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: 1026555
Sex: F
Age: 71
State: CA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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

Symptom List: Dysphagia, Epiglottitis

Symptoms: 1040 Pt was sitting in the post vaccine area and was seen holding her throat having some difficulty swallowing. I approached her and she confirmed having some tightness in her throat with some difficulty swallowing. She denied any SOB, no tingling of lips or swelling of tongue, no rash or hives. VS at 1040 were 142/84, 94 and 99%, skins W/D. 911 was called, and medication administration was held at that time without any other symptoms and pt wanted to wait as well on having any other medications administered at that time. Pt was advised to alert us of any further symptoms. Constant monitoring was done while waiting for EMS. Pt was taken off of an antibiotic last week with PCN in it and while experiencing some mild symptoms. Pt was on a 30min hold post having the Pfizer vaccine to the left deltoid due to having allergies to PCN. It was approx. 12 minutes after her vaccine when the symptoms started. Her second set of VS at 1049 were 140/80, 78, and 99%. No change in symptoms, pt remains calm without any SOB or hives. At 1056 pt states that it is getting easier to swallow. AMR on scene to evaluate. Pt had no further symptoms and continued to feel better. Pt signed out AMA with AMR unit 461. Pt was advised to call 911 back if any further symptoms arise.

Other Meds: none listed- stopped an antibiotic 1 week ago d/t having a reaction to it.

Current Illness: Diverticulitis

ID: 1026556
Sex: M
Age: 43
State: MA

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

Symptom List: Anxiety, Dyspnoea

Symptoms: Left facial paralysis/numbness.

Other Meds:

Current Illness:

ID: 1026557
Sex: F
Age: 64
State: TX

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Ultram

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

Symptoms: Patient's face was flushed and c/o "crawling things" on her face and itching and started coughing. Pt stated her throat was "closing up" but was able to speak and breathe. Pt's legs were raised, cold packs applied and Benadryl was given (per standing orders 25mg, PO). 0922 BP was 170/104, HR 61, Alert and oriented X4, hoarse voice and cough persist, no signs of labored breathing, able to complete sentences. Pt stated she had an EPI pen " just in case." At 0929 EMS arrived VS: 165/98, 88, 90%, at 0933 VS: 151/88, 86, 98% still alert and awake, no difficulty breathing noted. Patient declined to be transported to ED and stated "something similar happened when I got my flu shot " and when she received a "shot of antibiotics." VS at 0937: 128/76, 74, 98-99% Patient was assisted to car and she and Spouse drove away. No s/s of distress noted; pt was able to walk to her vehicle, denied other symptoms and stated she was "feeling better."

Other Meds:

Current Illness:

ID: 1026558
Sex: F
Age: 91
State: CA

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 02/12/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin family, medical adhesives

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Stomach abdominal pain starting approx 24 hours after vaccination

Other Meds: varies

Current Illness:

ID: 1026560
Sex: M
Age: 31
State: PA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Vaccine was administered without complications. approx 5 mins after vaccine was given, patient reported feeling light headed, feeling like they were going to pass out. Patient was laying down, eyes open but was lethargic, still responding but slow to respond. HR was 47BPM however patient reported he was a runner and normally had a low HR. Blood pressure was 66/44 , patient was pale and diaphoretic. Pt was conscious the whole time, was put in supine position, cold compress applied. Patient denied chills, shortness of breath, difficulty breathing, nausea, chest pain. Pt was monitored, given oral fluids, and within 15 mins after event, vitals returned to baseline, HR remained bradycardic less than 60, no additional treatment was given and patient left after observation around 8:00pm.

Other Meds:

Current Illness:

ID: 1026561
Sex: F
Age: 51
State: SD

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 02/12/2021
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: Patient experienced muscle and joint ache, weakness, and extreme fatigue approximately 12 hours after receiving both doses of the vaccine. Her symptoms improved within 24 hours after the first dose and 48 hours after the second dose. Patient took Tylenol and had to miss work due to the severity of her symptoms.

Other Meds:

Current Illness:

ID: 1026562
Sex: M
Age: 40
State: PR

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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: rash and itching in all the body

Other Meds: no

Current Illness: no

ID: 1026563
Sex: F
Age: 71
State: FL

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/12/2021
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: On Jan 8, i received the first Moderna vaccine. Then i received the second dose on Feb 5. After the first dose I experienced diarrhea which did not worsen after the second dose On feb 6 after the second dose I had a fever of 100. My usual temperature is around 97. I also got a rash on my back waist, breasts area under my breasts ander my arm pits. This rash lasted for 2 days. After the rash went away the itching continued to today 2-12. I took childrens claritin last night to help with itching which interfers with sleep.

Other Meds: diltiazem hcl 180 mg irbesartan 150 mg triamterrene-hctz 37.5-25 Cleanse more: herbal and mineral formula, vegetarian capsules

Current Illness: none

ID: 1026564
Sex: F
Age: 57
State: NC

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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 according to Immunization Consent

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient reports having localized reaction , redness, lump at site. Patient went to see her PVT MD who suspects it was given subcutaneous instead of IM.

Other Meds: Unknown

Current Illness: Unknown

ID: 1026565
Sex: F
Age: 30
State: TX

Vax Date: 02/04/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: Bactrim

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I began experiencing muscle weakness/fatigue at the injection site on or around 2/10/21. I did not notice it before that date. I noticed it when I picked up my toddler. My upper arm got tired unusually quickly after picking him up. It is also occasionally difficult for me to raise my arm using that muscle. I also occasionally experience a tingling sensation at and near the injection site. I have not discussed it with a doctor.

Other Meds: Zyrtec

Current Illness: Cough, runny nose, sore throat, congestion around 1/4/21; covid test negative

ID: 1026566
Sex: F
Age: 84
State: MO

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

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

Lab Data:

Allergies: steroids

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

Symptoms: started 1 hr after shot she started to feel nauseous then felt better after a little while. then we were having lunch at 1:30 and she started to vomit.

Other Meds: thyroid blood pressure and blood thinner meds

Current Illness:

ID: 1026567
Sex: F
Age: 48
State: PA

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/12/2021
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: Zithromax

Symptom List: Rash, Urticaria

Symptoms: Initially had itching about 10 minutes following injection, at the injection site. About five minutes following that, developed mild itchiness in the ears, roof of mouth. Never experienced difficulty breathing or swelling of face or throat. Checked in with table monitoring the clinic, described symptoms and was advised to take Benadryl and report to an ER if symptoms worsened. Took 50 mg of liquid Benadryl as soon as I got home around 6pm and again the following morning and evening. Injection site remained itchy until 1/31/21 and began to subside. Mouth then erupted with ulcers and tingling beginning evening of 1/31/21 into 2/1/21 and some minor tongue swelling. When I arrived at work I asked one of the physicians to take a look and tell me what their thoughts were. They were not sure. I was then advised by my Supervisor to notify employee health, which I did with my supervisor present. They recommended to fill out an RL 6 form and seek medical treatment if necessary. I began taking Claritin, Allegra and Pepcid in case this was continued reaction. I messaged PCP to get their thoughts, but they were unfamiliar with what different side effects of vaccine are or how to proceed. I did rinses and mouth care to treat ulcers which have begun to subside as of 2/9/21. Advised to report as no one seems to know if this is something brought about by immune system. Employee health recommends seeing immunology in case of needing to receive vaccine in future, which I do intend to get again if it is required annually. Have not seen anyone yet.

Other Meds: Synthroid 137mcg; Celexa 10mg; Multivitamin;Vitamin D 5000 IU; Aspirin 81mg; Flonase; Linzess 145mcg

Current Illness: Covid-19 on 12/13/21

ID: 1026568
Sex: F
Age: 75
State: CA

Vax Date: 01/30/2021
Onset Date: 02/02/2021
Rec V Date: 02/12/2021
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: petechiae on both ankle

Other Meds: prednisone 5mg PO qD, Gabapentin 100mg PO qD, Lisinopril 20mg PO qD, Omeprazole

Current Illness: #1 Seronegative RA #2 HTN #3 GERD #4 Abnormal LFT

ID: 1026569
Sex: F
Age: 71
State: NC

Vax Date: 02/04/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: No

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

Symptoms: Given in upper left thigh. after 7 days, redness and ache disappeared and now have itchy feeling and redness with some slight swelling

Other Meds: Famotidine, 40 mg/ 1 per day Vitamin D 4000 units/day Calcium Citrate +D3 / 1 per day Vitamin C/ 500 mg, 1 per day Zinc 30 mg. 1 per day

Current Illness: No

ID: 1026570
Sex: F
Age: 30
State: IL

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Avocado, Norco, Peach, Sesame Seed, Soy. Strawberries, Latex, Tape

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

Symptoms: Itching, difficulty breathing, tachycardia IV established Sat of 99%, tachy in 120's Patient was given 25 mg IV Benadryl, 20 mg Pepcid IV, and 125 mg IV Solumedrol Patient with ongoing difficulty breathing over following 5-10 minutes 911 called. Report given. Patient stable at time of departure.

Other Meds: Baclofen, Linzess, Trulicity, Vyvanse, Amlodipine, Sertraline, Trazodone, Levocetirizine, Duloxetine, Meloxicam, Topiramate, Sumatriptan, Albuterol

Current Illness: None

ID: 1026571
Sex: F
Age: 44
State:

Vax Date: 01/19/2021
Onset Date: 01/23/2021
Rec V Date: 02/12/2021
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: shingles/herpes zoster along dermatone, mild case, no post-herpetic neuralgia.

Other Meds:

Current Illness:

ID: 1026572
Sex: M
Age: 84
State: AZ

Vax Date: 02/01/2021
Onset Date: 02/06/2021
Rec V Date: 02/12/2021
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: Chills/fever, temp @100, extreme tiredness. Fever broke at noon on day 2, 2/8/2021. Slept most of 24 hours. Day 3, 2/9/2021, slept 3/4 of the day, up for an hour or so and down for 2 hours. Day 5, 2/11/2021, returned to usual activities but residual tiredness.

Other Meds: Multiple vitamins and minerals Flecinide Acetate 50mg, Metoprolol Tartrate tablet 12.5mg, Dorzolumide HCI 2%

Current Illness: Hernia surgical repair on 1/26/2021

ID: 1026573
Sex: M
Age: 71
State: NY

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Seafood Ragweed Poison Ivy

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Sciatica like pain radiating from R gluteus Maximus to knee and slightly upward w extreme limit of response and weak weight bearing w extreme discomfort - pain sitting standing walking and even sleeping

Other Meds: Torsemide, Amolodipine, Lipitor, Epeleronone, Allopurinol, Colchicine, Irbesartan , 81 Asprin, CoQ10, Omega 3, Vit D, Multi-Vitamin Vit B C

Current Illness:

ID: 1026574
Sex: F
Age: 43
State: CA

Vax Date: 01/21/2021
Onset Date: 01/27/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: All Sulfa medications and walnuts.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: On 1/27/21 Client felt pain and lump to right underarm. Client went to ED and MD said not sure if lump was related to vaccine. Client was advised to self-monitor. On 01/30/21 client went back to ED due to red/hot/itchy rash below injection site and numbness to right hand. ED MD ordered an ultrasound and CBC. MD stated no infection or blood clot. PMD prescribed an antibiotic, Cephalexin, for possible cellulites. Client has completed antibiotic. Today, 2/12/21, area is itchy and discolored at injection site. Client advised to get a note from PCP or health care professional before having 2nd dose of vaccine. Client was agreeable.

Other Meds: None

Current Illness: None

ID: 1026575
Sex: M
Age: 72
State: WV

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/12/2021
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: Patient came to the Health Department on afternoon of 2/12/21 to report incident. He received the vaccine approximately 4:20pm. According to the patient, he felt at his normal all evening. At 9:15pm, he reports he started having chills and was very cold. He rested with a blanket until he got up at 9:30pm to get a drink of water and check his temperature. Per the patient, he remembers checking his temperature, which was 97.6F, then awoke on the floor. He had passed out, believes he was "out" for no more than a minute. Patient reports he felt well when he awoke and has felt at his baseline ever since. He has abrasions to bilateral hands, as well as his chin. His upper lip was busted. He did not see his doctor in regards to this. He admittedly does not see a doctor often. Encouraged patient to follow up with is doctor, as he states he has a history of a stroke and heart attack.

Other Meds: Aspirin, other meds unknown

Current Illness:

ID: 1026576
Sex: F
Age: 74
State: WA

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No

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

Symptoms: At 11:50 am on Feb 9,2021,patient lost consciousness for 2-3 seconds and felt difficulty breathing, and was unable to move body such as turning around when lying on bed. Patient also felt dry in the upper jaw. The above symptoms persisted till 12:20 pm. After short nap to 2:30 pm, Patient recovered from the above symptoms.

Other Meds: No

Current Illness: high blood pressure

ID: 1026577
Sex: M
Age: 37
State: OR

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Fluconozole

Symptom List: Unevaluable event

Symptoms: Minor headache, body aches, chills, low grade fever, tiredness, sore arm from injection site down to my forearm, joint pain, and elevated heart rate (110-125 pulse rate).

Other Meds: Odefsey, multivitamin, vitamin d, Claritin, clobetasol (topical), echinacea

Current Illness:

ID: 1026578
Sex: F
Age: 70
State: FL

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/12/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Approximately 4 hours after receiving vaccine I developed a strong metallic taste in my mouth. This has persisted for 7 days. Neither brushing teeth nor using mouthwash alleviates strong metallic taste.

Other Meds: atorvastatin 20mg, multi-vitamin, CoQ10 100mg, calcium w/vitamin D, 600mg

Current Illness: None

ID: 1026579
Sex: F
Age: 62
State: MN

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Body Aches, headache, fever.

Other Meds:

Current Illness:

ID: 1026580
Sex: F
Age: 36
State: MD

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: tree nuts and dander

Symptom List: Injection site pain, Menorrhagia

Symptoms: Left arm swelling at injection site., unable to fully articulate arm, acute cellulitis spread down deltoid muscle to anticubtal area, shovers, felt warm, light headed. Took shower to relieve discomfort. 2/10/2021- pain in arm, swollen, and read, headache, - not relieved by oral meds. Blurry vision out of work 3 days. 2/11- arm pain 5-7 out of 10, hands that were numb improving, 2/11 better

Other Meds: unsure

Current Illness: None

Date Died: 02/04/2021

ID: 1026581
Sex: M
Age: 71
State: WA

Vax Date: 01/15/2021
Onset Date: 02/04/2021
Rec V Date: 02/12/2021
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: Erythromycin, PCN, Hmg-coa reductase inhibitors, nifedipine, tetanus toxoids, tetracyclines

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

Symptoms: He had sudden death on Feb 4th. Unclear if this could be related to vaccination but since it was close in timing report has been filed. No known immediate reaction to vaccination.

Other Meds: Spironolactone, amlodipine, tamsulosin, losartan, pantoprazole, tadalafil, propranolol

Current Illness: He had sudden death on Feb 4th. Unclear if this could be related to vaccination but since it was close in timing report has been filed.

ID: 1026582
Sex: M
Age: 79
State: PA

Vax Date: 01/27/2021
Onset Date: 02/08/2021
Rec V Date: 02/12/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt developed pain and swelling in his leg on 2/8/21. Sent to the emergency room on 2/10/21 and found to have DVT. No history of clots in the past.

Other Meds: Losartan Nystatin Loratadine Fluticasone nasal spray Tamsulosin Ammonium Lactate 12% cream Clotrimazole 1% cream Mupirocin Calcium 2% ointment

Current Illness:

ID: 1026583
Sex: F
Age: 33
State: MD

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient felt faint and moved her self to the floor. She was unconscious and began to have witnessed seizure activity, which lasted approximately 3 minutes. When she did become conscious again, she was disoriented and urinated on herself. 911 was called but when the ambulance arrived, they asked her if she was okay, and she said she was ok . Information relayed to the drivers of what was witnessed but they declined to take her to the hospital. Her husband came and took her home about an hour later. No further seizure activity. Vitals were stable

Other Meds: none

Current Illness: none

ID: 1026584
Sex: M
Age: 50
State: TX

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: NKDA

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

Symptoms: "Patient is a 50 year old male who initiates telemedicine visit today for what he believes are side effects from his second coronavirus vaccine that he received yesterday about 2:30 PM. Patient states he noticed a mild symptoms during the middle of the night but really noted them this morning after waking up. Thanks and state symptoms include fever, chills, body aches and a little bit of diarrhea. Patient states he had the same symptoms after the first dose of the vaccine but to a much lesser degree."

Other Meds: Omeprazole, Ambien, Metoprolol Succinate

Current Illness: None

ID: 1026585
Sex: M
Age: 74
State: FL

Vax Date: 02/04/2021
Onset Date: 02/08/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: NO

Symptom List: Nausea

Symptoms: VERY TIRED, WEAK, HARD TIME WALKING. FEELING UNWELL.

Other Meds: CIPOFLOXACIN 500 MG TAB, ONE TABLET BY MOUTH TWICE A DAY. SMZ-TMPDS TAB ONE TABLET TWICE A DAY.- SUB FOR:BACTRIM DS TABLETS.

Current Illness: BLADDER INFECTION

ID: 1026586
Sex: F
Age: 85
State:

Vax Date: 01/28/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: February 10, 2021 my right arm at the injection site felt tight and appeared a little red. The pain I have experienced has been short pains which radiate up into my neck. I was told that one one the side effects could be a knot but this is a slight swelling which leaves the upper right arm puffy. The only medication that I have taken for pain is Aleve.

Other Meds:

Current Illness:

ID: 1026587
Sex: F
Age: 73
State: TX

Vax Date: 01/26/2021
Onset Date: 02/04/2021
Rec V Date: 02/12/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Itchy arm, warm to the touch, a slight rash

Other Meds: Metformin, levothyroxine

Current Illness: None

ID: 1026588
Sex: F
Age: 70
State: OK

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Bacitracin

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

Symptoms: 5 minutes following injection, left ear began to feel 'itchy/tingling' in middle ear location, moving to inside upper throat area then to right middle ear. Approximately 2 minutes later, patient felt shortness of breath, mild chest pain and difficulty breathing. She immediately took 25mg Benadryl PO. 20 minutes following injection, RN at site notified of symptoms. HR 110, feeling flush, no change in other symptoms, patient escorted outside (15F weather) and second dose of 25mg Benadryl PO given. 22 minutes following injection, remaining outside, improvement in ability to breathe. HR 90. Tingling/itchy feeling still in left middle ear, right middle ear improving. 24 minutes following injection, no further change in symptoms except HR 80. 45 minutes following injection, HR 70, dull headache beginning, throat feeling 'scratchy', but no difficulty breathing or chest pain at this time. Patient is employee at site and remained under observation for one hour. No further change in symptoms.

Other Meds: Synthroid qd 81mg aspirin qd

Current Illness: none

ID: 1026589
Sex: F
Age: 37
State: MI

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Entyvio, Remicade, Bactrim

Symptom List: Tremor

Symptoms: Patient recieved her first dose of the Moderna Vaccine at 13:30. Aroung 13:45 patient stated to have a metalic taste in her mouth, felt naseated, flush and had a rash on her chest. Patient stated that she had eaten prior to getting her vaccine. EMS on scene. BP was 186/109, P- 128, Resp- 18, o2 sat 96% RA, Blood Sugar was 97. 14:04 Benedryl 50mg IM was given in Rt arm by EMS. 14:10 BP- 162/108, P-100, 02- 99 4 lead EKG taken SR 14:17 - 18g Lt A/C placed 14:18 - 4mg Zofram IV given for Nasea 14:22 - BP- 199/113, P- 131 14:25 - EPI 0.3mg IV given 14:28 - 114/92, HR- 123, 02 100% RA 14:30 - Rash gone and patient trasported to hosptial by EMS

Other Meds: Triamtererene 37.5mg/HCTZ 25mg

Current Illness:

ID: 1026590
Sex: F
Age: 68
State: SC

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 02/12/2021
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: penicillin, ampicillin, citrus

Symptom List: Erythema, Pruritus

Symptoms: pt stated that her face started swelling a couple of days after receiving the vax. She also had redness in her face and chest when she got hot. Pt states the swelling is going down but her face is still tight. Pt saw her PCP on 2/11 for normal annual check up and he advised her not to take the 2nd dose.

Other Meds: no

Current Illness: no

ID: 1026591
Sex: M
Age: 70
State: SC

Vax Date: 01/17/2021
Onset Date: 01/19/2021
Rec V Date: 02/12/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: None

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

Symptoms: I began experiencing muscle aches, chills, night sweats, shortness of breath, blurred vision, dizziness and a nagging headache about 2 days after the first Moderna injection. These symptoms continued for well over a week but gradually got better each day for over a week. I monitored my body temperature and it was continuously normal and I never lost sense of taste or smell.

Other Meds: None

Current Illness: None

ID: 1026592
Sex: F
Age: 30
State: OH

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

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

Lab Data:

Allergies: None

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

Symptoms: Vaccination administered too low on the left arm. Possibility of subcutaneous administration. Site warm, red, and itchy within 30 minutes of administration. By 4 hours post vaccine, knot noted under the injection site, redness decreasing.

Other Meds: None

Current Illness: None

ID: 1026593
Sex: F
Age: 58
State: MA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: Chills, fever, body aches and exhaustion. Tylenol,fluids and rest. Subsided in about 16 hours.

Other Meds:

Current Illness:

ID: 1026594
Sex: F
Age: 39
State: GA

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 02/12/2021
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: NKDA

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

Symptoms: at 3:42pm patient reports she has had an itchy throat for the past 5 minutes. At 3:45pm patient takes 50mg Diphenhydramine, PO. At 3:55pm patient states itchy throat is improving and denies other symptoms.

Other Meds: meloxicam, celexa, flexiril

Current Illness:

ID: 1026595
Sex: F
Age: 73
State: IL

Vax Date: 02/03/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: Sulfa drugs

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

Symptoms: Redness, warmth, and hardness at the injection site. Beginning at day 3 and still red and hot at day 9

Other Meds: Citalopram 20 mg Simvastatin 20 mg

Current Illness: None

ID: 1026597
Sex: F
Age: 56
State: MN

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

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient received her first dose of Pfizer on 1/28/21 and then second dose of Pfizer 2 weeks later on 2/12/21

Other Meds:

Current Illness:

ID: 1026598
Sex: F
Age: 29
State:

Vax Date: 01/06/2021
Onset Date: 01/13/2021
Rec V Date: 02/12/2021
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: After my 1st dose vaccine, my left arm was swollen and I got a big lump at the injection site. It was very painful upon palpation. I went to the Urgent Care where I was prescribed a steroid cream. My lump then started to spread to my entire arm, it was hot, burning and very painful to touch. I also had an allergy test which was negative.

Other Meds:

Current Illness:

ID: 1026599
Sex: F
Age: 85
State: MA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: LATEX AMOXICILLIN ASA CLONIDINE LISINOPRIL

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

Symptoms: DAY 1 POST VACCINE PT HAD MODERATE-SEVERE SHORTNESS OF BREATH THAT WORSENED AROUND 1400. PT WAS BROUGHT TO THE EMERGENCY ROOM BY HER DAUGHTER.

Other Meds: TYLENOL AMIODARONE VIT B COPLEX BIOTIN CALCITIOL FLONASE LASIX NOVOLOG INSULIN LANTUS LACTULOSE MELATONIN METOPROLOL MIDODRINE NAPROXEN OMEPRAZOLE CRESTOR SENNA SEVELAMER

Current Illness:

ID: 1026600
Sex: F
Age: 74
State: OH

Vax Date: 02/03/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: Sulfa

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

Symptoms: February 11, 2021: This patient called to obtain guidance regarding post-COVID-19 vaccination side effects. The patient received the first dose of COVID-19 vaccine on Feb. 3, and noticed soreness of the arm at the vaccination site. On Feb. 10 (evening), a hard lump with redness the size of a tennis ball in diameter was observed, and the area was ?itchy?. The side effects have continued, and patient called for further direction. Patient advised to call primary healthcare provider to report the side effects and question if an evaluation and, or treatment is recommended. Patient to call physician?s office. Patient recalled a similar reaction (side effects) following a vaccination years prior to date, but was unable to recall the type of vaccine (thought may have been a flu shot). The patient has continued to receive influenza vaccinations annually without these side effects. February 12, 2021: TC to the patient to obtain clinical and healthcare provider follow-up information. Patient reported she had an office visit with Dr. CCF this morning. The MD wasn?t sure if the reaction was related to the vaccination, or an infection. Cephalexin (antibiotic) prescribed x 5 days. The side effects reported yesterday remain present with slight improvement. The patient has not experienced an elevated temperature, or any new side effects.

Other Meds: Thyroid medication (hypothyroid) and anti-depressant.

Current Illness: No illnesses at the time of vaccination, or during the month prior to illness onset.

ID: 1026601
Sex: F
Age: 59
State: IL

Vax Date: 02/05/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Bactrim

Symptom List: Vomiting

Symptoms: Raised , hard red lump on upper arm appearing 1 week after shot. Itchy

Other Meds: Centrum, calcium+ Vit D, probiotic, Curcumin, Relizen ( Swedish bee pollen)

Current Illness: None

ID: 1026602
Sex: F
Age: 36
State: OH

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: patient reports swelling and redness of neck

Other Meds:

Current Illness: unknown

ID: 1026603
Sex: F
Age: 42
State: IL

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 02/12/2021
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: Mushrooms (anaphylaxis), melons, codeine, penicillin

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

Symptoms: Dizziness that increased throughout the day; rash in the form of red dots on both arms but more pronounced on the left arm which was the injection arm

Other Meds: Wellbutrin, Allegra, multivitamin, vitamin D, Vitamin B12

Current Illness: Nkne

ID: 1026604
Sex: M
Age: 44
State: NY

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Severe headache, high fever(104.5), chills, body aches, joint and muscle pain. Onset of symptoms did not occur immediately. Mild (typical) post vaccination pain at injection site about 8 ot 9 hours after administration. Went to sleep without any systemic symptoms and woke up about 12 hours after administration with fever and chills. Temp approximately 101.5 at this point and chills body aches were moderate. Then woke up another 4 hrs later with severe headache, chills, weakness, joint and muscle pain and high fever(104.5). Symptoms have all begun to gradually improve, but still febrile with all other symptoms not being moderate and not severe, 26 hrs post vaccine administration.

Other Meds:

Current Illness:

ID: 1026605
Sex: M
Age: 55
State: MO

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

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

Lab Data:

Allergies:

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

Symptoms: The second dose of COVID-19 vaccine was given 5 days earlier than recommended.

Other Meds:

Current Illness:

ID: 1026606
Sex: F
Age: 86
State: FL

Vax Date: 02/05/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: Penicillin

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

Symptoms: Large red rash/hive arose surrounding the injection site about 5 days after receiving second dose. Raised, warm, painful to the touch. Approximately 6-8 inches in diameter. No other adverse symptoms.

Other Meds: Multaq, potassium, calcitrol, ambien, protonix, centrum multivitamin

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm