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: 1013118
Sex: F
Age: 70
State: CA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: pt presents with onset of mild dizziness, no other s/s, 99% o2 on room air, 99 hr, t 98.9, pt states she hasn't had a meal today and feels as though that may be a contributing factor. 11:30 no other s/s, states dizziness still mild, 99% o2 on ra, 95 HR,. 11:45 no change, po fluids offered to patient, she is thirsty, tolerated well. 11:50 pt states dizziness better to none and would like to go outside for fresh air, feels the gym is warm, T98.9. 11:55 patient able to ambulate well, dizziness better to none, feels better after going outside for fresh air, feels back to baseline, dc'd home, 99%o2 on ra, 98 hr, pt in no distress. no

Other Meds: none

Current Illness: none

ID: 1013119
Sex: M
Age: 38
State: NJ

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 02/08/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Mild pins and needles/Itching feeling intermittently throughout body since 1/28 continuing through today and hasn't gone yet.

Other Meds: None

Current Illness: None

ID: 1013120
Sex: F
Age: 89
State: MN

Vax Date: 01/24/2021
Onset Date: 01/27/2021
Rec V Date: 02/08/2021
Hospital: Y

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: No known allergies

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

Symptoms: On 1/27/21, resident experienced shortness of breath and felt some pressure on her chest. Systolic Blood Pressure was in the 200's and Diastolic Blood Pressure was in the 100's, HR 117. She was sent to Hospital and diagnosed with: St Elevation Myocardial Infarction due to occlusion of circumflex coronary artery, Acute Systolic Heart Failure, and Aspiration Pneumonia.

Other Meds: Lantus Insulin, Novolog Insulin, Lisinopril 5mg

Current Illness:

ID: 1013121
Sex: F
Age: 80
State: NJ

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient had increased BP, felt flush, sweaty, and shaky about 15 minutes after receiving the vaccine. Patient vitals taken every 10 minutes and monitored until she returned to her baseline. Patient also provided a water and snack. After about 20 minutes of additional observation the patient was fine and able to leave.

Other Meds:

Current Illness:

ID: 1013122
Sex: M
Age: 35
State: OK

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Sharp pain (8/10) radiating down arm accompanied by numbness in left hand. Started on Saturday, 2/6, at the injection site and has progressively gotten worse since then. Also having a constant headache starting on Saturday, 2/6. HA started out as a 4/10 and has progressed to 6/10 on pain scale.

Other Meds: None

Current Illness: No illnesses since December.

ID: 1013123
Sex: F
Age: 72
State: KY

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/08/2021
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: Penicillin & Keflex

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

Symptoms: About 5 hours after getting the vaccine, I developed a headache on 1/26/21. Somehow the vaccine seemed to inflame by nose and sinuses. I went from a headache to a pressure headache from below my eyes to the top of my forehead. Today, is 2/8/21 and I still have a headache. I have contacted my doctor, on 2/1/21 and she prescribed Celecoxib 200 MG for a week. On 2/4/21 I developed a lot of drainage at the back of my throat. I would like to know if I show take the second vaccine? Dr. has recommended that I hold off at this time.

Other Meds: Synthroid, Omeprazole, Hydrochlorothulazide, Fluvastatin Sodium ER, Diltiazem, Allegra, Chlorpheniramine Maleaste, Mucinex, Nasacort, Azelastine, MiraLax, Citracal, Flaxseed Oil, Estrace cream & allergy shots every three weeks

Current Illness:

ID: 1013124
Sex: F
Age: 44
State: OH

Vax Date: 02/01/2021
Onset Date: 02/02/2021
Rec V Date: 02/08/2021
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: The morning after the vaccine was given (2/2/2021) had body aches, headache, felt cold and felt like had the flu. On 2/4/2021 she felt much better but still had a headache.

Other Meds:

Current Illness:

ID: 1013125
Sex: F
Age: 35
State: OH

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: Bactrim, Ceftin

Symptom List: Pharyngeal swelling

Symptoms: 2/8/21 Caregiver came back to Vaccine clinic at 1410 and talked to Nurse manager of Occupational Health. Caregiver states after her 15 min observation time she went back to her unit and developed a flush face, feeling of being hot and having a redness on her chest and one raised bump was noted. Nurse placed caregiver back in Observation. RN was the observation nurse. At 1421 caregiver states she was feeling very warm, felt flush, face was red and chest was red in color per RN. Caregiver was given 60mg Fexofenadine PO per protocol for symptoms.. At 1435 vital signs: bp=113/75, HR 100, Sao2 100% on room air and Temperature was 36.9. At 1440, Observation nurse states the caregiver c/o her heart racing. Her heart rate was 120 via radial pulse.. At 1442, vital signs: bp= 107/74, HR= 104, sao2= 100% on room air.. At 1450, RN Staff nurse came to observe caregiver. Patient is alert and oriented x3. Respirations easy and nonlabored. No redness noted on chest but cheeks are still flush. Apical Heart rate at 96, regular and respirations easy at 20.. At 1500, Caregiver states she still feels "hot" and full feeling in her face. She also c/o her heart rate increasing and decreasing. Denies any heart history. States she "did have some flushness with her first dose but not to this degree." Vital signs: bp=113/67, HR=97, RR=18, Sao2=100% on room air. AT 1523 RN states caregiver states feeling better--denies feeling dizzy, lightheaded, denies sob or chest pain. Face still with some redness but less and caregiver c/o still feeling "full" in the head and a headache. Caregiver advised to seek medical attention if symptoms increase. Caregiver encouraged to go home and rest if she is able to. Caregiver denies need to go to Emergency room to be evaluated. At 1527 caregiver discharged from observation room with steady gait.:

Other Meds: BCP, Amitriptyline, Ambien, Trazadone

Current Illness: Anxiety and depression

ID: 1013126
Sex: M
Age: 80
State: MO

Vax Date: 02/02/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: On the 3rd day after vaccination, the patient developed mild malaise. As the day progressed, there was increasing difficulty moving and talking. That night the patient began hallucinating,. Later at night the patient awoke and couldn't move at all. By the morning, things were better and patient could get out of bed and eat. Ity sounds like a dopamine reaction which the aptient has previosuly expeicned, however, there was no irregularity in L-dopa dosing.

Other Meds: Ldopa/carbidopa; entacapone, finasteride, losartan

Current Illness: none

ID: 1013127
Sex: F
Age: 37
State: NY

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 02/08/2021
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: Unknown

Symptom List: Diarrhoea, Nasal congestion

Symptoms: One day after receiving vaccine patient developed cellulitis

Other Meds: Unknown

Current Illness: Unknown

ID: 1013128
Sex: F
Age: 44
State: CO

Vax Date: 01/11/2021
Onset Date: 01/25/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient states that she experienced redness, swelling, itching and warmth at injection site. Beginning 2 weeks post vaccination. Patient reports that area of redness was approximately 6 inches in diameter. Symptoms lasted 3 days.

Other Meds:

Current Illness:

ID: 1013129
Sex: F
Age: 66
State: CA

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Rash started then turned into hives on the neck the rash moved to her hands, then her feet. now it is on her back rash is on fire

Other Meds:

Current Illness:

ID: 1013130
Sex: F
Age: 44
State: OR

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: Latex, apples, tree nuts

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

Symptoms: 2/5/21 @ 4:30 pm began feeling body aches. Developed chills, fever, clenched muscles, headache by 8:00 pm. 2/6/21 chills and clenched muscles remained, supraclavicular lymphnode right side swollen considerably, revert to the touch. 2/7/21 only lymphnode swelling remains 2/8/21 lymphnode swelling decreasing, new symptom of comprehensive neck stiffness. Began at 9:00 am and is growing increasingly stiff for movement in any direction.

Other Meds: Citalopram, venlafaxine, levothyroxine, nature-throid

Current Illness: None

ID: 1013131
Sex: F
Age: 43
State: VA

Vax Date: 01/28/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
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: Lactose intolerant

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

Symptoms: Soreness in the left arm for the first few days after Injection on 1/28/21 and then itchy red rash appeared at and around the injection site on 2/4/21.

Other Meds: Allegra, Flonase. Astelin, Venlafaxine, Lorazepam, Ibuprofen , Prilosec

Current Illness: Seasonal allergies

ID: 1013132
Sex: F
Age: 78
State: MO

Vax Date: 01/28/2021
Onset Date: 02/03/2021
Rec V Date: 02/08/2021
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: adhesive tape

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

Symptoms: It was my heartbeat that was irregular and my pulse was higher than normal (between 92 and 105) and my blood sugar was running higher than normal (157 one day, then two normal days, 132, 149, then 132 again today). Blood pressure was lower 100/70 (blood pressure is normally 125 over 70).

Other Meds: anostrazole 1 mg daily vitamin b12 1000 mcg calcium 1200 mg 2x daily atorvastrin 10 mg daily glucose (as needed) pantoprazole sodium 40 mg daily loshartin potassium 100 mg daily carvedilol 3.125 mg 2x daily glipizide XL 5 mg amlodip

Current Illness: No

ID: 1013133
Sex: F
Age: 50
State: WA

Vax Date: 01/28/2021
Onset Date: 02/03/2021
Rec V Date: 02/08/2021
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: NKDA

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

Symptoms: About one week after the vaccine, she developed some itching, redness, swelling and firmness of skin just below the vaccine site. This spread over the next day or so, was stable, and then a couple days later started to improve. I will note that this is the same reaction that two of my coworkers had, also 7-8 days after their first moderna coronavirus vaccine. I saw a news article describing it as "COVID arm"

Other Meds: metoprolol; PRN lorazepam, PRN zolpidem, PRN ondansetron

Current Illness: none

ID: 1013134
Sex: M
Age: 16
State: TX

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 02/08/2021
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: NKDA reported on consent

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

Symptoms: Vaccine administration error: Adolescent was 16 yrs old when first dose was given.

Other Meds: Unknown

Current Illness: Unknown

ID: 1013135
Sex: F
Age: 63
State: MA

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: Sulpha drugs, but don't know my reaction. Happened as an infant and parents are deceased.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Started getting a headache within a few hours of receiving the vaccine. By 12:30am, had a severe headache, body aches, nausea, chills, vomiting and joint pain. Vomited twice and then just slightly nauseous. Severe headache/body aches and joint pain lasted about 30 hours. Nothing dangerous, but I thought you should be aware. Also, there is conflicting information about the types of pain relievers you may take. I was told nothing but tylenol by 2 physicians but the CDC says ibuprofen is OK. I only took tylenol and it did NOTHING for the pain. Sunday by about 10am (42 hours or so after vaccination) I felt 1000 times better, but still have a slight headache.

Other Meds: 50mg Sertraline, 400 mg Ibuprofen taken 18 hours prior to vaccine, 1 tylenol and 1 zyrtec taken 3 hours prior to vaccine.

Current Illness: none

ID: 1013136
Sex: M
Age: 83
State: MS

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient received 2nd dose of Moderna. He was placed in the WR. After about 5 minutes he starting complaining of throbbing headache and would drift off and about to fall out of chair. NP was called and she assessed patient. Glucose was obtained it was 107. He is diabetic. Per , an ambulance was called. When ambulance techs arrived, patient refused to leave in/with the ambulance. After about 30 minutes he left with (lives with her). Instructed to call or seek medical attention should anything change.

Other Meds:

Current Illness:

ID: 1013137
Sex: F
Age: 45
State: MT

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 1) canker sores broke out in my mouth about 2 hours after receiving Covid - Moderna vaccine 2) 8 days after Moderna Covid vaccine a red, double circle rash broke out at injection site. Looked like figure 8, each circle was the size of a quarter. Rash was hot, and raised, not itchy. Treated with Claritin, rash was gone in next 24 hours.

Other Meds:

Current Illness:

ID: 1013138
Sex: F
Age: 68
State: IL

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
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: No Known Allergies

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

Symptoms: 10 minutes after vaccination patient became unresponsive, staring forward with stiff body, arms flexed and hands fisted. She required sternal rub without response. She was incontinent. Episode lasted 1-2 minutes. She had no recollection of the episode. Paramedics assisted, with Temp 97.1, HR 80, B/P 122/80, pulse ox 98%, fingerstick 101. She was transported by ambulance to Hospital. Laboratory assessment was unremarkable for for CMP, CBC, Troponin, Lactic acid. EKG, CXR and CT head were also unremarkable. She was discharged with diagnosis of possible vasovagal syncope episode and instructed to follow-up with her pcp.

Other Meds: "Blood pressure and thyroid medication"

Current Illness: None

ID: 1013139
Sex: M
Age: 70
State: MI

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: latex

Symptom List: Unevaluable event

Symptoms: Vaccine needle injected arm, solution leaked out, needle disconnected from syringe, very minimal - none of the solution injected into arm; Dose repeated.

Other Meds: unknown

Current Illness: no

ID: 1013140
Sex: M
Age: 40
State: AZ

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 02/08/2021
Hospital: Y

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: Peanuts

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

Symptoms: Patient presents to ED on 1/14/2021 with respiratory arrest and started around 1300. Per EMS, reportedly told fiance that he had taken some sleeping pills and was going to go to sleep. EMS was called after the patient was found unresponsive about 15 minutes later. Family attempted to do CPR. Upon EMS arrival to the patient's home, patient had a pulse, was in respiratory distress with agonal breathing. They also reported emesis in the airway. EMS performed nasal intubation and administered 10 mg IV Narcan en route. Upon arrival to the hospital, patient was moving arms more and gritting teeth. Patient had movements of decerebrate posturing of arms intermitting with a relaxed posture. GCS was 4 on arrival. Patient is currently still in ICU and has been extubated.

Other Meds: Albuterol inhaler, zolpidem, quetiapine, doxepin, diazepam, advair diskus

Current Illness:

ID: 1013141
Sex: F
Age: 0
State: MI

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
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: Allergy to hazelnuts; additional food sensitivities

Symptom List: Injection site pain, Pain

Symptoms: Patient vaccinated at 2:37pm. At 2:46pm, patient reported throat tightness, tongue tingling, and extremities tingling. Administered liquid Benadryl 25mg at 2:46pm. Continued to observe patient for 30 minutes. Vital signs remained WNL throughout observation period. Patient reported overall improvement 15 minutes after Benadryl administered. Symptoms diminished by end of observation period.

Other Meds: Unknown

Current Illness: None

ID: 1013142
Sex: F
Age: 69
State: NJ

Vax Date: 01/29/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Injection site pain, Menorrhagia

Symptoms: Covid arm, rash redness, itching around injection site but one week after injection

Other Meds:

Current Illness: None

ID: 1013143
Sex: M
Age: 83
State: CA

Vax Date: 02/06/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
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: NKA

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

Symptoms: Pt is on hospice services for 5 months for CVD/CVA. On 2/8/21 pts dtr called to report new onset seizure (no hx of seizures). Per dtr report only change in pts condition is that he rcvd the COVID vaccine on Saturday 2/6/21. Dtr called 911 due to severity of seizure.

Other Meds: Morphine PRN, APAP PRN, Prochloperazine PRN

Current Illness: Overall decline, on hospice

ID: 1013144
Sex: F
Age: 52
State: TX

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/08/2021
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: no

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: January 27, 2021, I received the second dose of the Moderna Vaccination. I began to feel cold chills and a high fever 101.2 around 2:35am. I notified my doctor and went to the ER January 28, 2021.

Other Meds: Prescription: Famotidine 40mg, Albuterol 90mcg, Docusate NA 100mg. Cyclobenzaprine HCL 0mg, Diclofenac NA 75mg, Carboxymethylcellulose NA 0.5% OPH SOLN, amlodipine 5/benazepril 10mg Aspirin 81mg, Gabapentin 300mg

Current Illness: None

Date Died: 02/07/2021

ID: 1013145
Sex: M
Age: 56
State: FL

Vax Date: 02/05/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient texted a friend on 2/7/2021 c/o arm pain and feeling tired. I don't know if he was taken to a hospital. Autopsy today.

Other Meds: unknown

Current Illness: unknown

ID: 1013146
Sex: F
Age: 64
State:

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
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: NKA

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

Symptoms: Patient reported feeling flushed and sweaty 10 minutes after receiving the vaccine. BP 165/74 P 99. SpO2 100%. No shortness of breath. No rash. No prior history of hypertension. BP rechecked after 10 minutes 149/72. Patient reported feeling somewhat improved. Rechecked in another 15 minutes and parent felt back to normal and left clinic.. Checked again by phone at 2:30 PM . "feeling fine"

Other Meds:

Current Illness:

ID: 1013147
Sex: F
Age: 49
State: MO

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Tightness of cheat and have trouble breathing

Other Meds: Zaleplon, spirva lamatrogine risperidone ropinerole simvastatin levothyrixine. Zyertec

Current Illness: Chronic kidney disease copd diabetic

ID: 1013148
Sex: F
Age: 56
State: NY

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: Intractable nausea and vomiting with sever headache x 48 hours requiring intervention with zofran

Other Meds: Coumadin, Losartan, spirinolactone, Plaquenol, zyrtec

Current Illness: None

ID: 1013149
Sex: F
Age: 67
State: CA

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: erythromycin

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

Symptoms: pt stated she started having body aches with sweating with out fever. She also has fatigue and light headiness. Pt has not contacted her PCP at this time.

Other Meds: Hydrocodone 7.5 mg-325,

Current Illness: sinus infection

ID: 1013150
Sex: F
Age: 44
State: OH

Vax Date: 02/01/2021
Onset Date: 02/02/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: The morning after the vaccine was given (2/2/2021) she had body aches, headache, felt cold and felt like she had the flu. On 2/4/2021 she felt much better, but still had a headache.

Other Meds:

Current Illness:

ID: 1013151
Sex: F
Age: 41
State: MD

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
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: developed numbness and tingling 3 or 4 on a scale of ten radiating down left arm to fingertips. Gradually improved during observation period.

Other Meds:

Current Illness:

ID: 1013152
Sex: F
Age: 48
State: IN

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/08/2021
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: PCN, sulfa

Symptom List: Erythema, Pruritus

Symptoms: Almost 24 hours after my first vaccine, I woke up from a nap and my left armpit was swollen and sore. Within a few hours, I had throbbing pain into the left side of my breast. I assumed it was from my lymph nodes reacting, but I didn't know if this is normal or expected. Also, I hadn't heard anything about swelling, tenderness in the armpit or breast discomfort. I took tylenol and ibuprofen and the breast throbbing went away before I went to sleep that night. The swelling and tenderness in my left armpit lasted for 4 days.

Other Meds: tylenol, ibuprofen, trintilex, pharmacy brand probiotic

Current Illness: no

ID: 1013153
Sex: F
Age: 49
State: SD

Vax Date: 02/02/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
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: Sulfa Drugs

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

Symptoms: Diagnosed with lightheadedness -- Patient states she felt a warm feeling in her chest, dizziness and like she was going to pass out at 11:45. She stated it would come and go, then she went to the ED at 12:33. She also had increased heart rate and blood pressure. Patient was treated with 10mg Dexamethasone IV and 1,000 ml lactated ringers solution. She was then discharged home.

Other Meds: levothyroxine 112 mcg daily, cetirizine 5 mg daily, Prilosec 10 mg daily, ibuprofen PRN

Current Illness: Rash appeared 1 week after receiving first vaccine on 12/30/20

ID: 1013154
Sex: F
Age: 70
State: OH

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/08/2021
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: latex

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

Symptoms: I have the chills. I feel numb in the bottom half of my face and my tongue. I do not have a lot of energy. It's a familiar feeling I get when I am around cats.

Other Meds: no

Current Illness: no

ID: 1013155
Sex: F
Age: 87
State: KS

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Progress Notes Nurse Practitioner Cosign Needed Expand All Collapse All 2/4/2021 Patient: DOB: 11/21/1933 Date: 2/4/2021 MRN: Subjective Patient is a 87 y.o. female who was seen at COVID Vaccine Clinic today for her first dose of the COVID 19 vaccination. She was given the Pfizer vaccination in the right deltoid muscle. During her 15 minute waiting period after the injection, the patient began to experience funny feeling in face, lightheaded and HA. She denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, dizziness, facial swelling, lip swelling and tongue swelling. This provider was notified of patient reaction and she was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to abdominal pain, blood pressure abnormality , chest pain, collapse, drooling, hypotension, increased swelling, rapid progression of symptoms, respiratory distress, skin changes, tongue swelling and vomiting. ALLERGY REVIEW OF SYSTEMS: Funny feeling in facial area: Previous Reactions: Levaquin Objective Vitals Vitals: 02/04/21 1505 02/04/21 1523 BP: (!) 172/81 (!) 184/75 Pulse: (!) 102 SpO2: 95% 95% Pt reports she is on Blood pressure medications and took these this am. Physical Exam Constitutional: Appearance: She is well-developed. HENT: Head: Normocephalic and atraumatic. Right Ear: External ear normal. Left Ear: External ear normal. Nose: Nose normal. Eyes: Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Neck: Musculoskeletal: Normal range of motion and neck supple. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds. Abdominal: General: Bowel sounds are normal. Palpations: Abdomen is soft. Musculoskeletal: Normal range of motion. Skin: General: Skin is warm and dry. Capillary Refill: Capillary refill takes less than 2 seconds. Neurological: Mental Status: She is alert and oriented to person, place, and time. Assessment/Plan Treatment included: no therapy Follow up response to treatment: excellent. Patient discharge: Stable to go home and follow up with PCP. Differential Diagnosis: Vaccine-Related Anxiety (include misc mental health) Pt left at 15:40pm accompanied by husband. FU with PMP regarding blood pressure Electronically Signed 2/4/2021 3:44 PM

Other Meds:

Current Illness:

ID: 1013156
Sex: M
Age: 77
State: WA

Vax Date: 01/21/2021
Onset Date: 01/31/2021
Rec V Date: 02/08/2021
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: NKA

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

Symptoms: Patient began experiencing left facial droop on 1/31/2021. Diagnosed with bell's palsy on 2/1/2021 and started on antiviral, PPI, and steroids.

Other Meds: metoprolol, senna, torsemide, potassium chloride, miralax,

Current Illness:

ID: 1013157
Sex: F
Age: 74
State: MT

Vax Date: 01/26/2021
Onset Date: 02/03/2021
Rec V Date: 02/08/2021
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: Unknown

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

Symptoms: Moderna COVID- 19 Vaccine EUA Vaccination was on 01/26/2021. Client noticed itching at injection site on 02/03/2021. Redness was observed, although small in size. The swelling and redness increased in the following days. Client called public health on 02/08/2021 to report symptoms. She stated that the swelling had decreased and itching is controlled by topical Benadryl cream. The area of redness and swelling is about 5 inches x 4 inches at the injection site. This client does not have a cell phone so is not enrolled in V-Safe. She plans to receive her second dose as scheduled.

Other Meds: Unknown

Current Illness: Unknown

ID: 1013158
Sex: F
Age: 67
State: IN

Vax Date: 02/03/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Restless legs; blurry vision; headache; nausea; lots of confusion; dizzy; metallic taste in mouth

Other Meds: B12 1000mcg; Biotin 10,000 mcg; Stahist La Full Strength 8/25/40/0.19/0.1mg; D3 2000IU; Nortriptyline hcl 25 mg; famotidine 20 mg; pantoprazole 40 mg; carvedilol ; lisinopril 20 mg

Current Illness:

ID: 1013159
Sex: F
Age: 26
State: MS

Vax Date: 01/27/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: RIght sided facial swelling. Itching and burning on right side of body as well as swelling to right arm. Pt is being treated with prednisone, pepcid, claritin, vistaril, and Clindamycin.

Other Meds: Nexplanon

Current Illness: psoriasis in ear, lip, head, and elbow.

ID: 1013160
Sex: F
Age: 77
State: OK

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
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: Penicillian

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

Symptoms: Note:Tested positive to CV19 27th October 2020 Pharmacy. CV19 Symptoms: High fever and fatigue. No loss sense of taste and/or smell. No breathing problems. 5th February 2021 Pfizer 1st dose CV19 vaccine. Scary symptoms started in grocery store parking lot around 6PM (after vaccine at 8:35A) my legs felt like they were partially paralyzed and I would not be able to walk to the car. I struggled to walk. Got home and laid down. Thought it was side effects to vaccine and it would pass if I went to sleep. Woke up and felt totally paralyzed and it required a lot of effort to turn on my side to try to reach my phone. All my muscles and joints ached. I am never sick and not a complainer.

Other Meds: Aspirin

Current Illness: None

ID: 1013161
Sex: F
Age: 46
State: MT

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Severe lower back pain began approximately 12 to 15 hours after injection. Severe pain was spread evenly throughout the lower back muscles, and prevented me from being able to walk for 2 days, and lasted for more than 4 days.

Other Meds:

Current Illness: Currently being treated for breast cancer

ID: 1013162
Sex: F
Age: 24
State: PA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
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: Allergy to sulfa drugs

Symptom List: Vomiting

Symptoms: Felt soreness at injection sight almost immediately after. Then felt extreme fatigue followed by chills and fever around hour 6, at about hour 12 had nausea and vomiting then woke up Saturday morning feeling achy but no more nausea. Felt fine during the day, but closer to the being extreme fatigue and a fever occurred again. Woke up Sunday feeling almost completely back to normal, just itchiness and ?COVID arm? at the sight of injection

Other Meds: Zoloft 100mg, Nexplanon arm implant

Current Illness:

ID: 1013163
Sex: F
Age: 33
State: MS

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 02/08/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Began having chest pain upon deep breathing approximately 12 minutes after administration. BP 142/82 HR 66, appeared flushed, but denied dizziness or lightheadedness, states pain 3-4/10. Refused ambulance. Taken to clinic by car. Provider advised that patient be evaluated at ER, patient transported to ER via ambulance. Seen in ER and discharged later that evening.

Other Meds:

Current Illness:

ID: 1013164
Sex: F
Age: 64
State: IL

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/08/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Had had fever (100.5) starting 12 hours post vaccine along with fatigue and body aches. Fever, fatigue and body aches lasted about 12 hours. Back muscle spasms started about 40 hours post vaccination.. Back spasms are continuing going on 36 hours from starting.

Other Meds: None

Current Illness: None

ID: 1013165
Sex: F
Age: 69
State: CA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
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: Sulfa drug, adhesive tape

Symptom List: Injection site swelling, Limb discomfort

Symptoms: One & a half inch red area around injection site noticed the next day. Red area still present after 4th day. Headache, fatigue and sore arm.

Other Meds: Amitiza, fish oil, V-d, b complex, V-c, turmeric.

Current Illness: none

ID: 1013166
Sex: F
Age: 74
State: NY

Vax Date: 01/01/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Swelling Redness Itching

Other Meds: Eliquis Cardia XT Lisinopril Pravastatin D3 Zinc Probiotic

Current Illness: None

ID: 1013167
Sex: F
Age: 28
State: MD

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/08/2021
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: Zoloft

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

Symptoms: Itching in tongue/mouth/throat, hot flashes, dizziness, sweating, tongue swelling, tachycardia

Other Meds: Valacyclovir, mirtazipine

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm