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: 1032082
Sex: F
Age: 32
State: MA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
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: amoxicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: intense pain in right arm at injection site

Other Meds: Buspar, Prozac, levithyroxine

Current Illness:

ID: 1032083
Sex: F
Age: 79
State: NE

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

Lab Data:

Allergies: e mycin (severe GI symptoms) penicillins (rash) Readi-CAT 2 Berry smoothi 2% suspension (GI symptoms) Hx Allergic contact dermatitis disorder

Symptom List: Anxiety, Dyspnoea

Symptoms: Here, brought in by EMS with complaints of having body aches, headaches, some cough, and generally not well since she got her second Covid Vaccine. She states that she has not been taking any tylenol because she did not have any. Denies nausea and vomiting and denies any dysuria. Her friend that is a retired nurse came over to check on her and gave her 1g of Tylenol 70 minutes ago. EMS stated her temperature was 106.7 on scene, but she is 98.4 here. She has no other focal complaints, just has felt bad since the second Covid Vaccine. Her oxygen saturation on admit to the ER was 84%.

Other Meds: Metformin 500 mg TID Levothyroxine 100 mcg Daily Gabapentin 600 mg BID

Current Illness:

ID: 1032084
Sex: M
Age: 38
State:

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

Lab Data:

Allergies: NKDA

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

Symptoms: VOMITING. Pt had COVID vaccine yesterday morning. Pt was at dinner. When he started with bodyaches and headaches. This morning pt became weak, dizzy, shacky, n/v multiple time. Pt did not take any medicines.

Other Meds: UNK

Current Illness: herniated disc in neck

ID: 1032085
Sex: F
Age: 75
State:

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: patient became flushed, lightheaded and felt rapid heart rate 15 minutes after receiving vaccine. no shortness of breath, no rash or hives.

Other Meds:

Current Illness:

ID: 1032086
Sex: F
Age: 26
State: OH

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: LA

Lab Data:

Allergies: Gluten

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

Symptoms: Sore arm, body aches, chills, headache 30.5 weeks pregnant

Other Meds: Synthroid, cymbalta, protonix, diamond, zofran

Current Illness:

ID: 1032087
Sex: F
Age: 48
State: NJ

Vax Date: 02/15/2021
Onset Date: 02/15/2021
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: Penicillin, latex, bees

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

Symptoms: Pretreated with Benadryl and Pepcid. Chest tightness, parasthesias 15 minutes after administration, worsening and shortness of breath took more Benadryl at 1hr , worsening 1hr 15 min post, epinephrine given. Improved for about an hour, resound reaction epi dose 2 given, prednisone given. To Ed for observation. Prescribed 5 days of steroids

Other Meds: Lexapro Zyrtec

Current Illness: None

ID: 1032088
Sex: M
Age: 38
State: CA

Vax Date: 02/12/2021
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: Sulfa drugs

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Woke up with a severely swollen uvula and tonsils making it hard to swallow and speak

Other Meds: Divalproex Sodium DR 500mg twice daily VitaFusion Men?s powerful multi 2 gummies daily

Current Illness: None

ID: 1032089
Sex: F
Age: 48
State: CO

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

Lab Data:

Allergies: No

Symptom List: Pharyngeal swelling

Symptoms: Delayed skin reaction, known as Covid arm.

Other Meds: Trazadone 50mg

Current Illness: No

ID: 1032090
Sex: M
Age: 59
State: NJ

Vax Date: 02/01/2021
Onset Date: 02/03/2021
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: Cephalaxaline antibiotic Cottonseed oil Slightly sensitive to yeast and soy products

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Muscle twitching in the area of the left arm that received the injection.

Other Meds: Per Day: 10 MG Zetia 100 MG Ubiquinol CoQ-10 1280 MG fish oil supplement with 1000IU vitamin D3 Probiotics with a multi-vitamin 81 MG Aspirin 25 MG Losartan Potassium 25 MG Hydroxyzine 100 MG Trazodone

Current Illness: None

ID: 1032091
Sex: M
Age: 81
State: CA

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin, Quinine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: The first day, he did not feel real good, felt weak. On Saturday had fever, no appetite. Sat down and couldn't get up, joint pain had no balance. The fever kept going and down. Felt weak, didn't feel like moving and slept most of the time. Felt better on Sunday, a little weak.

Other Meds: Omeprazole 20mg, Atorvastatin, Folic Acid, Metformin

Current Illness: no

ID: 1032092
Sex: M
Age: 22
State: OH

Vax Date: 02/06/2021
Onset Date: 02/06/2021
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: Tree nuts

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

Symptoms: 1540 Pt complaint of feeling nauseous, states feels this was when anxious. Pt at POD with girlfriend. Squad was called for girlfriend earlier after girlfriend fell to ground. States anxious watching all that happen. Denies any other symptoms. Drank juice. 1551 BP 118/60, RR 18, OSat 99%, HR 87. States feeling much better. States ready to go home. Advised pt to seek medical care if experiencing symptoms. Pt verbalized understanding. 1553 Pt left with girlfriend at his side.

Other Meds: None

Current Illness: None

ID: 1032093
Sex: F
Age: 27
State: MN

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

Lab Data:

Allergies: Amoxicillin

Symptom List: Rash, Urticaria

Symptoms: After second dose of vaccine, experienced body aches, chills, body pain. This lasted for about 36 hours. At the site of insertion: redness, swelling, warmth, and pain. This also lasted for 36 hours but now site is still red, bruised, and itching.

Other Meds: Birth control, sertraline, spironolactone, and multivitamin. Also took an additional vitamin water every day.

Current Illness: None

ID: 1032094
Sex: F
Age: 34
State: OH

Vax Date: 01/05/2021
Onset Date: 01/07/2021
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: No.

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

Symptoms: Two days after receiving 1st dose I started experiencing severe dizziness, almost similar to being too drunk. Coupled with a headache. Contacted an APP and she had me treat it like a post-concussion, brain rest, dark room. I could not work the rest of 1/7 and 1/8. Dizziness finally subsided that Sunday, 1/10, but headache continued (mild-moderate) for another 3-4 days.

Other Meds: Omeprazole, Wellbutrin

Current Illness: None.

ID: 1032095
Sex: F
Age: 63
State: CA

Vax Date: 02/10/2021
Onset Date: 02/11/2021
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: None

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

Symptoms: Extreme tiredness; blurred vision and mental fog; heaviness in the chest; difficulty breathing; mild headache; pain in my toes feeling like they were broken; chills; sweating. Lasted from 3-7 pm although 4-7 I was in a sound sleep but aware of the symptoms I was feeling. It was a very unusual feeling of unconscious then conscious delirium feeling.

Other Meds: Synthroid, Lexipro, singular, vitamins D3, C, multiple zinc.

Current Illness: None

ID: 1032096
Sex: F
Age: 67
State: WA

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

Lab Data:

Allergies: Sulfa, Erythromycin, Levaquin Allergic to bee strings, carry an epipen

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

Symptoms: Saturday, 2/13/21 7;00 am. chills, fatigue, nausea 11:00 am-3:00pm, vomiting 3 times, fever of 100 degrees ( normal temperature is 97.5) 6pm - 6:00 am. Fever spiking to 102.7 throughout night Sunday, 2/14/21 Fatigue and weakness. Increased pain at injection sight.

Other Meds: Valacyclovir HCL 500MG 2xday Acyclovir Ointment USP 5% D3 50 mcg (2000 IU) 1xday Acetaminophen 500 mg x1 every 5vhours

Current Illness: Active case of genital herpes being treated with Acyclovir

ID: 1032097
Sex: F
Age: 55
State: WI

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: PCN

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

Symptoms: At 725 pm was extremely tired. Went to bed. Woke up at 1030 pm with out of control shaking and fever of 102. Body aches and pains. Had to put on extra clothes and blankets. Went to work in am but had to leave early due to ongoing body pains and fever of 101. Also, inflamed lymph node in axilla of shot arm- very painful. Felt better by Sat late morning. Please note I am strawberry blonde as is coworker who had same response. Other individuals with us with very mild symptoms.

Other Meds: MVI, Zinc, Linzess

Current Illness: Na

ID: 1032098
Sex: F
Age: 68
State: MI

Vax Date: 02/08/2021
Onset Date: 02/09/2021
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: None

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

Symptoms: Severe continued soreness in injection arm occurred the morning following vaccine. Pain radiating from shoulder to wrist with limited mobility and not responding to over counter NSAIDS. Question if pain was related to administration of shot verses reaction to vaccine. Patient contacted PCP and was directed to go to urgent care.

Other Meds: Aspirin Cholecalciferol 2,000u once daily after meals Famotidine 10 mg daily am Loratadine-Pseudoephedrine Pseudoephedrine HCL oral prn

Current Illness: None

ID: 1032099
Sex: F
Age: 31
State: TX

Vax Date: 02/06/2021
Onset Date: 02/07/2021
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: Amoxicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Started out 02/07/2021, as 2 flat red spots on my right groin, then has spread around my hips and down thighs, a few on my arms, neck, and upper abdomen, and lower back. The spots grew bigger each day and looks like skin is peeled off. Bright red. They are still spreading every day.

Other Meds: Wellbutrin, Xanax, Tylenol 3

Current Illness: Sore throat

ID: 1032100
Sex: F
Age: 42
State: OH

Vax Date: 02/09/2021
Onset Date: 02/09/2021
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: Zofran, PCN

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 1237 Patient feeling light headed slightly. States she felt something like this after first dose of Moderna. BP 148/82, No other symptoms. HR 77, O2 98%.

Other Meds: Adderall, Singulair, Amitriptyline

Current Illness: None

ID: 1032101
Sex: M
Age: 42
State: CO

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

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

Lab Data:

Allergies: None known

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

Symptoms: Chills, aches, fatigue, fever of approximately 101.7 that lasted approximately 24 hours after starting. No medical treatment necessary. Not a reaction that seemed dangerous or overly onerous, but one that prevented normal activity for about 24 hours.

Other Meds: None

Current Illness: None

ID: 1032102
Sex: F
Age: 43
State: CA

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

Lab Data:

Allergies: unknown

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

Symptoms: She complained of headache, chills, nausea, vomiting, and body aches the next morning after the vaccination. She took Tylenol and Ibuprofen for comfort.

Other Meds: unknown

Current Illness: none

ID: 1032103
Sex: F
Age: 28
State:

Vax Date: 01/28/2021
Onset Date: 01/28/2021
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: 12 hours after her second COVID-19 vaccine, the patient experience shortness of breath that seemed to be an asthma attack (which she hasn't had in 10 years). She used a short acting inhaler. Then she experienced hives 1 hr after shortness of breath which she treated with benadryl. She was asymptomatic by the morning and has continued to be stable since event.

Other Meds: hydrochlorothiazide

Current Illness:

ID: 1032104
Sex: F
Age: 42
State: CA

Vax Date: 02/01/2021
Onset Date: 02/01/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Approx 10- 12 hours after the shot was given, patient was home and in severe pain deep joint and muscle pain, shivering, sweating, freezing, low grade fever, severely weak, collapsed to the floor the first morning after receiving the 2nd dose shot bc she couldn?t make it back upstairs on her own. Injection site was red and swollen with a defined border. Severe pain at injection site as well. All symptoms listed to this point lasted for 48 hrs. After that severe joint and muscle pain diminished and pain medication (ibuprofen 800mg) was no longer being taken. However, severe arm soreness, tenderness, redness, swelling and itchiness remained/started on day 3. Itchiness spread from only the arm to entire body by day four. Patient went to hospital on day 4 but did not get admitted because they wanted to care for her in the Covid unit without knowing if she had Covid or not. Patient administered self-care by taking Benadryl continuously for approximately 48 hours starting on day 4. She stayed home after attempting to get help from redlands community hospital ER because she didn?t feel comfortable being told she could only get care if she went into the covid unit without a covid test being offered or done to her first. Patient was bedridden and severely sick from February 1 through February 7 2021. Feb 11 2021 patient took a covid test to rule out covid as the reason she felt so bad. Test result for covid was negative.

Other Meds: Tulana birth control pill Armour 60 mg hypothyroid pill

Current Illness: None

ID: 1032105
Sex: F
Age: 37
State: IA

Vax Date: 01/08/2021
Onset Date: 01/08/2021
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: no

Symptom List: Injection site pain, Pain

Symptoms: My lymph nodes in my neck and my throat swelled up. My throat became red and swollen. (The throat symptoms were within 2 hours and lymph nodes swelled up overnight) I became congested and started sneezing and coughing. I got a fever, chills, headache - within two hours, body aches, fatigue. The rest of the symptoms came within 24 hours. On Saturday morning, I called URGENT CARE - and they had me talk to an Urgent Respiratory Care 50 mg of Benadryl and ibuprofen - 800 mg every 8hours - Following Monday still very sick and I was seen on Monday at Urgent Respiratory Clinic and at that point of time they did a COVID test (January 11th). Told to take: Mucinex and nasal spray and antibiotic because my ears were so full at that time they were not draining. They helped reduce the symptoms. I was sick for the entire week. It took me out of work for a week.

Other Meds: no

Current Illness: none

ID: 1032106
Sex: F
Age: 39
State: MD

Vax Date: 02/13/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Seasonal allergies

Symptom List: Injection site pain, Menorrhagia

Symptoms: Large (approx 3.5 inch) red, hot, swollen circle around injection site. Swelling is going down but diameter of red circle is still increasing. There is also a small bruise. Area is very sore and itchy

Other Meds: None

Current Illness: None

ID: 1032107
Sex: F
Age: 24
State: OH

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

Lab Data:

Allergies: sesame seeds, shell fish, bamboo

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

Symptoms: 1205 throat started tingling cold feeling on arms. 1214 BP 150/92, O2 99%, BL lungs clear. 1232 130/80, )2 98%, HR 106, T 98.6 @ 1236 Pt states she is feeling better. 1253 BP 102/80, 02 99%, HR 99. Pt has a ride home. Will monitor for another 10 min and per MD. she is good to go home with a friend who drove her. @ 1258 Pt swallow normally. @ 1308 Pt left the room stating feeling better and confident to go home. This nurse advised pt to call PCP and call 911 in case of worsening vital signs.

Other Meds: birth control, benadryl, PRN

Current Illness: PCOS, Chronic migraine

ID: 1032108
Sex: F
Age: 32
State:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Sore throat, cough.

Other Meds:

Current Illness:

ID: 1032110
Sex: F
Age: 40
State: CA

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

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fainted twice! Causing massive head trauma & wounds. It happened 35 hours after the vaccination & I was given no warning that this could happen.

Other Meds: None

Current Illness: None

ID: 1032111
Sex: F
Age: 26
State: WA

Vax Date: 02/08/2021
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:
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: Very swollen lymph nodes in the arm that received vaccination. Started with lymph node in armpit, then worsened with lymph node at the opposite side of the arm from the vaccination and the wrist.

Other Meds: Vyvanse Oral probiotic Multi-vitamin Albuterol Flovent

Current Illness: None

ID: 1032112
Sex: F
Age: 47
State: MO

Vax Date: 02/11/2021
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: RA

Lab Data:

Allergies: Sulfa

Symptom List: Nausea

Symptoms: Swollen lymph node near the collar bone on the left side. Tender to the touch

Other Meds: Ibuprofen

Current Illness:

ID: 1032113
Sex: M
Age: 76
State: MD

Vax Date: 01/21/2021
Onset Date: 01/28/2021
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: Penicillin

Symptom List: Injection site pain

Symptoms: Rash lasted 4 days, slight itching in evenings only Not seen by medical folks

Other Meds: Ditiazem 180 mg Atorvastatin 10 mg Niacinamide 500 mg Vitamin D3 4000 IU Magnesium 400 mg

Current Illness:

ID: 1032114
Sex: F
Age: 41
State: NY

Vax Date: 02/07/2021
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: none

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

Symptoms: Next day the injection site became red, itchy, warm to the touch, and circular in appearance. It got better after a few days. While the injection site improved, I had bilateral rashes on my forearms. This became better, then 1 week after the shot, which is today, the injection site became inflamed again, felt like a hard lump, became itchy. Appears to be "covid arm" as I've researched.

Other Meds: probiotics

Current Illness: none

ID: 1032115
Sex: F
Age: 83
State: OH

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: PCN

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

Symptoms: Leaving pt after 20 min monitoring and felt dizziness as exiting site. Client reports taking meds this morning + not eating. O2 95%, BP 100/70, after eating a slice of pizza + sniker bar she reports feeling better. Hydrated with water. Monitor additional 30 min and scorted to her car. Recently hospitalized due to asthma 2 weeks ago.

Other Meds: Pravastatine; Metoprolol,

Current Illness: Asthma

ID: 1032116
Sex: F
Age: 74
State: FL

Vax Date: 02/08/2021
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: Peniciliin, sulfur, Trelegy

Symptom List: Tremor

Symptoms: Redness, swelling, warm to touch

Other Meds: Yes, maintenance medications

Current Illness: No

ID: 1032117
Sex: F
Age: 37
State: IA

Vax Date: 02/05/2021
Onset Date: 02/06/2021
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: no

Symptom List: Erythema, Pruritus

Symptoms: I took Ibuprofen 800 Mg - taking every 8 hours - I took this after I started having symptoms which was the next morning. I noticed the next morning and it lasted 24 hours - headache; fever, chills and fatigue.

Other Meds: Loratadine 10 mg;

Current Illness: Adverse reaction for dose 1 of the Moderna vaccine - otherwise no other illnesses

ID: 1032118
Sex: M
Age: 36
State: OH

Vax Date: 02/12/2021
Onset Date: 02/12/2021
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: None

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

Symptoms: 1340 reporting dizzyness

Other Meds: None

Current Illness: None

ID: 1032119
Sex: M
Age: 78
State:

Vax Date: 01/28/2021
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:

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

Symptoms: redness and itchiness around area of vaccine >7 days after vaccine given.

Other Meds:

Current Illness:

ID: 1032120
Sex: M
Age: 30
State: SC

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: unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: burning sensation at injection site that radiates to left neck and left side of head behind ear. dizziness. chest tightness. foreign body sensation in back of throat.

Other Meds: 50 mg of benadryl about 15 minutes after injection

Current Illness: no known illness at time of injection and up to one month prior

ID: 1032121
Sex: F
Age: 48
State: TX

Vax Date: 01/27/2021
Onset Date: 02/03/2021
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: Shrimp Latex Sulfa drugs Levaquin

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

Symptoms: After a week or 10 days, a large knot appeared on arm with a red mark with fever in it. It now looks like a bruise.

Other Meds: Topirimate Duloxitine Diltiasan Corlenor Furosemide Cyclobenziprene Clanazopan IVIG Melatonin Zinc Elderberry

Current Illness: Sinus infection

ID: 1032122
Sex: F
Age: 44
State: IL

Vax Date: 02/06/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Red swollen hive near the injection site. It is hot to the touch, firm under the skin. Appeared one week after I received the shot.

Other Meds: Q-Nasal

Current Illness: none

ID: 1032123
Sex: F
Age: 69
State: WA

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

Lab Data:

Allergies: Penicillin, Sulfa, Clindamycin, Lodine, Indocin, Topical Chlorhexadine

Symptom List: Pain in extremity

Symptoms: Itching, soreness and warm red circle around injection site. Itching comes and goes. Ice application provides relief

Other Meds: Synthroid, Triamterene /HCTZ, Lamotrigine, Rosuvastatin, Omeprazole, Tamoxifen , Multivitamin, Vit D3, Potassium, Calcium

Current Illness: None

ID: 1032124
Sex: M
Age: 79
State: NE

Vax Date: 02/09/2021
Onset Date: 02/09/2021
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: NKA

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

Symptoms: 79 Yr old pt had Covid Vaccine 2nd injection on Tuesday. Pt became ill on Tuesday noc with generalized bodyaches and loose stools. No fever. No cough nor HA. No redness nor swelling of arm. Injection was the Moderna. Last voided this evening. Last normal meal was AM of vaccine injection. 2. Increased dependent lung base atelectasis 3. Mild gallbladder wall edema suggesting choleycystitis. No biliary ductal dilitation or calcified stone. 4. Mild pancreatitis without abscess or necrosis 5. Colonic diverticulosis without diverticulitis. Impression: 1. Mild-Moderate Dehydration 2. Reaction to second dose of Covid -19 Moderna vaccine 3. Elevated LFT's suggesting CD Obstruction 4. Elevated wbc most likely related to #3 or #5 5. Bibasilar atelectasis with low lung volumes and accounting for Hypoxia; suspect related to #6 6. Acute Pancreatitis with Amylase 348 and Lipase 1109 7. Elevated D Dimer ; DISCHARGE SUMMARY Date of Admission: 2/11/2021 Date of Discharge: 02/12/2021 Admitting Diagnosis: Acute pancreatitis, acute cholecystitis Discharge Diagnosis: Acute pancreatitis, acute cholecystitis, sepsis History of Present Illness: Pt presented with 2 days of generalized malaise, abd pain, and diarrhea, starting shortly after his second Moderna COVID-19 vaccination. In the ER, he was found to have acute pancreatitis and cholecystitis as determined by CT scan and U/S without biliary tree involvement. Given new O2 requirements, CT chest performed and was negative. Labs showed elevated amylase/lipase, elevated bilirubin, AST/ALT/alk phos. Disposition: Transfer to Medical Center for further management Condition: Fair

Other Meds: Active Home Meds Medication Strength Dosage Route Frequency Start Date Last Dose Date Last Fill Date Prescribing MD Special Instructions NITROGLYCERIN SUBLINGUAL [0.4MG](NITROSTAT) 0.4 MG Tablet Sublingual 0.4 mg Sublingual as needed every

Current Illness: Sleep Disorder

ID: 1032125
Sex: M
Age: 70
State: SD

Vax Date: 01/29/2021
Onset Date: 02/02/2021
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: Ceclor, Ibuprofen

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

Symptoms: I could NOT get out of bed. It was if I was paralized on my legs.

Other Meds: fentanyl Patch, Omeprazole, Gabapentin, Mirtazapine, Tamsulosin, Movantik, Oxycodone Multi-vitamins, Vitamin D3, Miralax

Current Illness: None

ID: 1032126
Sex: F
Age: 33
State: CA

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

Lab Data:

Allergies: Sulfa, codeine

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

Symptoms: Chills, no fever, pulled my back in the morning with blinding pain/hearing loss, mostly recovered by next day (14th) now feels like a regular pulled muscle

Other Meds: None

Current Illness: None

ID: 1032127
Sex: F
Age: 75
State: CA

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Vomiting

Symptoms: Excessive pain in arm . Fever with chills, chattering teeth. Strong head aches. Aches in legs and arms and all joints. Feeling like "crawling ants". Stomach ache and nauseated. Loss of appetite and unable to eat and drink. Couldn't get warm. Endured 2 days, first day very strong, second day milder. Diarrhea during the night after second day. On the third day still no appetite and feeling weak. I am still normally very active and alert.

Other Meds: Losartan, Aspirin 81mg + Nexium + Vitamin B-12 + Vitamin D-3

Current Illness: none

ID: 1032128
Sex: F
Age: 44
State: AZ

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

Lab Data:

Allergies: Gluten Bee venom Iodine in x-ray dye

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Within 45 minutes, had an overwhelming metallic taste in mouth. Lost ability to taste food for 36 hours. Also had a fuzzy feeling in ears. Next day had fatigue, headache, aches, shortness of breath. Subsided within 48 hours.

Other Meds: Enbrel, amitriptlyine, calcium pills

Current Illness: Rheumatoid arthritis Fibromyalgia

ID: 1032129
Sex: F
Age: 76
State: CA

Vax Date: 02/06/2021
Onset Date: 02/15/2021
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: none known

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

Symptoms: Large red itchy spot at injection site

Other Meds: None

Current Illness: none

ID: 1032130
Sex: F
Age: 63
State: AZ

Vax Date: 01/18/2021
Onset Date: 01/18/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: strange feeling and some pain began on left side of neck, left ear and went up my whole neck to my face. Unsure what the feeling was then realized it felt numb and swollen. tongue felt thick. kinda of like after being numb at dentist office. I also felt kind of tired. I was afraid my throat was going to close up but it didn't. after 1 hour the feeling began to fade. and then went away.

Other Meds: amlodipine

Current Illness: high blood pressure

ID: 1032131
Sex: F
Age: 42
State: NY

Vax Date: 01/27/2021
Onset Date: 01/28/2021
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: Sensitive to narcotics

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

Symptoms: I was fine until 24 hours later. I felt I was coming down with the flu. I had aches, felt feverish, foggy. I left work and went home to lay down. That lasted 2 or 3 days. I arm was swollen with a lump underneath, which went away after a week but it's still red. I started feeling better, but the symptoms started again about 2 weeks. I started experiencing symptoms like I got the shot again. I keep getting dizzy and I'm having headaches, which I'm still experiencing.

Other Meds: Norvasc 5 mg Vitamin C

Current Illness:

ID: 1032132
Sex: F
Age: 47
State: CA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Allergic to penicillin, sulfa drugs

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

Symptoms: Headache and fatigue 2/11 and 2/12 followed by itchy rash on left front chest 2/13. Rash spread to back and became painful on 2/14. Got diagnosed with shingles at Urgent Care on 2/15.

Other Meds: Myrbetric 50 mg/daily Estradiol 1mg/daily Amitriptylin 50mg/daily Escitalopram 10mg/daily Bupropion SR 100mg/daily Lactulose L-Methylfolate 15mg/daily

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm