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: 1021030
Sex: F
Age: 66
State: AL

Vax Date: 01/28/2021
Onset Date: 01/30/2021
Rec V Date: 02/10/2021
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: Penicillin, Sulfur, Ibprofen, Hydrocodone and slight reactions to Grits, Ragweed

Symptom List: Dysphagia, Epiglottitis

Symptoms: Swelling and itching around site day after shot. Yesterday, February 9, 2021--Site of shot started itching again...not severe just concerning since I usually have no reaction to vaccinations.

Other Meds: LICINOPRIL, 81% Aspirin, Vitamins B, C, D; Folic Acid Tylenol Arthritis, Ibuprofen,

Current Illness: Acute Sciatica

ID: 1021031
Sex: F
Age: 27
State: NH

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: Pt developed lightheadedness, tingling of tongue and mild nausea 1-2 minutes after injection. She suspects that she may have passed out momentarily. BP was 105 systolic. HR: 98, SP02: 100%. She was given snacks and a drink and improved without intervention. She left appx 45 minutes after injection and noted that she felt back to normal.

Other Meds: none

Current Illness: none

ID: 1021032
Sex: F
Age: 32
State: AL

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

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

Symptoms: /Pt reports, a numb tingling sensation, became diaphoretic, described blurry vision. BP 80/40, pt laid down with feet propped up, EMS activated. Pt allowed to rest, regained color and states she feels better. 16:25, patient refused transport to ER via EMS, 16:45 Patient ambulated out of the clinic with out assistance with husband.

Other Meds: YASMINE, TRINTELLIX

Current Illness: NONE

ID: 1021033
Sex: M
Age: 74
State: PA

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt called 1 day after vaccine and said to RPh that arm hurt. Was told by Rph to use OTC pain meds and that it is a common side effect of the immunization. He called again 3 days later and asked RPh again. RPh told pt that it should last about 72 hours but has heard of reports of pain lasting around a week. On 2/10, pt called and said arm still hurts. RPh told pt to contact his MD and keep us updated with what the MD says.

Other Meds: rosuvastatin 20mg, losartan/hctz 50-12.5mg

Current Illness: none

ID: 1021034
Sex: F
Age: 41
State:

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 02/10/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient experienced severe shoulder, neck and jaw pain that prevented her from eating. Onset was 12-24 hours. The symptoms resolved without intervention after 3 weeks.

Other Meds: N/A

Current Illness: N/A

ID: 1021035
Sex: F
Age: 67
State: CA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: unknown

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

Symptoms: Patient reported metallic taste in mouth and nausea 15 minutes after receiving vaccine. Tingling in lips and tongue Moved to EMT area- BP-162/82, pulese-62, Second set 142/76, pulse 68, O2 sats- 97%

Other Meds: unknown

Current Illness: none

ID: 1021036
Sex: F
Age: 62
State: IN

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/10/2021
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: Seasonal allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Chills, fever101 for greater than 36 hours, then low grade for 24. Eyes burned, unable to have open, headache for 36-48 hours. Localized reaction. Arm with hard knot at site, baseball size, diffuse redness from upper arm to elbow and around to underarm and axilla area. Started on oral antibiotics on day 7 for cellulitis to arm

Other Meds: Metformin, glipizide, januvia, hctz, olmesartan, montelukast, baby aspirin, atorvastatin, humalog, levemir

Current Illness: None

ID: 1021037
Sex: F
Age: 52
State: NY

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Felt hot and flushed. BP 130/82, P74, no respiratory sx. no wheeze. no orbital swelling.received 25 mg benadryl po. felt better in 15 minutes

Other Meds: none

Current Illness: Von Willebrand's Disease

Date Died: 02/01/2021

ID: 1021038
Sex: F
Age: 95
State: MO

Vax Date: 01/13/2021
Onset Date: 01/01/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient had passed since the first dose was given.

Other Meds:

Current Illness:

ID: 1021039
Sex: M
Age: 87
State: MN

Vax Date: 01/06/2021
Onset Date: 01/20/2021
Rec V Date: 02/10/2021
Hospital: Y

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 reported

Symptom List: Diarrhoea, Nasal congestion

Symptoms: . Patient with increased lethargy, generallized edema, UTI and pneumonia,

Other Meds: Lactulose, , Tylenol, allopurinol, aspirin, melatonin, Colace, bisacodyl, MiraLAX, oxycodone, tamsulosin, gabapentin, Seroquel, Lyrica, and Xtampza ER

Current Illness: chronic medical conditions, no acute problems identified

Date Died: 01/17/2021

ID: 1021040
Sex: M
Age: 47
State: NE

Vax Date: 01/06/2021
Onset Date: 01/17/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: Unknown - LTCF will also be reporting

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine Hospital Emergency Room Provider reported cause of death as COVID vaccine administered 11 days prior to death. Additional information being reported from LTCF.

Other Meds: Unknown - LTCF will also be reporting

Current Illness: Unknown - LTCF will also be reporting

ID: 1021041
Sex: F
Age: 18
State: OH

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: Headache, metallic taste in mouth, fatigue

Other Meds:

Current Illness: Ear infection

ID: 1021042
Sex: M
Age: 37
State: MO

Vax Date: 01/08/2021
Onset Date: 01/01/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: tinnitus starting mid january. constant. unresolved

Other Meds: sertraline, bupropion

Current Illness: none

ID: 1021043
Sex: F
Age: 77
State: KY

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: Chlorthalidone 25 mg, Crestor 10mg, Predisone2.5 mg, Folic Acid 1mg, Protonix 40mg, Synthroid 75mg, one-a-day vitamin, omega red 1 daily, D3 5000mg, calcium, vitamin C. Allergies Levaquin.

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

Symptoms: Elevated Blood Pressure 168/84 ,Low Grade fever 99.3, Chills, and headache

Other Meds:

Current Illness: None

ID: 1021044
Sex: F
Age: 56
State: CA

Vax Date: 01/12/2021
Onset Date: 01/29/2021
Rec V Date: 02/10/2021
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: Tetracycline Hcl

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

Symptoms: Developed acute left anterior shoulder burning pain radiating down to mid upper arm since last week Friday. Has some neck pain. The only thing that was new was receiving the first dose of COVID19 vaccine #1 on 1/12/2021. She only had mild muscle pain that resolved shortly after the first vaccine dose. XR 2/1/21 Ortho 2/8/21 = Parsonage Turner Syndrome

Other Meds: atorvastatin (LIPITOR) 40mg Tab TAKE 1 TABLET BY MOUTH DAILY Disp: 90 Tab Rfl: 1 gabapentin (NEURONTIN) 300mg Cap Take 1 Cap by mouth daily at bedtime Disp: 30 Cap Rfl: 0 diclofenac sodium (VOLTAREN) 1 % Gel 2 g to affected area(s) four t

Current Illness:

Date Died: 02/01/2021

ID: 1021045
Sex: F
Age: 94
State: MO

Vax Date: 01/13/2021
Onset Date: 02/01/2021
Rec V Date: 02/10/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient had passed since the first dose was given.

Other Meds:

Current Illness:

ID: 1021046
Sex: F
Age: 51
State: MI

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: Cat/feline, Dairy, Dog dander, dust mite tree and shrub pollen, camila, PCN, Simvastitin, Soybean extract

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

Symptoms: itching all over - eyes, arms, legs

Other Meds: Unknow

Current Illness: None

ID: 1021047
Sex: F
Age: 57
State:

Vax Date: 01/05/2021
Onset Date: 01/07/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: L shoulder Adhesive Capsulitis developing within days of receiving COVID-19 pfizer vaccine in L shoulder. Significant L shoulder functional limitation due to pain and stiffness, passive and active ROM severely limited to less than 90 degrees abduction and forward flexion.

Other Meds:

Current Illness:

ID: 1021048
Sex: F
Age: 61
State: FL

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Became very ill for 48 hours after injection. Chills, fever, severe myalgia, unable to stay up for more than 10 min at a time ,severe unrelenting headache.stuffy nose. Gradually subsided after 2nd day . Headache lasted a few days longer as well as stuffy nose.

Other Meds: Synthroid, Zoloft, Allegra, multi vitamin

Current Illness: Had symptoms of Covid but tested negative 14 days prior to injection

ID: 1021049
Sex: M
Age: 35
State: CA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: dizziness and increased heart rate Resolved after monitoring for 30 minutes

Other Meds:

Current Illness:

ID: 1021050
Sex: F
Age: 43
State:

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/10/2021
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: Patient reported rash developing on face within 24 hours of vaccination. No lip/tongue edema or other sign of anaphylaxis. Patient given oral antihistamine, symptoms resolved. Patient was monitored for anaphylaxis and released once no signs and symptoms of anaphylaxis were noted.

Other Meds:

Current Illness:

ID: 1021051
Sex: F
Age: 27
State: NE

Vax Date: 12/30/2020
Onset Date: 01/16/2021
Rec V Date: 02/10/2021
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: Unevaluable event

Symptoms: I was expected to start my period on or around January 16. Today is February 10th and I still have not started. I have taken two pregnancy tests both after my missed period date and both were negative.

Other Meds: None

Current Illness: None

Date Died: 02/10/2021

ID: 1021052
Sex: M
Age: 93
State: MO

Vax Date: 01/13/2021
Onset Date: 02/01/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient had passed since the first dose was given.

Other Meds:

Current Illness:

ID: 1021053
Sex: M
Age: 51
State: CA

Vax Date: 01/13/2021
Onset Date: 01/27/2021
Rec V Date: 02/10/2021
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: Demerol

Symptom List: Injection site pain, Pain

Symptoms: facial droop left( Bell's palsy)

Other Meds: Biktarvy, Xanax, Cymbalta, Imuran, lisinopril, Androgel , vitamin d

Current Illness: none

ID: 1021054
Sex: F
Age: 30
State: NY

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

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

Lab Data:

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Employee developed difficulty breathing, hives. Employee immediately sent to the Emergency Department for evaluation and treatment.

Other Meds: none

Current Illness:

ID: 1021055
Sex: F
Age: 38
State: OH

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/10/2021
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: Sulfur Drugs, Neomycin, Lanolin, Nickel

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

Symptoms: About 4 hours later, started getting an intense pain in stomach. At night had cold sweats, vomited once, severe diarrhea, low temp, blacked out, but did not go to the ER. Arm soreness and swollen. Stopped around 1:00 the next day. Monday felt a little froggy. Feeling better now.

Other Meds: Claritin D

Current Illness: no

ID: 1021056
Sex: F
Age: 40
State: IL

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 02/10/2021
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: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: started with feeling achy about 20 hours after vaccine, then headache and very nauseous with a sore arm, the nausea was off and on for about 28 hours, the achy and yucky feeling lasted about 48 hours, and the headache lasted about 72 hours

Other Meds: Symbicort, birth control pill, venlafaxine, blood pressure med, vitamin C and D, multivitamin

Current Illness: none

ID: 1021057
Sex: F
Age: 28
State: TX

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: Bactrim, gluten, lavender, eggs

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Dizziness, followed by chest pain, then difficulties breathing. Couldn't take deep breaths without pain or coughing.

Other Meds: Mirena IUD

Current Illness: Staph infection

Date Died: 02/10/2021

ID: 1021058
Sex: F
Age: 72
State: MO

Vax Date: 01/13/2021
Onset Date: 02/01/2021
Rec V Date: 02/10/2021
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:

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

Symptoms: Patient had passed since the first dose was given.

Other Meds:

Current Illness:

ID: 1021059
Sex: F
Age: 47
State: NY

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/10/2021
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: Nine hours following injection, I developed a fever of > 100F and severe all-over-body ache, which lasted 36 hours.

Other Meds: thyroxine 100 mg norethincrone .35 mg Wellbutrin ex 150 mg

Current Illness: None

ID: 1021060
Sex: F
Age: 69
State: CA

Vax Date: 02/02/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: none known

Symptom List: Injection site pain

Symptoms: Immediate tenderness unlike any vaccination I've received since polio vaccine when I was 6 and the doctor administering the shot bent the needle in my arm. Sensitivity mostly resolved after a day or so. Within 24 hours, sensitivity on my right side at or just below the waistline. Day 8, itchy upper arm, swallow, red, warm, firm around injection site.

Other Meds: levothyroxin 50mmg

Current Illness: none

ID: 1021061
Sex: F
Age: 57
State: AZ

Vax Date: 01/26/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
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: Pt received the first dose and tested positive for COVID 19 13 days later.

Other Meds:

Current Illness:

ID: 1021062
Sex: M
Age: 80
State:

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
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: Fever, body aches, and rash during the night after vaccination.

Other Meds:

Current Illness:

ID: 1021063
Sex: F
Age: 77
State: MA

Vax Date: 01/29/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: Red, itchy rash to left arm started today. size approx 6-7 inches oval in shape to left arm (site of injection). No other associated sxs.

Other Meds:

Current Illness:

ID: 1021064
Sex: F
Age: 22
State: CT

Vax Date: 01/13/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: None

Symptom List: Erythema, Pruritus

Symptoms: Tested positive for covid 4 weeks after 2nd dose of Pfizer vaccine

Other Meds: Prozac 20mg daily

Current Illness: None

ID: 1021065
Sex: F
Age: 48
State: TX

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 02/10/2021
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: no

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

Symptoms: Arm tenderness same day. On following day, it was swollen and raised and red and hot. Later that afternoon, one of the Hospital facility Dr's took a look and he determined it was a local reaction. He prescribed (an equivalent to Benadryl) Hydroxyvine -25 mg. It helped with the itching. The symptoms totally resolved by the end of the week (Friday).

Other Meds: no

Current Illness: no

ID: 1021066
Sex: F
Age: 73
State: MT

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 02/10/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Patient called to report raised, red, itchy skin the size of a quarter at the injection site that started 3 days after the injection. Reported to patient that this has occurred with many patients and it should resolve in 1-7 days. Reporting to VAERS as this is not included in the information about usual vaccine reactions.

Other Meds:

Current Illness:

ID: 1021067
Sex: F
Age: 69
State: CA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Slight numbness on tongue and right side of mouth. Resolved with monitoring for 30 minutes

Other Meds: unknown

Current Illness:

ID: 1021068
Sex: F
Age: 25
State: CA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: throat tightness, VP 112/63, O2 sat 99%, HR 87

Other Meds: oral contraceptives

Current Illness: N/A

ID: 1021069
Sex: M
Age: 62
State: FL

Vax Date: 01/26/2021
Onset Date: 01/31/2021
Rec V Date: 02/10/2021
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: Peanuts

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

Symptoms: Bruising and minor swelling. Bruising down entire upper arm. 2nd shot given on 1-26-2021 and bruising did not appear until 1-31-2021

Other Meds: Multivitamin, Fish oil

Current Illness: n/a

ID: 1021070
Sex: M
Age: 42
State: AL

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: Pain in extremity

Symptoms: Pt sitting up in chair became pale, pasty, diaphoretic, states he isn't thinkin straight. Pt laid in floor, legs elevated. EMS activated, evaluated by paramedics, orthostatics negative, patient allowed to rest for until 1635. Patient color returned, states he felt better, ambulated out of clinic independently. Wife at side.

Other Meds: alprazolam 0.5mg tid

Current Illness:

ID: 1021071
Sex: F
Age: 55
State: GA

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: Morphine and Flu shot 2016

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

Symptoms: Huge swollen under right arm lump node. Tired leg syndrome and joint pain. Severe pain in injection site, upper back and neck. weakness. Stiff muscles, dizziness and light headed, flu like symptoms. Extreme pain in right arm x 10, swollen red bumbs and rash around injection site.

Other Meds: Losartan 100mg, hydrochlorathazied 10 mg, Vitamin C 500mg, Vitamin D3 4,000

Current Illness: None

ID: 1021072
Sex: M
Age: 1
State: NY

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: nkda

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

Symptoms: child inadvertently given a kinrix when a prevnar (pneumococcal 13) and hib had been ordered. No adverse effects immediately noted. Family notified. Will wait one month then give prevnar and hib.

Other Meds: none

Current Illness: none

ID: 1021073
Sex: F
Age: 19
State: NY

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: Sat down post vaccination, was emotional. Sipping water. patient fainted in the chair . came around within 5 minutes. Attended by EMS and Doctor.

Other Meds:

Current Illness:

ID: 1021074
Sex: F
Age: 33
State: NY

Vax Date: 01/18/2021
Onset Date: 01/25/2021
Rec V Date: 02/10/2021
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: Shellfish, Artificial Food Coloring, Penicillin, Dairy

Symptom List: Vomiting

Symptoms: On Sunday, January 24th, I woke in the morning (6 days after vaccination) with a 3x2 flat red ring around injection site. The following morning, Monday, January 25th I woke with extreme red inflammation of my left eye. An opthamologist diagnosed the condition as nodular scleritis. My infectious disease doctor reported a component in the Moderna vaccine to have molecular mimicry to shellfish, to which I am extremely allergic. The nodular scleritis was treated with a course of Prednisone at 40mg tapered over 10 days, which lessened the redness and swelling gradually. My infectious disease doctor advised that I should not receive the second dose of Moderna.

Other Meds: Gianvi, Nutrafol, Vitamin D, Biotin

Current Illness: None

ID: 1021075
Sex: F
Age: 58
State: MN

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
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: CT dye, shellfish

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After about 4 hours, I developed a large swelling of about the size of a goose egg under my right arm pit on the lymph node. The swelling was painful. I went in to see my doctor the next afternoon at 3:20 p,m, and the swelling had shrunk in half. Soft and moveable. No fever or rash or muscle aches other than the pain of the lump.

Other Meds: Lisinopril 25mg Metoprolol 75mg Aspirin 81mg Ventolin Inhaler PRN

Current Illness: None

ID: 1021076
Sex: M
Age: 16
State: NM

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
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: Penicillins

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

Symptoms: Per the pt he felt nauseous and had a migraine as soon as he received the vaccine.

Other Meds: None

Current Illness: None

ID: 1021077
Sex: M
Age: 34
State: TX

Vax Date: 02/03/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: nausea dizziness disturbed stomach

Other Meds: Ibuprofen

Current Illness:

ID: 1021078
Sex: F
Age: 50
State: NY

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: After 12-18 hours: pain in right arm, shoulder, shoulder blade, neck. Headache. Fatigue. After 24 hours: fever of 100.6, headache (right-sided)

Other Meds: none

Current Illness: none

ID: 1021079
Sex: F
Age: 40
State: NM

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: None known.

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

Symptoms: Patient noticed mild swelling to upper lip around 0630 am. Several hours later, the patient developed swelling to left upper eyelid and left cheek/jaw. She reports slight irritation to her throat, with no evidence of tongue or throat swelling. Denies cough, difficulties breathing, or shortness of breath. Also having nasal congestion/runny nose, which has been intermittent for the past week. The facial swelling had already improved upon my evaluation of the patient. She did not take any medications for the symptoms prior to her arrival. She was given a prescription for Zyrtec 10 mg daily and Pepcid 20 mg BID x 10-14 days with strict return precautions for any signs of worsening.

Other Meds: ibuprofen 600 mg (over-the-counter) x 1 dose on 2/9/21- evening.

Current Illness: Seasonal allergic rhinitis/allergic conjunctivitis- unknown allergen. Has been ongoing/intermittent for the past 12+ months.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm