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
92,076
AK1,880
AL6,345
AR4,151
AS46
AZ14,991
CA66,887
CO12,550
CT8,943
DC1,795
DE2,009
FL42,724
FM4
GA17,031
GU124
HI2,580
IA4,919
ID2,892
IL22,128
IN24,197
KS5,047
KY9,111
LA5,500
MA15,718
MD13,434
ME3,351
MH8
MI20,971
MN13,585
MO10,747
MP30
MS3,198
MT2,477
NC18,051
ND1,501
NE3,109
NH3,218
NJ20,216
NM4,218
NV4,728
NY37,667
OH20,793
OK6,692
OR9,244
PA25,607
PR2,588
QM2
RI2,163
SC7,261
SD1,282
TN10,445
TX39,890
UT4,618
VA15,980
VI67
VT1,830
WA16,071
WI12,042
WV2,571
WY926
XB5
XL1
XV2

ID: 1036285
Sex: M
Age: 69
State: NC

Vax Date: 01/27/2021
Onset Date: 02/02/2021
Rec V Date: 02/17/2021
Hospital: Y

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

Lab Data:

Allergies: Sulfa and Shellfish

Symptom List:

Symptoms: First Covid vaccine on Jan 27. I don't know the brand, Fatigue, SOB, Leg swelling, Tingling, Hospitalized on 2/16 with bilateral LE and UE weakness MDs accessing for GBS?

Other Meds: Glyxambi

Current Illness:

ID: 1036286
Sex: M
Age: 44
State: WA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Seizure

Other Meds:

Current Illness:

ID: 1036287
Sex: F
Age: 46
State: TX

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Approximately 8 hours after receiving the second dose I experienced itching at the injection site on my arm, sore arm, nausea, body aches, chills, high temperature up to around 103, fatigue and restlessness, my heart was racing, and I was experiencing Pulsatile tinnitus in my ears where I could hear whooshing sounds that I assume were of my heartbeat. This lasted for two days and started to get better around the 3rd day.

Other Meds:

Current Illness:

ID: 1036288
Sex: F
Age: 16
State: KS

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient is 16 years old and Moderna vaccine is for individuals 18 years and older.

Other Meds:

Current Illness:

ID: 1036289
Sex: F
Age: 31
State: AZ

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

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

Lab Data:

Allergies: hair, skin and nails vitamins

Symptom List:

Symptoms: Head Ache and fatigue since the night of the second dose

Other Meds: Dexilant and Pre-natal vitamins

Current Illness: None

ID: 1036290
Sex: F
Age: 28
State: NY

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Body aches and fever

Other Meds:

Current Illness:

ID: 1036291
Sex: F
Age: 63
State: GA

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: Had vaccine on Fri and sat AM woke up with abdominal pain. On Sun had excessive flatulance and belching in afternoon and mucous and blood and water as stool. Had urge to have BM but unable(This is a total change in BM pattern,Never experienced this before. This lasted through Mon and called Digestive Dr and goot in for an appt on Tues

Other Meds: Lipitor 20 mg daily

Current Illness: None

ID: 1036292
Sex: F
Age: 44
State:

Vax Date: 01/28/2021
Onset Date: 02/04/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: oyster allergy

Symptom List:

Symptoms: Severe vertigo starting on the morning of day 7 that took 10 days to fully resolve

Other Meds: Vit D, Zinc, Vit C, Fish Oil, B complex, Magnesium

Current Illness: none

ID: 1036293
Sex: F
Age: 83
State: MI

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

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

Lab Data:

Allergies: Caffeine, Sulfa medication

Symptom List:

Symptoms: "Covid arm" red swollen arm at injection site. Lasting for 5 days and still...

Other Meds: metoprolol, spironolactone, amlodipine, hydrochlorothiazide, atorvastatin, cetirizine, escitalopram.

Current Illness: No illness reported

ID: 1036294
Sex: M
Age: 74
State: IN

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient reported: he felt a "jolt" at injection site during administration. Briefly felt lightheaded but then felt fine to drive home. On way home felt confused and jittery. Felt jittery all night and could not sleep. Had same reaction 40 years ago when stung by yellow jacket. Reported no breathing issues or elevated heart rate. Symptoms resolved by next day.

Other Meds:

Current Illness:

ID: 1036295
Sex: F
Age: 85
State: CA

Vax Date: 02/01/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Shellfish Aspirin Penicillin Demerol

Symptom List:

Symptoms: Welts, rash, shedding of skin Treating with po benadryl 25 mg and gel

Other Meds: Multi vitamins Atenlolol Losartan Plavic Pravastatin

Current Illness: None

ID: 1036296
Sex: U
Age: 64
State: CT

Vax Date: 01/20/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: I woke up laying on the side that the vaccine was administered. My arm has been hurting since then, similar to a serious muscle pull, and it has not subsided since last week. I have used ice and heat and ibuprofen, which helps. Much more painful than what I reported at the beginning in days following vaccine. My next vaccine is tomorrow and I?m worried if I will be the same if my other arm is vaccinated or if I should stick with the same arm so that I can sleep on the other side.

Other Meds: Chlorthalidone 25mg Potassium 20meq Calcium Vitamin D Centrum women multivitamin

Current Illness:

ID: 1036297
Sex: F
Age: 35
State: IL

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

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

Lab Data:

Allergies: Carageenan

Symptom List:

Symptoms: At 10am on 2/9, I had a headache, body ache, and overall fatigue. At 2pm, my temperature was 102.1 on an ear thermometer. Other symptoms included soreness at the injection site and nausea. At 2:30pm the nausea intensified caused me to vomit. The fever remained throughout the day. By evening, it had reduced to 101.6. The following morning my temperature was 100.6, and I was extremely fatigued and still very nauseous. Only 1 episode of vomiting occurred.

Other Meds: Prenatal vitamin, Buproprion, Gabapentin, Progesterone in oil, Estradiol, vitamin D, NAC, baby aspirin

Current Illness: None

ID: 1036298
Sex: F
Age: 32
State: CA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: 2 hours after: severe nausea that lasted for about 1 hour Approximately 8 hours later: fever, chills, body aches, fatigue, headache. These symptoms lasted for approximately 3 days. Symptoms started to improve and then headache came back even worse and included severe nausea and vomiting that lasted into 5 days post vaccine.

Other Meds: Celexa 10mg, Ortho tri-cycled, Benadryl

Current Illness:

ID: 1036299
Sex: F
Age: 77
State: FL

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

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

Lab Data:

Allergies: nka

Symptom List:

Symptoms: Pt. began to have tightness in the chest and throat. Pt. refused epipen. After further observation, I called 911. Outcome unknown

Other Meds: cortisone

Current Illness: unknown

ID: 1036300
Sex: F
Age: 43
State: MD

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

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

Lab Data:

Allergies: keflex, corn, seasonal allergies, soybeans

Symptom List:

Symptoms: rash at injection site. given antibiotic cream and benedryl for symptoms

Other Meds: Singulair 10mg trimethicolone topical Benadryl Allergy 25 mg tablet Vitamin D prenatal multivitamin

Current Illness: n/a

ID: 1036301
Sex: F
Age: 74
State: CA

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

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

Lab Data:

Allergies: Penicillin, sulfa, proton pump inhibitors, tetracycline, z-pak., Multaq, metropolol. Cipro, nitrous oxide, metronidazole, Dronedarone, Rabeprazole,

Symptom List:

Symptoms: Itchy skin all over. No rash. Started about 8 hours after injection. Took diphenhydramine and it finally subsided enough to sleep.

Other Meds: Asmanex Twisthaler, Atrovent, probiotic, cranberry pills

Current Illness: None

ID: 1036302
Sex: F
Age: 50
State: CA

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

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

Lab Data:

Allergies: unknown maybe wheat

Symptom List:

Symptoms: Flush face chest, swollen checks , lips, tongue, had issues talking

Other Meds: Multivitamins, pseudoephedrine for sinuses and and congestion, Hyrochlorhiazide 25 mg,/ celebroxib 200mg./,gabapentin 300mg

Current Illness: back issues

ID: 1036303
Sex: F
Age: 72
State: AZ

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

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

Lab Data:

Allergies: latex; afrin; calcium combining aents; celebrex; choletic hida scan dye; ibuprofen; internal use iodine; keflex; lactose; lexapro; skelaxin; toradol; vioxx; milk; shellfish; garlic; onions, broccholli, cauliflower

Symptom List:

Symptoms: 4hrs after vaccine, extreme weakness, difficult to walk/move. During night difficult breathing. Slept on 2 pillow. In am noted left side of face swollen and tight.

Other Meds: zyrtec; montelukast; co q 10 100mg; bee pollen 500mg; metanx 35mg; nettle leaf 450mg; probiotic 10; tumeric liquid 1000mg

Current Illness: asthma, ongoing

ID: 1036304
Sex: F
Age: 65
State: NY

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

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

Lab Data:

Allergies: Codiene, IVP Contrast dye, Dilantin

Symptom List:

Symptoms: Soreness, stiffness at injection site, aches, chills, fatigue

Other Meds: Depakote, Floxitine, Amlodopine, Claritin, Fish Oil, Calcium +D, Mutivitamin, Airborne, Baby aspirin

Current Illness: None

ID: 1036305
Sex: F
Age: 37
State: MD

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

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

Lab Data:

Allergies: Hydrocodone Oxycodone

Symptom List:

Symptoms: Headache, body aches, chills, low grade fever (100.4F), sorr arm. Total of 30 hrs.

Other Meds: Methimazole Vitamin D

Current Illness:

ID: 1036306
Sex: F
Age: 68
State: CO

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

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

Lab Data:

Allergies: Sulfa, Fentanyl, Naprosyn, Percocet

Symptom List:

Symptoms: Moderna COVID-19 Vaccine EUA Had Covid beginning 12/24/2020 with a positive test 12/28/2020. Within 8 hours of receiving the first vaccine I got a bad headache, my chest felt heavy again, I was nauseated and felt a general malaise - all symptoms I had experienced with Covid. These symptoms lightened over the next few days, but I developed a cough again, and my headache continued off and on through day 5.

Other Meds: L-thyroxine, Propranolol Hcl, Fish Oil, Vit D3,Vit C, Caltrate

Current Illness: None - but had Covid beginning 12/24/2020

ID: 1036307
Sex: F
Age: 34
State: OH

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

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

Lab Data:

Allergies: seasonal

Symptom List:

Symptoms: C/o "One sided sore throat worh lical swelling/red" Symptoms started 2 days ago There is redness and swelling. Hx of peritonsillar abscess with removal of tonsils following. Pain is constant. Worse with swallowing. Current pain 2/10. Took Tylenol for relief. Experiencing otalgia, improved. Had co worker look in ear yesterday d/t constant pain. Reported fluid in ear. Reports having 2nd dose of Moderna vaccine on 2/14/21 at 1230. Had flu like symptoms afterwards. Fever lasted for about 36 hours. Headache persists.

Other Meds: Birth control

Current Illness: URI 3 weeks prior with negative COVID test

ID: 1036308
Sex: F
Age: 74
State: CA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Syringe needle defect. Injected patient, needle detached. Partial missed dose, due to needle/syringe malfunction. Provided patient with full dose after partial dose.

Other Meds:

Current Illness:

ID: 1036309
Sex: F
Age: 59
State: MA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: about 10 mins after patient recieved the Moderna vaccine she came in c/o numbness to lip area only and felt warm like mint. Vitals obtained. SPO2 100% on RA BP138/82 P70 and regular. Denies any difficulty breathing or shortness of breath. Rapid response called and patient transfered to ER for observation

Other Meds:

Current Illness:

ID: 1036310
Sex: F
Age: 40
State: MI

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Allergy status to other drugs, medicaments and biological subs

Symptom List:

Symptoms: Patient had an allergic reaction after received the shot. Onsite EMS was called vitals were taken BP 112/74 98% O2 room air HR 78. Patient refused evaluation/care. Left aginst medical advice.

Other Meds:

Current Illness:

ID: 1036311
Sex: F
Age: 20
State:

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Pain in arm within 2 hours of receiving vaccine, Started feeling generally not well and nausea 3-4 hours after vaccine. Vomiting occurred multiple times starting 8 hours after receiving vaccine. Day after vaccine felt generally unwell and was hard to eat.

Other Meds:

Current Illness:

ID: 1036312
Sex: F
Age: 43
State: WV

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: penicillins, prochlorperazine edisylate, metoclopramide

Symptom List:

Symptoms: I had a rash that developed on my chest, neck, and chin. I took pictures to document. I also have had a stiff neck and headache since the day after the shot and have needed to take Advil daily to relieve the pain. I have gone to the Chiropractor and had and adjustment and stem therapy. Called my primary care physician and she offered a Toradol shot but have declined at this time since Advil seems to be helping.

Other Meds: Crestor, Prozac, Loprssor, Claritin, Multi-Vitamin, Vitamin CD

Current Illness:

ID: 1036313
Sex: F
Age: 44
State: NH

Vax Date: 01/29/2021
Onset Date: 02/13/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: After the injectio,I developed fever 103.3, 2 days later I realised a hard lamp in my armpit.Cold sores on my lips too.But the bad one started on 02/13/2021. I developed pins and needles with numbness that started under my feet,by the following day the tingling sensation was moving up to my arms. By day two of this symptoms,I deloped a severe hot flash on both my fit but with lessening pins and needles. The worst part of this is that I also developped very severe sore muscle and joint pains,equating it to like someone who has been beaten and like my musles are being ripped off the bones.That is what I am feeling up to now, I am not able to walk or drive now. After seeing the HCP she put me on gabapentin 100 mg BD

Other Meds: None

Current Illness: None

ID: 1036314
Sex: F
Age: 61
State: NC

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

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

Lab Data:

Allergies: Ceclor, Erythromycin, Penicillin, Nystatin, Percocet, Betadine, Latex sensitivity Mild beef allergy, Class I Dust and Dust Mites allergy

Symptom List:

Symptoms: I received my first dose at 9:50am on February 3, 2021. Approximately 15 minutes after the first vaccine dose was given (10:05am) I began to get an itchy throat along with an allergic type cough. The cough went away in about an hour but I still had the itchy throat off and on throughout the afternoon. I called my Primary Care provider and she recommended I take 25mg of Benadryl every 6 hours and to call 911 if my symptoms got worse. I took the recommended doses at 5:10pm and 11:15pm that day and all symptoms resolved. I had no symptoms the following day and did not take any Benadryl the following day. I would like to note that I was sent outside the building immediately after the vaccine to wait for the 15 minutes because they could only have 20 people in the room, so there was essentially no monitoring if my symptoms would have gotten worse. We drove to the ER and just sat in the parking lot to be sure the symptoms were not progressing. I am still waiting to see if it is recommended that I receive the second dose of the vaccine. At my provider's recommendation, I am seeing an allergist tomorrow to further discuss.

Other Meds: Daily: Atenolol 25mg 2xday, Aspirin 81mg , Claritin 10mg, Flonase, Azelastine, Restasis 2xday, Vitamin D3 5000iu, Magnesium 400mg, Intrarosa 3x week

Current Illness: none

ID: 1036315
Sex: F
Age: 72
State: NY

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

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

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: I woke up feeling ill with chills and slight fever. Overall tired and a bit nauseous. Body feels heavy.

Other Meds: Tylenol

Current Illness:

ID: 1036316
Sex: M
Age: 19
State: TN

Vax Date: 12/26/2020
Onset Date: 01/29/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient received first vaccine on 12/26/20 and it was a Moderna vaccine. Patient came for 2nd dose of his vaccine and received Pfizer by accident at our site. Patient was notified and states he had no unexpected side effects.

Other Meds:

Current Illness:

ID: 1036317
Sex: F
Age: 80
State: PA

Vax Date: 02/03/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Grasses, dust, IVP dye, statins.

Symptom List:

Symptoms: Burning and severe itching in genital area. Used 180mb Benadryl. PCP is prescribing a ingested medication and genital cream application.

Other Meds: lisinopril 20mg in am; 10mg in pm; Repatha 140mg/ml every 2 weeks; Restoril 30 mg in pm; Xanax .5; Plavix 75mg pm; Restasis Drops 1 in ea. eye am & pm; red yeast rice' \Fiolate 666mcg M-W-F; Probiotic 1/am; Aspirin 81mg pm; Vitamin D 5000

Current Illness: None

Date Died:

ID: 1036345
Sex: F
Age: 79
State: FL

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: crab allergy, none others

Symptom List:

Symptoms: Patient developed lethargy and malaise several hours after vaccine with a low grade fever. The following morning she reported to her husband inability to taste food or drink. She developed nausea and vomiting which persisted from 1/30/21 through her death. She was found deceased in bed by her husband this morning.

Other Meds: levothyroxine

Current Illness: none

ID: 1036358
Sex: U
Age:
State: LA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: was stored in the refrigerator instead of the freezer since 01DEC2020 and has since then been administered to patients; It was also administered concomitantly with VARlVAX / intended to give MMRII but instead administered PROQUAD; intended to give MMRII but instead administered PROQUAD; This spontaneous report as received from a registered nurse refers to a patient of unknown age and gender. No information regarding the patient's pertinent medical history, drug reactions or allergies and concomitant therapies was provided. On 01-DEC-2020, measles, mumps, rubella and varicella (oka-merck) virus vaccine live (PROQUAD) was stored in the refrigerator instead of the freezer. It experienced the temperature excursion of 44 degrees Fahrenheit for 1506 hours. There was no previous temperature excursion. The digital data logger was not involved. On an unknown date (reported as since then), the patient was administered with the incorrectly stored doses of measles, mumps, rubella and varicella (oka-merck) virus vaccine live(PROQUAD) 0.5 milliliter, lot # T025221, expiration date 19-JAN-2022 (route of administration was not reported) for prophylaxis, instead of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II) (dose, route of administration, lot # and expiration date were not reported) for prophylaxis. Additionally, on the same day, the patient received varicella virus vaccine live (oka/merck) (VARIVAX) 0.5 ml (route of administration, lot # and expiration date were not reported) for prophylaxis. There was no adverse event reported.

Other Meds:

Current Illness:

ID: 1036359
Sex: U
Age:
State: MT

Vax Date:
Onset Date:
Rec V Date: 02/17/2021
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Symptoms: is late for the second dose / The first dose was administrated oin January 2020; This case was reported by a pharmacist and described the occurrence of incomplete course of vaccination in a adult patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix (received 1st dose in January 2020). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced incomplete course of vaccination. On an unknown date, the outcome of the incomplete course of vaccination was unknown. Additional details were provided as follows: The age at vaccination was not applicable for this report. Till the time of reporting, patient did not received 2nd dose of Shingrix, which led to incomplete course of vaccination. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1036360
Sex: F
Age: 33
State: NJ

Vax Date: 01/07/2021
Onset Date: 02/03/2021
Rec V Date: 02/17/2021
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Symptoms: Vaccination was not administered correctly/not in the right spot (closer to the acromion process); Tingling in my hand; Hand still numb; A spontaneous report was received from a nurse concerning a female consumer who received Moderna's COVID-19 vaccine (mRNA-1273) that was not administered correctly/not in the right spot (closer to the acromion process)/ Vaccine administered at inappropriate site. The patient subsequently experienced tingling in her hand/paresthesia and her hand was still numb/hypoaesthesia. The patient's medical history was not provided. Products known to have been used by the patient, within two weeks prior to the event, included multivitamins and unspecified over the counter medications. The patient received their first of two planned doses of mRNA-1273 (Lot number: 032L20A) on 07 Jan 2021. On 03 Feb 2021, prior to the onset of symptoms, the patient received their second of two planned doses of mRNA-1273 (Lot number: 032L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 03 Feb 2021, the patient reported that the vaccination was not administered correctly and wasn't on the right spot (it was closer to the acromion process). After the vaccination, the patient developed a tingling in her hand that did not hurt but was still numb. No treatment was provided for the events. The patient received both scheduled doses of mRNA-1273 prior to the events; therefore, action taken with the drug in response to the events is not applicable. The event vaccination was not administered correctly/not in the right spot (closer to the acromion process) was considered resolved on 03 Feb 2021. The outcome of the event tingling in hand and hand still numb was unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. However, the causality for the event of vaccine administered at inappropriate site remains as not applicable.

Other Meds: MULTIVITAMINS [VITAMINS NOS]

Current Illness:

ID: 1036361
Sex: F
Age: 59
State: MA

Vax Date: 01/04/2021
Onset Date: 02/02/2021
Rec V Date: 02/17/2021
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Symptoms: Patient passed out without warning (fell) and hit ceramic floor; Patient passed out without warning (fell) and hit ceramic floor; Black eye; bruised extremities; Been "out of it" since then; A spontaneous report was received from a consumer concerning a 59 year old female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and passed out and hit a ceramic floor causing a black eye, bruised extremities, and the patient was been out of it since the event ( feeling abnormal ). The patient's medical history was not provided. No relevant concomitant medications were reported. On 01 Feb 2021, approximately one day prior to the onset of the events, the patient received their second of two planned doses of mRNA-1273 (lot number 028L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. The patient passed out without warning and hit a ceramic floor, which cased a black eye, bruised extremities, and the patient has been out of it since the event. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the events passed out and hit a ceramic floor causing a black eye, bruised extremities, and the patient was been out of it since the event ( feeling abnormal ) were unknown.; Reporter's Comments: This case concerns a 59 year old female subject, who experienced a serious unexpected event of loss of consciousness after second dose of mRNA1273 (Lot# 028L20A). Very limited information has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1036362
Sex: F
Age: 68
State: NC

Vax Date: 01/21/2021
Onset Date: 01/01/2021
Rec V Date: 02/17/2021
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Symptoms: Rash on the injection arm; Retinal bleeding present in the left eye; A spontaneous report was received from a consumer, concerning herself, a 68 years-old female patient, who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced retinal bleeding present in the left eye and rash on the injection arm. The patient's medical history was not provided. Concomitant medications reported included simvastatin. On 21 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (lot # 032L20A), intramuscularly for prophylaxis of COVID-19 infection. On 21 Jan 2021, following the vaccination, the patient experienced a rash on the injection arm that had lasted for about a week. Additionally, the patient went for a routine eye exam on an unknown date in Jan 2021 and it was determined that there was retinal bleeding present in the left eye. The rash had subsided at the time of the report, but the retinal bleeding remained the same. Action taken with mRNA-1273 was unknown. The event rash on the injection arm was considered resolved on an unspecified date in Jan 2021. The event retinal bleeding present in the left eye was considered not resolved at the time of this report.; Reporter's Comments: Very limited information regarding these events of unlisted serious event of retinal hemorrhage and non-serious listed event of injection site rash has been provided at this time. No further information is expected.

Other Meds: SIMVASTATIN

Current Illness: No adverse event (No medical history reported)

ID: 1036363
Sex: F
Age:
State: NY

Vax Date:
Onset Date: 02/05/2021
Rec V Date: 02/17/2021
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Symptoms: Vaccine administered via subcutaneous route; A spontaneous report was received from a healthcare professional concerning a 85-year-old, female patient who received a Moderna's COVID-19 vaccine (mRNA-1273) administered via subcutaneous route. The patient's medical history was not provided. No relevant concomitant medications were reported. On 05 Feb 2021, patient received their second of two planned doses of mRNA-1273 (Lot number: 013L20A) subcutaneously for prophylaxis of COVID-19 infection. On 05 Feb 2021, second dose of Moderna COVID-19 vaccine was administered via subcutaneous route to three patients. The patients have not reported any side effects. No treatment information was provided. The patient received both scheduled dose of mRNA-1273; therefore, action taken with the drug in response to the event is not applicable. The event, vaccine administered via subcutaneous route was considered resolved on 05 Feb 2021.; Reporter's Comments: This report refers to a case of Incorrect route of product administered for mRNA-1273 (Lot number: 013L20A) with no associated AEs.

Other Meds:

Current Illness:

ID: 1036364
Sex: F
Age: 73
State: IL

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/17/2021
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Lab Data:

Allergies: Latex, ethylenediamine

Symptom List:

Symptoms: Pt had onset of weakness in lower legs and forearms immediately following the vaccine and is very fatigued since receiving the vaccine.

Other Meds:

Current Illness:

ID: 1036365
Sex: F
Age: 52
State: OR

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 02/17/2021
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Allergies: Amoxycillin, Levaquin, Scallops

Symptom List:

Symptoms: 1/11/21 right after lunch 12:30-1:00 nauseous , body aches, wrist/finger/hip pain, intense headache could not open eyes, pt had to lay down, around 2:00 pt started to vomit throughout the day, later that afternoon pt woke up and missed the whole day rest of the day, pt drank water, 1/12/21 sometime around 1-2 AM patient vomited again, late morning pt tried to drink water and again vomited, pt slept most of the day and not able to consume water, 1/13/21 pt still tried to drink water, headache, body ache, pt was able to eat and then vomited, 1/14/21 pt continued to try drinking and eating light and this was the first day pt did not throw up, patient had to continue to lay down and close eyes, 1/16/21 left foot started to hurt and swell, 1/17/21 pt weighed and lost 7 lbs, left foot pain continued swelling and blue, top of foot was bruised and really oddly swollen, pt went to doc 1/18-1/19 not sure on date, doc thought maybe pt sprained it, pt stayed in bed sleeping, pt stated it looked like gout, foot pain continued for 8 days, 1/28 pt was able to sit in chair and attend class, pt still cannot put weight on left foot as of 2/17, discoloration is gone, toes are swollen, pt is scheduled to see a podiatrist. Hips/wrist/fingers are sill sore.

Other Meds:

Current Illness:

ID: 1036366
Sex: F
Age: 62
State: NM

Vax Date: 02/01/2021
Onset Date: 02/16/1921
Rec V Date: 02/17/2021
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Allergies: demeral

Symptom List:

Symptoms: it started to itch, was feeling feverish, next day i woke up with a big round red patch on right arm where injection was given. i went today to doctor and was given antibotics for infection of site.

Other Meds: thyenol,

Current Illness: none

ID: 1036367
Sex: M
Age: 25
State: MN

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/17/2021
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Allergies: No known allergies.

Symptom List:

Symptoms: Member reports going home the night of the vaccine and having a fever of 103, with chills, and fatigue. The next day the individual noticed swelling in the face, hands were itchy and tingly, and also skin welts in the back and shoulder area. Member went to urgent care and was advised to buy Zyrtec which he stated helped. Member has since recovered and is doing fine.

Other Meds: None.

Current Illness: None.

ID: 1036368
Sex: F
Age: 62
State: VA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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Allergies: Food allergies. Has epi pen at visit today.

Symptom List:

Symptoms: Patient c/o face/chin/cheek heaviness. 12:54 BP 150/70, P 58, R 28 PO2 98% 13:07 BP 130/65, P 58, PO2 98% 13:15 BP 120/60, P 60, O2 98% 12:58 Still some face heaviness 13:01 Still some face heaviness 13:05 Still some face heaviness 13:10 Starting to feel better 13:12 Heaviness disappeared, feels better 13:15 Heaviness disappeared, feels better Pat. completed 15 minute wait. Was on 30 minute wait after shot. Sought care when feeling face/chin heaviness.

Other Meds:

Current Illness:

ID: 1036369
Sex: F
Age: 67
State: FL

Vax Date: 02/01/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
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Allergies: None

Symptom List:

Symptoms: Experienced Bell's Palsy on right side of face. Noticeable when smiling.

Other Meds: Advance Formula ,Adults multivitamins with 25mcg Vitamin D3 and multimineral supplement by Publix (compare to Centrum), one tablet per day; Essential Zinc 50mg by Sundown, one tablet per day.

Current Illness: None

ID: 1036370
Sex: M
Age: 68
State: CA

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

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Allergies: none

Symptom List:

Symptoms: VS,water

Other Meds: 0858-Pt suddenly felt tired/fatigued with 10 minutes of vaccine. Pt respirations WNL no distress noted. B/P 144/82, O2 sat-98%,P-75, R-20. Pt w/o any other c/o at this time. Pt given water but refused a snack. Reports wants to go home and

Current Illness: none

ID: 1036371
Sex: F
Age: 45
State: FL

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/17/2021
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Lab Data:

Allergies: Penicillin Rash

Symptom List:

Symptoms: COVID-19 Vaccine 1. Had severe muscle pain at site for 2 days and bad muscle pain for 2 days after that 2. Swollen lymph node under the vaccinated arm that started 1 week after 3. Painful joint and muscle aches all over body but especially in vaccinated arm that lasted more than 2 weeks 4. Cold and hot flashes but no fever for more than 2 weeks 5. Nausea about once a day 6. Head ache for more than two weeks

Other Meds: Medications ?Omeprazole 40 DR (1 tab daily) ?Multivitimin X 1 ?Jardiance Empagliflozin 25 X 1 ?Prograf 3 capsules X 2 ?Metformin 1000 X 1; 500 X 1 ?Carvedilol 3.125 X 2 ?Baby Aspirin X 1 ?Nipedifine 60 mg X 1 ?Brilinta 90 mg X 2 ?Rosuvost

Current Illness: Allergies to pollen-stuffy sinuses

ID: 1036372
Sex: M
Age: 90
State: MA

Vax Date: 02/25/2020
Onset Date: 02/15/2021
Rec V Date: 02/17/2021
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Allergies: NKDA

Symptom List:

Symptoms: N/A

Other Meds: Finasteride 5mg once daily Tamsulosin 0.4mg once daily Senna 8.6mg once daily cyanocobalamin 1000mcg twice daily Remeron 7.5mg once daily Trazodone HCL 100mg daily

Current Illness:

ID: 1036373
Sex: F
Age: 48
State: MI

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/17/2021
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Lab Data:

Allergies: latex, adhesive

Symptom List:

Symptoms: Noted after first injection on 1/6/2021 within three hours, extreme fatigue, excessively sore arm and following morning significant brain fog and loss of energy. Noted after second injection on 1/27/2021, not much in the way of symptoms until about 3:15 a.m. on 1/28/2021 when was awakened from a sounds sleep with tremendous body aches, chills, fever, fatigue and headache. Took about 7 full days to completely recover. During weekly healthcare PCR testing, tested positive for COVID 19 on 2/10/2021. Two weeks later to the day. Week prior test was negative.

Other Meds: Zinc, Vitamin C, Vitamin D with K, Curcumin, Alpha Lipoic Acid, Thuja, Astragalas, Mitocore, NAC,

Current Illness: None

Total 2021 VAERS Injuries: 704,237

Page last modified: 03 October 2021 5:28pm