VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 1036618
Sex: M
Age: 42
State: CA

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

Lab Data:

Allergies: None

Symptoms: About 3 hours after the shot, my face and upper body broke out in hives. They lasted for about 90 minutes. I used some hydrocortisone cream and took an allergy pill which probably helped.

Other Meds: None

Current Illness: None

ID: 1036619
Sex: F
Age:
State: OH

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

Lab Data:

Allergies:

Symptoms: Patient in clinic to receive second COVID vaccine. Nurse drew up dose of 0.5 mL Moderna vaccine and noticed needle was bent inside the vial. The nurse changed out the needle ( it is not known if the volume in the needle was withdrawn into the syringe prior to needle change. Also patient noted the nurse pushed on the plunger and expelled some vaccine. Per patient, it looked as though she only received about 0.2 mL instead of 0.5 mL. Her arm was a little swollen the next day but not sore and she did not suffer from side effects. A group with quality, risk management, and pharmacy has reviewed and plans to reach out the patient.

Other Meds:

Current Illness:

ID: 1036620
Sex: F
Age: 55
State: MI

Vax Date: 02/04/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: N/A

Allergies: shellfish, vioxx

Symptoms: 12 days after 2nd Moderna dose, woke up around 2:15 am to a painful, sore, burning lump on the base of my rightside neck, clavicle area. Scheduled apt with PCP same day. Also had just began three treatments of a new product, Olay Peptide 24. Not sure if swollen lymphnode due to vaccine or new product. PCP instructed to monitor and take ibuprofen for pain/inflamation. When receiving both doses of the moderna vaccine, I experienced right neck stiffness within 2 hours of vaccination that lasted approximately 36 hours each time. To note previous medical history, I had Bells Palsy at the age of 12 years and Shingles around age 45, both impacting my right side.

Other Meds: no medications. Began 3 treatments of Olay Collagen Peptide 24

Current Illness: none

ID: 1036621
Sex: F
Age: 65
State: WI

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

Lab Data: HAS NOT SOUGHT MEDICAL TREATMENT WITH HER HEALTH CARE PROVIDER. CLIENT WAS ENCOURAGED TO SPEAK WITH HER HEALTH CARE PROVIDER.

Allergies: NUTS, PCN, ERYTHROMYCIN, MS04, DEMEROL, PAIN KILLER, HYDROCODONE, FISH, SEASONAL ADHESIVE TAPE, GLUCONATE SWABS.

Symptoms: 2/16/2021, CLIENT NOTICED RIGHT EYE SWELLING WHEN RETURNED HOME FROM VACCINATION AT 1200 PM. EYE ALSO LOOKED BLOOD SHOT. CLIENT APPLIED COLD MOIST COMPRESS TO EYE. BY EVENING, SWELLING WAS GONE BUT SCLERA PINK AND LIGHT SENSITIVE. THIS AM, 2/17/2021 EYE IS A LITTLE PINK YET, NO SWELLING. HAS NOT AFFECTED VISION.

Other Meds: LOSARTAN, PROPANOLOL, POTASSIUM, VITAMIN C, GINGER TEA

Current Illness: NONE

ID: 1036622
Sex: F
Age: 48
State: PA

Vax Date: 02/10/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: COVID Swab completed

Allergies: Amoxicillian

Symptoms: Had symptoms of a Sinus Infection, went to PCP and tested positive for COVID.

Other Meds: Protonix 40mg Levothyroidoxide .137 Hydrochlorothiazide 12.5 mg Amlodipine 5 mg Daily Vitamin Allergy Pill

Current Illness: None

ID: 1036623
Sex: F
Age: 69
State: IN

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

Lab Data:

Allergies: NONE

Symptoms: Within 24 hrs. had Vertigo

Other Meds: Triam/HCTZ, Hydroxychoriquine, Ezetimibe, Metoprolol, Glyzambi, Loratadine, Pilocarpine, Ursodiol, Potassium, Levothyroxin, Bayer, D3, Cranberry Caps

Current Illness:

ID: 1036624
Sex: F
Age: 49
State: CA

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Hives Difficulty breathing

Other Meds:

Current Illness:

ID: 1036625
Sex: F
Age: 67
State: FL

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

Lab Data: None

Allergies: Sulfa Penicillin and ampicillin Erythromycin

Symptoms: Fatigue started about 12 hours after 2d dose. About 13 to 14 hrs in, I felt chilled, then feverish, then intense nausea. The fever lasted about 24 hrs and went down slowly from over 100 to 98, while the nausea lasted only 2 or so hrs. No vomiting. Slept all day long and was fatigued. About 24 hrs after the symptoms began, I felt fine. Perhaps the fatigue lasted into the next morning as did the fogginess, but I was all better within 48 hrs from the dose.

Other Meds: Vitamin D 3 ?2000 IU Ezetimibe 10 mg Lorazepam .5 mg

Current Illness: None

ID: 1036626
Sex: F
Age: 40
State: MO

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

Lab Data:

Allergies:

Symptoms: ITCHY WARM RED BULLSEYE AT INJECTION SITE

Other Meds:

Current Illness:

ID: 1036627
Sex: M
Age: 66
State: FL

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

Lab Data: none

Allergies: none

Symptoms: BPH become much worse in a short period of time. It went from moderate annoyance, having to go to relief myself 2-3 times a night, to complete retention. Was near point of going to ER, but Ibuprofen seems to work to help something come out -- although limited. Tried Flomax for first time, (had prescription for if needed), but the Ibuprofen seems to help best. Makes me suspect inflammation from the vaccine. Other than that possibility, only reaction to the vaccine was a sore arm for a couple days.

Other Meds: Pygeum, Saw Palmetto

Current Illness: none

ID: 1036628
Sex: M
Age: 88
State: PA

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

Lab Data: None

Allergies: none

Symptoms: Bruising at or near injection site. Muscle area below was discolored, yellowish, as if there had been bleeding in the muscle. No pain or discomfort during or after injection. Site was not examined until discoloration was observed by wife about 5 days after the injection (2/13/2021) when he came out of shower. The discoloration covers a circular area of about 1.5" diameter. The red area at the top of the circle has not subsided. Observed by a physician during routine office visit for another purpose on 2/16.

Other Meds: Synthroid, pravastatin,Ranexa, VitD, aspirin 81mg,hydroxyurea,

Current Illness: none

ID: 1036629
Sex: M
Age: 69
State: CA

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

Lab Data:

Allergies:

Symptoms: Itching at injection site. BP 154/93, pulse 82; repeat BP 150/82, pulse 76. O2 sat 95%. Stabilized.

Other Meds:

Current Illness:

ID: 1036630
Sex: F
Age: 68
State: PA

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

Lab Data:

Allergies: None

Symptoms: Large swelling, bruising and redness

Other Meds: Adderall, Amolidipine, Viibryd, Atorvastatin, Bupropion

Current Illness: Nothing

ID: 1036631
Sex: F
Age: 74
State: CA

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

Lab Data:

Allergies: Aspirin

Symptoms: Day 2 - fatigue, body aches, chills, headache, extreme arm soreness, nausea. Symptoms subsided Day 3 but headache continued and large red circle appeared on arm, just below shot site, itchy and hot. At Day 6, arm is finally only moderately sore, redness gone, itchiness gone.

Other Meds: Creon 12000

Current Illness: None

ID: 1036632
Sex: F
Age: 82
State:

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

Lab Data:

Allergies:

Symptoms: I had my 2nd Pfizer vaccine , Lot:EL9264 at 10:30 on Feb. 13, 2021 at MC. I was beginning to get slight pain in my back by late afternoon the same day. By bedtime, it was much worse. I woke up around 2:am to go to the bathroom. I couldn't even stand up. My husband was able to help me and get me back to bed. I had excruciating pain with every step. I couldn't bend, turn, etc. I spend all of the next 2 days in bed. Yesterday, on the 3rd day, I was able to sit in a chair for a short time. Today I am better and can get along without assistance.

Other Meds:

Current Illness:

ID: 1036633
Sex: F
Age: 45
State: VA

Vax Date: 02/04/2021
Onset Date: 02/08/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data:

Allergies: Cat hair, pollen

Symptoms: Suspect delayed hypersensitivity reaction. Patient felt some malaise and pain over injection site for 2-3 days following 2nd SARS-COV-2 vaccine, however developed large targetoid erythematous, pruritic rash over injection site and much of this arm 3-4 days following vaccination.

Other Meds: Semaglutide 3mg PO qD

Current Illness:

Date Died: 02/16/2021

ID: 1036634
Sex: F
Age: 77
State: MD

Vax Date: 02/08/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: no medical testing done per family wishes

Allergies: NKDA

Symptoms: Patient had COVID in Sept. Minimal symptoms. Received 1st dose 1/18 without adverse reactions. Second dose on 2/8-had complaints of arm soreness several days after then appeared in usual state of health. On 2/14 @ 2 hours after having lunch, patient was found unresponsive with Respirations 60, pulse 130, PO 84%, blood pressure 105/68. Patient with lots of white foam coming out of mouth. Temperature to 101.3. Patient DNR B and family deferred transfer, wanted comfort measures only. Nursing received order for MSIR. Patient continued with temps in 99-100 range with tylenol suppositories. Patient passed on 2/16.

Other Meds: buspar, depakote, keppra, norvasc, synthroid, zoloft

Current Illness: none

ID: 1036635
Sex: M
Age: 0
State: AZ

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

Lab Data: N/A

Allergies: Sulphur Antibiotics Tetanus Shots/Vaccine

Symptoms: I have never suffered from headaches in my life - I had mild headache with the 1st dose; however, this second dose literally gave me migrane - now it is a cluster headache that I've had since February 5th, 2021 - the cluster headaches have not stopped - they are intolerable - I had to miss two days of work as a result - by the way the website gave me an error message when entering my age 52 years of age - it asked me for my age at time of vaccine and it tells me that it does not match their calculator

Other Meds: Amalodophine 5mg Crestor 10 mg Omepresol 40 mg

Current Illness: N/A

ID: 1036636
Sex: F
Age: 72
State: NC

Vax Date: 02/05/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: None

Allergies: Yes Ascorbic Acid, Sulfur drugs

Symptoms: Extreme itching about 10 days after

Other Meds: Bystolic, Benicar/ HCTZ, Torsemide, Amlodipine, Cholesterol medicine, Cod Liver Oil, Calcium, Vitamins, Chondrodin/MSM, B6,B12, Garlic pills, Iron pills, Turneric

Current Illness: None

ID: 1036637
Sex: M
Age: 49
State: MA

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

Lab Data: None

Allergies: Nothing prior to this immunization

Symptoms: Beginning Saturday 2/13/21 5:00 pm began with the rash. Prior to that had malaise, chills, joint pain &fever which started 2/12/21 evening. No rash after first dose-only had fever and malaise after first dose which subsided after 7 hours.

Other Meds: Probiotic Bioxx4

Current Illness: Nothing and had physical within the one month period.

ID: 1036638
Sex: F
Age: 40
State: CA

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

Lab Data: N/A

Allergies: Naratriptan

Symptoms: Fever (100-103? F for ~36 hrs), chills (~36 hrs) muscles aches (~48 hrs), headache (~72 hrs), rash/swelling to upper arm distal to injection site (~48 hrs after vax admin, ~2? x 3?, present for ~1wk)

Other Meds: Lamotrigine 100mg, Migrelief, Vitamin B12

Current Illness: N/A

ID: 1036639
Sex: F
Age: 68
State: MI

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

Lab Data: None

Allergies: Penicillin, amoxicillin, keflex, vancomycin, clindomycin, meropenem, cipro, daptomycin, & the contrast dye for MRI/CT ALL result in very itchy, full body rash. Had no adverse reaction to 1st Moderna Covid19 vaccine.

Symptoms: 60 hrs after receiving 2nd Moderna vaccine, rash began to emerge all over body from head to toe including palms & webs of fingers, arms, legs & trunk of body. The rash was extremely itchy & since this happened on wknd, took doses of chlortrimaton every 4 hrs for 3 days until new rash sites stopped erupting.

Other Meds: Xarelto

Current Illness: None

ID: 1036640
Sex: F
Age: 73
State: NC

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: none

Allergies: ace inhibitors, hydrocodone

Symptoms: Dizziness, took Meclizine 03/16/2021 around 3:30 pm

Other Meds: Dliitazem, xerelto, clorthadone, lorsatan, astrovastatan, vitamin d, fish oil, novolog, levemir

Current Illness:

ID: 1036641
Sex: F
Age: 58
State: MO

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

Lab Data:

Allergies:

Symptoms: Large area of redness and swelling at injection site, on day 5 symptoms continue but improving

Other Meds:

Current Illness:

ID: 1036642
Sex: F
Age: 32
State: FL

Vax Date: 01/06/2021
Onset Date: 02/05/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: None.

Allergies: Topical sulfa antibiotics.

Symptoms: Severe systemic inflammatory symptoms including high fever, shaking chills, full body myalgias, diffuse arthralgias (especially neck and back), headache, full body dermatologic allodynia - all beginning approximately 8-10hrs after vaccine administration and lasting up to 24hrs afterwards with only mild amelioration by NSAIDs. Severe arm soreness/pain including limited ability to ABduct the arm for 3 days due to pain.

Other Meds: Vitamin B12, Vitamin C, Prenatal multivitamin, Nicotinamide Riboside, Avmacol (broccoli sprouts).

Current Illness: None.

ID: 1036643
Sex: M
Age: 32
State: IL

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

Lab Data:

Allergies: None

Symptoms: Adverse event: Mild fever, body aches and fatigue 24 hrs after 2nd dose. Treatment: Ibuprofen and acetaminophen every 4 hrs . Outcome: reduced signs and symptoms. Adverse event: swollen L lymph nodes for one week (ended 2/4/2021)Treatment: Ibuprofen every 8-16 hrs . Outcome: reduced signs and symptoms.

Other Meds: None

Current Illness: None

ID: 1036644
Sex: F
Age: 32
State: IL

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

Lab Data:

Allergies: None

Symptoms: Left arm soreness began the night of (approx. 5hrs after injection). Body aches began the next morning (approx. 7am). Fever and chills began at approx. 12:00pm and extended for several hours, getting to a maximum of 102.5. Chills continued until evening past 10:00pm. Accompanying headache lasted throughout the day. Ibuprofen was taken throughout the day to help with headache and body aches. Erythematous rash surrounding injection site was noted in the afternoon, eased by the application of OTC hydrocortisone cream.

Other Meds: Nortrel 1/35 BC Multi-vitamin Vitamin C, D, E Spironolactone 100mg

Current Illness: None

ID: 1036645
Sex: F
Age: 39
State: FL

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

Lab Data:

Allergies: mirvaso, moncell solution, band aid adhesive

Symptoms: I have had dermal fillers in my lips and about 18 or 20 hrs after vaccine i had swelling on my upper lip two and half days .

Other Meds: diltiazem, lisinopril, vitamin D, C, magnesium, prenatal vitamin, pro biotics

Current Illness: covid 19 12/6/2020

ID: 1036646
Sex: F
Age: 85
State: OR

Vax Date: 02/13/2020
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: fatigue, anorexia, generalized weakness. patient describes as severe

Other Meds: eliquis, levothyroxine, metoprolol

Current Illness: pelvic fracture

ID: 1036647
Sex: F
Age: 84
State: MD

Vax Date: 02/12/2021
Onset Date: 02/15/2021
Rec V Date: 02/17/2021
Hospital: Y

Lab Data:

Allergies: None

Symptoms: On Monday, 15 February my mother in law suffered a stroke. She has been hospitalized since the stroke at Hospital.

Other Meds: Medicine for high blood pressure, one for high cholestrol and one for anxiety.

Current Illness: None

ID: 1036648
Sex: F
Age: 47
State: RI

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

Lab Data:

Allergies: caffeine, cat dander (asthma), smoke (asthma), penicillin, codeine (rash)

Symptoms: Received first dose of covid vaccine Within 15 min of receiving experienced tingling in lips and tongue. Then rings on arm. Did not receive anything at facility. Left and went back to office. Within 45 minutes asthma attack presented slowly. Treated with benedryl 25 mg , then took rescue inhaler. Checking pulse oxygen. It was normal. Chest remained tight throughout the got tighter last night and took more benadryl.

Other Meds: cyanacobalamin, diazepam, fluoxetine, metformin, multivitamin, proair, trazodone

Current Illness: none

ID: 1036649
Sex: F
Age: 49
State: CA

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

Lab Data:

Allergies:

Symptoms: Increased heart rate, numbness (right area of throat), difficulty talking. BP 190/109 (HR 130); repeat BP 172/102 (HR 123). Epi-Pen given, then taken to the ED. ED progress note - MD doubted anaphylactic reaction. Patient stabilized after observation in the ED and was discharged.

Other Meds:

Current Illness:

ID: 1036650
Sex: F
Age: 44
State: TN

Vax Date: 02/05/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: none

Allergies: mold, possibly guaifenesin?

Symptoms: large oval red rash occurred adjacent to injection site -

Other Meds: Vitamin C, Alfalfa Tablets, Cetirizine Hydrochloride tabs 10 mg., Potassium, Vitamin E., Calcium Citrate & Vitamin D3

Current Illness: none

ID: 1036651
Sex: F
Age: 80
State: NJ

Vax Date: 02/11/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: no

Allergies: latex and latex

Symptoms: pt stated that her left leg around the groin area in the muscles started to hurt. She had severe pain in the left lower back. She also had muscle spasms in the top part of her back then got nausea and vomited. No fever. Pt will call her PCP for medical advice.

Other Meds: Synthroid, Pantoprazole, calcium, calcitriol, Vitamin B-12, D, Metformin,

Current Illness: no

ID: 1036652
Sex: F
Age: 68
State: MD

Vax Date: 02/05/2021
Onset Date: 02/13/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: None

Allergies: No known allergies

Symptoms: Swelling and redness at injection site, first noticed on 02/13/2021, eight days after injection, resolved after ~48 hours. No other symptoms.

Other Meds: Multiple daily vitamin, Ocuvite, aspirin 81 mg daily

Current Illness: None

ID: 1036653
Sex: F
Age: 55
State: PA

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 02/17/2021
Hospital: Y

Lab Data: EKG; normal echo; normal

Allergies: n/a

Symptoms: 1/6 vaccination 1/7 I started feeling light headed and dizzy. Chest pressure. Went to ER. Hypertensive. Put on medication. Kept as inpatient; observation.

Other Meds: n/a

Current Illness: n/a

ID: 1036654
Sex: M
Age: 48
State: VA

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

Lab Data:

Allergies: ASA, Citric Acid, Percocet

Symptoms: left Lower jaw and neck Numb, Pain in shoulder (not at inection site), headache

Other Meds: Acetaminophen PM, Gabapentin

Current Illness: none

Date Died: 01/31/2021

ID: 1036655
Sex: F
Age: 69
State: IL

Vax Date: 01/13/2021
Onset Date: 01/31/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: Hospital labs 1/14-1/27 WBC 36.53; BUN 58; Cr 4.48; Albumin 1.5; Globulin 5.7; Alk Phos 667; SGOT 194; SGPT 77; Lymph 0%

Allergies: Captopril, lisinopril and plavix

Symptoms: Death on 1/31/2021 multiple comorbidities

Other Meds: Doxycycline twice daily; gabapentin daily; multivitamin daily; apresoline daily; cyanocobalamin; ascorbic acid; ergocalciferol; eliquis; nitrostat prn; allopurinol; famotidine; isosorbide; labetalol; tylenol; humalog

Current Illness: Chronic Stage IV sacral decubitis ulcer infected with necrotic tissue. Inpatient admit 1/14-1/27 for infected decubitis ulcer, osteomyelitis; bacteremia and possible cirrhosis and underwent multiple debridements while hospitalized.

ID: 1036656
Sex: F
Age: 67
State: WV

Vax Date: 02/12/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: Nond

Allergies: Bactrim

Symptoms: Red swollen indurated tender arm.. itches

Other Meds: Inderal, lasix. Pravastatin, duloxetine

Current Illness: Depression, hypertension

ID: 1036657
Sex: F
Age: 66
State: CA

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

Lab Data:

Allergies:

Symptoms: Symptoms right arm shoukder back and chest pain and numbness and neck stil numb no strength

Other Meds:

Current Illness: feb 5 feel pain on right shoukder and then back next day right arm feel numb i cannot hold anyhing next day i feel pain every time i breathe and pain on the chest until now i feel all the pain and numbness

ID: 1036658
Sex: F
Age: 83
State: WI

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

Lab Data: Blood glucose 122

Allergies: PCN and Levaquin

Symptoms: Patient received the first dose of her covid vaccine by Moderna in her left arm at 1445. Lot number 023M20A. Exp. 8-10-2021. Patient had no pain with injection. Tolerated well. Approximately 30 seconds to one minute after injection patient reported to nurse that her mouth and throat felt dry. This nurse asked the patient if she was feeling anything else different and if her throat felt itchy. Patient reported that her throat did feel a little itchy. This nurse called for assistance. RN obtained Dynamap to take patient vital signs. This nurse stayed by patient's side at all times. NP responded and was by patient's side throughout event. Patient now reporting feeling very hot. Ice pack applied to back of her neck. Initial vital signs 184/87, Map 123, HR 119. Patient tachypnic and tachycardic. Pulse ox WNL at 99%. Lung sounds clear. Radial pulse obtained, rapid. First responder called for with overhead page. Next vital signs 189/79.map of 113. HR 116. Patient still tachypnic and tachycardic with a pulse ox of 99%. Patient reports she is feeling dizzy and hot still. Able to answer questions and was oriented at all times. Dr and first responder team arrived at scene. Patient able to answer questions. Is still dizzy and not feeling well. Patient transferred safely to cart and strapped in with safety straps. All patient belongings placed on cart with her. Patient taken to ED for evaluation.

Other Meds: albuterol (PROVENTIL HFA;VENTOLIN HFA;PROAIR HFA) inhaler Inhale 2 puffs into the lungs Every 6 (Six) Hours As Needed Pharmacy to dispense brand covered by insurance. for Wheezing. amLODIPine (NORVASC) 5 MG tablet Take 1 tablet by mouth Da

Current Illness: None

ID: 1036659
Sex: F
Age: 41
State: MI

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: Beginning about 48 hours after shot, I became nausea, vomiting, severe diarrhea, headache, body aches and exhaustion until Tuesday February 16 (5 days post vaccine).

Other Meds: Prozac

Current Illness: none

ID: 1036660
Sex: F
Age: 43
State: WA

Vax Date: 02/14/2021
Onset Date: 02/15/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data:

Allergies: Aleve

Symptoms: Skin rash on upper arm below injection site.

Other Meds: Bupropion Lithium Escitalopram Vitamin D

Current Illness: None

ID: 1036661
Sex: F
Age: 59
State: AZ

Vax Date: 02/08/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: None

Allergies: Cantaloupe

Symptoms: Bruised. Itchy. Red. Warm

Other Meds: Baby aspirin Calcium Daily vitamin Estradiol Magnesium Progesterone

Current Illness: None

ID: 1036662
Sex: F
Age: 45
State: NY

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

Lab Data: N/A

Allergies: NKA

Symptoms: 10:25 - Pt compalins of tingling in mouth. Will continute to monitor. Initate VS. Lung sounds clear. 10:40 - Pt speech is muffled. Tongue minimally swollen. 10:41 - Benadryl 25 mg IM RA administered. 10:45 - Patient reports resolution of tingling in mouth. Tongue swollen resolved. 10:55 - Patient left.

Other Meds:

Current Illness:

ID: 1036663
Sex: F
Age: 44
State: NY

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

Lab Data: none

Allergies: dust, latex, nickel

Symptoms: within 15 minutes of Pfizer vaccine had itchy arms and facial twitching. She was observed for an hour and was told to take benadryl as needed after leaving. Noticed facial rash later that night. The next day patient was itchy in both arms and has some facial swelling, does not have any trouble breathing. was taking benadryl every 4 hours, seen by allergist next day for telemedicine visit and was advised to switch to cetirizine, max 2 tab bid.

Other Meds: none

Current Illness: none

ID: 1036664
Sex: M
Age: 75
State: NY

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: NA

Allergies: Iodine

Symptoms: Patient received the first dose of Pfizer covid-19 vaccine on 1/22/2021. He was observed for 15 minutes with no adverse events. On February 15th, he came back to the vaccine pod to receive his second dose of the vaccine and reported that he experienced an episode of Bell's palsy after the first dose. He reported it to his neurologist at the time and the reaction was self-resolved. The case was escalated to medical provider for second dose clearance. Patient was cleared to receive the second dose and did not experience any adverse effects while in the clinic.

Other Meds: Unknown

Current Illness: Unknown

ID: 1036665
Sex: F
Age: 34
State: MN

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

Lab Data: none

Allergies: none

Symptoms: 2/12 pm- start of sore arm and slight headache approaching at bedtime. 2/13- swollen lymph node in left axilla with pain, painful left arm and swelling at injection site, headache, fever over 101 degrees F, body aches, on/off nausea 2/14- on/off nausea 2/15- severe headache all day, on/off nausea, sensitivity to smells, light sensitivity, eye pain 2/16- slight nausea 2/17- slight nausea

Other Meds: baby aspirin daily

Current Illness: none

ID: 1036666
Sex: M
Age: 69
State: MO

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Lab Data: none

Allergies: None

Symptoms: Day of shot -OK. First day after--Injection site sore, Elbows and knees very sore and weak, 2 degree temperature increase, extremely tired, and no appetite. Second day after-feeling much better.

Other Meds: Centrum Silver vitamin, Zinc. 50 mg, Ibuprofen 200mg, Cetirizine 10mg

Current Illness: none

ID: 1036667
Sex: F
Age: 50
State: NY

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

Lab Data: none

Allergies: none

Symptoms: After the first shot I just had a sore arm and nauseous for 4 days. After the second shot I had a sore arm (significantly more than after the 1st), had a massive headache for about 24 hours, but woke up this morning (2nd day after the shot) with swollen nymph nodes under my left arm along with pain and tenderness. It hurts to lift my arm or have anything putting any form of pressure on it.

Other Meds: Amitriptyline, melatonin, NyQuil

Current Illness: none

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm