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

Incidents per State

State Total
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 1031883
Sex: F
Age: 29
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Tingly lips and throat. Red eyelids. Self-administered benadryl and all symptoms resolved after monitoring for 1 hour.

Other Meds:

Current Illness:

ID: 1031884
Sex: F
Age: 82
State: HI

Vax Date: 01/25/2021
Onset Date: 01/31/2021
Rec V Date: 02/15/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: aspirin

Symptom List:

Symptoms: 7 days post COVID #1 vaccine, onset of bilateral leg claudication (1/31/21). Subsequently dx'd with acute bilateral arterial clots in both legs requiring thrombolysis, bilateral popliteral/artery thromboembolectomy, heparin. Acute clot per vascular surgeon. Surgery performed 2/12/21.

Other Meds: Lisinopiril, atorvastatin, advair, metoprolol, amlodipine

Current Illness:

ID: 1031885
Sex: F
Age: 69
State: OH

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: The evening of Feb 4th she started feeling tired. Feb 7th still tired, started feeling anxious, heart was beating harder and faster, stomach felt upset, she was burping a lot Feb 8th went to primary care doctor. BP was 175/90. She felt dizzy and lightheaded, ringing in ears was louder than usual She gave another BP med to take, but she didn't take it. Instead took an extra of hr own propranolol. Yesterday was the first day the sxs were better. Other than taking the extra propranolol on Feb 8th, she just rested 2/11/21 is the first day the tiredness has let up

Other Meds: hypertension - HCTZ 25 mg, propranolol 40 mg BID Gout- allopurinol 100 mg BID Diabetes metformin 500 mg QD, Glimepiride 4 mg

Current Illness:

ID: 1031886
Sex: F
Age: 82
State: PA

Vax Date: 02/05/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Bee Venom; Voltaren; Clarithromicin; Fluoxetine Hcl; Erythromycin; Celexa; Rosuvastatin Calcium; Ace Inhibitors; Calcilo Xd

Symptom List:

Symptoms: Redness/rash, itching, soreness

Other Meds: Losartan 50 mg; Levothyroxine .075 mg; Desloratadine 5 mg;Omeprazole 40 mg; Montelukast 10 mg; Simvastatin 40 mg; Escitopram 20 mg; Krill oil omega 3 500 mg; multi vitamin; Fluticasone Propionate nasal spray

Current Illness:

ID: 1031887
Sex: M
Age: 75
State: IN

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Shingles

Other Meds: Metformin 1000 mg, glimepiride 1mg

Current Illness: None

ID: 1031888
Sex: F
Age: 67
State: CA

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulfa antibiotics

Symptom List:

Symptoms: I was felling a bit dizzy upon awakening the day after the vaccination. Once in the bathroom I became very dizzy and started sweating profusely. I tried to walk back to the bedroom but fainted. I came to sitting on the floor. My husband brought me some water and stayed with me. It took quite a while for those symptoms to subside enough that I could get up and go back to bed. For the next 7 or 8 hours I felt chilly and somewhat tired. Normal by late afternoon and evening.

Other Meds: 12,000 mg flax seed oil, 1,000 IU vitamin D3, 500 mg L-Lysine, LifeTime Osteo Density Blend, Viactive Calcium plus D

Current Illness: none

ID: 1031889
Sex: M
Age: 77
State: DC

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin in chikdhood

Symptom List:

Symptoms: Ipsilateral lymphocyl in the left axilla, 5 cm in diameter, about 1 cm in thickness. Tender, painful with movement, mild, without discrete palpable lymph node enlargement.

Other Meds: Levothyroxine Atorvastatin Stool softener ASA 81 Antioxidants Eye Vitamins Probiotic Calcium magnesium zinc Tea extract Melatonin

Current Illness: None active

ID: 1031890
Sex: F
Age: 17
State: OR

Vax Date: 01/24/2021
Onset Date: 01/24/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient was administered the Moderna vaccine prior to her 18th birthday.

Other Meds:

Current Illness:

ID: 1031891
Sex: F
Age: 47
State: MN

Vax Date: 12/18/2020
Onset Date: 01/04/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin, minacyclin,

Symptom List:

Symptoms: Severe enlarged lymph node, resolved in about a week, large lump in armpit that was super sore and hurt to the touch. Right arm pit.

Other Meds: Over the counter vitamins , polmicourt

Current Illness:

ID: 1031892
Sex: F
Age: 66
State: IN

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Woke up shaking, headache, hurting all over. Lasted about an hour. Feeling tired still on day 6. Day 4 one cold sore started, Day 5, two more cold sores.

Other Meds:

Current Illness:

ID: 1031893
Sex: F
Age: 71
State: FL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Codeine

Symptom List:

Symptoms: Welts, rashes, severe itching and pain

Other Meds: Multi vitamin, Glusosamine Chond, Metamucil, C, E, Fish Oil, Aspirin, Zinc, Calc/Mag/Zinc, Potassium , Motrin and Elavil

Current Illness: None

ID: 1031894
Sex: M
Age: 24
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: patient may have been given different dose. Patient on the list of the vaccinator when brought to attention

Other Meds:

Current Illness:

ID: 1031895
Sex: F
Age: 81
State: LA

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: codeine

Symptom List:

Symptoms: pt stated that she has had difficulty breathing at night, congestion, thickness in her throat, chills, nausea, constant dizziness, has a rash around her neck, has fatigue and weakness. Pt also has had pain in her right knee the night of the vax. Pt just feels bad, raised blood pressure, has numbness in both hands and is very uncomfortable. Pt called her PCP and was told to her to take an extra HBP pill. Since pt is still having most of these symptoms she will call her PCP back for more medical advice.

Other Meds: Furosemide 20mg, ezetimibe 10mg, losartan potassium 100mg, hydralazine 50 mg, diltiazem 120mg, Multivitamin, aspirin 81mg,

Current Illness: blood pressure running higher than normal

ID: 1031896
Sex: F
Age: 73
State: KS

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Naproxine

Symptom List:

Symptoms: fever, diarrhea, headache, sore arm, sore underarm, mouth sores (cheeks, tongue, under tongue, gums)

Other Meds: Levothyroxine allopurinol fluoxetine simvastatin omprazole fish oil probiotic apple cider vinegar

Current Illness: none

ID: 1031897
Sex: F
Age: 56
State: IL

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Compazine; Sulphur; tomatoes

Symptom List:

Symptoms: After getting vaccine, I got burning in my chest and after a few seconds that went away. After 15 minutes, I noticed a headache and after an hour it became more intense and I had to take something for it. No other symptoms except a headache until the next day. I had chills; general body aches; real bad joint point - couldn't work from home because I couldn't type on computer. Chills and headache continued - at midnight - the right side of my neck was really stiff and painful to touch. My lymph nodes on right side were enlarged. The next morning, at 11:00 - general fatigue; body aches and headache and chills and couldn't drive yourself. Went to my provider and got a COVID screening; mumps titer screen; Epstein Barr Virus titer; Nurse practitioner gave me doxycycline and Dr. told me stay off work until they got COVID test back. Went back to work that following Monday. On Monday test results were back and were negative for everything. Have had the same reaction to flu reaction about seven years ago. I had the same reaction to the Hepatitis Vaccine and the Hepatitis B vaccine - is what triggered my IGG numbers to be higher. Symptoms have lessened with flu vaccines over the years. This COVID vaccine was an intense response for the first dose. I took Ibuprofen and then Tylenol (alternating with Ibuprofen six hours later) for second dose of the vaccine and my response for that does wasn't as intense - it was there but not enough of a reaction where I couldn't work.

Other Meds: I was getting a weekly B12 injection; Vit D injection 50,000 IUD orally- a week

Current Illness: no

ID: 1031898
Sex: F
Age: 81
State: MO

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Bactrim

Symptom List:

Symptoms: Dose 2 given 14 days after dose 1

Other Meds: unknown

Current Illness: unknown

ID: 1031899
Sex: M
Age: 32
State: CA

Vax Date: 01/16/2021
Onset Date: 01/19/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Only known allergy is Penicillin.

Symptom List:

Symptoms: Severe hives and swelling in face/lips appx 3.5 days after getting 1st dose of Covid-19 Moderna Vaccine. Blood test showed that I am suddenly highly allergic to 19 different food groups. I have no known food allergies prior to C19 Moderna Vaccine. I have had hives every single day since they 1st appeared (3.5 days after vaccine). I have had multiple days of facial swelling as well and have been to the hospital multiple times. To this date (date of this report) I still have hives and facial swelling. Facial swelling is intermittent. I have stayed away from the list of foods that I am apparently suddenly allergic to and I still have hives and swelling. I occasionally have a irritated throat which makes it difficult to breathe in. I have a specialist appointment with an allergy/immunology doctor this coming Thursday to see what thier diagnosis is. My family doctor believes my potential angioedema diagnosis is directly related to my 1st dose of C19 Moderna Vaccine.

Other Meds: None.

Current Illness: None.

ID: 1031900
Sex: F
Age: 29
State: PA

Vax Date: 01/18/2021
Onset Date: 01/30/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Shellfish, pollen/seasonal allergies

Symptom List:

Symptoms: Left second toe became discolored and stinging/painful, then left 4th toe. Exam c/w pernio/chillblains

Other Meds: none

Current Illness: None other than lymphadenopathy also associated with vaccine

ID: 1031901
Sex: M
Age: 77
State: MN

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/15/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No Known Allergies

Symptom List:

Symptoms: 1/30/2021 23:08 Nursing Note Note Text: Patient refused to use incentive spirometer at bedtime. Writer administered prn Mucinex at 1600 and 2130 for upper chest congestion. 02 at 1 liter per NC during thru the night for comfort. 02 sats at 95%. Writer encouraged fluids at bedside. Patient was compliant in taking a shower earlier this afternoon but refused supper. Patient has been mildly confused to place and time, reoriented easily. Will continue monitor vital signs and encourage incentive spirometer. 1/31/2021 00:15 Nursing Note Note Text: Patient had very large incontinent fowl smelling bloody stools at mid noc. Writer called Nurse supervisor also to assess stool. MD was called new order to send patient to hospital for evaluation. Wife was called and updated, bedhold obtained.

Other Meds: Pantoprazole Sodium Tablet Delayed Release 40 MG Multivitamin Tablet (Multiple Vitamin) guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Atorvastatin Calcium Tablet 40 MG Aspirin EC Tablet Delayed Release 81 MG (Aspirin) Apixaban

Current Illness: ENCOUNTER FOR SURGICAL AFTERCARE FOLLOWING SURGERY ON THE CIRCULATORY SYSTEM PRESENCE OF OTHER VASCULAR IMPLANTS AND GRAFTS PRESENCE OF PROSTHETIC HEART VALVE OTHER SPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES NONRHEUMATIC AORTIC (VALVE) STENOSIS CEREBRAL INFARCTION DUE TO UNSPECIFIED OCCLUSION OR STENOSIS OF LEFT MIDDLE CEREBRAL ARTERY APHASIA FOLLOWING CEREBRAL INFARCTION ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS THORACIC AORTIC ANEURYSM, WITHOUT RUPTURE UNSPECIFIED ATRIAL FIBRILLATION GASTROINTESTINAL HEMORRHAGE, UNSPECIFIED ACUTE DUODENAL ULCER WITHOUT HEMORRHAGE OR PERFORATION POLYP OF COLON ABNORMAL ELECTROCARDIOGRAM [ECG] [EKG] LONG TERM (CURRENT) USE OF ANTICOAGULANTS ESSENTIAL (PRIMARY) HYPERTENSION HYPERLIPIDEMIA, UNSPECIFIED RETENTION OF URINE, UNSPECIFIED ACUTE POSTHEMORRHAGIC ANEMIA ALCOHOL ABUSE, UNCOMPLICATED DIAPHRAGMATIC HERNIA WITHOUT OBSTRUCTION OR GANGRENE OTHER POSTPROCEDURAL COMPLICATIONS AND DISORDERS OF THE CIRCULATORY SYSTEM, NOT ELSEWHERE CLASSIFIED

ID: 1031902
Sex: F
Age: 66
State: NY

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Significant discomfort when raising arm above a certain height and redness/inflammation at injection site

Other Meds:

Current Illness:

ID: 1031903
Sex: F
Age: 56
State: AL

Vax Date: 02/09/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: Rash on right buttock after first vaccine and went away. Came back after 2nd vaccine with burning and itching and more places. No pus just red and angry

Other Meds: Estradiol

Current Illness: None

ID: 1031904
Sex: F
Age: 66
State: MO

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None known

Symptom List:

Symptoms: Moderna COVID-19 Vaccine EUA Vaccine administered at 8:30 am on 2/11/2021. Left arm started becoming sore about 8 PM that night. Patient took 325 mg aspirin po to relieve inflammation. Chills began at 1:30 and persisted for 3-4 hours. Patient collapsed about 6:30 PM on 2/12/2021 and EMS responded to home within minutes. Vitals were WNL. EKG showed no significant problems. Blood glucose was 144 mg/dl.

Other Meds: Krill oil, aspirin, Vitamin C, Vitamin D, alpha lipoic acid

Current Illness: None

ID: 1031905
Sex: F
Age: 72
State: NH

Vax Date: 02/05/2021
Onset Date: 02/09/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: vicodin tetracycline bactrim

Symptom List:

Symptoms: 2/5 vaccination 2/6 arm a little sore when moved, very fatigued- 2/7-2/8-2/9 very fatigued 2/9 nausea, vomited once, diarrhea several times, aches, fever of 101.5, sleeping 2/10 totally recovered

Other Meds: metformin probiotics losartan lovastatin lantus solostar insulin

Current Illness: none

ID: 1031906
Sex: F
Age: 70
State: NY

Vax Date: 01/30/2021
Onset Date: 02/07/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Tegaderm tape

Symptom List:

Symptoms: Arm where shot was given became hot, swollen, covering 75% of area between shoulder & elbow. Presented on day 8 after injection, lasted eight days. Took thuja for five days.

Other Meds: Tacrolimus,Clobatsel, Protopic, Vit. D3,Vit. E, Fish Oil , S.A.T. , L-Glutamine, Citrus Pectin, Probiotic, Melotonin

Current Illness: Post chemo & Radiation 5 months out

ID: 1031907
Sex: F
Age: 40
State: FL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Fever over 102, body aches, headache, redness and swelling and knotting 10-15 cm in diameter at injection site.

Other Meds: None

Current Illness: None

ID: 1031908
Sex: M
Age: 75
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Acute sudden hearing loss in right ear 4 hours after being vaccinated with Pfizer Covid vaccine

Other Meds: Klonipin Synthroid

Current Illness: Sleep apnea Hypothyroidism Perioidic limb movement disorder

Date Died: 02/14/2021

ID: 1031909
Sex: F
Age: 56
State: FL

Vax Date: 01/08/2021
Onset Date: 01/30/2021
Rec V Date: 02/15/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: amoxicillin (swelling), sulfur (swelling), loratadine (rash)

Symptom List:

Symptoms: Pt received dose #1 of COVID-19 vaccine (Pfizer-BioNTech) on 12/18/20 and dose #2 ( Pfizer-BioNTech) on 1/8/21. On 1/30, patient was evaluated at urgent care due to back pain. No bloodwork done; metronidazole prescribed for 7 days. On 2/8, patient was admitted to outside hospital due to ongoing symptom progression. At time of admission, hgb 5 g/dL and plt 9k. Per Dr. (hematology/oncology), pt with schistocytes, LDH 1500, and elevated reticulocyte count consistent with thrombotic thrombocytopenic purpura (TTP). SCr >2 mg/dL. Patient immediately treated with plasma exchange and steroids, however continued to decline. Patient expired on 2/14/21.

Other Meds: Acetaminophen 650 mg PO q4h PRN for pain, amlodipine 10 mg PO daily, atenolol 100 mg PO daily, calcium carbonate/cholecalciferol 600 mg/200 mg PO BID, fluticasone 50 mcg per nare daily, HCTZ 25 mg PO daily, phentermine 37.5 mg PO AC breakfa

Current Illness: None known

ID: 1031910
Sex: F
Age: 33
State: CA

Vax Date: 02/12/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Malaise & hypersomnolence around 20 hours post-injection. "COVID arm" around 36 hours post-injection: redness and slightly raised bump all around injection site, ~1" diameter. Sensitive , tender, painful to touch, pain is about 2/10 without movement, 6/10 with palpation. Feels like a very bad mosquito or bug bite.

Other Meds: Prenatal

Current Illness: None

ID: 1031911
Sex: F
Age: 55
State: CA

Vax Date: 02/04/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Seasonal allergies, pollen , etc

Symptom List:

Symptoms: Small red rash on cheeks and diarrhea for 2 days

Other Meds: None

Current Illness: None

ID: 1031912
Sex: F
Age: 39
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: 12:36: Vaccine administered 0.5 ml Moderna. 12:46: Patient became, light headed and flushed. Assessed by RN on site. Vitals taken,Vitals :139/80 P:125 02:100%. Patient alert oriented and verbally reported feeling flushed. Pt given 50mg oral Benadryl and water, elevated legs. Symptoms relieved within 10 minutes of admin. Monitored patient for an aditional 30 mins, family onsite and availabe to drive patient home for safety. Advised patient to go home and rest for the the day, provided education to take Acetaminophen for any additional mild symptoms and to call emerency service or any unexpected adverse. V/S after 30 mins BP127/81 P92 02:99% and patient reported feeling back to baseline prior to vaccine administration. Supervisor on site currnetly in vaccination room and aware.

Other Meds: Unknown

Current Illness: Unknown

ID: 1031913
Sex: F
Age: 31
State: IN

Vax Date: 01/09/2021
Onset Date: 01/10/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Severe Chills, body aches. Fatigue

Other Meds:

Current Illness:

ID: 1031914
Sex: F
Age: 30
State: OK

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
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Allergies: None

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Symptoms: Besides the usual body aches and body chills, I also developed sinus pressure, chest pressure, and a very mild cough.

Other Meds: Balcoltra (birth control) Spironalactone

Current Illness: None

ID: 1031915
Sex: F
Age: 67
State: GA

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/15/2021
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Allergies: Augmentin Clarithromycin Doxycycline Sulfa Class Avelox

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Symptoms: 8 hours post the vaccine the pt experienced severe nausea, vomiting, diarrhea, fever , chills and aches

Other Meds: None

Current Illness: None

ID: 1031916
Sex: F
Age: 67
State: ME

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/15/2021
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Symptoms: Increased Temp and lethargy after second dose resolved after 24 hours

Other Meds:

Current Illness:

ID: 1031917
Sex: M
Age: 73
State: MA

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/15/2021
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Allergies: Hydrocodone/Acetaminophen

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Symptoms: Provider administered an expired hep-B vaccine by mistake. Vaccine expired 1/24/21 and visit was on 2/3/21. No patient harm noted. RN realized the error after patient left the clinic and scanned the vaccine vial for documentation.

Other Meds:

Current Illness:

ID: 1031918
Sex: F
Age: 55
State: MI

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/15/2021
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Allergies: LIDOCAINE,BACTRIM DS, CODEINE

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Symptoms: AFTER RECEIVING VACCINE SHE COMPLAINED OF HEADACHE AND LIGHT HEADEDNESS. GLUCOSE 69, BP 156/96 HR 68 100% O2 ON ROOM AIR SHE WAS TREATED WITH ORAL GLUCOSE WAITED 15 MINUTES RECHECKED GLUCOSE WAS 75MG/DL AND SHE FELT BETTER. SHE WAS RELEASED TO HOME, WITH A RECOMENDATION TO GET SOMETHING TO EAT.

Other Meds:

Current Illness:

ID: 1031919
Sex: F
Age: 68
State: MO

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
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Allergies: Penicillin, Adhesive

Symptom List:

Symptoms: Chills, Fever, Body aches

Other Meds: Escitalopram 10 mg, Dutasteride 0.5mg , Cranberry supplement, Hydrocodone 10-325 mb

Current Illness: N/A

ID: 1031920
Sex: F
Age: 67
State: MD

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
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Allergies: none

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Symptoms: received the 2nd vaccination of Moderna on 2/12 930a on 2/13 at 11a started to feeol diczzy - try to make it the bed but able to do so ended up part on bed and part on floor - unable to move - could hear things around me - the tv was on - I could feel the sweat drops coming off my face - (it felt like I was "locked in" - term used when coma pts can hear but able to move - I could feel the chills down my back - this lasted about 1/2 hr then started to be able to feel myself coming around - the whole time I kept telling myself to take slow deep breaths- the entire episode lasted about 1 1/2 -2hr - felt low energy after that - following morning felt back to normal

Other Meds: Hydroxurea 500mg qday HCTZ 25 mg /day ASA 81 mg

Current Illness: received 2nd Shingle shot Decemember 30

ID: 1031921
Sex: F
Age: 74
State: TX

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/15/2021
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Allergies: Demerol

Symptom List:

Symptoms: skin redness , irritation and itching. In arms, midsection and groaning areas. Mostly on the right side. Moderna Vaccine

Other Meds: Allergy medication

Current Illness: small area skin poison ivy infection

ID: 1031922
Sex: F
Age: 52
State: ID

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/15/2021
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Allergies: Sulfa

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Symptoms: Patient was waiting the 15 minutes for observation after vaccine was administered and after about 5 minutes patient slid out of chair and had a syncopal episode with extreme redness around throat area, elevated heart rate and blood pressure, extreme shakiness. And could not clearly describe her symptoms. Patient stated she just wanted to go to sleep. Patient was monitored and epi pen was administered to patient by provider. EMS was called and patient transported to ER.

Other Meds:

Current Illness:

ID: 1031923
Sex: F
Age: 17
State: OR

Vax Date: 01/24/2021
Onset Date: 01/24/2021
Rec V Date: 02/15/2021
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Symptoms: Patient was administered the Moderna vaccine prior to her 18th birthday

Other Meds:

Current Illness:

ID: 1031924
Sex: F
Age: 75
State:

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/15/2021
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Symptoms: Patient is a 75 year old female who has completed a 2 hours observation period with the following signs and symptoms of an adverse reaction; hypotension and loss of consciousness. Moderna COVID-19 vaccine #1 in series administered. 1318- pt. reported blurred vision to RN. Pt immediately assessed, during assessment pt. temporarily lost consciousness. Vitals- O2 sat-96%, HR-55, B/P-55/27, resp-16; 1320-DOD called, recommendation was to send to the ER via 911; 1324- Paramedics arrived and assessed pts. blood sugar (167), vitals O2 sat-98%, HR-71, resp 16, BP-91/40. Paramedics stated transfer to hospital was not necessary, but offered, Pt. declined ambulance transfer to ER. 1330- Continued to monitor pt. while giving oral fluids. Pt. reports she has fully regained consciousness, and blurry vision has resolved. Vitals, BP-102/42, HR-73, O2sat-96%, resp-16; 1335- Vitals, BP-110/50, HR-82, O2sat-96%, resp-16; 1400- Vitals, BP-121/45, HR-66, O2sat-97%, resp-18; 1420- Vitals, BP-125/31, HR-66, O2sat-96%, resp-16, DOD advised pt. should be assessed by MD. Pt. continues to refuse transfer via ambulance, no family members present. 1440- Pt discharged. o Action(s) taken: Recommended transfer to higher level of care, risk and benefits explained to patient, patient declined ride from ambulance to ER and was discharged. o Patient advised to discuss second dose considerations with a clinician

Other Meds:

Current Illness:

ID: 1031925
Sex: M
Age: 71
State: OH

Vax Date: 02/09/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
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Allergies: none

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Symptoms: On 2/9/2021 experienced headache, chills, and sore arm 0n 2/10/2021 still experiencing similar side effects but know light headed On 2/11/2-12: 930AM experienced a TIA . I totally believed it was a by product of the Covid shot - 1st dose. Had to go to ER and go through series of tests. Now on blood thinner. Since this occurred i know of 2 people that had similar results and experienced a stroke with 2 of them experiencing major stroke and died. people had similar results Now I don't think I will take second dose - very scared NOTE: I was in great shape prior to this vaccine

Other Meds: metformin simvastatin vitamin D3

Current Illness: none good health

ID: 1031926
Sex: F
Age: 37
State: OK

Vax Date: 02/08/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
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Allergies: NA

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Symptoms: Large knot under left arm discovered on Wednesday night after receiving vaccine on Monday. Area appeared to increase in size over next 4 days.

Other Meds: Crestor Vitamin C Vitamin D

Current Illness: None

ID: 1031927
Sex: F
Age: 61
State: OH

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
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Allergies: penicillin - hives, codeine - biliary sphincter pain, morphine - biliary sphincter pain

Symptom List:

Symptoms: diffuse red macular rash on face, chest, arms; eyelid swelling. describes as burning. appeared gradually after receiving injection 18-24 hours

Other Meds: levothyroxine, aspirin, calcium, potassium, zinc, coQ10, omega 3

Current Illness: none

ID: 1031928
Sex: F
Age: 87
State: OH

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/15/2021
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Symptoms: The night she received the shot she developed pain, tenderness, redness and swelling at the injection site. The next morning had headache, chills, heart felt loud and fast, could not think, could not remember even normal things like how to turn on TV, insomnia. Went to store and became weak and breathing hard with minimal activity, had to sit down and rest before leaving. Symptoms lasted about 3-4 days and at this point have resolved.

Other Meds: vitamine D3, valsartan, chlorthalidone, atorvastatin, guanfacine, metoprolol, tylenol, eye vitamin, iron, b complex , biotic, baby aspirin

Current Illness:

ID: 1031929
Sex: M
Age: 63
State: OH

Vax Date: 01/04/2021
Onset Date: 01/08/2021
Rec V Date: 02/15/2021
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Symptoms: I just had pain and swelling at the injection site that lasted over three days. On the 7th Thursday night, I developed a fever 101.5 and took Friday the 8th off of work. I also got a Covid test that came back negative and saw my PCP also tested for Flu A and B, tested negative. I felt lousy, has chills, aches, sinus head aches, I was miserable. My fever went away the afternoon of the 8th and I did not have a fever after that. On the 11th I saw my PCP and he referred me to an ENT and I saw the ENT on the 13th. I also called off work 14th-29th. I was admitted at the Hospital on the 14th with a code and had two surgeries and Gallbladder removed. I was in the Hospital for 5 days. I had my 2nd shot on the 5th with approve from Medical Dr.s with a little swelling but no other symptoms.

Other Meds:

Current Illness: Yes, I was having sinus issues. On and off fevers, about every other week.

ID: 1031930
Sex: M
Age: 47
State: CA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
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Allergies: None

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Symptoms: Shortly after the shot I began to feel itchiness in my right eye through out the day. The next day 2/13/21 I woke up with blood in my right eye. I did not have any itchiness, pain, or teary eye. On 2/14/21 the blood now was in 75% of my right eye. Today on 2/15/21 I went to urgent care to have it checked out and they told me I had a ruptured blood vessel. My entire eye is now covered in blood. I had not experienced any vomiting or had any cough of any type, or hit my eye anywhere for this to happen.

Other Meds: Multivitamin, Ginkgo Biloba, D3, and Fish oil vitamins

Current Illness:

ID: 1031931
Sex: M
Age: 36
State: IN

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
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Symptoms: Severe chills. Recurrent High grade fever, not responding much to ibuprofen and Acetaminophen. Mild chest pain Nasal congestion and post nasal drip

Other Meds:

Current Illness:

ID: 1031932
Sex: F
Age: 40
State: IL

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/15/2021
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Allergies: NKA

Symptom List:

Symptoms: Arm pain started within 2 hours of receiving injection. Same side neck pain started within 4 hours. Neck stiffness was noted within 8 hours. Within 12 hours, all-over body aches and non-fever related chills began. These persisted for 24 hours. Injection site was visibly swollen by hour 48. This last symptom dissipated within the week post injection. The body aches and chills were temporarily relieved with the use of acetaminophen; multiple doses were required.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm