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: 1024393
Sex: F
Age: 31
State:

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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient developed itching all over her body at 10 AM after receiving her vaccine at 7:07 AM. Patient states she has a scratchy throat and tongue as well. Was prescribed prednisone 40 mg daily for 10 days and famotidine 20 mg BID. Patient is taking Benadryl for the symptoms 50 mg, which does help, but has to take every 3 hours.

Other Meds:

Current Illness:

ID: 1024394
Sex: F
Age: 36
State: CA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Tomatoes, keflex, demerol

Symptom List: Anxiety, Dyspnoea

Symptoms: Hives, no treatment at this time.

Other Meds: Zyrter , Pepcid

Current Illness: None

ID: 1024395
Sex: F
Age: 34
State: NY

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: 1. Muscle aches, 14 hours, no treatment 2. Fatigue, 24 hours, no treatment 3. Joint pain, 14 hours, no treatment 4. Headache, 3 hours, no treatment 5. Fever, 102 degrees, 2 hour duration, no treatment 6. Rash at injection site, started 36 hours after injection, unresolved in 12 hours, no treatment 7. Rash on torso, neck, and back, started 36 hours after injection, unresolved in 12 hours, no treatment

Other Meds: Synthroid; Multivitamin

Current Illness: None

ID: 1024396
Sex: F
Age: 35
State: WA

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

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

Lab Data:

Allergies: sulfa orange juice

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 20 min later of vaccination the back of my tongue started getting swollen. I felt like my throat was closing. I felt like I was going to pass out & I felt very dizzy. I went to the Hospital the same day and they said that everything looked red inside my mouth and to follow up with my primary the next day. They gave me an IV. The dizziness continued for a few days & then I got very shaky the next day it lasted for a week but the swelling came down the next day.

Other Meds: Astrodienst Sertilin

Current Illness:

ID: 1024397
Sex: M
Age: 35
State: WI

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: IM
Vax Site: LA

Lab Data:

Allergies: environmental elements

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

Symptoms: One hive on right cheek Watch patient for addition 15 minutes and none noted on chest back or arm.

Other Meds:

Current Illness:

ID: 1024398
Sex: F
Age: 73
State: TX

Vax Date: 02/04/2021
Onset Date: 02/09/2021
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: Tetracycline

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

Symptoms: Swelling, redness, small bumps in 2inch area at site of injection.

Other Meds: Nefazadone, gabapentin

Current Illness: None

ID: 1024399
Sex: M
Age: 80
State: ND

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codine and Lorazepam

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: At 1200 it was noted resident had a small emisis. Resident responded minimally to this writer verbally and does track writer with his eyes. Respirations are noted to be labored. Respirations 32. Mouth cleaned, no obstruction noted. Oxygen applied via nonbreather at 5L. Temp 91.3, pulse weak and thready, BP 98/50 on R)arm, Pulse 90. Resident is very weak, pale diaphoretic. Resident shaking and jerking. Initially unable to obtain pulse ox. Emergency services contacted. At 1212PM BS 135 BP to R)arm 108/68, Sats 99% on 5L nonrebreather, respirations are even and unlabored 18. Resident is noted to open eyes and communicate. Dr.is notified and okays sending resident to ER. Wife notified of pt condition by staff she will meet at ER. EMS arrives and transports resident to ER 1223 and RN gives report to the ER.

Other Meds: Mirtazapine Tablet 15 MG SEROquel Tablet 25 MG (QUEtiapine Fumarate) Banatrol plus Packet (Banana Flakes) Aspirin Tablet 81 MG Give 81 mg Imodium A-D Tablet (Loperamide HCl) Cholestyramine Packet 4 GM Ferrous Sulfate Liquid Chole

Current Illness: No acute illnesses

ID: 1024400
Sex: M
Age: 83
State: UT

Vax Date: 01/29/2021
Onset Date: 01/30/2021
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: Aspirin

Symptom List: Pharyngeal swelling

Symptoms: Nausea, Couldn't hold food on stomach. Over a period of 10 days I vomited 5 times.

Other Meds: Synthroid, Budesinide, Doxsosasin,

Current Illness: None

ID: 1024402
Sex: F
Age: 55
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pressure in chest, shortness of breath

Other Meds: Bystolic, Lexapro, Hydrochloride, Klora-Con, vimpat, synthyoid

Current Illness: None

ID: 1024403
Sex: F
Age: 44
State: AR

Vax Date: 02/05/2021
Onset Date: 02/06/2021
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: Pollen

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Right eye doesn't close all the way when blinking or closing symptoms started 2/6/21 also couldn't keep mouth closed shut tight to swish after brushing teeth same night. Headache above right eye, right ear pain and right side neck pain all starting 2/6/21 morning. Had televisit on 2/8/21 who advised me to be further checked out. At the er they did an head ct without contrast which was normal did a neuro exam and determined I had bell's palsey. Prescribed prednisone 20 mg tid x 7 days and valacyclovir 1 gm tid x 7 days. They also advised to tape my eye shut when sleeping. My eye hurts when I drive or focus on pc or tv so I had to miss 2 days of work thus far.

Other Meds: Cetirizine, levothyroxine, vitamin c, vitamin b12, vitamin d3, iron, melatonin, probiotic

Current Illness: Uti one month prior

ID: 1024404
Sex: F
Age: 34
State: VA

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No

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

Symptoms: Chill, headache, fever, still muscles

Other Meds: Humira Spironolactone Atrovastatin

Current Illness: No

ID: 1024405
Sex: F
Age: 93
State: FL

Vax Date: 02/05/2021
Onset Date: 02/10/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Right sided facial swelling that extends from Jawline into neck. Also noted with redness to facial area. Onset 2/10/21 with worsening today 2/11/21

Other Meds:

Current Illness:

ID: 1024406
Sex: F
Age: 86
State: WA

Vax Date: 01/21/2021
Onset Date: 02/04/2021
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: Ace Inhibitors, paroxetine, sulfa

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

Symptoms: Patient received the Pfizer covid19 dose 1 on 1/21,2021, subsequently developed diagnoses by Dr. on 2/4/21, left lower extremity, Dr. authorized the second shot and patient received this on 2/11/21

Other Meds:

Current Illness:

ID: 1024408
Sex: F
Age: 42
State: UT

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: Achy in joints hips back and knees for 4 days, lump in right breast that burns and hurts.

Other Meds: Pantipazole, Ibuprofen, Tylenol, Vitamin D3, Vitamin C, zinc

Current Illness: N/A

ID: 1024409
Sex: F
Age: 41
State: PA

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: Amoxicillin, Zofran, Risperdal, Zithromax, cough syrup were mentioned at time of screening. She mentioned having food allergies after she was feeling her throat closing but did not state the foods.

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

Symptoms: About 25 minutes after receiving vaccine, Patient complained of weird feeling and tightness in her jaw and throat. Upon trying to drink water, she started to feel sick and dry heaved (never vomited) then she said she had problems trying to swallow. She did not report trouble breathing. I called 911, they had me ask her a series of questions. As soon as she said her throat was bothering her again, I administered the EpiPen at 12:10. We also called her emergency contact person.

Other Meds: None mentioned at time of vaccination

Current Illness: None stated

ID: 1024410
Sex: F
Age: 37
State: NV

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: 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: Within the first 15 minutes of receiving the first Pfizer dose, I felt dizzy. I was felt extremely fatigued and ended up having to go to bed at 6:00pm that day. Then days later, I began to feeling a shortness of breath that lasted about 1.5 week. I literally could not breath normally. My body would force me to yawn to get enough oxygen into my system.

Other Meds: None

Current Illness: None

ID: 1024411
Sex: F
Age: 82
State: WA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
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: NONE

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

Symptoms: PATIENT VACCINATED AT 10:10AM, WAITED FOR 15 MINUTES. FELL AT 10:42 AM WHILE ENGAGED IN RECREATIONAL ACTIVITY. NO ANAPHYLAXIS. NO FAINTING. AMBULANCE CALLED AND PATIENT TRANSPORTED TO HOSPITAL.

Other Meds: NONE

Current Illness: NONE

ID: 1024412
Sex: F
Age: 53
State: CA

Vax Date: 02/09/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient reports "eyes jumping" vertigo, nausea, and appears pale.

Other Meds:

Current Illness:

ID: 1024413
Sex: M
Age: 78
State: NM

Vax Date: 02/08/2021
Onset Date: 02/08/2021
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: Penicillin Shellfish

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient received dose #1 of the Moderna mRNA vaccine at 8:45 AM. MST. No reaction occurred immediately after injection. At 12:45 PM MST patient while driving and eating a sandwich patient suddenly dropped his sandwich and his wife noted new slurred speech and drooping of the lower right side of his face. They drove to the hospital. Patient was evaluated in the ER and was found to have a normal EKG, CT of the head and troponin which were normal. Facial drooping resolved prior to ER arrival but mild slurred speech persisted for 36 hours and then spontaneously resolved. MRI brain was done on 2/8/21 and was unremarkable.

Other Meds: allopurinol aspirin atorvastatin losartan tamsulosin diltiazem multivitamin B-complex tumeric echinacia zinc docusate vitamin D-3 QBC Plex Fish Oil

Current Illness:

ID: 1024414
Sex: F
Age: 58
State: WA

Vax Date: 01/05/2020
Onset Date: 01/05/2021
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: Lisinopril

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

Symptoms: Lower abdominal pain and lower back pain. My whole left side was painful to the touch, slight nausea for three days. Felt like I had bladder infection and yeast infection all in one. Had a hard time standing up. Has resolved now. 101.4 fever. my teeth were sensitive and sinuses hurt really bad. 01/05/2020 first vaccine.

Other Meds: Normal daily prescriptions

Current Illness: No

ID: 1024415
Sex: F
Age: 40
State: HI

Vax Date: 12/29/2020
Onset Date: 01/02/2021
Rec V Date: 02/11/2021
Hospital: Y

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: penicilen

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

Symptoms: --12/29/2020: Upon receiving the vaccination my heart rate plummeted to 45 BPM and suddenly raised to 134 BPM, thereafter stabilizing within 90 BPM. --01/02/2021: I felt extremely sick all of the sudden while at the same time my Watch triggered and alerted that my heart rate was in the 160's BPM and rising. I was rushed to ER where the medical staff fought to stabilize me and administered three doses of Adenosine to control my heart rate. Since 01/02/2021 I have been battling to control my heart rate with Propranolol. I have been to the ER multiple times weekly and have had numerous appointments with specialist at medical center--they are unable to diagnose me. They cannot find a reason for Tachycardia. Gastro, Endo, BH and Cardiology at medical center have many test, scans, echos, bloodwork and are unable to find cause let alone a solution.

Other Meds: none

Current Illness: None

ID: 1024416
Sex: F
Age: 79
State: ND

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
Hospital: Y

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

Lab Data:

Allergies: Codeine, Tramadol

Symptom List: Unevaluable event

Symptoms: At 1207, resident was noted having facial twitching and seizures and crackles , Vitals: BP 199/95, O2 Sats 89% on RA, PR 88, Temp 97.3, RR was hardly counted because of body movement. Blood sugar was 172 mg/dL. Hooked on O2 at 4L per NC. Informed MD and ordered to send to ER. Family - were updated. Ambulance was called. Family clarified resident's status is DNR. Report was given to ER nurse. Updated ER that INR today is 5.5 and MD ordered to HOLD Coumadin till 02-11-21.

Other Meds: Pravastatin Sodium Tablet 20 MG Give 20 mg by mouth one time a day related to OTHER HYPERLIPIDEMIA Vitamin D Tablet (Cholecalciferol) Give 2000 IU by mouth one time a day related to AGE-RELATED OSTEOPOROSIS WITHOUT CURRENT PATHOLOGICAL

Current Illness: No recent acute illnesses

ID: 1024417
Sex: M
Age: 29
State: NJ

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: Previous reaction to vaccine

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

Symptoms: Patient began to become tachypnec, short of breath, hives, was given epi immediately

Other Meds: Unable to obtain

Current Illness: Unknown

ID: 1024418
Sex: F
Age: 51
State: TX

Vax Date: 01/26/2021
Onset Date: 01/27/2021
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: Codeine, Hydrocodone, Vicodin, Morphine, Neomorph, Demerol, PCN, Vantin, Gentamycin, Latex, Iodine, IV Contrast Dye, Tape

Symptom List: Injection site pain, Pain

Symptoms: Fever that got up to 102.2 F, Aches, Pain, SOB, Malaise, Fatigue

Other Meds: Maxide, Tumeric, Ginko Biloba, Atenolol, Tagment, Vitamin C, Eye Vite, Vitamin D, Symbicort

Current Illness: Tested Positive for COVID 1/4/21

ID: 1024419
Sex: F
Age: 24
State: IL

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: I started getting chills around 8:00pm the same day I got my 2nd dose of Moderna?s COVID-19 vaccination. In the night I had a fever (105 F), sore muscles, headache, nausea, and fatigue. My fever continued throughout the day and is now (99 F) at 5:15pm the next day after receiving the vaccine. Fatigue, headache, and sore muscles have also continued.

Other Meds:

Current Illness:

Date Died: 01/24/2021

ID: 1024420
Sex: F
Age: 65
State: CA

Vax Date: 01/21/2021
Onset Date: 01/24/2021
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: Patient had the first Moderna Covid vaccine on Thursday 1/21/2021. She had a bit of sore arm on that day and the day after. On Saturday 1/23/2021, she had a fever of 100.5 F (11AM), nausea, light headache and chills. The temperature went down after she took ibuprofen. Patient's husband enrolled her to V-Safe to report all the adverse effects she experienced. On Sunday 1/24/2021, her temperature was 98.3F. She still had nausea and no appetite. She and her husband watched a football game in their bedroom upstairs. Husband noticed that his wife was pacing around the room many times. At 7Pm, Husband went downstairs for dinner but she refused to come down to eat. He went upstairs around 8pm, TV was still on. He turned off TV and went down stairs again thinking his wife felt as sleep while watching TV. He went back upstairs for bed around 10:30 PM. Husband said his wife had a deviated septum so she would snore very loudly when asleep. He didn?t hear her snoring so he went to check on her and found her not responsive. Husband called emergency services. Paramedic came at 10:45 and said patient was passed. Husband sent many texts to V-safe after that to report the incident. No response was received from V-safe. Patient?s doctor told her husband that she died due to cardiac arrest.

Other Meds:

Current Illness:

ID: 1024421
Sex: F
Age: 75
State: AZ

Vax Date: 01/01/2021
Onset Date: 02/01/2021
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: Sulfa drugs, Tetanus toxoid. Allergy tests indicated eggs and bananas but I've never had any reactions to these foods.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: On February 9, 2021, I noticed my left upper arm was warm and itchy. A red blotch, including the injection site, measured about 4x3 inches. Today, 2/10/21, I noticed a slight redness just above my left elbow that is not warm or itchy.

Other Meds: Metformin. Metoprolol, Lisinopril. Pravastatin Sodium, Albuterol inhaler(on rare occasions), Centrum Silver for Women, Cinnamon, Vitamin B12, Loratadine

Current Illness: none

ID: 1024422
Sex: F
Age: 72
State: IL

Vax Date: 02/04/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Opiod

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Achy, muscle soreness, fatigue, lack of appetite, diarreha

Other Meds: Fenofibrate Lamotrigine Linzess Clozapine Lorazepam Dexilant Famotidine Polyethiglycol3350 Vitamin D3 Florastor Methenamine 81mg Asprin Carvedilol Hydrochlorthiazide Restasis Retaine Refresh Celluvisc

Current Illness: Depression

ID: 1024423
Sex: F
Age: 19
State: CA

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: RA

Lab Data:

Allergies:

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

Symptoms: After receiving the vaccine, she began to complain of tingling of the hands and feet, and feeling of feeling faint. She was taken over to a gurney where she was laid down and had her vitals taken. BP 101/53, HR 117, O2 100% initially. After having her breath slowly and deeply for about 10 minutes, she her vital signs normalized and she denied any abnormal feelings. Final BP was 120/69, HR 86, O2 100%.

Other Meds:

Current Illness:

ID: 1024424
Sex: F
Age: 68
State: OH

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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Allergen Reactions ? Codeine Hives and Itching ? Doxycycline Hives, Itching, Nausea Only and Swelling ? Sulfa (Sulfonamide Antibiotics) Hives and Itching ? Bee Pollen ? Cat Hair Standardized Allergenic Extract ? Latex Hives ? Latex, Natural Rubber ? Pollen Extracts ? Sulfasalazine Hives

Symptom List: Nausea

Symptoms: The evening of the vaccine, the patient reported onset of chills, nausea, headache and deep fatigue. The next day, she had an ongoing deep fatigue, headache, nausea and intermittent palpitations. All symptoms have resolved except for ongoing nausea, intermittent headaches and fatigue.

Other Meds: acetaminophen Take 2 tablets (1,000 mg total) by mouth every 6 hours as needed. aspirin Take 325 mg by mouth daily. azelastine Use 1 spray into each nostril 2 times a day. Use in each nostril as directed cetirizine Take 1 tablet (10 mg tota

Current Illness: none

ID: 1024425
Sex: F
Age: 59
State: OH

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: 4 days of severe headaches, myalgias, night sweats

Other Meds: multivitamin, calcium/VitD

Current Illness: none

ID: 1024426
Sex: F
Age: 22
State: OH

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: 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: When the person had given me the shot, it was so painful and he had kept in my arm for a while. It was nothing like the first one. He had given it to me in my SUV. My arm was so sore for 2 days to where I could barley even lift it. I struggled so hard to do basic things and had to rest my arm and switch between hot and cold treatments for those 2 days. Still nothing really helped. I couldnt even lift my arm above my head without using my other arm to help support it. Even when i did that, it still was so painful. The night of getting the second shot, I had body aches and a fever that reached 100.2. As the days went one i was able to move my arm more and more but i still have pain when i move my shoulder a certain way.

Other Meds:

Current Illness:

ID: 1024427
Sex: F
Age: 51
State: IA

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: RA

Lab Data:

Allergies: NKA

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

Symptoms: Horrible body aches, exhaustion, headache

Other Meds: Metformin, Actos, Oxycodone, Fentanyl, Lyrica, Tizanidine, Duloxetine, Wellbutrin, Omeprazole, Benadryl, Procardia, Vitamin D3, Oxybutynin, Lopressor,

Current Illness: None

ID: 1024428
Sex: F
Age: 75
State: CT

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine. Morphine

Symptom List: Tremor

Symptoms: Severe chills, temperature 101, severe headaches, thirst, weakness, body aches , insomnia

Other Meds: Pantoprazole Sodium 40mg. Reloxifene 60mg. Vitamin C 500mg. Calcium 420mg. Mirolax. Ferro food. Magnesium 250mg. Tuna Oil 675mg.

Current Illness:

ID: 1024429
Sex: F
Age: 72
State: NY

Vax Date: 02/03/2021
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: antibiotic cream

Symptom List: Erythema, Pruritus

Symptoms: On day 8 a small itchy rash appeared . The itch mostly subsided within a few hours. Rash remains 6 hours later.

Other Meds: Synthroid Amlodopine Trial HCTZ

Current Illness:

ID: 1024430
Sex: F
Age: 50
State: WA

Vax Date: 02/09/2021
Onset Date: 02/09/2021
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: Seafood (2x) in 1997

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

Symptoms: Red raised rash from top of thighs to just under breasts all the way around my body. Started taking Benadryl 50mg at 9:00pm 2/9/21 . Unable to take every six hours per nurse hot line instructions been doing 2x during the day. As of 3:21 pm on 2/11/21 still some raised red rash but not completely covered.

Other Meds: Setraline 100 mg 1xdaily Methylphenidate HCL 36 MG 1xdaily

Current Illness: None

ID: 1024431
Sex: F
Age: 54
State: ME

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: bactrim

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

Symptoms: Localized redness (no pain/pruritus) to chest and distal lower extremity paresthesias; lower extremity paresthesias promptly resolved. Redness improved upon observation/close monitoring from 4:48 PM to 5:38 PM. Denied other systemic symptoms. She had taken benadryl 2 hours prior to arrival. Advised taking benadryl again when she got home if the redness was still apparent. Told her to go to the ED if she develops shortness of breath, respiratory distress, tongue swelling, rash, or hives.

Other Meds: N/A

Current Illness: N/A

ID: 1024432
Sex: F
Age: 59
State:

Vax Date: 01/07/2021
Onset Date: 01/08/2021
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

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fever x 3 days, malaise x 5 days, arm swelling x 2 weeks, rash x 2 weeks

Other Meds: multivitamin, calcium /Vit D

Current Illness: none

ID: 1024433
Sex: F
Age: 30
State: CA

Vax Date: 01/28/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Aloe (topical).

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

Symptoms: After receiving the first dose, experienced severe arm pain, shoulder pain, and hand numbness. Acute pain and numbness has worn off, but there is still moderate pain when using the arm. About a week post-dose, began spotting. Was not due to have menstrual period for 2-3 weeks according to birth control pill pack, and normally does not have any menstrual symptoms (no period) at all. Bleeding has increased daily, and is now fairly heavy. Accompanied by cramps.

Other Meds: Oral birth control pills (Mibelas 24FE), Abilify, Viibryd. AFTER vaccination, took pain killers for severe arm soreness, one dose of Seroquel to sleep one night, and then started on half of smallest dose of Buproprion on 2/4/2021 (new medic

Current Illness: IBS, depression, anxiety, OCD

ID: 1024434
Sex: M
Age: 34
State: CA

Vax Date: 02/10/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Flu like symptoms and headache.

Other Meds: None

Current Illness:

ID: 1024435
Sex: F
Age: 49
State: TX

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: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: complaint of lethargy 10min post vaccination. Denies chest pain, SOB, palpitation, headache, lightheaded, rash. BP: 154/103 HR: 74 Sp02: 98% RA Seen and cleared by EMS

Other Meds: Amlodipine

Current Illness:

ID: 1024436
Sex: F
Age: 27
State: CA

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: She reports having a hypersensitivity to many things, and has had allergic reactions to other vaccines in the past. Nothing severe reported.

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

Symptoms: She reported having profuse itching all over her body. No hives noted.

Other Meds:

Current Illness:

ID: 1024437
Sex: F
Age: 45
State: CA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Numbness in jaw on the right side. High fever of 103 Severe chills Severe body aches

Other Meds: Crestor

Current Illness: N/A

ID: 1024438
Sex: F
Age: 36
State: NY

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: IM
Vax Site: LA

Lab Data:

Allergies: Peanut (itching), cat (based on skin test)

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

Symptoms: Tingling on upper lip

Other Meds: Pregabalin BID for fibromyalgia, linaclotide (Linzess) 290 mcg daily for IBS, dapsone 5% gel apply to face BID for acne vulgaris

Current Illness:

ID: 1024439
Sex: F
Age: 52
State: NY

Vax Date: 02/04/2021
Onset Date: 02/05/2021
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: NO.

Symptom List: Vomiting

Symptoms: PAIN IN MY RIGHT SHOULDER AFTER 2HRS. AND FEVER THE NEXT MORNING( 100.6)

Other Meds: NO.

Current Illness: NO.

ID: 1024440
Sex: M
Age: 71
State: WA

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I noticed that tiny, red blood blisters appeared on my thighs and lower legs on the evening of 2/09/21 (9 days after receiving the vaccine). There was no pain or itching that accompanied the appearance of this 'rash'. The spots darkened by the next day and were clearly disappearing by the 11th of Feb. No other side effects, other than moderate soreness at the site of the injection and general mild aches and pains within the first 24 hours of receiving the vaccination. No treatment was sought.

Other Meds: atorvastatin 20mg celecoxib 100mg terazosin 2mg methylphenidate HCL 15 mg

Current Illness:

ID: 1024441
Sex: F
Age: 69
State: OH

Vax Date: 02/09/2021
Onset Date: 02/09/2021
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: Penicillin, Erythromycin, Sulfa - Hives Steroids, Spironolactone, Anti-Depressants - trigger bipolar manic episode

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

Symptoms: Within a few seconds I felt very sleepy, my face became numb which began spreading to my mouth. Mentally spaced-out, weak and unable to drive my car even a few yards. Requested ambulance and was taken to emergency room. EMT administered Intravenous Benadryl. In hospital Pepcid was administered immediately. The numbness eventually spread throughout my body and I felt twitching/trembling, particularly my mouth and jaw. My feet felt like they were being pulled away from my body. After testing was complete, Solu-Medrol was administered and all symptoms disappeared immediately.

Other Meds: Clonazepam , Buspirone, Lamotrigine, Latanoprost, Finasteride, Cetirizine, Fluticasone, Propionate Multi Vitamin, Glucosamine, Ocuvite, Omega 3, Probiotic

Current Illness: None

ID: 1024442
Sex: M
Age: 91
State: NC

Vax Date: 02/08/2021
Onset Date: 02/09/2021
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: Shrimp

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Extreme vomiting , diarrhea, dehydration, confused and very weak

Other Meds: Tylenol, mastic gum, Also on dialysis 3 times a week

Current Illness: None

ID: 1024443
Sex: F
Age: 42
State: NE

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Sulfa

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

Symptoms: Mouth rash at gum line and painful underside of tongue. Mild soreness from the arm, not as sore as first injection. Mild headache.

Other Meds: Amytriptyline 10 mg, 200 mg magnesium vit, melatonin 6 mg +HTP (Natrol) taken the evening prior to vaccine

Current Illness: None

ID: 1024444
Sex: F
Age: 23
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: soreness in left arm started around 6 hours after the dose. Day after the vaccine, pt woke up with a low-grade fever, fatigue, and full-body weakness, and nausea. Pt admits to sleeping for the majority of the day. No pain reliever or fever reducers were taken. After 26 hours post vaccine, fatigue lessened but low-grade fever and weakness persisted.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm