VAERS 2021 Database www.vaers.hhs.gov

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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: 1024340
Sex: F
Age: 39
State: WA

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/11/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: My face feels tingly and some parts feel numb.

Other Meds:

Current Illness:

ID: 1024341
Sex: M
Age: 26
State: TN

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/11/2021
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: seasonal allergies, allergy to grass (history of puffy eyes upon contact)

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient presented with puffy eyes approximately 4 minutes after vaccination. Was alert and oriented to time, person, and place upon questioning and was able to engage in conversation. Parent (mother) of patient was present who gave patient's medical history and reported allergy to grass with similar reaction. Blood pressure was taken and found to be 150/80. Mother reported patient had not taken his blood pressure medicine yet that day but his normal is 115/70 with medication. While nurse was assessing patient's pulse (patient's pulse was WNL at 85) and other nursing staff was obtaining medication to administer if needed after assessment, patient became unresponsive to verbal commands and his upper body became limp. At 1054, a one time, single dose of 50 mg of diphenhydramine IM was given in the left deltoid. On site EMT arrived on the scene at 1055, completed assessment, and confirmed giving diphenhydramine was the best course of action. At this time, 1055, patient became responsive to verbal commands and was oriented to time, place, and person. At 1056 O2 sat was at 97%, pulse 70, and at 1100, BP was 110/70. Patient stayed for observation 30 more minutes and remained stable. Patient and parent were educated on side effects of diphenhydramine, to watch for any returning symptoms of allergic reaction throughout the day, and if/when to head to the ER. Recommended patient not receive 2nd dose of COVID vaccination.

Other Meds: high blood pressure medication

Current Illness: no acute illnesses at time of vaccinaiton

ID: 1024342
Sex: F
Age: 45
State: WI

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/11/2021
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: Sulfa, cafergot

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

Symptoms: Pain at injection site, muscle/body aches, chills, prickly skin, headache, nausea & fatigue.

Other Meds: None

Current Illness: None

Date Died: 02/09/2021

ID: 1024343
Sex: F
Age: 75
State: HI

Vax Date: 02/05/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
Hospital: Y

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

Lab Data:

Allergies: ERYTHROMYCIN

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: PATIENT ARRIVED TO ED ON 2/9 IN FULL CARDIAC ARREST

Other Meds: HYDROXYCHLOROQUINE MONTELUKAST METOPROLOL XL PANTOPRAZOLE

Current Illness:

ID: 1024344
Sex: F
Age: 69
State: WA

Vax Date: 01/28/2021
Onset Date: 02/01/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Felt a bit ill the day of the shot. Tried to help do dinner later that day and turned white and sweaty and had to sit down for about 15 minutes. The next day injection site began to swell. By the 8th day post injection it was hard to the touch, about the size of a large marshmallow and hard to the touch. No skin discoloration, but felt warm to touch and very itchy. Used Lanacanevto stop the itch. Today the 11th, most of swelling is gone and just a little tender to touch. Did not contact anyone medical about this, but a friend said i should report it.

Other Meds: Lisinopril , gabapentin, metoprolol, furosemide, spironolactone, fish oil, tylenol, acyclovir, buproprion, escitalopram,

Current Illness: Psoriatic arthritis, osteoarthritis, fibromyalgia, CHF None

ID: 1024345
Sex: F
Age: 73
State: CA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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:

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

Symptoms: @1413 Hematoma formed pt reported itchiness on vaccine site ice pack was provided. @1417 Pt reports that " Ice is helping" denies itching at site @1419- Size of hematoma decreased in size swelling significantly went down. @1423 patient was discharged

Other Meds:

Current Illness:

ID: 1024346
Sex: F
Age: 61
State: MN

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/11/2021
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: Lexofloxcin-500mg- felt fuzzy, odd, slow motion feeling Amox tr k club 875-125 mg rash Macrobid CAPS-shortness of breath

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Approximately 40 minute after receiving the Moderna COVID-19 Vaccine EAU in my left upper arm , I experienced a thickening of my tongue and a tingling feeling It felt as though it was in the forward part of my tongue. It felt very odd and was very scary. I had no tingling in my lips or in my throat. I could speak, drink water and eat. The sensation lasted approximately 5 hours until it felt somewhat back to normal. I have my second doze of the Moderna vaccine scheduled for March 5. I am worried about getting it after having this reaction. Please advise me.

Other Meds: Synthroid 125 M,W,F 150 Su,Tu,Th.,Sa., omeperzole 40 mg daily,allergy relief 10 mg 2 Tylenol 500 mg each, 1advil, 200mg ( these were taken at 7:30 am )

Current Illness: None

ID: 1024347
Sex: F
Age: 75
State:

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Mild throat irritation noted 29 minutes after administration of 2nd covid19 vaccine. Patient speaking full complete clear sentences. No escalation of symptoms and no new symptoms during monitoring period (extra 20 min). No shortness of breath. Suspect that recent steroid injection to hip 2/4/2021 may have helped diminish reaction to the vaccine. Diphenhydramine 25 mg PO x 1 given prior to discharge from clinic

Other Meds:

Current Illness:

ID: 1024348
Sex: F
Age: 27
State: MD

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/11/2021
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: Chills and fever above 101 for the second half of the vaccine day and all of the following day. Aches and pain in arm, headache for three days.

Other Meds: Oral birth control pill, vitamin B12 supplement

Current Illness: None

ID: 1024349
Sex: F
Age: 69
State: IN

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
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: Penecillian, Sulfa drugs,Codine, adhesive tape, ingredients (not sure which) in products with SPF

Symptom List: Diarrhoea, Nasal congestion

Symptoms: About 12 hours after I had severe chills and fever up to 102.2, muscle pains & very slight headache Symptoms lasted 24hours EXCEPT for a feeling in my head that I have had when getting off my antideprssant--sort of fuzzy/shaken feeling. Wondering if it's making my meds for that ineffective.

Other Meds: Venlafaxine Er 37.5 mg - Pot CI Micro Meg Tab Ups -Atorvastatin 10Mg -Hydrochlorot 25 Mg. Tab Ivax Multiple Vitamin-Vit. D= B Complex-Probiotic

Current Illness: None

ID: 1024350
Sex: F
Age: 75
State: WV

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: Patient was administered first dose of COVID-19 Pfizer Vaccine 1/27/2021 no adverse effects from dose and was due 2nd dose Pfizer 2/17/2021.Patient returned to community vaccine event today 2/11/2021 and received COVID-19 Moderna dose in error with no adverse effects at this time.

Other Meds: NONE

Current Illness: NONE

ID: 1024351
Sex: F
Age: 59
State: SC

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 02/11/2021
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: IV Pepcid, sulfa

Symptom List: Rash, Urticaria

Symptoms: 1/5 vaccination later that evening; shakiness, heart palpitations, chills. Lasted for approximately an hour and then subsided.

Other Meds: Toporol, celexa

Current Illness: n/a

ID: 1024353
Sex: F
Age: 60
State: SD

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: Bovine manure dust; wasp stings

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

Symptoms: Tightness in chest, throat swelling, tongue tingling. Lasted about 45 minutes. Did NOT use epipen. Went to ER on site, received saline IV, was thoroughly checked and monitored, stayed 2 hours.

Other Meds: Allegra-D 24; multivitamin; C; Super B vitamin; calcium; D3; probiotic; zinc;

Current Illness: None

ID: 1024354
Sex: M
Age: 43
State: RI

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: Nka

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

Symptoms: 43 yr old male sitting in observation area after receiving 1st Covid vaccine injection felt faint and dizzy as well as nauseous. Pt appeared to be pale and skin cold,clammy, and diaphoretic and was moved to medical 2 for observation. Pt was placed in trendelenburg position and vs were taken. Pt bp was 102/62, hr 58, 98% ra and 18 reps. Led clear bil. Pt was allowed to rest for several minutes and vs were retaken and improved. Pt felt better and adverse symptoms subsided. Vs were normal at bp 110/70, hr 65, resp 18, spo2 was 100% ra. Pt felt like he can go home and doesn?t need t/p to hospital Er. Pt signed a refusal for transport and went back to observation room t rest.before returning home

Other Meds: Nonexistent

Current Illness: No illnesses today or 1 month prior to vaccine

ID: 1024355
Sex: M
Age: 77
State: MO

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: VACCINE ADMINISTRATION ERROR: patient presented to a vaccinator who vaccinated him w/o checking to see when his first dose was administered. The patient was sent an email as his appointment was too early but he did not see it. He was vaccinated 5 days too early. CDC guidance changed this week and the grace period is 4 days. We informed the Chief Medical Officer who felt he would be fine and that it would count as his second dose. She recommended we call Pfizer for official guidance. I called Pfizer and it was explained that the dose given today, 5 days early was outside of the EUA prescribing information and the the CMO may use clinical judgement. I was told that he does not need to be revaccinated and this would count as his second dose. The patient verbalized understanding.

Other Meds:

Current Illness:

ID: 1024356
Sex: M
Age: 25
State: DE

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Beginning 0200 morning after vaccination: Chills, low-grade fever (TMax 100.6 as of 1745 the day after vaccination), lethargy, nausea, headache, injection site soreness. As of 1745 the day after vaccination, nausea has subsided, but headache, fever/chills, and lethargy remain.

Other Meds: None

Current Illness: None

ID: 1024357
Sex: F
Age: 29
State: WI

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
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: Ariripiprazole caused restlessness

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

Symptoms: One hour after vaccine, her tongue and throat was itchy. She took Benadryl and it resolved.

Other Meds: Vilazodone, lurasidone, levothyroxine, lamotrigine, Adderall XR, Apri, Vitamin B complex, prenatal vitamin

Current Illness: no

ID: 1024358
Sex: M
Age: 39
State: IN

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient had a vasovagal response shortly after receiving the vaccine. Patient admits to having this reaction before with blood draws and other vaccines. Patient did not lose consciousness. Patient was given juice and crackers and a cool compress. He was observed for 30 minutes and then was comfortable going home.

Other Meds: Unknown

Current Illness: Unknown

ID: 1024359
Sex: F
Age: 36
State:

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: Aproximately 5 minutes after injection, pt felt burning type pain at injection arm which spread to chest area and up neck. HR 110. Anxiety noted. Pt escorted to ED for possible treatment but symptoms dissipated over the next 10 minutes without further intervention or provider review. Pt was NOT seen by ED provider. She felt she was ok to go home

Other Meds:

Current Illness:

ID: 1024360
Sex: F
Age: 32
State: NE

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Extreme muscle and joint pain, headache, dizziness, diarrhea, fever, fatigue, loss of appetite, film on tongue

Other Meds: N/A

Current Illness: N/A

ID: 1024361
Sex: F
Age: 65
State: IL

Vax Date: 01/29/2021
Onset Date: 02/05/2021
Rec V Date: 02/11/2021
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: penicillin

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

Symptoms: Pharmacist initially delivered the vaccine Below the deltoid muscle area causing a blood drip that required 2 band aids (first was full of blood ,removed and replaced with another). Within 24 hours round dark bruising about the size of a quarter developed. Bruise was sore and deepened in color over the following 10 days. One week after administration, on 2/5/21, the area under the point of shot, began to itch and swelled into a red hard lump.That area spanned about 2 inches by 1 inch and continued to maintain redness and itching for 1 week, but lump went down in 2 days.

Other Meds: atenolol 75mg, amlodipine 5mg, levothyroxine 25mcg, vitamin d 2000iu, b complex tablets, calcium and magnesium tablets

Current Illness: n/a

ID: 1024363
Sex: F
Age: 22
State: IN

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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 and amoxicillin

Symptom List: Unevaluable event

Symptoms: Chills/ aches, low grade fever, nausea

Other Meds: Birth control, celexa

Current Illness: N/A

ID: 1024364
Sex: F
Age: 29
State: NC

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: Acetaminophen, Sacha Inchi, Bee Venom, Latex

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

Symptoms: Approximately 4 minutes after receiving my vaccine I felt warmth down injected arm. Approximately 20 minutes post injection, I experienced a drop in my blood pressure, heaviness in my legs (like walking through cement), and ringing in my ears. At approximately 12:30-12:45pm I experienced mental fog (I couldn't remember how to turn off my windshield wipers), increased heart rate, rapid onset of feelings of panic, minor shortness of breath, neck/clavicle tightness on side of injection, and sweating. Between approximately 1:30pm and 2:30pm I continued to have extreme sweating, as well as: increased pulse, fatigue, dry throat, muscle weakness/shakiness, brain fog, and headache. At approximately 3:30 I hit my knee on the bed frame and felt like the wind had been knocked out of me and immediately had a severe drop in blood pressure that felt similar to a vasovagal event. I called the vaccine clinic and my symptoms were noted and I was told to seek help if my symptoms worsened or I felt like I was going to pass out. My symptoms have not worsened but I am still experiencing extreme sweating along with shivering, shakiness, blood pressure changes with movement (orthostatic hypotension), and fatigue - time is currently 5:50pm

Other Meds: NONE

Current Illness: NONE

ID: 1024365
Sex: F
Age: 54
State: VA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/11/2021
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

Symptom List: Injection site pain, Pain

Symptoms: fatigue, muscle aches, low grade fever (under 100 degrees) for 6 days now.

Other Meds: none

Current Illness: none

ID: 1024366
Sex: F
Age: 72
State: CA

Vax Date: 01/29/2021
Onset Date: 02/05/2021
Rec V Date: 02/11/2021
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, abalone

Symptom List: Injection site pain, Menorrhagia

Symptoms: Day 1 - Large red area on left arm near shoulder, approx 4"x4" itchy, tender Day 2 - Area increased in size to 4"x 6", swelling more visible, hot Day 3 - Area increased to 5"x 7" Looked at by doctor, began antibiotics. Some spots on right arm Day 4 - Area increased to 5" x 8", larger patch of hives appeared on lower arm and on upper and lower right arm

Other Meds: Rovostatin, 2.5mg, Topatrol, 5mg, Estradiol, vitamin D

Current Illness: None

ID: 1024367
Sex: F
Age: 19
State: UT

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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:

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

Symptoms: approximately 5 hours after receiving the vaccine, she noticed an elevated heart rate 99-138 bpm

Other Meds:

Current Illness:

ID: 1024368
Sex: F
Age: 39
State: OH

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
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: Lidocaine

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received her 1st dose of Pfizer vaccine around 1810 on 2/9. Approximately 10-15 mins later her arm was shaking uncontrollably, she felt that her throat was closing and had chest pressure. Medics noted hives and a rash on her chest and administered Epi and Benadryl. She began exhibiting stroke-like symptoms of expressive aphasia and dysarthria in the medic?s truck around 1850. She was crying and unable to speak. She had right sided facial droop, right sided grip weakness, and right sided arm drift. Patient was transferred to MC. Patient Update: Patient received tPA on 2/9 at 1949. CT revealed no hemorrhage or large territory stroke and no large vessel occlusion. NIHSS on admission to MC was a 3. Patient was also assessed by speech pathology. Patient appears to have been discharged home on 2/10. Patient to follow up with Outpatient Neuro PT Rehab as she is having some issues with mobility, gait, and overall functional mobility. She is using a 2 wheeled walker at this time.

Other Meds: Unknown

Current Illness: Unknown

ID: 1024369
Sex: M
Age: 54
State: TX

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: N/V, dizziness, headache

Other Meds: Metoprolol, diovan

Current Illness: N/A

ID: 1024370
Sex: F
Age: 40
State: CA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/11/2021
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: Facial paralysis on my right side, constant ringing in my ear, tongue is numb. Went to the ER and was told it was Bells Palsy

Other Meds:

Current Illness:

ID: 1024371
Sex: F
Age: 86
State: CO

Vax Date: 01/25/2021
Onset Date: 02/03/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: multiple

Symptom List: Nausea

Symptoms: rash and itching at injection site, topical hydrocortisone cream, 2-3 through 2-11, 2021

Other Meds: alpha lipoic acid, amlodipine, Vitamin C and D, benazepril, calcium-magnesium, duloxetine, fish oil-omega 3, insulin glargine, levoxyl, metoprolol, multi-vitamin, nateglinide, pro-biotic, spironolactone, whey powder

Current Illness: vaginal infection, macula edema

ID: 1024373
Sex: F
Age: 39
State:

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient stated that persistent throbbing pain was present in her lower left back area (kidney area) that lasted for about 2 days. As well as a sharp pain in the left side of her chest - on and off for about 2 hours the evening following the shot. Chills as well as sweats at night when trying to sleep for 2 consecutive nights.

Other Meds:

Current Illness:

ID: 1024374
Sex: F
Age: 77
State: CA

Vax Date: 01/31/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: Tetracycline, Flagel , Ciprofibrate, Temazepam, Azithromycin

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

Symptoms: Right arm at injection site red, slight rash, very itchy and slightly swollen Occurred 9 days after shot given on 1/31/21

Other Meds: Arimidex (Anastrozole) Rosuvastatin (Crestor) Vitamin D3

Current Illness: Lymphoma

ID: 1024375
Sex: M
Age: 69
State: KY

Vax Date: 02/07/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
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: Mild to moderate neck pain on Monday after injection on Sunday. Neck pain and stiffness increased Tuesday afternoon and on Wed he was unable to rotate head or hold head up against gravity due to severe neck pain. On Thursday the pain was moderate but able to sit up and move around slowly. Still unable to rotate head without pain as stiffness.

Other Meds: None

Current Illness: Nasal congestion

ID: 1024376
Sex: F
Age: 32
State: NC

Vax Date: 01/06/2021
Onset Date: 01/09/2021
Rec V Date: 02/11/2021
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: I am allergic to sulpha drugs, penicillin and cherries.

Symptom List: Tremor

Symptoms: On Jan 6th, I had fatigue and malaise. On Jan 9th, I had a lymph node reaction that had swelling and I was unable to move my arm without significant pain.

Other Meds: I take metoprolol and a birth control pill.

Current Illness: No

ID: 1024377
Sex: M
Age: 71
State: WA

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 02/11/2021
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: Erythema, Pruritus

Symptoms: Prior to dilution, stored at unacceptable temperatures prior to administration. Was held at room temp longer than the recommended by manufacturer. Does was repeated.

Other Meds:

Current Illness:

ID: 1024378
Sex: F
Age: 55
State: WA

Vax Date: 01/10/2021
Onset Date: 01/16/2021
Rec V Date: 02/11/2021
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: NSAIDS, Aspirin,

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

Symptoms: 6 days after first covid vaccine I ended in the ED with a mild heart attack and a spot on lungs for possible pneumonia. Tests ran showed no blockage or issue with heart and no blood clot found. Tests are still being run, but no cholesterol issues, low BP rate always, and no history of heart issues for myself or family members. 2nd dose caused shortness of breathing starting at 24 plus hours and increased heart rate for 7+ days and starting to decrease. Lungs cleared up after 6 days from 2nd dose.

Other Meds: vitamins, benedry, allerclear, ventolin inhaler as needed

Current Illness: none

ID: 1024379
Sex: F
Age: 100
State: FL

Vax Date: 02/05/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: No known allergies

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

Symptoms: Resident presenting today with facial swelling that extends from Chin into neck area. Redness to face.

Other Meds:

Current Illness: none

ID: 1024380
Sex: M
Age:
State: GA

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: Within our injection shot sore. No other adverse effects until 5:00 a.m. Woke up because body was very hot similar to being in a sauna. Removing for changing the blanket to a thinner one resulted in extreme chills within one minute. Covering with blanket resulted in extreme hot within 10 minutes. Repeated this cycle for several hours until fall asleep. High discomfort throughout body. Woke up at 10:00 a.m. with mild grade fever of 99.5? (average resting temperature is 96.5). Felt extreme cold and chills shivering body aches headache until 6:00 p.m. felt hungry and okay enough to eat. Main concern is the extreme hot to extreme cold cycle in early morning. It felt as though the body was not in sync. During fever throughout day/afternoon body's reaction was normal - fever meant chills and shivering, putting on a blanket meant comfortable warmth (after long periods of time). But in early morning no no fever yet body burning hot almost suffocating sauna heat insider body, and removing the blanket a immediate and severe chills with uncontrollable shaking, instead of relief from heat... Concerned if vaccine affects body's heart regulation system (hypothalamus, thyroid, etc). General malaise during this period is an understatement... It was not a single spot or feeling pain it was the whole body wanting to twist itself and feeling 'deprssed' and very 'ill' all over all at once.

Other Meds: Magnesium chelated, vitamin B complex, vitamin D

Current Illness:

ID: 1024381
Sex: F
Age: 41
State: NE

Vax Date: 12/31/2020
Onset Date: 01/03/2021
Rec V Date: 02/11/2021
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: No

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

Symptoms: I exp headache and body aches lasting 3 days. I had previously had Covid 7 wks prior it felt as if having the virus again.

Other Meds: Celexa, Nexium,Vit D3

Current Illness: No

ID: 1024382
Sex: F
Age: 66
State: NM

Vax Date: 02/05/2021
Onset Date: 02/08/2021
Rec V Date: 02/11/2021
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: Penicillin. Relafen Rice- large hives Kiwi. Pineapple

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

Symptoms: 3rd day I could barely move my limbs. Rash all over my upper torso. Tiny red dots in my skin Extremely tired. Hard time opening my eyes. Moving limbs. Slept 30 hrs.

Other Meds: Metoprolol Singular Clarity D

Current Illness: Asthma Border diabetes Migranes Allergies

ID: 1024383
Sex: F
Age: 69
State: CA

Vax Date: 01/30/2021
Onset Date: 02/06/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: NKMA (No known medication allergy)

Symptom List: Pain in extremity

Symptoms: On Saturday, 02/06/2021, evening around 6:00 PM, intense pruritus developed on right arm around injection site on right arm. Some warmness was also noted. The pruritus continued on Sunday and Monday. On Monday, 02/08/2012, evening, a small area of erythema was noted. On Tuesday morning, 02/09/2021, a large firm, bright erythematous plaque was visible. The plaque was warm and sensitive to touch. The pruritus had decreased. As of Thursday, 02/11/2021, the erythema has only slightly decreased.

Other Meds: Synthroid125mcg qd; Famotidine 40 mg qd; ASA80 mg qd; 1 Multivitamins qd

Current Illness:

ID: 1024384
Sex: F
Age: 51
State: CO

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Within 6 hours after vaccination administration, she developed fever of 100.3 F, diffuse joint pain, and swelling, soreness in left armpit. Also developed left-sided posterior neck pain and left-sided neck muscle (trapezius) pain and stiffness that eventually lead to approx 2cm nodule in left armpit/left breast that was warm to touch but no reddness or streaking. Symptoms completed resolved without treatment or intervention after 3 days.

Other Meds:

Current Illness:

ID: 1024385
Sex: F
Age: 29
State: OK

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 02/11/2021
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: Penicillin - family of; horse flies

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

Symptoms: Morning of 14th, I woke up and my left arm hurt to move - it wasn't the site itself, it was under my armpit (where the lymph node is). I didn't call my doctor at that point because I read that it was a side effect. Dull/always there pain at that point. On the 15th, shooting pains - this lasted two days. It started getting better again by the 17th. It was resolved by the 18th. 14-17th - Swelling that I could feel and see and that also went back to normal by the 18th. It was just tender to touch for a little while after that....after it didn't hurt to move I didn't pay as much attention to it. I was able to go to work but I had to modify what I could do at work. I could not do my normal swimming exercise until that next week.

Other Meds: Birth Control -Spirititec; Singuluar; Flonase; Claritin; Vit D 2000 UI

Current Illness: 2 weeks prior - I had a cold - Negative for COVID

ID: 1024386
Sex: F
Age: 83
State: CO

Vax Date: 12/29/2020
Onset Date: 01/19/2021
Rec V Date: 02/11/2021
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: Shellfish; Scapolamine

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

Symptoms: Three weeks after the first vaccination I had hives for two days. Two weeks after the second vaccination I had hives for 3 days. No anaflaxis occurred. Also, five days after the first vaccination I had a CT scan that alerted my cancer doctor to a possible breast issue. After having a mammogram and ultra sound the Doctor felt I may have a swollen gland as a result of the shot. I am to have a follow up ultra sound three months from the latest vaccination.

Other Meds: valsartan 160mg;albuterol HFA 90mcg, inhaler; atorvastatin 20mg;Advair Diskus 500-50; Geritol complete multi-vitamins; aspirin 81 mg; Vitamin D#, 2000 units; Oxygen, nocturnal 2l/min

Current Illness: none

ID: 1024387
Sex: F
Age: 43
State: IN

Vax Date: 02/08/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: N/A

Symptom List: Vomiting

Symptoms: Swelling in the armpit, tender to touch

Other Meds: Advair, montelukast, zrytec, fiber pills

Current Illness: N/A

ID: 1024388
Sex: F
Age: 46
State: TX

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/11/2021
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: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 2/3/21Pt received the2nd dose Moderna and at 3pm developed body aches. 6 pm Headache, fever 101.8 administered per self Ibprofen 400 mg. 2/4/21 12am -patient began sweating and chills, temperature 102.4, body aches and vomiting. 2/4/21 6am B/P 196/121, SOB, Chest pain called ambulance and to ER . Patient stated "received steroids and observed for 4 hours and discharged from ER.

Other Meds: Lisinopril 10mg daily

Current Illness: unknown

ID: 1024389
Sex: M
Age: 70
State: IN

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: Aches, headache, chills, night sweat, tired. All were over in 36 hrs.

Other Meds: None

Current Illness: None

ID: 1024390
Sex: M
Age: 33
State: CA

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Headache and sore left arm

Other Meds: Zyrtec

Current Illness: None

ID: 1024391
Sex: F
Age: 65
State: CA

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: Tree nuts, fresh fruit, latex

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

Symptoms: Facial flushing, swollen lips, and hives on abdomen after 1 hour. Took Benadryl and symptoms resolved.

Other Meds: Multivitamin, Calcium, glucosamine with MSM

Current Illness: None

ID: 1024392
Sex: F
Age: 57
State: OR

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: codeine, hydrocodone, oxycodone, trazodone - all intolerance and not actual allergy

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

Symptoms: Patient received 2nd dose Moderna vaccine at 21 days instead of recommended 28 days. Patient thought she had received her first dose on 1/13/21, but in reality had received it on 1/20/21.

Other Meds: APAP, alendronate, vitamin C, Calcium Carbonate, Vitamin D3, Vitamin B12, Gabapentin, metformin, omeprazole, probiotic, tramadol, tymlos 3120, venlafaxine

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm