VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
PLEASE CHECK BACK SOON
Download the files above while you wait.






Manufacturers

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

Incidents per State

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

ID: 1017309
Sex: F
Age: 90
State: MA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
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 LISTED ON INTAKE/CONSENT FORM

Symptom List: Dysphagia, Epiglottitis

Symptoms: Systemic: Fainting; symptoms lasted 1 day.

Other Meds:

Current Illness:

ID: 1017310
Sex: M
Age: 17
State: MD

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 02/09/2021
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 reported

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccination error, person under the age of 18. No adverse events reported by mother or patient.

Other Meds: unknown

Current Illness: none reported

ID: 1017311
Sex: M
Age: 69
State: FL

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/09/2021
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: clindamycin

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

Symptoms: Received Jan 27, and as of today Feb 9 2021 I am still having symptoms low grade fevers, night sweats, sever headaches, little appetite, fatigue, coughing. Comes and goes, has not disappeared as of this date Feb 9 2021 I have notified my Primary Doctor to the above and am waiting his call

Other Meds: symbicort, lisinopril, raberparzole, vitamin D3, lutein

Current Illness:

ID: 1017312
Sex: F
Age: 81
State: VA

Vax Date: 01/29/2021
Onset Date: 02/07/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Penicillin (rash) Cipro Oysters

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Bright red, hot site of vaccination, rash chest, neck , itching, at site of rash and ears

Other Meds: Dofetilide, Eliquis,Amlodipine,omeprazole, prednisolone acetate ophthalmic suspension

Current Illness:

ID: 1017313
Sex: F
Age: 93
State: AZ

Vax Date: 01/30/2021
Onset Date: 02/01/2021
Rec V Date: 02/09/2021
Hospital: Y

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: acute respiratory failure, atrial fibrillation

Other Meds: Carvedilol Lisinopril

Current Illness: none

ID: 1017314
Sex: F
Age: 80
State: CA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/09/2021
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

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

Symptoms: DIZZINESS.

Other Meds: ATENOLOL, FINASTERIDE, HYDROCHLOROTHIAZIDE

Current Illness: NONE

ID: 1017315
Sex: F
Age: 89
State: OH

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/09/2021
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: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1017316
Sex: F
Age: 53
State: TX

Vax Date: 01/27/2021
Onset Date: 01/30/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: latex

Symptom List: Pharyngeal swelling

Symptoms: 1. Very large red, warm to the touch swelling at the injection site which extended to the inner arm 2. Moderate Itchy rash on the right fore arm - occurred 2 day after the vaccine; lasted approximately 4 days - required hydrocortisone cream. 3. Large Itchy rash on the inner thigh area extending to the vaginal area - occurred approximately 6 days later; still persistent after Benadryl and hydrocortisone cream.

Other Meds: Remicade infusion 10 weeks prior methotrexate (take every Sunday) motrin multivitamin

Current Illness:

ID: 1017317
Sex: F
Age: 72
State: WI

Vax Date: 12/31/2019
Onset Date: 12/31/2019
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Penicillins Statins

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient came in on 02/03/21 for her COVID vaccine. When she was questioned about which arm she wanted it administered in, she stated she wanted it in her right arm as she still experiences soreness in her left arm due to her second Shingrix vaccine administered over a year ago. She stated it doesn't hurt all the time, but if she "bumps it or lifts her arm above her head," it is somewhat tender. She is a retired pharmacist, and she stated she did some research on her own. She stated she thought the needle may have caused a bursitis like condition. The patient is incredibly thin and thought maybe the needle went too far.

Other Meds: Loperamide 2mg (2 caps after 1st loose stool, 1 cap after each subsequent loose stool, up to a max of 8 caps / 16mg per day) Undergoing chemo for multiple myeloma... meds unknown as not administered or dispensed at this pharmacy

Current Illness: Multiple Myeloma

ID: 1017318
Sex: M
Age: 17
State: WI

Vax Date: 02/05/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received the Moderna vaccine but he is below age 18 as outlined by the EUA for Moderna.

Other Meds: none

Current Illness: None

ID: 1017319
Sex: F
Age: 48
State: IN

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Rigors, fever (102 F) and muscle aches starting about 13 hours after dose and not resolving until about 48 hours after dose. From 48 hour to approximately 72 hours there remained achiness and a headache that I would rate at a 7/10 on a 0/10 scale. Tylenol and Ibuprofen was used throughout episode with little impact to pain or fever.

Other Meds: Losartan, Metformin, Multivitamin, Bupropion, Lexapro

Current Illness: none

ID: 1017320
Sex: F
Age: 85
State: TN

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 02/09/2021
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: I have had no adverse effects from the Moderna Covid Vaccine. The reason I am using this form of reporting is that I have not been able to use the every day or every week online text reporting system since the link sent to me by text does not work.. I have tried typing it in manually and it does not work that way either. I just wanted to report that there were no adverse effects so that you would have some sort of feedback from me. Thank you.

Other Meds:

Current Illness: recuperating from open heart surgery in July and heart surgery in October 2020

ID: 1017321
Sex: F
Age: 72
State: CA

Vax Date: 01/27/2021
Onset Date: 01/30/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Tequin, Avalon, Blue Dye #1, hypromellose, hydroxypropyl methyl cellulose, singular, versed, soy, black pepper, sage, salmon, wheat/grains except rice and corn, coconut, mushrooms, dairy except cheese

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

Symptoms: Diarrhea with fecal urgency and incontinence lasting for 5+ days starting 2-3 days after the injection.

Other Meds: Liothyronine, levothyroxine, levonorgestrel/estradiol, Claritin, plaquenil, methotrexate (held for the vaccine), timolol, Lumigan, vitamin D, calcium, magnesium, vitamin B12, folate, zinc, melatonin.

Current Illness: None

ID: 1017322
Sex: F
Age: 78
State: FL

Vax Date: 01/27/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
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: PENCILLIAN, CIPRO, SULFA ANTIBOTICS, ALENDRONATE LATEX, TOMATOES

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

Symptoms: RED RASH ON LEFT ARM, SORE ARM

Other Meds: LISINOPRIL,AMLODIPINE,HYDROCHLOROT, FAMODINE, ATORVASTATIN ZYRTEC,EMERGEN-C,FLONASE,SUPER VITAMIN B-COMPLEX KRILL OIL, K2+D3, BENEFIBER

Current Illness: NA

ID: 1017323
Sex: F
Age: 39
State: NY

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/09/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: 20 hours after shot, persistent fever maintained at 102.7 while covered by Tylenol 1 gram and Motrin 800 mg being taken every 6 hours. Severe chills, shaking, body soreness, and fatigue. Left Arm swelling, redness the size of a softball, hard and hot skin. Arm swelling lasted for 6 days.

Other Meds:

Current Illness:

ID: 1017324
Sex: F
Age: 46
State: CA

Vax Date: 01/08/2021
Onset Date: 01/16/2021
Rec V Date: 02/09/2021
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

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

Symptoms: Menstruation was due 1/10/21 (2 days after vaccine). I am typically very regular. Period did not start until 1/24/21 and as of today (2/9/21) has not ended (17 days long so far). VERY heavy flow with A LOT of clotting. Additionally, on Day 8 after vaccination, injection site became red, hot, and itchy with a hard knot at injection site. This lasted for 2 days then went away.

Other Meds: none

Current Illness: none

ID: 1017325
Sex: F
Age: 61
State: NJ

Vax Date: 01/01/2021
Onset Date: 02/07/2021
Rec V Date: 02/09/2021
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: Transdermal scopolamine (Transderm scop)

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

Symptoms: 02/7/21: About 11 days after the first vaccine, I developed a 2 inch diameter red rash at the site of the vaccine. 02/8/21: the redness increased in size to 2-1/2 inches in diameter. It was now hot and raised. 02/9/21: the redness diminished slightly and the rash is now flat.

Other Meds: Valsartan Famotadine Magnesium Vitamin D Calcium Vitamin B12

Current Illness:

ID: 1017326
Sex: F
Age: 46
State: TX

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Morphine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I felt like racing in chest and had little red spots around chest area(appearance ringworms 40-50 in count).

Other Meds: Cholesterol, Metformin

Current Illness: No

ID: 1017327
Sex: F
Age: 58
State: CO

Vax Date: 01/12/2021
Onset Date: 01/20/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Eight days after vaccination patient reports significant swelling at the injection site. It resolve after two days. No additional treatment was needed.

Other Meds: N/A

Current Illness: N/A

ID: 1017328
Sex: F
Age: 90
State: MA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: None listed on intake/consent form

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

Symptoms: Systemic: Fainting; symptoms lasted 1 day.

Other Meds:

Current Illness:

ID: 1017329
Sex: F
Age: 29
State: NC

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
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: Systemic: Other- Chest Pain (requiring medical intervention post vaccine)-Medium

Other Meds:

Current Illness:

ID: 1017330
Sex: F
Age: 71
State: NV

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: INJECTED TOO LOW. PATIENT GOT INFECTION AT INJECTION SITE: REDNESS, SWOLLEN.

Other Meds: N/A

Current Illness: N/A

ID: 1017331
Sex: F
Age: 82
State: NC

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/09/2021
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: PCN, Cipro, and unknown food allergy

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

Symptoms: About 10minutes after vaccine patient felt light headed. Vital signs were within normal limits (BP: 130/60, Pulse: 80, Respirations: 12, Pulse ox: 96%), and patient started to feel better. Offered a snack but patient declined. Patient was reassessed after 10 minutes and patient was back to baseline and ready to go home.

Other Meds:

Current Illness: none at the time of vaccination, unknown prior

ID: 1017332
Sex: F
Age: 41
State: AR

Vax Date: 01/19/2021
Onset Date: 01/22/2021
Rec V Date: 02/09/2021
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: none mentioned

Symptom List: Injection site pain, Pain

Symptoms: She reported she started having a rash all over body reports she took Zyrtec and rash wen away.

Other Meds: none mentioned

Current Illness: none mentioned

ID: 1017333
Sex: M
Age: 54
State: IN

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Severe Injection site pain. Fever, Body Aches, Uncontrollable Shivering. Dizziness. On the first dose I got these Symptoms at 11:30pm then they subsided by 6:30 am with multiple doses of Tylenol. I was able to return to work the next day. The second night the symptoms returned around 11:00 and persisted until morning. They went away with more Tylenol and all but the injection site pain did not return. On the second dose I had the same symptoms The same night as injection. They did not go away with Tylenol, and continued through the entire next day. Fever never broke. Unable to go to work with fever over 100. All symptoms persisted through the next night until morning when fever finally broke, and I was able to go to work. That night the symptoms return overnight, but were gone in the morning, and all but the injection site pain did not return. It has been 5 weeks since the first injection, and two weeks since my second, and I still have injection site pain and weakness in both of my arms. It is not as severe as the first five days following injection, but still persistent and noticeable.

Other Meds: 300 mg of Allopurinol daily

Current Illness: None

ID: 1017334
Sex: M
Age: 22
State: IN

Vax Date: 01/12/2021
Onset Date: 01/18/2021
Rec V Date: 02/09/2021
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

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

Symptoms: Symptoms: Started with a rash in the left axillary region. Itching spread across all of upper torso. Itchy rash with hives. Diagnosed as unknown urticaria. Prednisone 20mg 1 time per day and hydroxyzine 10mg 3-4 times a day. After 1 days, symptoms have improved but not resolved

Other Meds: Claritin

Current Illness: None

ID: 1017335
Sex: F
Age: 47
State: NJ

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/09/2021
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: Tree nuts, latex sensitive

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Just reporting symptoms that started on 2/3/2021 and not 2/9/2021 as reported because I was not receiving daily updates for check in. Vaccine was at 5p on 2/2/21. Next morning I had fever, fatigue, chills and muscle aches and rash on torso. Left arm continues to itch from apparent rash. No treatment. Symptoms resolved in about 30-48 hours post injection but again just wanted to document appropriately the immune response I had. I don't know if I can correct data fir 2/9/21 but I'm back to 100%. Thank you

Other Meds: Trazadone, allergy

Current Illness: None

ID: 1017336
Sex: M
Age: 73
State: PA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/09/2021
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: Nausea, Vomiting, Diarrhea for 18 hours Pain - Discomfort @ injection site

Other Meds: simvastatin 40mg, diphenhydramine 25mg, CoQ10 100mg, Glucosamine Chondroitin MSM + Turmeric Triple strength

Current Illness: none

ID: 1017337
Sex: F
Age: 41
State: KY

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 02/09/2021
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: Extreme body soreness, fatigue, and low fever of 100.2, also swelling and soreness and itching at injection site

Other Meds: None

Current Illness: None

ID: 1017338
Sex: F
Age: 41
State: AL

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Singulair

Symptom List: Nausea

Symptoms: Patient reported to the ED about an hour after receiving the first dose of COVID-19 vaccine (Pfizer brand). She complained of left sided facial numbness with no facial droop or slurred speech present at the time. Her vitals were taken, she was monitored and seen by a PA. She was given an education handout on allergic reactions to medications and scheduled to follow up with her primary care physician regarding her elevated blood pressure (182/100). Patient did not report prior history of hypertension. She was discharged and able to ambulate our of the ED and drive home. Coure of care approximately 1 hour.

Other Meds: No medication reported by patient

Current Illness: None reported

Date Died: 02/05/2021

ID: 1017339
Sex: M
Age: 88
State: FL

Vax Date: 01/30/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin hives Sulfonamide Antibiotics hives

Symptom List: Injection site pain

Symptoms: Admitted to hospital with sob upon exertion that started prior to vaccine. Hx COPD, HTN, CKD, hyperlipidemia, bladder cancer in remission. Stated he has been taking Eliquis and Xarelto between renal doctor and cardiologist Dr. Anticipating going home 2/5/21 but then turned blue and stopped breathing under a DNR. COVID test negative. Labs show acute on chronic renal failure with an elevated troponin likely from demand ischemia.

Other Meds: Furosemide Lasix, 20 mg PO daily at 0600 Simvastatin 20 mg Tablet PO daily Amlodipine Norvasc 2.5 mg Tablet PO daily Tamsulosin HCl 0.4 mg Capsle PO daily Dutasteride 0.5 mg Capsule PO daily Metroprolol Tartrate Lopressor 25 mg Tablet PO on

Current Illness: sob with exertion, started just prior to vaccine

ID: 1017340
Sex: F
Age: 54
State: NY

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 02/09/2021
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: She reported pain at the injection site, headace, and fever of 101F. Symptoms resolved with Tylenol.

Other Meds:

Current Illness:

ID: 1017341
Sex: M
Age: 50
State: SC

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 02/09/2021
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: None

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

Symptoms: Extreme body aches, joint paints, fever, fatigue, headache, chills, and nausea. Test positive for COVID 01/09/2021

Other Meds: Multi Vitamin

Current Illness: None

ID: 1017342
Sex: F
Age: 59
State: NJ

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/09/2021
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: J&J Ethicon sutures

Symptom List: Tremor

Symptoms: Had Dose 1 ca 10:00 AM (late for 8:20 AM appt - wrong onsite location); ca 11:15/11:30 AM - sleepy/ drowsy, runny nose; ca 12:00 P - REQ 2 puffs of Xopenex rescue inhaler (breathless feeling; felt a deep heavy band across diaphragm area/ just below lungs - very diff from the stifled feeling typical to having an asthma attack, mine milder - a weighted heavyness to breathing), brain felt foggy, lightheaded (enough to be fearful of driving main or busier residential roads over the next 15 mins to arrive at apartment); ca 1:00 PM - single puff of Xopenex inhaler; drove home arriving ca 1:25 PM - felt wiped-out, very foggy brained, achy, headache & took Allegra 24 hour #3 dose, exceptionally groggy; napped heavily till ca 4:30/ 4:45 PM - less foggy, less exhausted, not confident in clear-headedness, did not feel sharp in perception enough to make contact tracing phone calls; 5:00 PM - clocked in to work remotely for 3 hours of professional reading, catch up with some regional, state pandemic happenings.

Other Meds: Centrum Silver (1/ day); Buprione HCL (300 mg/ day); Venlafaxine HCL (150 mg/ day); Amlodipine Besylate (5 mg/ day); Montelukast Sodium (10 mg/ day); Allegra 24 hour (2 - 3 tablets/ day); Advair 250/ 50 (2 puffs/ AM-PM - 2 X day); Flutacaso

Current Illness: none

ID: 1017343
Sex: M
Age: 29
State: CA

Vax Date: 01/07/2021
Onset Date: 01/27/2021
Rec V Date: 02/09/2021
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: Unknown

Symptom List: Erythema, Pruritus

Symptoms: Patient tested positive for COVID-19 after getting first immunization.

Other Meds: Unknown

Current Illness: Unknown

ID: 1017344
Sex: F
Age: 67
State: CA

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: C/O tingling sensation around lips. Similar episode after first dose Pfizer vaccination. Had a telephone consult with PCP, cleared for 2nd dose. Encouraged over the counter antihistamine and to get EpiPen auto injector. Patient talkative no lip or tongue swelling. No resp distress. 02 Sat 98% r/a. Able to speak in full sentences and drink fluids. Observed for an addition 30 minutes with no change in 02 saturation and swelling. Patient with family and is aware an order for EpiPen was prescribed.

Other Meds: Levothyroxine, aromasin, melatonin, baclofen, urea, Zyrtec, magox, motrin, vitamin D

Current Illness: none

ID: 1017345
Sex: F
Age: 85
State: GA

Vax Date: 01/13/2021
Onset Date: 01/28/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufacturer initial and booster).

Other Meds:

Current Illness:

ID: 1017347
Sex: F
Age: 65
State: GA

Vax Date: 01/28/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
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: latex hydrocodone celebrex

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient state on the evening of Feb. 5th, 2021 she noticed some discomfort and mild redness at the injection site. She reports she later woke with increased pain, redness, swelling and the area was hot to the touch. Patient states today (Feb. 9th, 2021) the area is greatly improved with no discomfort noted. Patient was instructed to follow up with PCP prior to receiving the second dose. Patient verbalized understanding.

Other Meds: Estridol

Current Illness: None

ID: 1017348
Sex: F
Age: 67
State: WA

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/09/2021
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:

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

Symptoms: Systemic: Other- Shortness of breath and pale color

Other Meds:

Current Illness:

ID: 1017349
Sex: F
Age: 57
State: TN

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
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: Pennicillin, Sulfa Drugs, Eggs

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

Symptoms: Flu type symptoms - Joint pain, body pain, chills

Other Meds: Clariten D, Vitamin D3, Fish Oil, Vitamin E, Probiotic,

Current Illness: None

ID: 1017350
Sex: F
Age: 43
State: ID

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Sulfa, unknown antibiotic

Symptom List: Pain in extremity

Symptoms: At 11:29 a female patient asked for my assistance.Patient complained of dizziness when putting her head back. Also stated she had some numbness and tingling in her arms and hands. Patient was pale. Patient was unsure if her symptoms were related to the vaccine or if they could be related to her MS. The patient was walked with me to a private area where we sat her down and took her BP (106/54), pulse (88) and Oxygen sat (100). We monitored said patient for 30 minutes. We provided her with warm blankets, water and asked her to eat a snack that she had with her. Vitals were monitored numerous times over the course of the 30 minutes with all vitals remaining in the same general range. Her temperature was 98.4. Over the course of the 30 minutes patient's cheeks became rosy and improved in color. Patient began to move about more, scanning her phone and engaging more freely in conversation. At the end of 30 minutes we took her BP sitting and standing and there was no significant difference. At this point the patient felt comfortable leaving our area. We offered continued assistance if she felt she needed it. Patient declined. Patient was encouraged to go home and rest and have someone available to monitor her for the rest of the day. Patient stated her son lived down the street and she would have him come over to her house. Patient stated she felt like she does after a long stressful day at work. Patient stated that her MS often causes her to feel like this when she exercises or works a long day at work. Patient discharged home ambulatory to her home and care of her son.

Other Meds: Baclofen, Venlafaxine, omeprazole, nuvagel, Topamax, tysabri, xanax

Current Illness: Multiple Sclerosis, celiac disease

ID: 1017351
Sex: M
Age: 56
State: LA

Vax Date: 01/21/2021
Onset Date: 02/08/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Temp. Imbalance Chills, Nausea , fatigue, foul diarrhea (like when I had COVID in July) low grade elevated temp.

Other Meds: SOTALOL,LIPITOR,XARELTO, DILTIAZEM Emergen-C

Current Illness: Atrial flutter/fibrillation S/p cardiac ablation 12/07/2020

ID: 1017353
Sex: M
Age: 43
State: OR

Vax Date: 02/05/2021
Onset Date: 02/01/2021
Rec V Date: 02/09/2021
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: Vial had been removed from Deep Freezer to cooler & kept in cooler beyond recommended time frame; was not noted until after administered to employee (patient). Patient experience expected side effects of chilling, body aches and fatigue next day,

Other Meds:

Current Illness: COVID-19

ID: 1017355
Sex: M
Age: 81
State: MS

Vax Date: 01/13/2021
Onset Date: 01/18/2021
Rec V Date: 02/09/2021
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: Altace

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

Symptoms: Right side vocal cord paralysis

Other Meds: Clonidine,allopurinol,hczc water pill,amlodipine,potassium simvastatin,80mg aspirin, lumigan eye drops

Current Illness: None

ID: 1017356
Sex: F
Age: 55
State: MI

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: Penicillin

Symptom List: Vomiting

Symptoms: Client received COVID 19 Vaccine (Moderna #038k20A) at 10:00 am. She waited out in the lobby for 30 min. when she started to feel flush and dizzy. Had complaints of her throat feeling like it was closing off. Client taken to clinic room. Benadryl 50mg administered IM into the RT Deltoid. Epi administered IM administered into the RT deltoid. EPI was drawn up by the RN and Administered by another RN. Benadryl drawn up and administered by RN. RN present and assessed for lung sounds and bp. Lung sounds were clear, unable to obtain bp in clinic room. 911 was called and client was transferred via EMS to ER for observation. Client was alert and oriented x 3 upon departure.

Other Meds: Unknown

Current Illness: none reported

ID: 1017357
Sex: F
Age: 28
State: WV

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/09/2021
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: She felt panicky prior to injection. Felt flush and panicky after injection. Had ginger-ale and ice pack to help with flushing. Left injection room approximately 35 minutes post-injection. When walking down the hall, she said she started to feel more panicky and felt paresthesias near lower jaw--stated she doesn't normally feel that way during a panic attack. Physical assessment normal. Vitals signs normal. Dexamethasone 4mg IM given. Paresthesias stopped about 10 minutes after dexamethasone. Went home and stated all had resolved by the time she got home and nothing has happened since.

Other Meds:

Current Illness:

ID: 1017358
Sex: M
Age: 79
State: TX

Vax Date: 01/29/2021
Onset Date: 02/03/2021
Rec V Date: 02/09/2021
Hospital: Y

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: NKDA

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

Symptoms: 2-3-2021 pt reported to ER c/o dyspnea, A-fib HR 91, SARSCoV2 RNA test positive in ER, dyspnea on exertion occasional cough, pt admitted to medical surgical floor with acute systolic CHF and COVID-19 with bronchitis, pt was discharged to a nursing home for rehab

Other Meds: atorvastatin calcium po 20mg qd, spironolactone 25mg po qd, coumadin 4mg po qd, torsemide 20mg po 2tablets qd, losartan potassium 50mg po qd, duo neb bid

Current Illness:

ID: 1017359
Sex: F
Age: 32
State:

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/09/2021
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: Ceclor, latex, bees, pressure hives

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Chills, slight fever (99.2-99.6), body aches, slight headache; symptoms began at approximately 8:00 p.m. on the night that the second dose was received; symptoms resolved by 8:00 p.m. the following night (2/8/21); no adverse reactions experienced following the first dose of the vaccine.

Other Meds:

Current Illness:

ID: 1017360
Sex: F
Age: 69
State:

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Pt in observation area for ten minutes before describing onset of "lump in throat." Confirmed she experienced the same issue after receiving the first dose. Took a Benadryl after the first dose and it improved symptoms. No other issues (no redness, rash, hives, difficulty breathing). EMT, took pt's vital signs - all WNL. Pt had oral Benadryl on hand and took one orally. EMT took vital signs again after ten minutes - vitals stable and WNL. Approximately 30 mins after taking oral Benadryl pt reported symptoms better. Pt stayed in observation area for approximately one hour total, stood up and walked out after symptoms resolved.

Other Meds:

Current Illness:

ID: 1017361
Sex: F
Age: 34
State: IL

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/09/2021
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: clarithromycin, cephalexin, trazodone

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

Symptoms: Fatigue, itching and swelling at the injection site. At 11 days post vaccination patient describes increased pain, redness, and itching that she feels has progressed to her armpit and breast.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm