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: 1027704
Sex: F
Age: 69
State: IN

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Chills and aches all over the day after

Other Meds:

Current Illness:

ID: 1027705
Sex: F
Age: 72
State: NC

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Sensitivity to penicillin as a child

Symptom List: Anxiety, Dyspnoea

Symptoms: Beginning ~2:00 AM following day, chills, muscle aches, general fatigue, loss of appetite. Lasted most of 02/12/2021. No fever, no headache, no other symptoms. Treatment: Tylenol and rest. Good sleep 02/12/21. Much improved morning of 02/13/21. Some lingering fatigue, other symptoms gone.

Other Meds: Clopidogrel, Carvedilol, Pravastatin, Aspirin, calcium vitamin Additional information for Item 9: Clopidogrel, Carvedilol, Pravastatin, Aspirin, mulivitamin, calcium citrate, fish oil

Current Illness: Head congestion, managed w/nasal flushes

ID: 1027706
Sex: F
Age: 31
State: IN

Vax Date: 02/05/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: N/a

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

Symptoms: Red itchy patch of skin at injection site, appearing 7 days after vaccine administration

Other Meds: Levothyroxine, birth control, Zoloft

Current Illness: N/a

ID: 1027707
Sex: F
Age: 44
State: WV

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Iodine Sulfa drugs CT injectable dye Symbicort Biaxin Skelaxin Flexeril Seafood Cats Dogs Grass Mold

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Tight , itchy throat, trouble swallowing, elevated blood pressure, hives, face red, fingers white with dusky tips

Other Meds: Lisinopril/HCTZ Viibryd Wellbutrin Pepcid Protonix Viberzi Lamictal Neurontin Bystolic Tramadol Zetia Breo Singulair Dimehydranate Meclizine Hydroxyzine Benadryl MultiVitamin Calcium Supplement Hum nutrition enzymes for digestion Pro

Current Illness: No

ID: 1027708
Sex: F
Age: 35
State: GA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Morphine - gives, itching Latex - hives and itching

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

Symptoms: Tingling and numbness in left arm and hand. This also happened with the first dose.

Other Meds: Effexor XR 75mg

Current Illness:

ID: 1027709
Sex: F
Age: 37
State: VT

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: When the nurse administer the vaccine some of the fluid leaked out of her arm.

Other Meds:

Current Illness:

ID: 1027710
Sex: M
Age: 64
State: IN

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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 known

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Mild headache Fatigue Soreness at the injection sight

Other Meds: Amlodipine 5mg Montelukast 10mg Zyrtec 10 mg Atorvastatin 40mg Omeprazole 40mg Flax seed oil 1000mg Co-Q-10 200mg

Current Illness: None

ID: 1027711
Sex: F
Age: 71
State:

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

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

Lab Data:

Allergies: Statin

Symptom List: Pharyngeal swelling

Symptoms: Palpitation that resolved after 30 min observation

Other Meds: Lasix, Tamoxifen, Lisinopril

Current Illness: None

ID: 1027712
Sex: F
Age: 23
State: NC

Vax Date: 02/04/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I have ?covid-arm? 2 inch swelling at the site of injection

Other Meds: Blisovi

Current Illness:

ID: 1027713
Sex: F
Age: 45
State: SD

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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: flagyl

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 0400 woke up freezing, 102.7 temp, nauseated, body aches, weakness, fatigue, dizziness, rash

Other Meds: celexa, Zyrtec, temazepam.

Current Illness: none

ID: 1027714
Sex: F
Age: 70
State: NC

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Injection site pain, headache, tiredness, muscle pain for 24 hours

Other Meds:

Current Illness:

ID: 1027715
Sex: F
Age: 71
State: MN

Vax Date: 02/03/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: On Feb 12, nine days after the vaccination, the site of the shot began to itch. On the morning of Feb 13, the site was red and felt warm to the touch.

Other Meds: Valsartan, Atorvastatin, Escitalopram Oxalate

Current Illness: none

ID: 1027716
Sex: F
Age: 45
State: WA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: patient reported localized pain at injection site day of shot 02/11/21. called into general advice line to report results worsening symptoms of whole body aches, fever, HA, whole body itchy rash with no shortness of breath or airway compromise. given delayed reaction, sounds most like side effect and is not consistent with anaphylaxis but recommended ED/911 if develops airway compromise, and discussed possibility could be allergic

Other Meds:

Current Illness:

ID: 1027717
Sex: M
Age: 76
State: NY

Vax Date: 01/22/2021
Onset Date: 02/02/2021
Rec V Date: 02/13/2021
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: None

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

Symptoms: Had major nausea beginning 4 days after vaccination. Then was tested positive for COVID 12 Days after Vaccination on 02/02/2020. Confirmed with Rapid test, Confirmed with PCR Test. Patient was 1 of 4 in a small group of elderly relatives who got vaccinated that day. 2 individuals received Moderna, 2 received Pfizer vaccine. His wife then also tested positive for COVID 1 week later. The Moderna Couple never tested positive for COVID. ( 3 Tests over 2 weeks. ) All 4 had practiced strong COVID preventative measures and did not ever let their guard down. Face Mask, Constant Hand Sanitizing, Washing, No Crowds. He started to worsen and was given Bamlanivimab infusion on 02/08/2020 which had an immediate positive affect. By end of 02/12/2020 he appears to have almost completely recovered.

Other Meds:

Current Illness: None

ID: 1027718
Sex: M
Age: 34
State: IN

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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: 1st shot: soreness at the injection site 2nd shot: soreness at the injection site, whole body aches, fatigue, headache, fever, chills, sweating, nausea (all symptoms only lasted one day after shot)

Other Meds:

Current Illness:

ID: 1027719
Sex: M
Age: 58
State: MA

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Redness at injection site; about 5 inches in circumference and warm;

Other Meds: Fluoxetine; Bupropion; Simvastatin; Vitamin D

Current Illness: None

ID: 1027720
Sex: F
Age: 34
State: VA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Lactose, Iodine, Aspirin, and Penicillin.

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA. Pain on injection site 2/12/2021 around 9:30pm Chills 2/12/2021 around 9:45pm still on and off 2/13/2021 it is 10:35am Mild Headache around 9:45pm Body aches 2/13/2021 still at 10:35am Tingling on feet for several minutes 2/13/2021 around 8:30am Tingling on left hand 2/13/2021 around 8:30am Fever (102) 2/13/2021 noticed when wake up at 7am feeling better now at 10:39am temperature now is 98.8. A very mild chest pain on left side it was sharp last for 10 minutes 2/13/2021 around 10am Back pain on base of left lung for around 1 hour 2/13/2021 8:30am Tiredness 2/12/2021 around 8:30pm, still happening at 10:42am on 2/13/2021

Other Meds: Theravir (Vitamin D, C, Zinc, Cooper, Melantonin, Quercetin Dihydrate), Vit B12.

Current Illness:

ID: 1027721
Sex: F
Age: 80
State: OH

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

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

Lab Data:

Allergies: latex, levaquin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: complains for numbness and tingling of tongue, lips and thick tongue. 60mg Allegra given, observed, all vitals within normal limits. Patient stated her tongue and lips are better, still with "thick tongue" but also complains for funny feeling in back of throat. 911 called to transport to ER for observation/treatment.

Other Meds: Zocor, prinizide, Tenormin, Glucophage, synthroid, eye vitamin

Current Illness: NA

ID: 1027722
Sex: F
Age: 38
State: MI

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I experienced intense nerve pain down my left leg and foot from about 8:15am-10:15am. I hadn?t experienced pain like that since my injury was new (7.5 years ago). After enduring for two hours I took ibuprofen which did help. The pain continued with reduced frequency for about 24 hours from onset.

Other Meds: None

Current Illness: None

ID: 1027723
Sex: M
Age: 54
State: PA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: 103+ fever. Blood work 2 days later the dropped wbc significantly. 3 days later the blood work came back to normal levels

Other Meds: Vitamin D (stopped taking a daily iron supplement about 2weeks earlier)

Current Illness: None

ID: 1027724
Sex: F
Age: 30
State:

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Headache.. Chills and left underarm / breast swelling and pain

Other Meds:

Current Illness:

ID: 1027725
Sex: F
Age: 80
State: IN

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: beef, pork, lamb, dairy (alpha-gal), gelatin

Symptom List: Unevaluable event

Symptoms: shaking, fever of 101.7, body felt like it had been beaten, very tired

Other Meds: calcium citrate, multi-vitamin, coenzyme Q10, curcumin, levothyroxine, probiotic, vitamin B 12, vitamin C

Current Illness: none

ID: 1027726
Sex: F
Age: 81
State: FL

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/13/2021
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: covid-19 vaccine EUA

Other Meds: Olmesarten Medoximil and Ezetimibe, colace and metimucil

Current Illness: possible infection in bladder or kidney. bleeding hemmorrhoids (under control)

ID: 1027727
Sex: F
Age: 62
State: MN

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Pfizer-BioNTech COVID-19 Vaccine EUA Injection site pain Headach Chills Fever Injection site swelling Feeling unwell

Other Meds: None

Current Illness: None

ID: 1027728
Sex: F
Age: 66
State: IL

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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 allergies to medications. Side effects in past to Codeine = chest pain and Aloxi = migraine.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Approximately 15 hours (7:00 am) post vaccine, experienced mild headache. Took 600 mg Ibuprofen. Approximately 5 hours later (noon), I experienced increasing headache, generalized body aches, and chills. Rest and alternating Tylenol and Ibuprofen. As of now, February 13, mild headache only.

Other Meds: Biotin, Vitamin D, Vitamin C. Tylenol after injection.

Current Illness: None

ID: 1027729
Sex: F
Age: 44
State: OH

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/13/2021
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: Sulfa allergy-sores on tongue Pregabalin-headache, pain, dizziness

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

Symptoms: Tingly sensation in both arms and slow and heavy breathing. Mask and morning exertion could have been a cause of the slow and heavy breathing. Tingly sensation went away quickly. The breathing issues resolved after inhaler was used and the patient drank some water.

Other Meds: Vitamin C 500mg one tab daily Vitamin D3 5000IU once daily Multi Vitamin once daily Miralax as needed Docusate Sodium 100mg 1 capsule twice a day Lyrica 100mg 1 capsule three times Morphine Sulfate ER 30mg 1 tablet twice a day Norethindron

Current Illness: Fibromyalgia Spinal fusion Herniated disc

ID: 1027730
Sex: F
Age: 67
State: OK

Vax Date: 02/05/2021
Onset Date: 02/10/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Large rash at injection site. Fist size bump at injection site. Itching and bump kind of burns

Other Meds: Effexor. Metroprlol. Crestor. Plavix. Ezetimibe

Current Illness:

ID: 1027731
Sex: F
Age: 45
State: CO

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Chills, fever, body aches and pains in both muscles and joints

Other Meds: Birth control

Current Illness: NA

ID: 1027732
Sex: F
Age: 56
State: AZ

Vax Date: 01/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/13/2021
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: Compazine, Topamax, Sulfa

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

Symptoms: Within 20 minutes I began to feel heart racing, shaky/jittery - resting heart rate was around 140 per FitBit watch; I was in the 30 minute observation line due to allergies with other medication; staff provided me with 50 mg. of liquid Benadryl - needing to help me hold/bring to lips due to shaking; called on-site medics - noted increased HR, increased BP, conducted EKG ; attempted IV x4; called paramedics for transport to the Hospital - attempted/placed IV but infiltrated; at hospital 6th attempt at IV was successful and provided Saline; PVC's were noted on monitor but EKG was normal; HR remained increased; BP gradually returned to normal; HR decreased but did not return to normal until 24+ hours post-vaccination; released from hospital after about 4 hours of observation

Other Meds: Losarten, Rosuvastatin, Omeprazole, Claritin, Nasocort, Osteo-bi-flex

Current Illness: None

ID: 1027733
Sex: F
Age: 73
State: NJ

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Macrobid

Symptom List: Nausea

Symptoms: Chills and headache

Other Meds: Metformin, lisinipril, benlodipine, folic acid, trulicity, CoQ10, cinnamon, vitamin D, Lipic Acid, krill oil

Current Illness: None

ID: 1027734
Sex: F
Age: 53
State: OH

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Fever, body aches, shivering, pain in arm

Other Meds:

Current Illness:

ID: 1027736
Sex: F
Age: 73
State: NC

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs, COX-2 Inhibitors (eg Celebrex), Black cohosh, Benadryl, Lactose, Soy Lecithin

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

Symptoms: Moderna COVID-19 Vaccine Chills, Aching all over, fever 99.9, fatigue, itching below injections site (still itching on 2/13/21) 6"x3", slight nausea and no appetite. Took Extra Strength Tylenol (2) every 6 hrs. Temp went to 102.3 several times on 2/10/21, slept most of the day. On 2/11/21 still had fever (99.7-99.6) and took Tylenol but feeling better, stomach still not right. On 2/12/21 Fever gone but stomach still not right and feeling better. Itching continues.

Other Meds: Multivitamin, Calcium Citrate 1,000mg, Melatonin 5mg, Prilosec OTC 20mg, Folic Acid 1mg, Prednisone 2mg, Azelastine 0.1 Nasal Spray 2xday, Fluticasone Propionate Nasal Sjpray 50mg 2xday, Colace 2-3xday, Gaviscon anti-acide. B&L PreserVision

Current Illness:

ID: 1027737
Sex: F
Age: 70
State:

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Keflex - anaphylaxis

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

Symptoms: Patient developed throat tightness but no other symptoms. No rash, flushing, swelling. Sxs self resolved with observation. Vitals remained stable with BP 110/70s Sat 98%. Patient discharged home in good condition.

Other Meds: Levothyroxine, tamoxifen

Current Illness: NA

ID: 1027738
Sex: F
Age: 29
State: VA

Vax Date: 02/04/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Wheat, soy, casein, egg whites, beef, chicken, yeast, apples, oranges, bananas, kiwi, dragon fruit, cacao, potatoes, tomatoes, corn

Symptom List: Tremor

Symptoms: While I?ve been report on the vsafe that I?ve often on had extreme exhaustion, starting last night 2/12/21, I started feeling pain in the injection site as bad as I did the first few days. It?s extremely red and feels like there?s a nodule beneath the skin. It?s hurts to move that arm.

Other Meds: Women?s multivitamin, iron, b-complex, probiotics, elderberry, generic Zyrtec, azelastine

Current Illness: None

ID: 1027739
Sex: F
Age: 70
State: FL

Vax Date: 02/04/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Itchy, red rash around injection site starting on Day 8

Other Meds: Vitamin C, D3, Zinc, CoQ-10, Caltrate, Ocuvite, Rheumate

Current Illness: None

ID: 1027740
Sex: F
Age: 87
State: FL

Vax Date: 01/22/2021
Onset Date: 01/27/2021
Rec V Date: 02/13/2021
Hospital: Y

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: penicillin & sulfa

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

Symptoms: After only a couple days post-vaccine, patient was unable to sit up, walk or feed herself. Taken to ER via EMS on 2/7/21. Nothing remarkable discovered. Slight dehydration, scant UTI bacteria. She is now in the Hospice contracted bed at the hospital returning to hospice care at home with 24/7 aides to feed and car for her.

Other Meds: Carvidiol, Midodrine, Seroquel, Remeron, Vit D3, multi-vitamin, Xylatan

Current Illness: vascular dementia, glaucoma, macular degeneration

ID: 1027741
Sex: F
Age: 72
State: MN

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: CIPRO, SULFA, ASPIRIN, PERCOCET

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

Symptoms: Patient was instructed to stay for observation for 30mins due to reported allergies. Approx 20mins after patient reported chest tightness/burning sensation in lungs/center of chest. Pt declined any signs of heart attack and no lightheadedness, swelling of tongue or throat or shortness of breath; and no hives. Patient took Benadryl 25mg tab, used cold cloth/ice pack on neck, drank water. Dose of Benadryl 25mg repeated in 25mins per patients preference. After 1 hour, patient reported just a slight burning in center of chest and took a dose of tums. Still no hives. Patient was comfortable going home at 5:10pm (husband driving)

Other Meds:

Current Illness:

ID: 1027742
Sex: F
Age: 35
State: IN

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I got my shot at 2:30 pm on 2/11. I woke up 2/12 slightly achy. By 2:00 pm on 2/12 I had a moderately severe headache, had chills, was a lot more achy, and had some neck pain. At about 7 pm, my headache was only minor and the aches were minor. Chills were gone and neck pain was minor. By 8, headache and aches were gone. I woke up this morning feeling back to normal. I never took Tylenol or ibuprofen.

Other Meds: Multivitamins

Current Illness: None

ID: 1027743
Sex: F
Age: 90
State: MI

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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: Nine really

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

Symptoms: I began to feel very tired and weak the same day slept through the night and all day the next day And all night the second night till 10 o?clock in the morning on the 13th. Within 12 hours my kidneys were working overtime I was running to the bathroom constantly. Couldn?t hold It at all. Made me incontinent for at least 24 hours up three or four times to go to the bathroom. Lack of appetite. Arm is aching at site of injection and a little red.

Other Meds: Losartan 25 mg Blood Pressure medicine Vitamin D and Oscal a calcium pill

Current Illness: None

ID: 1027744
Sex: M
Age: 80
State: NY

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Doputamin

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

Symptoms: Fever, headache

Other Meds:

Current Illness:

ID: 1027745
Sex: F
Age: 67
State:

Vax Date: 02/13/2021
Onset Date:
Rec V Date: 02/13/2021
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: Did not have breakfast, felt dizzy after the shot that resolved after drinking juice

Other Meds: Lithium, Thyroxine, Wellbutrin

Current Illness:

ID: 1027746
Sex: F
Age: 49
State: TX

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Patient stated she felt like something was in her throat as they were parking immediately after her vaccine was administered. She was able to talk and breathe without difficulty, she just felt like her throat was closing. EMS checked her out and found her BP to be 193/109. Patient stated she was claustrophobic and the ambulance was causing anxiety. Patient moved to personal vehicle and monitoring equipment brought to patient's car. BP checked after she was feeling less claustrophobic . Repeat BP 181/113 (sitting). Patient complains of feeling "jittery". Patient refused EMS transport and said she would be going to the ER (to have her BP/symptoms checked out).

Other Meds:

Current Illness:

ID: 1027747
Sex: F
Age: 75
State: IN

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: None

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

Symptoms: Diahhrea

Other Meds: Lipitor, Atenalol, Levothyroxine, 81 mg aspirin

Current Illness: None

ID: 1027748
Sex: M
Age: 46
State: VA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: At 10:30pm (received vaccine shot #2 at 8:18am), i stood up and immediately felt chilled to the bones and started shaking/shivering uncontrollably for 5min. Took temp, no fever. No other issues

Other Meds: Losarten (Blood Pressure)

Current Illness: None

ID: 1027749
Sex: F
Age: 74
State: NJ

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: shellfish

Symptom List: Vomiting

Symptoms: chills, fever, upset stomach, rash on face, fuzzy head

Other Meds: none

Current Illness: none

ID: 1027750
Sex: F
Age: 71
State: OH

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/13/2021
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: Latex Spermicide jelly Estrogen cream Iodine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Rapid heart beats, nausea, weakness. Tends to happen when I lay down at night to sleep, only sleeping about 6 hours a night. . I tend to feel better in the afternoon,

Other Meds: Calcium Vitamin D Probiotic Statin Elavil Multi vitamin

Current Illness: I had several rapid heart episodes in Jan. Nothing had been diagnosed

ID: 1027751
Sex: F
Age: 63
State: NH

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/13/2021
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: sulfa

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

Symptoms: 8 days after shot. Red circle of rash and itching surrounding the injection site.

Other Meds: lisinopril, multivitamin, vitamin d, calcium, fish oil, cranberry, valocyclovir

Current Illness: none

ID: 1027752
Sex: F
Age: 25
State:

Vax Date: 01/31/2021
Onset Date: 02/01/2021
Rec V Date: 02/13/2021
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: Shaking chills, generalized fatigue, body aches, headache. Took 1500mg Tylenol every 6 hours with relief of chills only. Completely resolved in about 15 hours.

Other Meds: Sertraline 100mg Spironolactone 50mg

Current Illness:

ID: 1027753
Sex: F
Age: 26
State: OH

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: Passed out after receiving

Other Meds: Xanax

Current Illness: Anxiety

ID: 1027754
Sex: F
Age: 80
State: IL

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA

Other Meds: Losartan 100 mg Glucosamine HCL Turmeric 2 daily Aspirin 81 mg Vit D3 1000 ui Amlodipine Besylate 5 mg Ezetimibe 10 mg

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm