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: 1036954
Sex: F
Age: 39
State: NV

Vax Date: 02/06/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
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: Barley

Symptom List: Dysphagia, Epiglottitis

Symptoms: My left arm has a large, red, hot, itchy welt.

Other Meds: Taytulla birth control

Current Illness: None

ID: 1036955
Sex: F
Age: 35
State: NY

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/17/2021
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: Dairy and Maple

Symptom List: Anxiety, Dyspnoea

Symptoms: Extremely fatigued unable to perform daily activities. Worst was next day after vaccine (Thursday) through the 5th day (Monday). Starting Monday afternoon thru Wednesday afternoon (Now) extreme sweating, like the soaked clothes kind. Still extremely weak and fatigued

Other Meds: Celexa 40 mg Wellbutrin 300 mg Adderall 20 mg Aleve 440 mg

Current Illness: None

ID: 1036956
Sex: M
Age: 75
State: IL

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
Hospital: Y

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: None

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

Symptoms: I had a seizure. My wife found me on the bathroom floor convulsing. I was unconscious for over an hour and a half. I was taken to hospital by ambulance. I have short term memory lost. All of the scans were normal and all my vitals signs were normal . I never had a seizure before and it was not signs of a stoke on the cat scan.

Other Meds: AmLodipine 10 mg tablet

Current Illness: None

ID: 1036957
Sex: M
Age: 67
State: OR

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/17/2021
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: Administered incorrect dosage per Moderna vaccine guidelines. patient received 0.3 mL instead of 0.5mL. Per CDC if more than half the dose was given, do not repeat the dose. If less than half the dose was given, then repeat the dose. in this case more than half the dose was given based on CDC guidelines. Incident reported to patient by clinics Doctor. Reviewed the 5 rights of medication administration to ensure incident will not happen again.

Other Meds:

Current Illness:

ID: 1036958
Sex: F
Age: 72
State: CA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: UNKNOWN

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

Symptoms: UNKNOWN

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1036959
Sex: F
Age: 17
State: AZ

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Patient Too Young for Vaccine Administered

Other Meds:

Current Illness:

ID: 1036960
Sex: F
Age: 60
State: MI

Vax Date: 02/09/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
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: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA At 2:30 am woke up with nausea and stomach ache. Continued through the night. I could not sleep. In the morning (9:00) I tried to sleep but had very bad chills for over an hour. Went down to couch and covered up with many blankets. Chills continued for 4-5 hours. Also experienced tiredness, and general 'feeling unwell' throughout the day, as well as extreme heartburn. I stayed home from work and sat on the couch all day, feeling unwell. By about 8pm all of the symptoms disappeared.

Other Meds: Losartan, 50mg. Metaprol suc E 25 mg. Atorvastatin 40 mg. Clonazepam .5. Tylenol before the shot. Ibuprofin after side effects started.

Current Illness: N/A

ID: 1036961
Sex: F
Age: 67
State: FL

Vax Date: 02/02/2021
Onset Date: 02/08/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: about a week after the injection i noted my left upper arm to be red, hot and itchy. In the following days a distinct circular lesion about 2" in diameter developed, then subsided. It continued to be red and hot. Relief was achieved after benadryl 25 mg bid x 2 days . Stopped for a day and then hot red returned on 15th day.

Other Meds: Daily: asa 81mg, levothryoxine 88mcg, atorvastatin 20 mg extimibe 5 mg, vit c 500 mg , vit D 2000u benadryl 25mg

Current Illness: none

ID: 1036962
Sex: F
Age: 72
State: IL

Vax Date: 01/30/2021
Onset Date: 02/08/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: many

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Eight days after the vaccination I broke out in hives that covered my hands and arms. The itching was almost unbearable. The hives spread to my back and legs. Now seventeen days after the vaccination I still have very itching hives over most of my body. Benadryl helps some, but it is always very difficult to concentrate on my work which requires me to research and write. I feel like I have been dropped into a nightmarish alternate universe, where all I can do is try to fend off the itching and the pain.

Other Meds: many

Current Illness: none

ID: 1036963
Sex: M
Age: 34
State: HI

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: C/O dizziness. Medical reserve corps volunteer took vital signs @12:53 BP 120/80, pulse 68, RR 16, breath sounds clear. Reported history of discomfort after shots. Bottled water given. Client reported feeling better, cognitively intact. Answered questions appropriately, made good eye contact. Released from post-vaccination monitoring area.

Other Meds:

Current Illness:

ID: 1036964
Sex: F
Age: 35
State: OH

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Within a minute, there was a different taste in my mouth. Shortly after, began to feel incredibly hot, flushed, burning, and tingling throughout body. Throat and tongue also became tingly. It was like a wave that moved through my body. After waiting it for a few minutes to see if there was improvement, there was a strong ?wave? that came with all of the above, but my heart started racing with palpitations. HR was 120. The heat feeling became worse. Would describe the feeling as a CT contrast feeling, including the feeling of voiding or heat/burning of the bladder. Tongue and throat more tingly. A few minutes later the feeling all became stronger and this is what became the strongest ?wave? of the feeling with my heart beating incredibly fast. The heat/burning/tingling (including the mouth and tongue) were severe. HR 148. Nauseated and lightheaded/dizzy. Transferred to ED. In the ER, epi was administered due to the persisting flushing/burning of the skin/and tingling of the throat and tongue with tachycardia. IV fluid bolus, Benadryl, and zofran were also administered. Tryptase was obtained approximately 35 - 45 minutes after injection. Tryptase 10.8. Improvement in all symptoms following epi/benadryl. Was monitored in the ER and within approximately 1.5 hours, the burning feeling returned, but was centralized in my core (felt internal versus skin). Abdomen/chest area with intermittent burning. At approximately 2-3 hours, the tingling began to return. Slight tingling of the tongue, lip. The burning feeling continued to worsen, now back to the skin as well as the core, and additional benadryl was administered in addition to solu-medrol. Prior to this, the attending physician was concerned that my heart rate remained elevated into the 110/120s 3 hours after the epi administration and she recommended transfer to an adult facility for further evaluation. Due to the burning in my chest, EKG was obtained. Sinus tachycardia. Slight chest tightness, duoneb provided. Had not taken inhalers throughout the day and felt similar to tight chest/difficulty getting deep breath in relation to asthma. Relief after the second dose of benadryl and duoneb. BP remains elevated from shortly after vaccine administration. Transferred to MVH at 4-5 hours post vaccine. En route to facility, HR 130s and BP lower (90s/60 and 90s/50s) - Medic did not think was accurate BP. At MVH, cardiac rule out completed with additional EKG due to development of some chest pains and return of core burning sensation as well as ongoing tachycardia. EKG remains sinus tach, troponins normal. Requested anxiety medication to see if that would help with heart rate. Low dose ativan given. Minimal change to resting heart rate, still elevated. Also received 4 baby aspirin and tylenol for extreme headache. Oxygen saturations were 97-100%. Oxygen saturation at MVH was 90-93%. Attending physician not concerned with going home and saturation still being low 90s as long as there was no shortness of breath. Discharged home with methylprednisone 4 mg 6 day pack and pepcid prescriptions. Resting HR was low 100s at time of discharge. Instructed to continue with antihistamines every 6 hours. DX anaphylactic reaction. Husband checking on me while sleeping, oxygen saturation in sleep 89-91%. After awakening, saturation improved to 94-95%. At home, burning skin and core feelings persisted. Tingling of the throat/tongue/lips continued to be intermittent. Antihistamines helped to relieve symptoms. 26-28 hours after vaccine, symptoms were very strong, was suffering from extreme burning and tingling of the mouth/lips. Considered return to ER but oxygen saturation was okay. HR elevated. 125 at rest. MVH attending physician encouraged me to try to not use the prednisone packet unless necessary/return of symptoms. Started prednisone with the return of symptoms. Continued on routine Benadryl until myoclonic jerking became too pronounced, discontinued on 12/25/2020 and changed to hydroxyzine. Jerking remained but improved and was less bothersome. Continued taking daily dose of Claritin, daily pepcid, daily aspirin. Hives developed 12/25/2020. Return to ER on 12/29/2020 as the jerking was intense and felt to be in chest along with palpitations. EKG and troponin was good, only notable thing physician reported on labs was an elevated WBC count. Did not discuss jerking. To PCP on 1/4/2020 - discussed adverse reaction. Continued problems after vaccine include: intermittent tachycardia (low 100s at rest occasionally vs norm of 70s/ low 80s), higher heart rate when active, burning skin (feels similar to bad sunburn feeling), random pains and occasional brief numbness/tingling/tremoring in muscles/extremities, jerking (continues to improve - recommended change off of benadryl/hydroxyzine to zyrtec), increased need for inhaler, bubbling sensation in left lower abdomen. It does feel as if it comes in waves. Burning sensation, internal tremors of left upper thigh, and intermittent tachycardia continue, 1 month post vax. Antihistamines do help, but discontinued due to jerking. Continue on daily claritin.

Other Meds: Synthroid 25 mcg, Claritin 10 mg, aspirin 162 mg, famotidine 20 mg, albuteral/symbicort inhalers, hydroxyzine 25 mg PRN, and many supplements including Vitamin C, Vitamin D, Zinc. Intermittently take: Quercetin, omega 3, B vitamins, coq10,

Current Illness:

ID: 1036965
Sex: F
Age: 62
State: VA

Vax Date: 02/14/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1036967
Sex: F
Age: 64
State: OH

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Bactrim

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

Symptoms: Passed out twice, for a few seconds each time, during trip to bathroom in attempt to vomit. Nausea, low grade fever, cold sweats following. Did not vomit. Arm soreness at site, other muscle soreness, headache, fatigue continued for six hours. Symptoms lessened and continued for 24 hours at lesser extent.

Other Meds: Hydrochlorothiazide, Simvastatin, Probiotic, Multivitamin, Iron Supplement, Vitamin C, Vitamin D, Zinc, Glucosamine, Fish Oil, Garlic

Current Illness:

ID: 1036968
Sex: F
Age: 17
State: OR

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: Patient was administered the Moderna vaccine, instead of the Pfizer Vaccine. The Moderna vaccine is not indicated for her age group. Her DOB was clearly written on her consent form, entered online when she made her appointment, and verified on her drivers license. She also selected Pfizer when asked which vaccine she would prefer.

Other Meds: Simvastatin 40mg

Current Illness: none

ID: 1036969
Sex: M
Age: 72
State: CA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: UNKNOWN

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

Symptoms: Gave pt COVID vaccine yesterday morning. Was using a different syringe than normal and accidentally gave pt 1 mL instead of 0.5. Called pt 2/16/21 at 3 pm said he was doing fine just had a sore arm. Told him to call me back if he is having any issues.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1036970
Sex: M
Age: 78
State: CA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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 known drug or food allergies

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

Symptoms: Patient received 2nd dose Pfizer COVID 19 vaccine today. The patient was observed for 15 minutes without incident. After he left the facility, it was discovered that the patient received undiluted 0.3ml Pfizer COVID 19 Vaccine. Physician contacted tried to contact patient immediately after discovery of the incident X 2. Voice mail was left. At 6:15, physician was able to reach patient who reported that he felt fine. He was advised to contact physician or his primary care physician for any minor symptoms. For significant symptoms he is to contact 911 for immediate assistance. Doctor reached out to him again today, 2/17. Per patient, he feels fine.

Other Meds: PGE1-Papaverine-Phentolamine 10 mcg-12 mg-1 mg/mL Inj Inj Abiraterone (ZYTIGA) 250 mg Oral Tab predniSONE (DELTASONE) 5 mg Oral Tab insulin syringe-needle U-100 (BD Insulin Ultra-Fine) 1 mL 30 gauge x 1/2" Misc Syringe Container (BD

Current Illness: None

ID: 1036971
Sex: F
Age: 86
State: CA

Vax Date: 02/01/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
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: Aspirin

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

Symptoms: She had the injection with no effect until a week later. The vaccine site became red and hot to the touch and tender. The redness and swelling traveled down her arm to her elbow. She went to the hospital and received some medication. Her arm is still inflamed and will see her Dr on Friday

Other Meds: Levi thyroxine

Current Illness:

ID: 1036972
Sex: M
Age: 68
State: HI

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Lisinopril, sulpha drugs, seafood

Symptom List: Ear pain, Hypoaesthesia

Symptoms: C/o dizziness post-vaccination. VS@12:55 BP 137/91, pulse 66, RR 16. Referred to EMT: systolic BP 124; EKG showed irregular heartbeat, unspecified. Recommended further assessment by participant's cardiologist. Bottled water given. Client reported feeling better. Stood up and walked a few steps. Coherent, pleasant, answered questions appropriately, appropriate eye contact.

Other Meds:

Current Illness:

ID: 1036973
Sex: F
Age: 27
State: CA

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Chocolate

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Migraine - Resolved within 8 hours Fever - On and off from night of vaccination to present (2/17) Rash on Arm - Appeared within 24 hours after vaccination. Continued to grow over the course of a few days, raised and hot to the touch. I went to urgent care for my fever and rash and was given antibiotics and steroids. I was given Keflex and Prednisone. I am currently on day three of taking both meds. My rash has gone down significantly however I am still feeling dizzy and feverish.

Other Meds: Lexapro, Xanax, Vitamin D3, Biotin, Vitamin B12

Current Illness: N/A

ID: 1036974
Sex: M
Age: 77
State: FL

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, bees

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

Symptoms: Mini seizure, jerking limbs , eyes rolling in back of head, choking.

Other Meds:

Current Illness: Diabetes, HBP, Obesity

ID: 1036976
Sex: F
Age: 65
State: WA

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin, Talwin, Doxycycline

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

Symptoms: Tennis Ball sized lymphadenopathy right axilla times 5 days before swelling began to resolve

Other Meds: Zyrtec, Famotidine, Omeprazole, Singulair, Estring

Current Illness:

ID: 1036977
Sex: F
Age: 73
State: OH

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/17/2021
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

Symptom List: Unevaluable event

Symptoms: Fever, chilled and no appetite when waking in the morning. Took Tylenol and rested. Okay by the evening.

Other Meds: Metform

Current Illness:

ID: 1036978
Sex: F
Age: 33
State: CT

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
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: Banana, almonds, egg, gluten

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

Symptoms: Pt developed an anaphylaxis reaction to vaccine with resultant "throat tightening" and voice changes. Epi administered. EMS was alerted and patient was transported to the hospital. Of note, prior to leaving she received benadryl.

Other Meds:

Current Illness:

ID: 1036979
Sex: F
Age: 22
State: MI

Vax Date: 01/25/2021
Onset Date: 02/02/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: I can not think or remember things my arms go to sleep i cant feel hot and cold i cant drive and i get very winded

Other Meds: Iron Zolof 25mg

Current Illness: None

ID: 1036980
Sex: F
Age: 61
State: AZ

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Additional Details: 5 minutes after taking the vaccine pt stated that she felt dizzy and lighheaded. After about 10minutes later she started grabbing her throat indicating she cannot breath. we gave her 2 epipens 5 minutes after the 1st dose and called the ambulance

Other Meds:

Current Illness:

ID: 1036981
Sex: F
Age: 70
State: ID

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/17/2021
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: Compazine, demerol, statins and citrus.

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

Symptoms: Arm pain, diarrhea, syncope, fatigue, rash.

Other Meds: None reported

Current Illness: Runny nose

ID: 1036982
Sex: M
Age: 22
State: WA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: Golden Kiwi

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Chills and sweating, general soreness throughout the body, difficulty catching breath, migraines, lethargy.

Other Meds: Concerta

Current Illness: None

ID: 1036983
Sex: F
Age: 62
State: VA

Vax Date: 02/14/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
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: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1036984
Sex: F
Age: 67
State: VA

Vax Date: 02/09/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: Itchy rash that started one week after injection

Other Meds: Multivitamin, Viactive, turmeric, cinnamon, Claritin, hydroclorothyazide

Current Illness: None

ID: 1036985
Sex: F
Age: 68
State: GA

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 02/17/2021
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, epiniphrine, sulfa,

Symptom List: Nausea

Symptoms: Extreme red swollen knot, itching that could not be tolerated, encompassing whole upper arm. Things done to allieve: ice pack, cortizone cream (which burned so had to be cleaned off). Started when patient woke up in the morning, got progressively worse as the days wore on. Lasted approximately a week.

Other Meds: aspirin, calcium, claritin, coumadin, crestor, folic acid, neurontin, prednisone, prozac, singulair, trelegy ellipta, vitamin b12, lasix, potassium.

Current Illness: covid

ID: 1036986
Sex: F
Age: 68
State: AL

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain

Symptoms: Patient received COVID-19 vaccination and waited her 15 minutes. As she was walking out to her car her throat and tongue started itching and she was having trouble swallowing. She came back to pharmacy and made us aware. I (the administering pharmacist) went out to her and assessed the situation. I instructed staff to call 911 due to the difficulty swallowing and called for a CODE WHITE. I moved pt to IMZ booth where I further assessed the situation. I did determine that epi-pen was not needed due to the pt breathing well. I did give an oral benadryl . EMT arrived and assessed the situation and instructed pt to go to the ER with them, although the pt refused stating they would go home and go to their MD if needed. I called pt later in the day to check and she was doing ok, but the throat itching did come back after the benadryl wore off, so she took another. I instructed pt that if it has not resolved in by tonight she would need to be seen, she agreed.

Other Meds: None noted

Current Illness: None

ID: 1036987
Sex: F
Age: 81
State: RI

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 02/17/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Error: Booster Given Too Early

Other Meds:

Current Illness:

ID: 1036988
Sex: F
Age: 46
State: CO

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
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: Seasonal allergies and phenobarbitol

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

Symptoms: Developed rash on lower left back within a day of shot. Rash continued to get worse in pain and spread some, went to doctor?s office 3 days after vaccine for continued severity of rash and waking up that day with a slight droop on right side of mouth and tingling Sensations. Doctor identified rash as shingles and possible bells palsy episode. Mouth droop and tingling went away next day, shingles still present.

Other Meds: Vitamin C and vitamin D

Current Illness: None Checked at obgyn for irregular mensuration premenopausal findings

ID: 1036989
Sex: F
Age: 80
State: CA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital: Y

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

Symptom List: Tremor

Symptoms: This person received the 1st dose COVID-19 vaccine Pfizer @ 08:13am. Then @0930 am, c/o "feeling something on top of her chest, heaviness of chest", sweaty hands, clammy, chest pain. Rapid Response Team called at 09:35 am. Transferred to Emergency Room. In ED: Diagnosis included but not limited to STEMI, NSTEMI, unstable angina, anxiety. At 10:04am- based on EKG, code STEMI was called. Consultation with cardiologist. Then the patient was sent emergently to Cath Lab. The patient was admitted to ICU, intensive care, following Cath Lab

Other Meds: Unknown

Current Illness: Unknown

ID: 1036990
Sex: F
Age: 37
State: NM

Vax Date: 01/22/2021
Onset Date: 02/08/2021
Rec V Date: 02/17/2021
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: Honey bees

Symptom List: Erythema, Pruritus

Symptoms: For 3 days after the injection I had fever, fatigue, headache, chills, muscle/ joint pain, nausea, diarrhea and injection sit pain, redness, and swelling. Then all the symptoms except for diarrhea went away for 2 weeks. I have a history of IBS, so diarrhea isn't uncommon for me, but I don't typically have it everyday like I am now. On February 8 I began having fatigue and headache. On February 10, my left arm became red, swollen, painful and hot again, just like after the injection. By Feb 11, I started having nausea, more severe fatigue/ headache, chills and I developed a low grade fever @ 100.9. Since then, I have continued to have these symptoms. They are intermittent as far as severity. When my arm really hurts, I'm very nauseated, fatigued, my headache is severe and I typically have a low grade fever. I've also noticed hives on my arm, chest and neck intermittently since Feb 11. I have a history of hives too, but this is usually after eating certain foods. On Feb 11 when I got hives, I hadn't eaten for many hours (I was nauseated) and that is very atypical for me. For treatment, I got a covid for test done on 2/12 that was negative, and I took motrin yesterday for increasing headache, arm pain and fever.

Other Meds: Adderall, gabapentin, xanax, multivitamin/ mineral, vitamin d

Current Illness:

ID: 1036991
Sex: F
Age: 97
State: RI

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 02/17/2021
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:

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

Symptoms: Error: Booster Given Too Early

Other Meds:

Current Illness:

ID: 1036992
Sex: F
Age: 81
State: FL

Vax Date: 01/29/2021
Onset Date: 02/03/2021
Rec V Date: 02/17/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Jaw bone popping and sometimes out of place, lower back pain . Reporting for your side effect information only. No need for medical attention ar this time

Other Meds: Jaw pain with popping of jaw bone, lower back pain, hot flashes, low on and off headache pain.

Current Illness: Only glaucoma. I use only eye drops at night. No prescription drugs. I go to gym 3 or 4 times a week.

Date Died: 02/16/2021

ID: 1036993
Sex: M
Age: 73
State: IA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: noted on admin form: Ibuprofen

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient reported at review of questionnaire had headache that day. Temp was taken, 97.8, okay. proceeded. Conversing customer friend in store afterward. When timer went off, said he was fine, he and his wife left. Daughter called to store Wednesday morning, said Pt had passed away Tuesday, that it was unknown the cause, and just wanted to let us know. We did not take down her phone number and last name. The patient was a long time customer.

Other Meds: Known Prescription Meds dispensed at pharmacy: Oxycodone/Acet Prn, Gabapentin, Metoprolol, Pantoprazole, Tamsulosin, Atorvastatin, Clopidogrel, Montelukast, Trazodone, Do not have info on OTC or Dietary supplements

Current Illness:

ID: 1036994
Sex: F
Age: 22
State:

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/17/2021
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:

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

Symptoms: At spot of injection, red and hot skin, sensitive to touch and clothing, swollen, sometimes itchy.

Other Meds: Effexor and Wellbutrin

Current Illness:

ID: 1036995
Sex: F
Age: 81
State: RI

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Booster Given Too Early

Other Meds:

Current Illness:

ID: 1036996
Sex: F
Age: 16
State: CA

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Bee stings

Symptom List: Pain in extremity

Symptoms: 1917 patient reported dizziness, tightness in chest , hyperventilating and pulse rate of 118 bpm.

Other Meds: None reported

Current Illness: Anxiety/panic attacks

ID: 1036997
Sex: F
Age: 47
State: UT

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Tenderness under right arm began on Fri. Feb. 12. The next day, the pain had increased enough that I looked in the mirror, to find a moderately large swelling. It increased in size overnight Sat. Feb. 13. Sunday, the swelling reduced a bit, to the same size I found it originally. It has remained that size - a decent golf ball - since then, Sun. Feb., 13. Though localized tenderness in lymph nodes has decreased quite a bit, I'm now in a significant Fibromyalgia flare (which could also be explained by a change in weather).

Other Meds: Depakote, Celebrex, Duloxetine, Flax Seed Oil, Vitamin

Current Illness:

ID: 1036998
Sex: F
Age: 79
State: IL

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/17/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1036999
Sex: M
Age: 68
State: WA

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/17/2021
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: Comparing, Demerol

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

Symptoms: Severe pain and swelling in prosthetic left knee times 24 hours

Other Meds: Singulair, Omeprazole, Famotidine, Simvastatin, Flomax

Current Illness:

ID: 1037000
Sex: F
Age: 24
State: GA

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 02/17/2021
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: From 3:00pm on 1/8 to the morning of 1/12, experienced high fevers, severe body aches, chills, fatigue, night sweats, and headache. My heart rate was consistently in the 110s-120s and my blood pressure was in the 100s/40s. My highest temperature was 103.5. My fianc? is a nurse who took care of me at home. I alternated Tylenol and ibuprofen for the aches and fever. I slept the majority of each day and was unable to perform my activities of daily life or exercise. I lost my appetite for about 1 week. I had no sense of taste in Sunday, which slowly returned over the next week. I was concerned about the loss of taste so I scheduled a COVID-19 swab which came back negative on 1/11.

Other Meds: Escitalopram 10mg daily, Minastrin 24fe birth control, Floraster probiotic daily

Current Illness: None

ID: 1037001
Sex: F
Age: 81
State: VA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1037002
Sex: M
Age: 76
State: CA

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Extreme fatigue and weakness; very mild headache

Other Meds: Lisinopril/HCTZ Lipitor

Current Illness: None

ID: 1037003
Sex: F
Age: 17
State: CA

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
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: PATIENT GOT THE VACCINE BY MISTAKE AS HER DATE OF BITH WAS 2003 AND ASSUMED SHE IS 18 AND WE CONULTED THE CDC AND THEY TOLD US TO GIVE THE SECOND DOSE OF MODERNA

Other Meds:

Current Illness:

ID: 1037004
Sex: F
Age: 40
State: CA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
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

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

Symptoms: nausea, body aches, fever

Other Meds: Levoxyl, Vitamin D

Current Illness:

ID: 1037005
Sex: M
Age: 71
State: FL

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/17/2021
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: NKA

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

Symptoms: Developed shingles the next day. Didn't realize that was what had occurred for several days but it gradually got worse. Not saying the vaccine caused it, as it probably just lowered his resistance, but he is never sick and this has really been hard. Just wanted to to make you aware. His physician did verify that it was shingles but too late to do anything so just waiting it out.

Other Meds: Vitamins

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm