemide, gabapentin, calcium, ibuprofen, fluticasone/salmeterol, albuterol hfa, carvedilol, aspirin, spironolact

Current Illness: None reported

ID: 1007065
Sex: F
Age: 58
State: MN

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

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

Symptoms: febrile, sore throat, body aches, leg cramps, chest pain (hurts to breathe)

Other Meds:

Current Illness:

ID: 1007066
Sex: F
Age: 52
State: OR

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

Vax Type:
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Lab Data:

Allergies: Sulfa drugs Bee stings

Symptom List: Rash, Urticaria

Symptoms: Malaise, fever, chills, body aches, bad headache, water diarrhea, sinus pressure, and weaknesa.

Other Meds: Morphine 15 mg ER and IR 1 each. Meloxicam Lisinipril Hydrochlorithyizide Aspirin 84 baby Phenetermine 30 mg Toprimate 25 mg Clonidine 10mg 2 times a day Methocarbomal 750 mg Atorvastatin 80 mg Duloxetine 90 mg Tylenol for fever and body

Current Illness: Healthy not ill or having any issues.

ID: 1007067
Sex: M
Age: 58
State: VA

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

Vax Type:
Manufacturer:
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Lab Data:

Allergies: none

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

Symptoms: Pain, Numbness and loss of feeling from right neck, right shoulder, arm elbow and index and middle fingers. Started 2/1/21 worsened until this report 2/5/2021. Seeing neurologist 2/6/2021. Treatment rest and inactivity. Unknown outcome at this time.

Other Meds: Glucovance 2.5/500 , 1 tab in AM, 3 tabs in PM Januvia 100mg 1 tab in AM Zinc 50 mg daily Magnesium 250 mg daily Vitamin D3 25mcg BID Vitamin C 500 mg daily

Current Illness: none

ID: 1007068
Sex: F
Age:
State: CO

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

Vax Type:
Manufacturer:
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Lab Data:

Allergies: None

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

Symptoms: I did not feel particularly lightheaded or dizzy, but I passed out in my kitchen while preparing breakfast at approximately 7:30 AM on the morning following my vaccination

Other Meds: Propaphanone Lisinopril Tobias Estrace suppository Women?s flora probiotic Maganesium malate Ubiquinol B vitamin complex Vitamin C

Current Illness: None

ID: 1007069
Sex: F
Age: 84
State: IL

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

Vax Type:
Manufacturer:
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Lot:
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Lab Data:

Allergies: Dimetapp

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

Symptoms: Cold and shivering, painful arm, tiredness, nauseated, sweating. The next day she felt better but had no appetite.

Other Meds: Tylenol Arthritis, stool softner, Losartan, Atorvastatin, Amlodipine, Omeprazole, One A Day, Calcium

Current Illness: no

ID: 1007070
Sex: F
Age: 22
State: MI

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Vax Site:

Lab Data:

Allergies: n/a

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

Symptoms: Since the day of the vaccine, I have had a change in taste. Whenever I eat meat or anything savory, it tastes like gasoline. Some other things taste funny too. It began with my toothpaste, so I just thought it was a bad tube. After buying a new brand of toothpaste, I discovered that it was my tastebuds that were off. Toothpaste and anything minty or savory I once loved eating now tastes like gasoline smells. Once loved smells from cooking food are also unbearable now. Most sweet foods still taste the same, though and are good.

Other Meds: omeprazole, 40 mg

Current Illness: n/a

ID: 1007071
Sex: F
Age: 23
State: NC

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

Vax Type:
Manufacturer:
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Lot:
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Vax Site:

Lab Data:

Allergies: none

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

Symptoms: Pt was in observation after her COVID administration. She began to feel lightheaded, felt her heart was racing. She denied SOB, sensation of throat swelling, sense of impending doom. She reported she had not eaten for hours and felt "very hungry." She was offered juice but she states she does not drink juice. She was sipping water. She ate some crackers. Feet were elevated upon encountering pt. She was with her partner. Initial vitals: Pulse 58 O2 sat 100% BP 80/52 (pt reports her BP always "runs low") 5:35 pm vitals: Pulse 55 O2 sat 100% BP 96/70. Pt reports she is at baseline. Continued to report she felt she had worked herself up into an "anxiety attack." Pt left facility with her partner eager to "go eat." She had all contact information if she has any other sxs. Pt was in observation after her COVID administration. She began to feel lightheaded, felt her heart was racing. She denied SOB, sensation of throat swelling, sense of impending doom. She reported she had not eaten for hours and felt "very hungry." She was offered juice but she states she does not drink juice. She was sipping water. She ate some crackers. Feet were elevated upon encountering pt. She was with her partner. Initial vitals: Pulse 58 O2 sat 100% BP 80/52 (pt reports her BP always "runs low") 5:35 pm vitals: Pulse 55 O2 sat 100% BP 96/70. Pt reports she is at baseline. Continued to report she felt she had worked herself up into an "anxiety attack." Pt left facility with her partner eager to "go eat." She had all contact information if she has any other sxs.

Other Meds: none

Current Illness: none

ID: 1007072
Sex: M
Age: 32
State: AZ

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

Vax Type:
Manufacturer:
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Lot:
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Vax Site:

Lab Data:

Allergies: Erthyromycin, Doxycycline

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received his vaccine and was waiting in the post-vaccination waiting space. Within 5-10 minutes he slumped in his chair and became unresponsive. Became responsive to voice but was slurring his words. Patient was diaphoretic. HR in 90s, O2 98%. His eyes rolled back in his head suspecting vasovagal episode, we moved patient to the floor and raised his legs. He became more responsive. Was fully oriented although did not seem incredibly alert. Cycled multiple BPs with 100s-110s/60s-70s. HR 70s-80s supine, O2 sat 96-98%. EMS was called for transport to ED given patient's lack of prompt recovery. We attempted to sit patient up and he again became lightheaded and had to lie back down. While in supine position, remained with normal and stable VS. At no time did he manifest any rash, respiratory symptoms, throat or chest tightness, abdominal discomfort, or other overt signs of anaphylaxis. Patient was transported to the ED where ROS was reported as: - CONST: +fatigue, denies fevers or chills - EYES: Denies vision changes - ENT: Denies rhinorrhea, sore throat - CV: Denies new chest pain - RESP: Denies SOB or cough - GI: Denies abd pain, n/v, diarrhea - GU: Denies dysuria - MSK: Denies new joint swelling or pain - SKIN: Denies new lesions or rash - NEURO: Denies new HA, numbness, or weakness - PSYCH: Denies suicidal ideation Vitals: BP 116/67, O2 99% on RA, Temp: 97.7F, Pulse 79. ED provider felt this was most likely vasovagal episode given occurrence following vaccine administration and associated sxs. EKG without evidence of dysrrhythmia. No PE risk factors, SOB or CP. Pt with HA that was not thunderclap nor severe in nature and was consistent with prior migranes, thus do ot suspect SAH. No hx to suggest anemia and no anemia on blood work today. No report of seizure. Pt is alert without report of post-ictal period.

Other Meds: Prazosin, Triumeq, Cholecaliferol, Mirtazapine

Current Illness: None

ID: 1007073
Sex: F
Age: 62
State: TN

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

Vax Type:
Manufacturer:
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Lab Data:

Allergies: NK

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: soreness in arm, headache

Other Meds: Simvastatin, Hydrochlorothiazide, Cozaar, ASA81, PepcidNKn

Current Illness:

ID: 1007074
Sex: F
Age: 61
State: MN

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: woke up with sore arm and some nausea

Other Meds:

Current Illness:

ID: 1007075
Sex: F
Age: 69
State: IL

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

Vax Type:
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Lab Data:

Allergies: Pollens, Animal dander, mold

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

Symptoms: Received call from patient next day with complaint of left upper arm swelling, redness and pain from injection site downward to elbow. Advised Zyrtec 10mg for daytime and Benadryl 25mg 2 po for nighttime until better, continue cold compresses/ice off and on throughout day. Can use ibuprofen for pain as directed otc. Sent topical cortisone to her pharmacy. She can use it topically bid to red area. Outcome: 2/4-still treating

Other Meds: Alprazolam, Calcium + D, Clobetasol cream, Estradiol vaginal cream, Hydrochlorothiazide, Montelukast, MVI, Nystatin cream, Synthroid, Zyrtec

Current Illness: grief-husband had just passed

ID: 1007076
Sex: F
Age: 61
State: MD

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

Vax Type:
Manufacturer:
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Lot:
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Vax Site:

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Syncope and hypotension. No previous history of syncope. Syncopal episode 20 hours after injection . Other symptoms were chills, low grade fever, headache. No allergic rxn, no rash. Hypotension lasted for several hours.

Other Meds: Actonel one pill weekly

Current Illness: None

ID: 1007077
Sex: M
Age: 29
State: NJ

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Na

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

Symptoms: Chills , Fatigue , Severe Head Ache , Body Aches , congestion , fever

Other Meds: Na

Current Illness: Na

ID: 1007078
Sex: M
Age: 63
State: NJ

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

Vax Type:
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Lab Data:

Allergies: Honeydew melon Mold Cats Grass

Symptom List: Injection site pain, Pain

Symptoms: Trouble falling asleep night of vaccine, headache, nausea,,dizzy, off balance (slight).

Other Meds: Bystolic Zetia Livalo Finasteride Tamsulosin

Current Illness:

ID: 1007079
Sex: F
Age: 51
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: about 10 minutes after receiving vaccine i got swelling of the tongue, mouth and a little hard to swallow , constriction of throat. i was given an epi pen and taken to Emergency at Medical Center. I was released a couple hours later. I ended up going back to Emergency later on that evening but to Hospital. Tongue started to swell up again and was getting constriction of the throat and hard to swallow. Got released a couple hours later

Other Meds: Daily multi vitamin, Fish Oil,

Current Illness: N/A

ID: 1007080
Sex: F
Age: 68
State: CA

Vax Date: 01/26/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Tenderness, swelling, itching, heat rash in irregular shape over area of vaccination started 2/4/21 at 6 PM, slightly improved on 2/5/21.

Other Meds:

Current Illness:

ID: 1007081
Sex: F
Age: 27
State: CA

Vax Date: 01/12/2021
Onset Date: 01/14/2021
Rec V Date: 02/05/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 4 hours after the dose I became extremely sleepy and was unable to lift the arm I got the vaccination in. 2 days after the first dose I experienced very sharp stomach pains in my upper abdominal area (close to my solar plexus region). This lasted for approximately 2 days. No vomiting from it but I was nauseous.

Other Meds: Wellbutrin, Gabapentin, Adderall, Deplin

Current Illness: None

ID: 1007082
Sex: M
Age: 21
State: AZ

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: benadryl

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Tingling sensation down right arm (arm of injection) into fingers. Had sensations of hitting funny bone in elbow. We gave apple juice. Started to feel light headed and escorted to emergency room.

Other Meds: no

Current Illness: none

ID: 1007083
Sex: F
Age: 59
State: MN

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Severe body aches beginning the evening of 2/4

Other Meds:

Current Illness:

ID: 1007084
Sex: M
Age: 51
State: WA

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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Allergies: None

Symptom List: Nausea

Symptoms: Headache Body/joint ache Chills 101.5 F fever Above symptoms lasted about twelve hours. Symptoms abated after administering ibuprofen

Other Meds: None

Current Illness: None

ID: 1007085
Sex: F
Age: 43
State: TX

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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Allergies: N/A

Symptom List: Injection site pain

Symptoms: In addition to severe pain in my left arm at and around the injection site, my left lower back - which had been being treated by a doctor for a couple of years and was not hurting anymore - is now ON FIRE! Like hot knives stabbing me constantly in the same spot that was initially problematic resulting in MRIs, physical therapy, and taking Meloxicam (which I had stopped taking). My arm and back have both gotten progressively worse throughout the day.

Other Meds: Levothyroxine Norethindrone Acetate and Ethinyl Estradiol Tablets

Current Illness: Tested positive for Covid 1/14/21. Tested negative for covid 1/22/21. Received a cortisone shot for a sore throat, severe cough, and loss of voice on 1/11/21.

ID: 1007086
Sex: F
Age: 46
State: FL

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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Allergies: Sulfa drugs Shellfish Tree nuts - pecan, brazil, macadamia

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

Symptoms: Within a few minutes of vaccine, I got a severe piercing headache and nausea / vomiting which we attributed to nerves and I went to go home without reporting. During the drive the headache and nausea got worse and my extremities and face began to tingle. My chest felt tight. My body was shaking. My colleague noted weak pulses and pale complexion. I am a doctor and gave myself epinephrine 0.3 mg IM and within 60 to 90 seconds the symptoms improved dramatically. I had my husband pick me up at the office and went home. The headache and nausea worsened on the drive but then settled down significantly. I rested for a few hours, then took oral pred 20 mg at about 2:45. I noticed that my headache was back and very intense at about 3:15 pm. No nausea this time, but my left eye began itching and it was very tight / hard to breathe. My extremities began tingling and I had spasms / tremors of my muscles. I injected another 0.3 mg epi into my thigh and followed with dex sodium phosphate 4 mg IM. Symptoms resolved within about 2 to 3 minutes. I took 40mg more of oral pred. I also took 10 mg of pepcid PO. I am still feeling well now with no headaches or other symptoms at this writing (7:30 pm), but I have another doctor with me and we are 2 minutes from the ER if needed. I am marking unknown below since it has only been a few hours without symptoms.

Other Meds: Ondansetron 8 mg at 7:30 am Vit D, A, Zinc

Current Illness: None A little nauseous this am, not sure why, but no other GI signs and ate breakfast / drank tea

ID: 1007087
Sex: F
Age: 29
State:

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 02/05/2021
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Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: Fatigue started roughly 1-2 hours after vaccination and lasted 3 days. Left deltoid started feeling stiff at around 3 to 4 hours after injection. Injection site developed a small hard lump roughly the size of the quarter. Painful when arm is moved and warm to the touch, lasting two days.

Other Meds:

Current Illness:

ID: 1007088
Sex: F
Age: 36
State: TX

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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Allergies: None

Symptom List: Tremor

Symptoms: Headache started 2-3-2021 at 9pm. I am still having headaches today (over 48 hours after vaccine). I was not sure if I needed to report it after it stops. I have not seek treatment for this.

Other Meds: Lo loestrin fe Multi vitamin gummy Align

Current Illness: None

ID: 1007089
Sex: M
Age: 83
State: IN

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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Symptom List: Erythema, Pruritus

Symptoms: Elevated temp 100.2

Other Meds:

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ID: 1007090
Sex: F
Age: 40
State: WA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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Allergies: Anaphylaxis to latex and tilapia fish

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

Symptoms: 10.5 to 11hrs after injection developed shaking rigors, severe diffuse joint pain preventing ability to ambulate normally, worse than after first series, fatigue, fever

Other Meds:

Current Illness: Severe joint pain for 2+ weeks after first Covid injection

ID: 1007091
Sex: F
Age: 51
State: AZ

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

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

Symptoms: Her neck was red and then patient stated it hurt and that she can't breathe. Given 50mg Benadryl IM and 1mg of Epi IM and transported to emergency department

Other Meds: Vitamin D 400 units, Vitamin C 500mg, divalproex ER 500mg, Lovenox 40mg, Lidoderm 5% topical patch, Lisinopril 10mg, Nicoderm patch 14mg, Zincate 220 capsule

Current Illness: None

ID: 1007092
Sex: F
Age: 38
State: NY

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/05/2021
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Allergies: sulfa (throw up from meds with this)

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: red blotchy spots on arm and some hives on that arm. The spot right around where the vaccine was given was very white and everything else red/pink

Other Meds: ortho tri cyclen low, adderal, paxil, trazadone

Current Illness: NA

ID: 1007093
Sex: F
Age: 16
State: OR

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

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

Symptoms: This patient was vaccinated with the Moderna vaccine despite being <16 years of age. A voicemail message was left for her, she was asked to return the call, and her employer's HR office was notified because the vaccination was given at her place of employment. No adverse events were noted and she waited the full 15 minutes under RN monitoring.

Other Meds: N/A

Current Illness: No known illnesses.

ID: 1007094
Sex: F
Age: 51
State: OK

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/05/2021
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Allergies: None

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

Symptoms: 30 minutes after injection, I began to have sciatic pain in left buttock. It progressively became worse throughout the day. Took pain pills I had on hand & went to bed. Woke up around 0200 in excruciating pain & took 2 more pain pills. When I woke up the following morning I was pain free & it never returned.

Other Meds: Zoloft, Oxybutynin ER, Lo Loestrin, Protonix, Vit D, MVI

Current Illness: None

ID: 1007095
Sex: F
Age: 49
State: FL

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

Symptom List: Pain in extremity

Symptoms: RECEIVED VACCINE AT 11:00 AM. ABOUT 3:00 PM, ARMS AND HANDS BECAME VERY ITCHY WITH A RASH. RETURNED TO VACCINE CLINIC TO REPORT REACTION, WAS RECOMMENDED TO SEEK FURTHER TREATMENT AT OUR IN-HOUSE URGENT CARE. URGENT CARE AT 3:25 pm Family Medicine Allergic reaction, initial encounter +1 more Dx Hives Reason for Visit Progress Notes Expand All Collapse All Subjective Patient ID: 49 year old female. Patient seen at clinic Patient came in because of itchy red skin in different parts of the body started today and asked last 2 or 3 hours, patient had Covid vaccine about 4 hours or 5 hours ago, No prior history of hives like this, she had first Covid vaccine without any side effect, Symptoms have been persistent. Prior h/o similar complain- not sure, may be No new pets/soap/detergents/cream No new meds No insect bites This is a new problem to me. Review of Systems With the exception of pertinent +/- in the HPI above, a complete review of systems was reviewed and are negative. Constitutional: Negative for fever, weight loss, malaise/fatigue and diaphoresis. HENT: Negative for nosebleeds, congestion, sore throat and ear discharge. Eyes: Negative for blurred vision, double vision, photophobia, pain, discharge and redness. Respiratory: Negative for cough, hemoptysis, Shortness of Breath Cardiovascular: Negative for chest pain and palpitations. Gastrointestinal: Negative for heartburn, nausea and vomiting. Genitourinary: Negative for dysuria, urgency, frequency and hematuria. Musculoskeletal: Negative for myalgias, joint pain and falls. Neurological: Negative The following have been updated as appropriate in this visit:- Tobacco | Allergies | Meds | Problems | Med Hx | Surg Hx | The following have been reviewed- Medical History Past Medical History: Diagnosis Date ? Gastroesophageal reflux disease with esophagitis 5/6/2020 ? Generalized anxiety disorder 5/6/2020 has a current medication list which includes the following prescription(s): azithromycin, baclofen, escitalopram, eszopiclone, ibuprofen, methylprednisolone, savella, omeprazole, and topiramate. Family History Problem Relation Age of Onset ? Hyperthyroidism Mother ? Bladder cancer Father ? Breast cancer Aunt ? Breast cancer Cousin Social History Socioeconomic History ? Marital status: Married Spouse name: Not on file ? Number of children: Not on file ? Years of education: Not on file ? Highest education level: Not on file Occupational History Social Needs ? Financial resource strain: Not on file ? Food insecurity Worry: Not on file Inability: Not on file ? Transportation needs Medical: Not on file Non-medical: Not on file Tobacco Use ? Smoking status: Current Every Day Smoker Packs/day: 0.50 Start date: 5/6/2019 ? Smokeless tobacco: Never Used ? Tobacco comment: smoke x 5 years and stop x 20 years Substance and Sexual Activity ? Alcohol use: Not Currently Frequency: Monthly or less ? Drug use: Never ? Sexual activity: Yes Partners: Male Lifestyle ? Physical activity Days per week: Not on file Minutes per session: Not on file ? Stress: Not on file Relationships ? Social connections Talks on phone: Not on file Gets together: Not on file Attends religious service: Not on file Active member of club or organization: Not on file Attends meetings of clubs or organizations: Not on file Relationship status: Not on file ? Intimate partner violence Fear of current or ex partner: Not on file Emotionally abused: Not on file Physically abused: Not on file Forced sexual activity: Not on file Other Topics Concern ? Not on file Social History Narrative ? Not on file Objective BP (!) 133/74 | Pulse 92 | Temp 97.4 ?F | Resp 18 | Ht 5' 3" (1.6 m) | Wt 136 lb (61.7 kg) | SpO2 99% | BMI 24.09 kg/m? Constitutional: oriented to person, place, and time. well-developed, well-nourished and in no distress. HENT: Head: Normocephalic. Eyes: Pupils are equal, round, and reactive to light. Neck: Normal range of motion. No tracheal deviation present. Ear- Normal Mouth- Tongue, uvula- Normal, No oral rash Cardiovascular: Normal rate, regular rhythm and normal heart sounds. Exam reveals no gallop and no friction rub. No murmur heard. Pulmonary/Chest: Effort normal and breath sounds normal. NO W/R/R Abdominal: Soft. There is no tenderness. S/NT/ND Musculoskeletal: No edema and no tenderness. Lymphadenopathy: has no cervical adenopathy. Neurological: Neurological: Pt displays no motor weakness, no tremor, normal facial symmetry, and normal speech. Psychiatric: Affect normal. Skin,-erythematous skin rash is noted on the chest arm skin, also on the upper back, Impression/Plan Patient was seen today for hives. Diagnoses and all orders for this visit: Allergic reaction, initial encounter - famotidine (PEPCID) injection 20 mg - diphenhydrAMINE (BENADRYL) injection 25 mg - Sodium Chloride 0.9% infusion 1,000 mL Thrombocytosis (CMS/HCC) - famotidine (PEPCID) injection 20 mg - diphenhydrAMINE (BENADRYL) injection 25 mg Patient evaluated and worked up for over 50-minute during urgent care visit. Time was spent was for preparing to see the patient by reviewing patient's medical history and previous test results,directly obtaining information regarding today's encounter, evaluating the patient, performing an examination, communicating test results, placing orders. Patient was seen second time and discussed the finding of lab results and assessment plan is discussed in detail. Patient was given a liter of IV fluid with Pepcid and Benadryl, and watched for more than 45 minutes, patient's rash improved, still had some rash, advised to take Claritin once a day Pepcid once a day and Benadryl every 4-6 hours, no shortness of breath, New patient complain to me Symptoms improved treatment here, Stable at d/c- decreased rash, no SOB/Wheezing, No throat swelling, Cool compresses to the skin will help. Claritin or Zyrtec once a day Benadryl 25-50 mg every 8 hours for 1st day & then as needed If the symptoms flare again,go to Nearest emergency STAT Reviewed prior labs, diagnostic test & prior visit notes. Reviewed current medication and management planned considering current prescription/meds. Please note this clinic note was performed utilizing voice recognition software. Due to the voice recognition software there may be grammatical errors inadvertently enclosed that do not reflect the nature of the visit. For worsening of symptoms, Patient is instructed to return sooner either to ER or urgent care/PCP. Patient is instructed to follow up in 1-2 weeks with PCP I have educated patient on supportive care therapy. Patient agreed with plan and voiced understanding. No barriers to adherence perceived by myself. Department of Urgent Care

Other Meds: UNKNOWN

Current Illness: C/O COLD SYMPTOMS X 3 DAYS AFTER RECEIVING VACCINE AND HAVING SYMPTOMS. RESPONDED "NO" TO HAVING A CURRENT MODERATE OR SEVERE ILLNESS WHEN ASKED PRIOR TO VACCINATION.

ID: 1007096
Sex: F
Age: 95
State: IN

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 02/05/2021
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Allergies: Penicillin

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

Symptoms: Eye problem, retina bleeding, partial area no sight, right eye

Other Meds: Irbasartan Metoprolol Xyralto atorastatin hydrochloride vitamin D

Current Illness: None other than norm for 95 year old

ID: 1007097
Sex: F
Age: 67
State: OK

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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Allergies: None

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

Symptoms: Chills; body aches

Other Meds: Dotti Patch 0.1MG,Lisinopril 10 MG, /Atorvastatin 20 MG, Meloxicam 15 MG, Dymista Spray, Zyrtec 10MG, Tizanidine 4 MG, Terbinafine 250, Calcium 600, Lutein 6MG,Selenium 200mcg,,B100, Iron 65 mg, Beta Carolene 25,000 IU, Vit E 400,Vitamin C

Current Illness: None

ID: 1007098
Sex: F
Age: 74
State: CA

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

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

Symptoms: Itchy and red rash along stomach area lasting approximately 5 hours. She applied alcohol to the area to help relieve itchiness. No other symptoms.

Other Meds: Metformin 500mg, Lisinopril 40mg, Amlodipine Besylate 5mg, Atorvastatin 10mg, Hydrochlorothiazide 25mg, Aspirin 81mg, and a Tylenol

Current Illness: None

ID: 1007099
Sex: F
Age: 35
State: NC

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

Symptom List: Vomiting

Symptoms: Pt was sitting after her COVID vaccine and began to feel faint. She reported feeling clammy. She denied SOB, CP. She had not eaten in ~5 hours. She states she has fainted before. Pt was provided juice and crackers. Her feet were elevated. BP on initial encounter 110/68, Pulse 98 O2 sat 99%. At 5:25 BP 117/73 Pulse 82. O2 sat 99%. At this point pt felt back to baseline. She denied lightheadedness, feeling clammy, SOB. 5:50pm pt left facility with co worker with no concerns. Aware to hydrate and eat prior to next vaccine. Aware also to come with someone.

Other Meds: norethindrone-e.estradiol-iron 1 mg-20 mcg (21)/75 mg (7) TK 1 T PO QD UTD

Current Illness: none

ID: 1007100
Sex: M
Age: 73
State: AZ

Vax Date: 02/01/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Temp. Tremors. Confusion. Slowly coming to awareness 30 hours later Keeping hydrated and taking temp

Other Meds:

Current Illness:

ID: 1007101
Sex: M
Age: 51
State: TX

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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Allergies: None

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

Symptoms: Usual expected soreness at the injection site. But, I woke up with extremely low blood pressure 86/47. BP slowly recovered over 12 hours to 120/80.

Other Meds: Benazepril HCL, 10 mg 2x daily Chlorthalidone, 25 mg 1x daily Terminafine, 250 mg 1x daily

Current Illness: None

ID: 1007102
Sex: M
Age: 45
State: CA

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

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever , headaches, pain at injection site, and body aches. Have developed ?itch? on chest.

Other Meds: Ciprofloxacin, Metrodizanole

Current Illness: None only Diverticulitis

ID: 1007103
Sex: M
Age: 42
State: TX

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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Allergies: None

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

Symptoms: 3 minutes after vaccination the patient began to feel a tingling and pain in his arm where the vaccine was placed. Within minutes the patient began to feel faint and proceeded to faint as he was gently laid to the ground by the healthcare provider to initiate an emergency response. The patient was alert and oriented at 5:30 but felt nausea and a tingling sensation in the tongue. The patient stated that he had been fasting for 2 days and we determined low blood sugar likely played into his response to the vaccine. Glucose gel was placed in mouth and patient felt better within 15 minutes.

Other Meds: None

Current Illness: None

ID: 1007104
Sex: F
Age: 55
State: VA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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Allergies: Pork beef tea chocolate milk

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

Symptoms: Toghtness in chest, localized rash on right wrist, trouble swallowing, sore throat all within 20 minutes of injection. Took inhaler and felt fine after 20 minutes.

Other Meds: Lipitor singulair ozempic

Current Illness: None

Total 2021 VAERS Injuries: 704,237

Page last modified: 26 October 2021 2:21am