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: 1031617
Sex: M
Age: 17
State: OR

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 02/15/2021
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: Unknown-VAR is not in front of me

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient was inadvertently administered the Moderna vaccine before the age of 18. Patient and parent did not report any adverse effects following vaccination.

Other Meds: Unknown

Current Illness: Unknown

ID: 1031618
Sex: F
Age: 25
State: OR

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/15/2021
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: abilify, ativan, benadryl, haldol, latuda, morphine, zyprexa

Symptom List: Anxiety, Dyspnoea

Symptoms: Tightening of throat, raspy throat, facial and tongue swelling, rash on chest.

Other Meds: Pepcid, Zantac, Chlorpromazine, gabapentin, guanfacine, levothyroxine, lithium, prazosin, trazodone

Current Illness: N/A

ID: 1031619
Sex: F
Age: 77
State: CA

Vax Date: 02/05/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
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: Sulfamethoxazole, cephalexin, Clindamycin, Augmentin, Cipro, Erythromycin, Rocephin, Lyrica, Neosporin and aloe vera give rashes, or stomach pains to all medicine listed.

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

Symptoms: On 2/12/21 noticed that she had some itching in the area of the vaccine, a week after the vaccine. Now she has a red, roundish rash, looks like covid arm from the internet. No other problems. She put some cortisone cream on it as it itches at times.

Other Meds: Fioricet, Pantoprazole, Hydrochlorothiazide, vitamin D, Gabapentin.

Current Illness: None.

ID: 1031620
Sex: F
Age: 22
State: KY

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fever (highest- 102.5 F), dizziness, muscle aches/soreness, chills, fatigue, chest pain, shortness of breath, muscle weakness, night sweats, vomiting, fainting

Other Meds: Daysee birth control, nuvigil, spronalactone, zyrtec, singulair, famotidine, albuterol inhaler as needed, symbicort, flonase, amitiza, allergy injections

Current Illness:

ID: 1031621
Sex: M
Age: 82
State: NE

Vax Date: 02/09/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: mediations penicillin and cepro

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

Symptoms: TONGUE PAIN AND BLISTERS, LIP SORES, SORES INSIDE CHEEK, DIFFICULTY EATING AND CHEWING

Other Meds: mouth and tongue blisters or sores similar to cold sores - general pain when eating hot, spicy or hard to chew food

Current Illness: none

ID: 1031622
Sex: F
Age: 66
State: IN

Vax Date: 02/04/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
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: Any sulfa products

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

Symptoms: Itching around the injection area and approximate 1 in diameter hardness with soreness

Other Meds: Amandine, Methimazole, Etodolac, Cetirizine

Current Illness: Bacterial Vaginosis

ID: 1031623
Sex: F
Age: 82
State: LA

Vax Date: 02/06/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
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: Benedryl, Streptomycin, Penicillin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: My left arm started to hurt during the night and when I got up on Friday, the 12th it was hard to move it without severe muscular pain. The pain has persisted into today, Monday, the 15th, but it is slowly getting better. The pain is localized to my upper arm, and depending on how I move it, can become worse. I am treating the symptoms with Tylenol and aspirin-containing creams.

Other Meds: General Vitamin pill and a Vitamin C pill

Current Illness: None

ID: 1031624
Sex: F
Age: 27
State: CA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: After receiving vaccine patient complaining of, nausea, dizziness, and back pain. Vital signs: B/P 110/82 Pulse-76 Respirations 20 Oxygen Saturation 100% Patient assessed by a provider, no further treatment necessary. Patient had family member come pick her up and drive her home. Advised patient if symptoms worsened to go to nearest hospital. 2pm vaccine administered 2:15pm Complaining of nausea, dizziness, back pain vital signs taken 2:20pm provider assessed patient 2:30pm provider cleared patient to go home no further treatment necessary 3:15pm patient sister arrived to pick patient up, patient symptoms improving no further complaints.

Other Meds: unknown

Current Illness:

ID: 1031625
Sex: F
Age: 42
State: NJ

Vax Date: 02/06/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
Hospital: Y

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

Lab Data:

Allergies: bacitracin Bactrim sulfa

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: developed diffuse tender adenopathy, weakness and fevers. Admitted with severe neutropenia - ANC 0.

Other Meds: methimazole atenolol

Current Illness: Grave's disease

ID: 1031626
Sex: F
Age: 81
State: MD

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
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: Avelox

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Soreness around the injection site (left deltoid), lasting about 36 hours.

Other Meds: Flecainide, aspirin, Culturelle, magnesium, Omeprazole

Current Illness: None.

ID: 1031627
Sex: F
Age: 76
State: AZ

Vax Date: 02/01/2021
Onset Date: 02/09/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, cipro, codine, latex, kiwifruit

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

Symptoms: Red rash on arm that was injected. This began 8 days post injection.

Other Meds: Synthroid, benazopril, pepcid, zyrtec, Tylenol

Current Illness:

ID: 1031628
Sex: F
Age: 51
State: OH

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
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: Levaquin

Symptom List: Rash, Urticaria

Symptoms: Arm pain, next day fatigued, body aches and joint pain , headache, lightheaded, itching across chest and neck. day 3 prickly rash on chest . Day 4 rash on chest

Other Meds:

Current Illness:

Date Died: 02/11/2021

ID: 1031629
Sex: F
Age: 85
State: IA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: GI upset from Fentanyl, No other food or drug allergies

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

Symptoms: Patient became nauseated about 10 minutes after vaccine administered, this subsided but returned several hours after the vaccine was given. She continued with intractable nausea and vomiting for about 24 hours. This patient was enrolled in hospice and she continued to decline and refused to eat or drink. She was taking Ibuprofen due to intractable back pain. Her emesis was coffee ground color. After this her condition continued to decline until her death

Other Meds: Amlodipine, Fentanyl Transdermal, Gabapentin, Lorazepam, Metoprolol, Morphine, Omeprazole, ONdansetron, Miralax, Tylenol, Ibuprofen

Current Illness: Compression fracture

ID: 1031630
Sex: F
Age: 48
State: HI

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/15/2021
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:

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

Symptoms: 12 hours after second shot (1/29/2021): Chills for 5 hours, 101 fever; 24 hours after second shot (1/30/21): 99 fever and throbbing pain in left and right forearms. Took 1 Tylenol on 1/30/21 that relieved the fever but not the pain in the forearms. Pain in forearms stopped on 1/31/2021.

Other Meds: Methimazole, Vitamin D 2000 ICU

Current Illness:

ID: 1031631
Sex: F
Age: 48
State: NY

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/15/2021
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: uticaria 2cm diameter, ipsilateral, distal to injection site

Other Meds: none

Current Illness: none

ID: 1031632
Sex: F
Age: 38
State:

Vax Date: 12/01/2020
Onset Date: 12/01/2020
Rec V Date: 02/15/2021
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: REDNESS AND SWELLING AT INJECTION SITE IN ARM, TREATED WITH BACTRIM FOR 1ST AND 2ND DOSE

Other Meds:

Current Illness:

ID: 1031633
Sex: F
Age: 80
State: CA

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 02/15/2021
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: Penicillin

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

Symptoms: red sore lump initially . Followed by red itchy patch approx 3x4 inches, Took Benydril. Currently, 2 weeks in, red patch has moved forward on the arm and rash has appeared on chest with dappled red spots on arms and thighs. Also my face is swollen .

Other Meds: Levothyroxine, Tramadol, Nexium, Restasis, Bystolic, Nortriptyline, Meloxicam, Lipitor, Losarton Potasium, Tizanidine HCL, Baby Aspirin, Multi-vitamin, Vitamin C, B-12, Calcium/D3, Calcium Citrate, D3, Probiotic, Prebiotic, Docusate Sodium

Current Illness: None

ID: 1031634
Sex: F
Age: 41
State:

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 1330- report received from RN. Patient continues to report itching on face, entire back and upper right arm, which has spread from initial mid back. Rash noted on chest, right arm, on face (specifically cheeks), and lower back. Patient states after receiving first Bendryl 25 mg dose given by RN, no changes or improvement noticed. Patient given Benadryl 25 mg PO. Doctor aware. 1345- BP 141/82 HR 90 RR 18 98% SpO2 on RA 1355- patient has new c/o dull headache. Doctor notified. Per Doctor, continue to monitor at this time. 1405- patient states feeling improvement with itching. "it's not as itchy as before". Will continue to monitor. 1430- patient states "just slight itching now". BP 127/76 HR 89 98% SPO2 on RA RR 18. Per Doctor, to educated patient before she can leave back to work. Patient educated on returning for care in ED or Urgent care if symptoms worsen. Patient agree to this. Patient discharged from the observation area at this time.

Other Meds:

Current Illness:

ID: 1031635
Sex: M
Age: 85
State: CA

Vax Date: 01/11/2021
Onset Date: 01/22/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: A few days after getting the vaccine, we had bad wind storm come in and I was without power for about a week. I was unable to shower and could not see my arm good. Around the 22nd I went over to my granddaughter's home to shower and noticed that my bicep was black, over the next week it spread to the left breast, collarbone to the elbow. The where the shot there is about a mark on the muscle where I got the shot. On 28th of January, I went to see my doctor, my shoulder was swollen and I could not raise my arm to about my shoulder level. When I try to move I could feel a pain up there. Doctor put ice on it and told me to take Aleve. Since the swelling has went down I am no longer putting ice on it, I am not using heat. I tried to put my arm in a sling but it is painful. The other pain I feel no pain in my arm is I sit on the couch and put my arm straight out and do not move. The black area on the bicep is almost gone, the darkened area up by my collarbone went away, most of the darkened area is on my left breast. If I rotate my arm counter clockwise or clockwise there is pain there and it feels like it is stretching the muscle. I have also seen Doctor on the 2nd or 4th of this month. I am thinking of going to see him again this week. My doctor thinks that the person who gave me the vaccine, hit a blood vessel and that is what caused the blackness on my arm. The pain is mainly in the collarbone area and in the bicep. Before this started, about the first of January I came home and went to put my keys up and went to reach up and had some pain in my arm, but the pain and mobility issues both went away before receiving the vaccine.

Other Meds: Provision with vitamins added 2 pills a day,

Current Illness:

ID: 1031636
Sex: M
Age: 60
State: NE

Vax Date: 01/26/2021
Onset Date: 01/31/2021
Rec V Date: 02/15/2021
Hospital: Y

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

Lab Data:

Allergies: Strawberries

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

Symptoms: Patient developed SVT on January 31. He presented to the ER and received two doses of adenosine to convert back to a normal sinus rhythm.

Other Meds: None

Current Illness: None

ID: 1031637
Sex: M
Age: 75
State: NJ

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
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: SEASONAL ALLERGIES

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

Symptoms: 18 HRS AFTER VACCINATION PATIENT DEVELOPED MACULOPAPULAR RASH NON-TENDER, PURPLISH OVER LEGS, ABDOMEN, ARMS AND THORAX. PRESCRIPTION GIVEN FOR TOPICAL STEROIDS AND ANTIHISTAMINES (TOPICAL AND OPHTHALMIC)

Other Meds: NONE

Current Illness: NONE

ID: 1031638
Sex: F
Age: 54
State: MD

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
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: Unevaluable event

Symptoms: Pain and inflammation medial bicep Approximately 2x4 inches Resolving after 2 trails of Benadryl and heat compress

Other Meds:

Current Illness:

ID: 1031639
Sex: F
Age: 17
State: OR

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 02/15/2021
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: Unknown-VAR not in front of me

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

Symptoms: Patient was inadvertently administered the Moderna vaccine before her 18th birthday. She and her parent reported no adverse reactions following vaccination.

Other Meds: Unknown

Current Illness: Unknown

ID: 1031640
Sex: F
Age: 72
State: MA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
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: PCN

Symptom List: Injection site pain, Pain

Symptoms: 2 days of chills, weakness, profound fatigue & of course sore arm, starting about 4-5 hours after the shot and lasting for ~ 48 hours

Other Meds: Prozac, Gabapentin

Current Illness: None

ID: 1031641
Sex: F
Age: 65
State: CT

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: Anaphylaxis to NSAIDs. Allergic to penicillin / amoxicillin, latex, tree nuts.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Approximately 10 hours after vaccination (Pfizer-BioNTech Covid-19), developed severe arm pain, fever of 101.5F followed by shaking chills,, then fever again. Experienced myalgia and severe migraine-like headache with light sensitivity. The arm pain from shoulder to mid-palm was so severe that I couldn?t lift my arm. This resolved by approximately noon on 02/10/2021. The other symptoms largely resolved by midday 02/11/2021 wit residual low-grade headache, dizziness, and unsteadiness on my feet. I woke up on 02/11/2021 around 7AM with left axillary lymphadenopathy approximately the size of a tennis ball cut in half with associated moderate discomfort. The discomfort resolved by 02/14/2021, but the lymphadenopathy remains at about half the mass noticed originally.

Other Meds: None.

Current Illness: None.

ID: 1031642
Sex: F
Age: 33
State: CA

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/15/2021
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: Contrast dye

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

Symptoms: Patient complained of scratchy throat approximately 5 minutes after receiving vaccine. HX of anaphylactic reactions in the past with same onset of symptoms. Requested benadryl, 25mg of benadryl po administered. Symptoms resolved after 10 minutes. Pt monitored for 30 mins, VSS, asymptomatic, and was discharged.

Other Meds:

Current Illness: none

ID: 1031643
Sex: M
Age: 41
State: VA

Vax Date: 01/27/2021
Onset Date: 01/30/2021
Rec V Date: 02/15/2021
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: Intense vertigo with nausea and nystagmus started 3 days after injection (1/30). Couldn't walk or stand so went to Emergency Room on 1/31. MRI of head & neck done to rule out stroke. Meclizine 25mg & ondansetron 4mg ODT prescribed. Meclizine 25mg x 2-3 doses per day was needed for the next 7 days to perform daily activity. Was able to resume walking slowly with medication on 2/1, but could not look at a computer screen to work without meclizine due to nystagmus until 2/6. Symptoms did not improve enough to be cleared to drive until 2/9. Full symptom resolution by 2/11.

Other Meds: None

Current Illness: None

ID: 1031644
Sex: F
Age: 71
State: CT

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: pain/itching at site, redness/flushed feeling, body aches, fatigue

Other Meds: Levothyroxine, multivitamins

Current Illness:

ID: 1031645
Sex: F
Age: 76
State: FL

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

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

Lab Data:

Allergies: none

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

Symptoms: Date and time of vaccination: (list both if they received both shots): 1-15-21 4:15PM MODERNA LOT # 012L20A, 2-12-21 4:15PM MODERNA LOT # 010M20A. Fever 104F, took one Tylenol.

Other Meds: simvastatin 20mg QHS, Zetia 10mg QHS, Nexium 40mg QHS

Current Illness:

ID: 1031646
Sex: F
Age: 66
State: CA

Vax Date: 02/14/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: penicillin, codeine

Symptom List: Nausea

Symptoms: My face became swollen and red. I called the Pharmacy when I got home and he told me to take a antihimstine within an hour my face was back to normal

Other Meds: None

Current Illness: High blood pressure, talking medication for it

ID: 1031647
Sex: F
Age: 52
State:

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient feels that her throat is closing started today after receiving 2nd dose of covid vaccine She was given Benadryl 50 mg po before coming to urgent care She received first dose of Pfizer vaccine and 12/22/2020 and had same side effects Denies chest pain, shortness of breath, rash States she was given steroid injection and Ativan last time which helped

Other Meds:

Current Illness:

ID: 1031648
Sex: M
Age: 4
State: NE

Vax Date: 10/30/2020
Onset Date: 10/30/2020
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: Egg

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

Symptoms: Patient had no adverse reactions.

Other Meds:

Current Illness:

ID: 1031649
Sex: F
Age: 72
State: MO

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
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: Sulpha. Gabapentin. Tanizine. Percocet. One of the blood thinners can?t remember the name. Tape. Enderol. Something they used for prepping on one of my surgery. Bee stings. Poison ivy. Not sure of food allergies

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

Symptoms: Light head mess and dizziness off and on but mild. Not having them now. Itchy arm immediately and day #2 red hot swollen and a small knot today I measured it at 2 inches in Diameter. It?s a tad better today. Very sore. And kind of a rash there but the rash is getting lighter. I have soreness throughout my body but mostly my right arm I am having spells of light nausea come and go. I didn?t have a headache but stiff neck and it?s starting to get better. But I just had a strange sensation for the first Three days in my forehead and didn?t hurt but annoying and it is not as noticeable today so maybe it is going away. No fever or anything else like flu none of that My arm at the site is still warm today. I am feeling ok other than that.

Other Meds: Metformin Lisinopril Metoprolol Omeprasol Myrtriq All taken at At9:00am taken

Current Illness: None

ID: 1031650
Sex: F
Age: 71
State: CT

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
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: Tremor

Symptoms: Pain and itching at site, redness and flushed feeling, with body aches.

Other Meds: Levothyroxine, multivitamins

Current Illness:

ID: 1031651
Sex: F
Age: 61
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: When asked, patient stated she had gotten the Pfizer vaccine for the first dose. Afterwards the vaccine card showed she had gotten the Moderna a month ago in another facility.

Other Meds:

Current Illness:

ID: 1031652
Sex: F
Age: 70
State: AZ

Vax Date: 01/24/2021
Onset Date: 01/25/2021
Rec V Date: 02/15/2021
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: lots of airborne, penicillin, lactose intolerant

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

Symptoms: Day 2 sore arm, body aches, 99.8 temp, by evening large red spot around injection site Day 3 swing from chills to fever, red spot enlarges, is swollen and hot, tylenol helps temp down to 99.7 Days 3 - 7 arm gets hotter, stays swollen, hot and very red from above elbow to almost top of arm. Slowly dissipates. Blood Pressure spiked one day to 162/105 and saw doctor about that.

Other Meds: cymbalta, synthroid, menest, liprinisol, B12, nasacort, HyQvia, alprazolam, levocetirizine, restasis

Current Illness: Covid

ID: 1031653
Sex: F
Age: 80
State: MA

Vax Date: 02/01/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
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: Sulfa, Quinine, procainamide

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

Symptoms: Covid Arm: Vaccination area became pink (half dollar sized), itchy, lump under skin. Lasted 2-3 days. Still itches occasionally.

Other Meds: Nadolol, L-Thyroxine, vitamin D3, CoQ10, Lomotil, Fluticasone, vitamin C

Current Illness: None

ID: 1031654
Sex: M
Age: 48
State: KS

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

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

Lab Data:

Allergies: penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient received 0.3 mL of incorrectly diluted or undiluted Pfizer vaccine. When the nurse went to administer another 0.3 mL from the vial to the next patient, she noticed that there was insufficient volume. Only one vaccination was drawn from the affected vial, and that vaccination was given to this patient. Patient had left the facility at the time that the error was discovered, but he was contacted by telephone to be notified that he potentially received an improperly diluted or undiluted dose of Pfizer vaccine. Patient was notified that typical symptoms of immune response after being vaccinated, such as headache, fever, body aches, etc, may be exaggerated. Patient was instructed to use over-the-counter antipyretic acetaminophen according to bottle instructions, as needed for those aforementioned symptoms.

Other Meds:

Current Illness:

ID: 1031655
Sex: F
Age: 59
State: AZ

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
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: shellfish

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

Symptoms: injection site pain - tiredness - headache - muscle pain - chills - joint pain - fever 101.9 - nausea - feeling unwell

Other Meds: n/a

Current Illness: n/a

ID: 1031656
Sex: F
Age: 73
State: AZ

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
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: Scopolamine Morphine

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

Symptoms: Extreme redness & soreness & swelling at site. All symptoms of Covid. Dizziness weak fatigued ache all over. Still day #5

Other Meds: Breo Paxil singular loserten multi Vit. Vit D C

Current Illness: None

ID: 1031657
Sex: F
Age: 73
State: OH

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: Allergic to grass, trees, dust, mold

Symptom List: Pain in extremity

Symptoms: Site of injection began to itch, redness, swelling, lump - this seems to be improving after about 3 1/2 days. Still have some itching, but the swellling is down and the lump seems to be dissipating.

Other Meds: Losartan Hydrochorothiazide Levothyroxine Pantoprazole Atorvastatin Montelukast Potassium

Current Illness:

ID: 1031658
Sex: F
Age: 67
State: OR

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: sulfa

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

Symptoms: Myalgias, fatigue, headache, weakness, nausea, chills, decreased appetite and easy bruising.

Other Meds: none

Current Illness: none

ID: 1031659
Sex: F
Age: 57
State: CA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
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: Sulfa drugs.

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

Symptoms: Allodynia, hyperalgesia, Universal joint pain, exaggerated symptoms of ongoing CRPS in all four extremities. Continued moderately severe pain almost 2 weeks out

Other Meds: Topiramate 125mg, duloxitene 60mg, sertraline 50mg, Magnesium, senna.

Current Illness: None

ID: 1031660
Sex: F
Age: 87
State: MI

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
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: Avelox [moxifloxacin] Not Specified Nausea And Vomiting Demerol [meperidine] Not Specified Nausea And Vomiting Fentanyl Not Specified Nausea And Vomiting Pentothal [thiopental Sodium] Not Specified Nausea And Vomiting Streptomycin Not Specified Unknown Per her ENT doctor Sulfa Only (sulfonamide Antibiotics) Not Specified Nausea And Vomiting Versed [midazolam] Not Specified Nausea And Vomiting Amoxicillin Low Rash Dyrenium [triamterene] Low Rash Edecrin [ethacrynic Acid] Low Rash Penicillins Low Rash Tetracyclines Low Palpitations

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

Symptoms: The patient had immediate dyspnea and dizziness. When there was no immediate resolution, she was taken to the ER on campus. She was released home following ER evaluation.

Other Meds: acetaminophen (TYLENOL) 325 MG tablet docusate sodium (COLACE) 100 MG capsule ferrous sulfate 324 mg (65 mg iron) TbEC fluticasone (FLONASE) 50 mcg/actuation nasal spray loratadine (CLARITIN) 10 mg tablet losartan (COZAAR) 50 MG tablet magn

Current Illness: n/a

ID: 1031661
Sex: F
Age: 60
State: WA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/15/2021
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:

Symptom List: Vomiting

Symptoms: Started getting very tired the evening of the vaccination (day 1), the next day (day 2) extreme fatigue, chills, headache and muscle ache, stomach ache through the day and that night. Felt much better the morning of day 3 with some residual stomach ache.

Other Meds:

Current Illness:

ID: 1031662
Sex: F
Age: 73
State: MI

Vax Date: 02/06/2021
Onset Date: 02/08/2021
Rec V Date: 02/15/2021
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: Penicillin and sulfur drugs

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Developed rash around front neck area and below neck , sensitivity to touch. Lasted about 10 days with still some sensitivity today. Four days after the injection I had pain in lower jaw that at fist I though was a tooth ache. It was on the same side of my body as the shoot ( left side) . Lasted several days and on the sixth day after the shoot also hurt on the other side of my mouth(lower back teeth area) but milder and gone the next day. Spoke with my Doctor, she recommends the second shoot since my reactions were not severe.

Other Meds: Metoprolol suc er 1/2 of 25 mg 1x a day 600 mg calcium, 2000 iu vitamin raw D3, coenzyme Q10 22mg, omega3 565mg+70mgGLA and vitamin B12 1000 mcg. These I take every other day

Current Illness: None

ID: 1031663
Sex: F
Age: 66
State: MO

Vax Date: 02/01/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: penicillin

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

Symptoms: Two inch hard round red spot on left arm below where I received the shot.

Other Meds: metformin, Jardiance, lisinopril, atorvastatin, Zyrtec, Mylan brand levothyroxine.

Current Illness: None

ID: 1031664
Sex: F
Age: 34
State:

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/15/2021
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: 0830- Patient reports that her face / upper back and chest are itching. Red spots are appearing on her chest. No redness on face or back. Also reports itching of palate - no SOB / wheezing. VS - BP 147/81 HR 105 (pt reports that these are elevated from her normal) O2 sat 100% RR20 History of multiple allergies and anaphylaxis (to Humerma). Currently taking prednisone. Has taken Benadryl in the past for allergic reactions. 0832 - Benadryl 25mg PO given 0835 - no increase in sx 0840 - decreasing redness of chest, continued itching of face near hair line 0849 - feeling well, minimal itching. Offered Urgent Care of ER visit... Patient declines both. She is on her way to work and will continue to monitor for any increase in reactive sx. 0850 - left covid observation area by her own decision

Other Meds:

Current Illness:

ID: 1031665
Sex: F
Age: 62
State: MN

Vax Date: 02/05/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: On Day 8 following the initial dose of the Moderna vaccine for COVID-19, I began to experience itching and stinging on my left arm at the vaccine injection site and noticed a 2-1/2 inch diameter red rash at the injection site. My upper arm was swollen, too. I proceeded to seek medical consultation at Urgent Care Clinic the same day. On Days 7,8 and 9, I had some slight fatigue .Prior to this delayed adverse reaction event, I had only felt muscle soreness on the first and second days after receiving the vaccine.

Other Meds: Calcium supplement, 500 mg, with Vitamin D, 400 IU Vitamin D, 1000 IU

Current Illness: None

ID: 1031666
Sex: F
Age: 70
State: IL

Vax Date: 02/04/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
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: Sulfate base

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

Symptoms: Red, swollen spot about 2 inches below the injection site - minor pain, itches at time. Swelling lasted only the first night, but redness continues. About the size of a quarter or a little larger.

Other Meds: Trazodone 50mg, Spiriva 18mcg caps inhaler, Pantoprazole 40mg, chewable vitamin C 1000mg, vitamin D3 50mcg, vitamin B12 1000mcg, Calcium Citrate 800mcg, acidophilus probiotic, fish oil 1200mg

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm