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: 1028116
Sex: F
Age: 34
State: CA

Vax Date: 12/18/2020
Onset Date: 12/18/2020
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: Adhesive (reaction: blisters)

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received the Pfizer-BioNTech COVID-19 Vaccine EUA at 1006. Developed flushing tongue itching, local redness on shoulders at 1010. Patient was given Benadryl 25mg po in the clinic and remained for observation. After observation, patient cleared to leave clinic - was instructed to call 911 and go to ED if exhibiting any signs or symptoms of anaphylaxis. Patient was given an extra dose of Benadryl, 25mg to take if needed.

Other Meds: Unknown

Current Illness: Unknown

ID: 1028117
Sex: F
Age: 74
State: FL

Vax Date: 02/09/2021
Onset Date: 02/09/2021
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: Ampicillin, Sulfa, Levofloxacin

Symptom List: Anxiety, Dyspnoea

Symptoms: Chills began 10 hours after vaccine and lasted from 11:00 pm-9:00 am. Brain Fog most of next day after vaccine. Terrible headache and nausea began 24 hours after vaccine and lasted approximately 6 hours. 3 Tylenol helped. Inflammation at injection site lasting 2 days.

Other Meds: Valsartan-HCTZ 160-12.5 mg., B12 5000 mcg., Mega Red 750mg.,D3 2000 IU., PreserVision AREDS 2, Mature Multi-Vitamin, Calcium, 600 mg.

Current Illness: None

ID: 1028118
Sex: F
Age: 28
State: CA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
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: Penicillin - Anaphylaxis Prazosin - Heart arrhythmia Zolpidem, Bupropion, Citalopram - Anxiety, Suicidal Ideation Adhesive Tape - Rash, Hives

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

Symptoms: 10 minutes After injection, tongue and throat began to swell, breathing became labored, and skin on neck was itchy and red. Liquid Diphenhydramine was attempted, however was unable to be administered without slight aspiration, so injection of Epinephrine was administered. Within 5 minutes, airways returned to normal, SPO2 on room air was 98%, and was cleared to go home.

Other Meds: Venlafaxine 300mg PO daily Topiramate 100mg PO daily Metformin 500mg PO daily Atorvastatin 40mg PO nightly Progesterone 100mg PO nightly Testosterone Ciponate .25ml SubQ twice weekly Anastrozole .25mg PO twice weekly with Testosterone

Current Illness: None

ID: 1028119
Sex: F
Age: 31
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: On the first night, I had severe muscle pain in the left arm. The next day, I felt severely fatigued and had whole body muscle pain especially in my back and between my ribs. My left arm was still very sore and was hard to lift anything heavy with my left hand. The second day I woke up with numbness and tingling in the right half of my lower lip.

Other Meds:

Current Illness: none

ID: 1028120
Sex: F
Age: 28
State: NC

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: None

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

Symptoms: Called to see patient ~10 min after prime dose of Moderna COVID-19 vaccination. Patient reported acute onset of left eye swelling sensation and throat tightening. Was able to talk without difficulty. Normal salivation. Moved immediately from observation area to treatment room. Reaffirmed that symptoms persisted and that time she also reported chest tightness. Vitals were normal and pulse oximetry = 99%. Exam conducted while vitals being measured. No wheeze or stridor. No rash. No obvious oral lesions or swelling. Eye lids not swollen. Epi IM given at once (within 1-2 min of arrival at the treatment room). Symptoms resolved over the next 10 mins. Vitals were monitored frequently. Heart rate was increased before and just after Epi then dropped to ~70 b/m. Other vitals also remained normal and she was comfortable. EMS was called and she was transported to ED for continued observation. Husband accompanied her. She was seen in ED and observed for 4 hours. Benadryl, Pepcid and Prednisone taper prescribed. She was released from ED.

Other Meds: None

Current Illness: None

ID: 1028121
Sex: F
Age: 46
State: NC

Vax Date: 02/02/2021
Onset Date: 02/03/2021
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: Morphine

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

Symptoms: Extreme Leg pain,, joint pain, 102 fever, entire body aching, just felt terrible. I was out of work for two days.

Other Meds: Wellbutrin Lisinopril

Current Illness:

ID: 1028122
Sex: F
Age: 54
State: AZ

Vax Date: 01/16/2021
Onset Date: 01/16/2021
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: Azithromycin, Beclomthasone, Clindamycin, Doxycyline, Hydrocodone

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: An hour and a half after injection pt reports she had itching all over her body, Redness and extreme swelling of the arm.

Other Meds:

Current Illness:

ID: 1028123
Sex: F
Age: 52
State: GA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
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: Amoxicillin

Symptom List: Pharyngeal swelling

Symptoms: Numb face, lips, mouth, tongue, flushing, dizziness,

Other Meds: Lisinopril, Aimovig, synthroid, tizanadine, le a pro, albuterol

Current Illness:

ID: 1028124
Sex: F
Age: 0
State: PA

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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Five (5) minutes after receiving vaccination (21:15), patient experience redness of skin or urticaria in the entire body area. The Paramedic on-site assisted the patient immediately evaluating airway, breathing and circulation (ABC) which were never compromised. Patient blood pressure (BP) was 185/100, heart rate (HR) 80 and oxygen saturation of 96% at room air. Paramedic applied Benadryl (25mg, IM) on right deltoid muscle (opposite to vaccination site). Ten (10) minutes after Benadryl injection ABC remained stable with a BP 179/99, HR 78 and oxygen saturation of 96%. Thirty-five (35) minutes after vaccination patient remained alert, stable, and urticaria diminished visually.

Other Meds:

Current Illness:

ID: 1028125
Sex: F
Age: 80
State: NJ

Vax Date: 02/04/2021
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: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 7 days after receiving the vaccine, I felt a lot of itching in the site of injection, some inflammation and very hot and red, which I had not felt since the moment they gave me the vaccine

Other Meds: losartan , levothroid, metformin, xanax, dexilant, glimepiride, zinc, vit c, B12.

Current Illness: No

ID: 1028126
Sex: F
Age: 69
State: FL

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: None

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

Symptoms: Coughing, severe headache, muscle pain through out back arm and hip area

Other Meds: Lisinopril 40 mg 1 tablet daily; Losartan Potassium 25 mg 1 tablet daily; Atorvastatin 10 mg 1 tablet daily; Famotidine 40 mg 1 tablet daily. Fluoxetine HCL 20 mg 1 tablet daily

Current Illness: No illnesses. Survey May left knee replacement; January 4 back survey

ID: 1028127
Sex: F
Age: 44
State: RI

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: S,yncopal. Episode due to anxiety

Other Meds: None

Current Illness: None

ID: 1028128
Sex: F
Age: 71
State: IA

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Lisinopril, Doxepin, Metformin, Maltodextrin

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

Symptoms: Tachycardia

Other Meds: Melatonin, Alogliptin, Metoprolol, Divalproex, Losartan, Venlafaxine, Mirtazapin, Hydrochlorothiazide, Fish oil, Atorvastatin, Amlodipine, Clonazepam, Tolnaftate powder

Current Illness: None

ID: 1028129
Sex: M
Age: 46
State: IL

Vax Date: 02/01/2021
Onset Date: 02/11/2021
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: 102 fever, chills, body aches, fatigue, head ache.

Other Meds: None

Current Illness: None

ID: 1028130
Sex: F
Age: 59
State: WI

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: none

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

Symptoms: Arm pain after about 2.5 hrs. Chills, fever, overall body aches, nausea after about 12 hrs. Treatment: ibuprophen, tylenol PM, immodium.

Other Meds: none

Current Illness: none

ID: 1028131
Sex: F
Age: 56
State: NY

Vax Date: 12/31/2020
Onset Date: 01/01/2021
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: PCN

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

Symptoms: Headaches, joint pain and fatigue. Headaches and joint pain continued and increased after second vaccine. My BP which had always been controlled was 190/118 and I went to ED in Hypertensive crisis. Added more medication Norvasc. BP remains high 170/100 and I continue to have headaches.

Other Meds: Lopressor 50 mg OD Asa 81 mg OD Altace 10 mg OD Tylenol 100 mg prn

Current Illness: None

ID: 1028132
Sex: F
Age: 77
State: NY

Vax Date: 02/12/2021
Onset Date: 02/13/2021
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: n/k

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

Symptoms: patient complains of severe shoulder pain 1 day after receiving vaccine. she said she is not able to move arm (reported to us on 12/13/21 at 1:30 pm )

Other Meds: n/k

Current Illness: n'k

ID: 1028134
Sex: F
Age: 35
State: CA

Vax Date: 12/21/2020
Onset Date: 12/21/2020
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: No known allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received the Pfizer-BioNTech COVID-19 Vaccine EUA at 1758. Patient reported itchy tongue and dry mouth, itching at injection site at 1809, she was given Benadryl 25mg po. At 18:20 itchiness and dry mouth resolved, but patient then developed chills and felt cold and clammy, visibly shivering. At 18:35 still had chills. 18:43 chills/shivering resolved but felt ?less cold?. 18:45 patient returned to the hospital to finish shift and give sign-out. Clinic RN gave another Benadryl 25mg to the patient and asked the patient to return to the vaccine clinic after the end of her shift to reassess. 19:36 Patient returned to clinic, all symptoms resolved.

Other Meds: Unknown

Current Illness: Unknown

ID: 1028135
Sex: F
Age: 55
State: NY

Vax Date: 01/29/2021
Onset Date: 02/08/2021
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: latex, Sulfa, Levaquin, Skelaxin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 2 rashes to left arm first 1.5 by 2 inches 2nd lower down 3 x3 inches after 1st dose warm firm itchy. used benadryl went away 2 days later then returned on 2/12 1 rash 3.5 by 4 inches not warm of firm but itchy again using benadryl rash still present not itchy and now pink in color.

Other Meds: multivitamin, calcium with vitamin D

Current Illness: none

ID: 1028137
Sex: F
Age: 34
State: WV

Vax Date: 02/04/2021
Onset Date: 02/11/2021
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:

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

Symptoms: Covid-arm. Red, itchy, lump at the injection site. The red site has continued to grow. It is now 9 days since the vaccine was received.

Other Meds:

Current Illness:

ID: 1028138
Sex: F
Age: 47
State: CO

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Fish/Shellfish

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

Symptoms: Heart racing/palpitations noted for first ten minutes after receiving the vaccine and then stopped.

Other Meds: Multivitamin, Calcium, Probiotics, Estradiol 0.05mg Patch

Current Illness:

ID: 1028139
Sex: F
Age: 29
State: CA

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: mild reaction to cefaclor and amoxicillin

Symptom List: Unevaluable event

Symptoms: Injection site pain, arm pain from shoulder to elbow in injection arm full body aches throat pain headache/sinus pain jaw pain

Other Meds: Daily multi-vitamin

Current Illness: none

ID: 1028140
Sex: F
Age: 40
State: AZ

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: None

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

Symptoms: First shot no side effects...second shot chills on night 1 for a couple hours then fatigue the next day and then all side effects went away until Wednesday the 10th...started having weakness in arms, legs, chills and dizziness with low grade fever...still experiencing side effects as of today Saturday 2/13

Other Meds: Tylenol

Current Illness: Headaches/Migraines

ID: 1028141
Sex: F
Age: 41
State: WA

Vax Date: 01/19/2021
Onset Date: 01/20/2021
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: Penicillin

Symptom List: Injection site pain, Pain

Symptoms: I had a slight fever (lower than 100'), body aches, fatigue, and felt nauseous. I felt like I had the flu.

Other Meds: Lamictal, Zolpidem

Current Illness: I had a hysterectomy on 12/2/20.

ID: 1028142
Sex: M
Age: 66
State: FL

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: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Injection site pain, headache, chills, sweats, fever to 102

Other Meds: Prilosec

Current Illness: None

ID: 1028143
Sex: M
Age: 47
State: AZ

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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin/Amoxicillin

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

Symptoms: Ringing in left ear, decreased hearing

Other Meds: None

Current Illness: None

ID: 1028144
Sex: F
Age: 65
State: CA

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: Nausea, Pain in extremity, Pyrexia

Symptoms: After receiving the first shot on Jan 19 I had a nosebleed. It was mild and happened about an hour after the shot. When I received the 2nd shot on Feb 9 I had a very severe nosebleed about 24 hours after the shot. It took about 45 minutes to stop and I passed several clots. It was very frightening.

Other Meds: Turmeric, vitamin D, calcium, famotidine, B12

Current Illness: None

ID: 1028145
Sex: F
Age: 39
State: CA

Vax Date: 02/05/2021
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: RA

Lab Data:

Allergies: Allergic to cipro and flagyll

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 8 days after the vaccine I woke up to a large, hot, itchy bump at the vaccine site.

Other Meds: Zoloft and singular

Current Illness: None

ID: 1028146
Sex: F
Age: 37
State: CA

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

Lab Data:

Allergies: No

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

Symptoms: I received Covid vaccine #2 shot on 2/12/21 ~1:15 pm. I did not have any adverse effects till around 10 pm that night. I started with very chill feeling which I know is one of the expected SE. No issue with #1 shot. On 2/13/21 ~9:15 am, while I was preparing breakfast, I felt sudden nausea, dizziness and collapsed on the floor. I don't remember how long I lost consciousness. My 9 yo child came in and called me because he heard broken plate sounds. Then, I regain consciousness.

Other Meds: Ferrous sulfate 325 mg 1 tablet the night before vaccination

Current Illness: No

ID: 1028147
Sex: M
Age: 34
State: CA

Vax Date: 12/21/2020
Onset Date: 12/21/2020
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: Peanuts (reaction: shortness of breath, severity: high) Penicillin (reaction: anaphylaxis, severity: high) Amoxicillin, cephalexin, ciprofloxacin, levofloxacin (reaction: rash, severity: low) Allergy to all nuts and phenobarbital (reaction and severity not specified)

Symptom List: Nausea

Symptoms: Patient received Pfizer-BioNTech COVID-19 Vaccine EUA at 1324. At 1339 felt tightness in hands, 1350 itchiness/tightness/anxiety, 1430 sore joints. Given Benadryl 25mg at 1350. After further observation, patient felt good and left at 1452.

Other Meds: Unknown

Current Illness: Unknown

ID: 1028148
Sex: F
Age: 32
State: OR

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

Symptom List: Injection site pain

Symptoms: I received my 2nd shot on 02/05/21 at approx. 2pm. On 02/06/21 at approx. 3pm I started having chills, body aches, and a fever. These symptoms got much worse at approx. 8pm. On 02/07/21 I woke up to severe fatigue, headache, and a fever. From 02/08/21 to today 02/13/21 I have experienced a low grade fever. I feel dizzy, nauseas, fatigued, and over all unwell. Yesterday, 02/12/21, I vomited. I've had to miss work all week due to these symptoms. Even today, 02/13/21 I have a fever and feel unwell. My fever has ranged between 99.5-100.4.

Other Meds: Celebrex, Wellbutrin, Buspar, Nexium, Flexirill

Current Illness: N/A

ID: 1028149
Sex: F
Age: 30
State: RI

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Nkda

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

Symptoms: Severe anxiety, felt like she was going to pass out she states

Other Meds: Iron

Current Illness: Anxiety

ID: 1028150
Sex: F
Age: 56
State: WA

Vax Date: 12/24/2020
Onset Date: 12/29/2020
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: diclofenac (caused hand/foot swelling)

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

Symptoms: Left lower quadrant mastitis presenting 12/29/2020, 5 days after receiving dose #1 Pfizer Covid19 vaccine in the left deltoid. I was seen in urgent care and treated successfully with sulfamethoxazole-trimethoprim orally twice daily for 7 days.

Other Meds: Enbrel (etanercept) sureclick, 50 mg SQ q wk, Premarin (conjugated estrogen) cream 0.5 grams intravaginal three times per week, celecoxib 200 mg po once daily, levothyroxine 88 mcg po once daily, methrotrexate 15 mg po once weekly, folic

Current Illness: none

ID: 1028151
Sex: F
Age: 58
State: NY

Vax Date: 02/08/2021
Onset Date: 02/08/2021
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: Baclofen Levaquin Docycycline

Symptom List: Tremor

Symptoms: Injection administered high in left deltoid. I IMMEDIATELY felt medication being injected into arm with radiation of med up into anterior shoulder. This caused immediate pain. Swelling in deltoid that has continued for 6 days at time of completing this form Treatment has been OTC pain relief, tylenol, ice to area and rest with little to no improvements in symptoms Will f/u with primary Md when office reopens monday 2/15

Other Meds: Q vair 1 puff daily Multivitamin Vit d Vitamin B12 Calcium Tramadol as needed

Current Illness: None

ID: 1028152
Sex: F
Age: 50
State: TX

Vax Date: 01/28/2021
Onset Date: 01/28/2021
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: High fever 103, sever headache, bilateral lower back pain, hematuria, nausea, loss of taste and smell, fatigue, Shortness of breath, cough, asthma exacerbation.

Other Meds: Levothyroxine

Current Illness: Asthma, hypothyroidism, breast cancer in remission

ID: 1028153
Sex: F
Age: 28
State: TX

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

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

Symptoms: Arm was sore the evening after receiving the shot. The next day, on 2/11, I woke up with a high fever, body aches, and horrible headache. These symptoms lasted about 18 hours. I also noticed a bruise and some redness on my arm around the injection site on 2/11. Now today, on 2/13, the redness is about 5 inches in diameter and the bruise is about 1 inch in diameter. My arm is sore to the touch, itchy, and has a hard lump where I was injected.

Other Meds: N/a

Current Illness: Diagnosed with covid-19 on 1/18/2021. Fully recovered at time of vaccine.

ID: 1028154
Sex: F
Age: 81
State: CA

Vax Date: 01/28/2021
Onset Date: 01/28/2021
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: Strawberries, tree pollen

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

Symptoms: Approximately 75 minutes after vaccine had significant shortness of breath, extreme fatigue (difficulty walking to the bathroom). Over the next week and a half, blood pressure and heart rate swung widely (outside of normal range). Heart rate periodically dropped down into 30-40 range. Experienced whiteouts.

Other Meds: Verapamil 360mg/1x day (high blood pressure) Prevastatin 20mg/1x day (high blood pressure) Losartan potassium 100mg/1x day (high blood pressure) Metformin HCL 1000mg/2x day (diabetes) Levothyroxine 50mcg/1x day (Thyroid) Asprin 81mg ev

Current Illness: None

ID: 1028155
Sex: F
Age: 72
State: KS

Vax Date: 01/29/2021
Onset Date: 01/30/2021
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: One day post..slight fever and arm pain One week post: severe knee pain for one night that then was off and on mild for several days. Also entire anterior upper arm from elbow to injection site hot, itchy, swollen currently for one week and not diminishing.

Other Meds: Trazadone, lipitor

Current Illness: None

ID: 1028156
Sex: M
Age: 66
State: MI

Vax Date: 02/02/2021
Onset Date: 02/09/2021
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: None

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

Symptoms: Red spot on arm, swollen and hard

Other Meds: Multi vitamin, vitamin D, Tamsulosin hcl, Finasteride

Current Illness: None

ID: 1028157
Sex: M
Age: 68
State:

Vax Date: 01/12/2021
Onset Date: 02/01/2021
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:

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

Symptoms: Light headed or dizziness showed up on the 20th day following shot #1. Other symptoms were sore shoulder and mild headache that appeared on the second day following the shot. The soreness and headache were expected and if those were the only symptoms I would not have reported them. The dizziness was unexpected and had not completely gone away at the time of my second shot on 02/09/2021. After the second shot they dizziness has gotten slightly worse. The soreness in the arm is WAY worse with the second shot and there is achiness in my back, shoulders and neck as well as a headache that comes and goes. Again, The only symptom that I did not expect was the dizziness.

Other Meds:

Current Illness:

ID: 1028158
Sex: M
Age: 72
State: TX

Vax Date: 02/01/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Blood in urine

Other Meds: Met form in Vitamin c

Current Illness: Diabetes 2

ID: 1028159
Sex: F
Age: 40
State: NY

Vax Date: 01/28/2021
Onset Date: 01/28/2021
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: None

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

Symptoms: Tachycardia HR>100 at rest, going up to 140?s-150?s with movement. Seen in the ED and was sinus tachycardia with some T wave inversions in the EKG. Tachycardia improved the following days and worsened day again day 7-12 after vaccination. Cardiac work up was done, including ECHO and C-CTA that was negative. Tachycardia self resolved after day 12 post vaccine. It was associated with fatigue and i ability to perform daily tasks. Had to take off from work and rest.

Other Meds: None

Current Illness: None

ID: 1028160
Sex: F
Age: 46
State: MD

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

Lab Data:

Allergies: Atarax

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

Symptoms: I received the vaccine at 11:10am...at 11:20am I became very quickly flushed, disoriented, heart racing, was very short of breath and had a rash on my face...I was given epi and put on 8lpm oxygen and taken by ambulance to the loca hospital for observation...I was kept for a few hours and allowed to go home with epi pens...I am very sore today with a migraine, fever, joint pain and chills

Other Meds: None

Current Illness: None

ID: 1028161
Sex: F
Age: 51
State: NJ

Vax Date: 02/03/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Severe burning pain in Right leg. Paralysis in right foot. Lasting 30 minutes. Next day tingling and mild weakness in right leg

Other Meds: Vitamin C Zinc Vitamin D Calcium

Current Illness: No e

ID: 1028162
Sex: M
Age: 67
State: FL

Vax Date: 01/10/2021
Onset Date: 01/12/2021
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: Iodine

Symptom List: Vomiting

Symptoms: PVC?s

Other Meds: Multas 400mg bid, Losartan 50mg q day, Eliquis 5 mg bid, Zyrtec 1 tab q day

Current Illness: None

ID: 1028163
Sex: F
Age: 35
State: DC

Vax Date: 01/30/2021
Onset Date: 01/31/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Body aches the day after second dose administration

Other Meds: Lexapro Flonase Biotin gummies Zyrtec Melatonin

Current Illness: None

ID: 1028164
Sex: F
Age: 40
State: NJ

Vax Date: 01/14/2021
Onset Date: 01/15/2021
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: Chemical allergies (perfumes, household cleaning supplies, cigarette smoke etc)

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

Symptoms: Severe arm/shouler pain. Started one day after vaccine. Severe enough that it is not dulled by 600 mg of ibuprofen. 4 weeks after vaccine(before second dose) range of mption of arm is still limited.

Other Meds: Hair vitamins, birthcontrol, metformin, loratidine, omeprazole

Current Illness: None

ID: 1028165
Sex: M
Age: 17
State: AZ

Vax Date: 01/09/2021
Onset Date: 02/12/2021
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: Patient was vaccinated with two parents during end of day waste avoidance protocols, on the 8th day of dispensing Moderna; patient returned for dose 2 with parents, where it was discovered he was not 18 years of age; Moderna Dr. was contacted and indicated he may be able to receive dose 2, if parents agreed to enter son into a Moderna clinical trial for adolescents; parents sais, "No" to the clinical trial and all departed without dose 2

Other Meds:

Current Illness:

Date Died: 02/10/2021

ID: 1028166
Sex: F
Age: 95
State: TN

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

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

Lab Data:

Allergies: ALLERGIC to monopril

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

Symptoms: Patient was found unresponsive on her kitchen floor about 9:45 AM on February 10, 2021 approximately 18 hours after receiving her first Covid-19 vaccination. Exact time of the event is unknown. She was known to get up between 6:30 and 7:30 AM. It appeared that she had not eaten breakfast nor taken any medication that morning. She was taken by ambulance to Medical Center where a CT scan showed an unrecoverable massive brain hemorrhage. She died at approximately 3:50 PM after the respirator was removed. She was sent to the local Medical Examiner afterwards.

Other Meds: See Continuation Page MEDICATION, DOSAGE, FREQUENCY Coreg,6.25 mg,Twice daily Hydralazine HCL,10 mg,Twice daily Isosorbide mononitrate ,30 mg,Once Daily Warfarin,20.5 mg,per week Acyclovir ,800mg,4x Daily Atropine Sulphate, 1% Op Sol,Tw

Current Illness: Glaucoma, corneal virus in right eye, IBS

ID: 1028167
Sex: F
Age: 52
State:

Vax Date: 12/22/2020
Onset Date: 12/22/2020
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:

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

Symptoms: Patient received the Pfizer COVID immunization today, About 3 hours ago. About 15 minutes after the administration of the vaccine patient stated she developed mottling of the skin, paresthesias as well as palpitations and throat tightness. Was given 25 mg oral Benadryl after initially experiencing the symptoms. Subsequently 1 hour later was given another 25 mg of oral Benadryl because symptoms remain. Was subsequently transferred here to Urgent Care about 30 minutes ago. Patient stated that her symptoms remained of throat tightness however the palpitations and paresthesias as well as skin mottling resolved. Denies any rash at any point. Denies any swelling of the face, mouth, lips or body. Denies any shortness of breath or chest pain.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm