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: 1049203
Sex: F
Age: 69
State: NM

Vax Date: 02/12/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: I got bruised, because shot hit a vein. Bruise is still there aftern11 days. But pain in shoulder started back up. First weekend I could not lift my arm. Now it is back to being painful when using my shoulder.

Other Meds: alendronate sodium 70 mg

Current Illness: none

ID: 1049204
Sex: F
Age: 61
State: IL

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: FEVER, FATIGUE, AND HEADACHE

Other Meds:

Current Illness:

ID: 1049205
Sex: F
Age: 79
State: NC

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Pinesol, codeine derivatives, penicillin, Sulfa, beta-blockers, Tramadol, Compazine, Demerol, bananas, contrast dye, dust, iodine, latex, molds, shellfish, strawberries, avocados, mangos (anything that comes from a rubber tree). She went into shock 4 times due to shellfish, avocados, contrast dye and latex (latex being the worst). Cats and dogs.

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

Symptoms: She woke up on the morning of 2/14/21, was not feeling real good, but noticed a tightness in her mouth. Her cheeks were swollen, she felt that maybe her tongue was as well. She got the liquid Benadryl and let it stay there and it helps that feeling. She had taken the Zyrtec and Singulair the night before. She did the inhaler puff in the morning, the feeling did not go away. She then took the Ventolin and it seemed to calm down. The symptoms then went away and didn't come back, and thought that she was ok. She felt bad for about a week and a half like she wanted to sleep all the time, but did what she had to do. She is fine now.

Other Meds: Sertraline, Disopyramide, Montelukast, Zyrtec, Verapamil, Melatonin, vitamin D, Iron, Furosemide, Pantoprazole, Eliquis, stool softener, Flovent, allopurinol, B12, Vitamin C.

Current Illness: None.

ID: 1049206
Sex: F
Age: 44
State:

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient reported bilateral numbness in fingers and feet with dry mouth. Symptoms lasted greater than 15 minutes.

Other Meds:

Current Illness:

ID: 1049207
Sex: F
Age: 75
State: GA

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: Diphenhydramine Metronidazole PCN Class Milk

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

Symptoms: Body and lip itching after 2nd dose of vaccine- required medication intervention.

Other Meds: MVT Vitamin D3 Vitamin B-12 Lipitor

Current Illness: None

ID: 1049208
Sex: F
Age: 31
State: OH

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 02/23/2021
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: erythromycin (hives)

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

Symptoms: 1. hives/ break out across shoulders delayed reaction 2. Burning sensation in spine (lasting 1 week, now occasionally appears)

Other Meds: ibuprofen taken after vaccination

Current Illness: n/a

ID: 1049209
Sex: F
Age: 70
State: OH

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
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: Homatropine, Codeine, Diazepam, Levofloxacin, Penicillin, Mobic, Lyrica

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Hives, Diarrhea

Other Meds: ASA, Calcium, Vit. D, Fosamax, Linzess, Oxybutynin, Omeprazole, Celecoxib, Bupropion, Cymbalta, Ambien, Simvastatin, Norco.

Current Illness: None.

ID: 1049210
Sex: F
Age: 70
State: OH

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient came to our drive thru Covid 19 vaccination clinic to receive her second dose of Moderna. Pfizer vaccine was given inadvertently to patient. Patient denies any reactions. Dr. phoned the patient the next day and patient is fine, still no reaction.

Other Meds:

Current Illness:

ID: 1049211
Sex: M
Age: 52
State:

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: A few minutes after receiving the vaccine, patient reported 1/10 chest pressure to left chest, to left shoulder, improving after 15 minutes. No nausea, light headedness. Non-smoker, no HTN or DM.

Other Meds:

Current Illness:

ID: 1049212
Sex: F
Age: 43
State: WI

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: penicillin, amoxicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 30 minutes after: nausea, dizziness, fatigue; later in the day and for days after: pain and swelling and tenderness at injection site, muscle tenstion, fatigue; next day and multiple days after: muscle and joint aches, fatigue, some headaches and chills

Other Meds: 1 venlafaxine 150 mg extended release capsule, 2 gabapentin 300 mg capsules, Coenzyme Q10 , ascorbic acid (vitamin C) 500 mg tablet, Magnesium Carbonate Powder (Calm brand citrate), magnesium oxide 250 mg tablet, cholecalciferol (vitamin D

Current Illness: no

ID: 1049213
Sex: F
Age: 52
State: FL

Vax Date: 01/20/2021
Onset Date: 02/01/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: Reglan, Lipitor & seasonal allergies

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

Symptoms: Rash to the top of bilateral thighs, waist and breast bilaterallys, Palms of bilateral hands bright red and tongue felt a little thich

Other Meds: Metformin, Rybelsus, HCTZ, Atenolol, ASA, Crestor, Zetia, Protonix, Levothyroxine, Tylenol, Motrin, Vit D, Multi Vitamin, Biotin

Current Illness: Viral Illness - Headache, sore throat late december

ID: 1049214
Sex: F
Age: 37
State: KY

Vax Date: 02/03/2021
Onset Date: 02/12/2021
Rec V Date: 02/23/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: 9 days after vaccine, I noticed a red rash under my left arm. Day 10, I experienced extreme tenderness above the rash along with what feels like a swollen lymph node. Area felt bruised and could not be touched without pain for 3 days following. Day 11, I felt a pulling sensation when lifting my arm overhead and noticed when lifting my arm, it looked like a tendon was protruding through the skin(under my arm), and the tendon is easily palpable when touching the arm lightly Day 20, my arm feels extremely heavy, I still have pain under my arm, there is still tightness, the tendon is still protruding, and Im having slight numbness in my left hand.

Other Meds: Sprintec, Turmeric tincture, Vitamins for runners

Current Illness: none

ID: 1049215
Sex: F
Age: 36
State:

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/23/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Passed out twice. Nausea and Headache.

Other Meds:

Current Illness:

ID: 1049216
Sex: M
Age: 71
State: IN

Vax Date: 02/02/2021
Onset Date: 02/04/2021
Rec V Date: 02/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Extreme muscle pain in buttocks and thighs and biceps began 2 days after injection. Pain and muscle weakening increased and moved on to include total leg, wrists, forearms and hands. Could not sit or rise from seated position or bend with out using cane. Could not grip blankets to cover myself in bed or put on socks by myself. This lasted for 2 weeks. Now have recovered to 95% pain free

Other Meds: Amlodipine, Aspirin (81), Atorvastatin, Celecoxib, Finasteride, Fish oil, Losartan hydrochlorothiazide, Metformin,Metoprolol succinate, Tamsulosin

Current Illness: Hip tendonitis

ID: 1049217
Sex: M
Age: 81
State: NE

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 02/23/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Got shot on 1-11-21 and on 1-13-21 am was totally unresponsive , oxygen level low and passed away on 1-14-21

Other Meds: hydrocodone prednisone gabapentin clonazepam methotrexate

Current Illness: congestive heart failure arthritis

ID: 1049218
Sex: M
Age: 45
State:

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
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:

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

Symptoms: Patient reported throat irritation, which started a few minutes after receiving vaccine. Symptoms improved at 15 minutes. Had similar reaction with flu vaccine. 14:00 Patient called. Reported he took diphenhydramine. Throat irritation decreased. Reports headache.

Other Meds:

Current Illness:

ID: 1049219
Sex: M
Age: 35
State: CA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 02/23/2021
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: penicillin; vancomycin

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

Symptoms: About 8 pm that night, I felt my chest going really fast - my heart rate was high. I called the nurse hotline. They asked me if I had pain and I said no. Just a high heart rate. WAs told to monitor it. Next day, I had chest pain and tightness in chest and fast heartrate. I went to ER. Gave me IV; fluids and steroids. They sent me home with steroids for five days. About three or four days after steroids were done, it resolved the symptoms.

Other Meds: Prilosec

Current Illness: COVID - after of Pfizer Vaccine Dose 1

ID: 1049220
Sex: F
Age: 53
State: IN

Vax Date: 01/27/2021
Onset Date: 01/29/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: KNDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 10cm x 5cm large circular erythematous itchy rash. which resolved with Benadryl but patient presented into office with right neck 1cm lymph node which appeared when the rash did.

Other Meds: synthroid, albuterol

Current Illness: none

ID: 1049221
Sex: M
Age: 70
State: WI

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt presented to vaccine clinic to receive second dose of COVID 19 Moderna vaccine. Pt did not have his COVID vaccine administration card. When Pt presented to this writer to receive vaccine, he had already been checked in and verified and provided his informed consent form that was completed and signed. Pt reported that he had no adverse events from his first dose of Moderna. This writer verified Pt's name, DOB, and reason for visit to vaccine clinic. Pt was informed of potential adverse events and offered appropriate education. Vaccine administered and Pt observed for 15 minutes post injection. No adverse event noted and Pt left vaccine clinic ambulatory. Upon return to the clinic, Pt's second dose of Moderna vaccine was documented. This writer became aware that the Pt had received his second dose of the Moderna vaccine one week too early when verifying the schedule for an upcoming vaccine clinic. A telephone was made to the Pt to inform them of the event that occured and explain that Pt would not need to receive an additional dose, however, there was no answer and there was no voicemail available to leave a message.

Other Meds: Buprorpion, Clopidogrel, , Ferrous Sulfate, Flomax, Hydrochlorothiazide, Lipitor, Lisinopril, Paxil, Potassium Chloride, Pro Air Inhaler, Protonix, Spiriva, Ventolin Inhaler, Breo Ellipta, Zyrtec

Current Illness: None

ID: 1049222
Sex: F
Age: 45
State: IL

Vax Date: 02/15/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: FATIGUE

Other Meds:

Current Illness:

ID: 1049223
Sex: F
Age: 52
State: PR

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
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: NO

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

Symptoms: Strong headache, in the left arm and all over the body. Nauseas Chills Dizziness

Other Meds: NO

Current Illness: Hypoglycemia Hives Arthritis

ID: 1049224
Sex: F
Age: 74
State: AZ

Vax Date: 02/01/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin

Symptom List: Unevaluable event

Symptoms: COVID Arm

Other Meds: Amiloride, Indapamide,, Vitamin D, Levothyroxine, Escitalopram, Potassium

Current Illness: None

ID: 1049225
Sex: F
Age: 80
State: FL

Vax Date: 02/11/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
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: Penicillin, Sulfa Drugs, Iodine, Aspirin, Wool, Benedryl (very severe), Latex (mild),

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

Symptoms: Redness and swelling from shoulder to elbow. skin hot.

Other Meds: Bystolic, Potassium Chloride,

Current Illness: Controlled high blood pressure,

ID: 1049226
Sex: F
Age: 64
State: MN

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 02/23/2021
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: Penicillins products Poison Ivy Poison Oak

Symptom List: Injection site pain, Pain

Symptoms: Moderna Covid vaccine. Covid arm stron g reactions. 2/11- 2/13 Swelling, bruising, redness, extreme itchiness, pain to to tightness. Treated with Benadryl, hydrocortisone crepe, ibuprofen, rest. Three day duration. Another brief reaction 2/17. Same symptoms milder and shorter duration of i.5 days.

Other Meds: None

Current Illness: None

ID: 1049227
Sex: F
Age: 66
State: AZ

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: Gabipenton

Symptom List: Injection site pain, Menorrhagia

Symptoms: Dyspnea at 3different times within 24 hours

Other Meds: Synthesis Prevacid Immutable Prednisone Oxycodone

Current Illness: Autoimmune hepatitis

ID: 1049228
Sex: F
Age: 49
State: NC

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/23/2021
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: Sulfa; Shellfish

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

Symptoms: Fever Headache Body Aches Diarhea Swollen Lymphnodes Terrible Shoulder/Arm pain Attacked Lymphatic System

Other Meds: Tylenol; Sertraline

Current Illness: None

ID: 1049229
Sex: F
Age: 47
State: NC

Vax Date: 02/21/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
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: n/a

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Swelling underneath arm pit. doctor advised Tylenol and warm compress

Other Meds: blood pressure, sinuses

Current Illness: n/a

ID: 1049230
Sex: M
Age: 34
State: PA

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Chills that were worse than the first time for about 4 hrs. Mild headache next day.

Other Meds: None

Current Illness: None

ID: 1049231
Sex: F
Age: 22
State: NY

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
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: Penicillin - hives

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Patient assessed via virtual visit on 2/21 Got 2nd dose of Moderna vaccine on 2/20. On way home was having tongue swelling. Sharp CP radiating to diaphragm and throat swelling since last night. +wheezing. Walking from bed to bathroom gets SOB SOB gradually worsened as time passed Dizziness since difficulty breathing paresthesia in hands diaphoresis - pt attributes to fever/chills she has been getting since having the vaccine Denies n/v, abdominal pain, syncope Dyspnea, oral swelling, CP began s/p Moderna vaccine 2 of 2 and gradually worsening Advised ER via ambulance. Pt prefers to wait for her dad to take her to the ER Counseled pt on risk of death due to airway cut off due to worsening sx: bronchial inflammation/throat swelling or decreased oxygen to heart/brain with dizziness (MI/stroke). Advised tools EMS would be able to administer life saving medications to support her in these emergent situations and quickly get pt to ER vs having her die in car with dad bearing guilt of losing daughter. Pt expresses understanding, will wait for her dad. Suggested pt have a code word to say so if things getting worse her dad pulls over to call 911. Pt agreeable.

Other Meds: metoclopramide HCl, 10 mg rapid dissolve PO tid

Current Illness: Gastroenteritis

ID: 1049232
Sex: F
Age: 30
State: CA

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Nausea

Symptoms: Dizziness, nausea, headache, feeling on lip swelling and "dripping" feeling to back of throat

Other Meds: n/a

Current Illness:

ID: 1049233
Sex: M
Age: 85
State: FL

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Injection site pain

Symptoms: My husband started having a reaction 12 hours later, he said he didn't feel good, he didn't want to move, cold and felt weak, and couldn't get out of his chair, he was unstable.

Other Meds: Atorvastatin 10mg (PM), Amlodipine 2.5mg, Plavix 75mg, Donepezil HCL/Aricept 10mg, (AM) Memantine HCL 5mg(am&pm),

Current Illness: no

ID: 1049234
Sex: F
Age: 38
State: TN

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: Latex, flu vaccine

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

Symptoms: States a few minutes of receiving first Covid vaccine (Moderna) complaints of swelling, burning, and itching on L arm which progressed to left neck and ear. Went to see HCP immediately and received Benadryl and steroid shot. Feeling better day after receiving vaccine.

Other Meds: Benadryl pill

Current Illness:

ID: 1049235
Sex: F
Age: 73
State: IL

Vax Date: 02/12/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
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: Yes. Sulfa

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

Symptoms: Rash, hives, warm to touch, itching, swelling, ache. Took antihistamine, applied hydrocortisone. Still red,etc. on 2/23/2021

Other Meds: No

Current Illness: No

ID: 1049237
Sex: F
Age: 31
State: AL

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
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: Gluten

Symptom List: Tremor

Symptoms: Fatigue, Nausea, Vomiting, Chills, Body Aches, Very stiff arm from injection, extremely bad taste in my mouth as soon as I was given the shot

Other Meds:

Current Illness: NA

ID: 1049238
Sex: F
Age: 74
State: MN

Vax Date: 02/06/2021
Onset Date: 02/14/2021
Rec V Date: 02/23/2021
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: Some dairy and eggs

Symptom List: Erythema, Pruritus

Symptoms: Aches ,sore arm/slight fever/1 day...tired,sore arm.6 days loss of taste and smell 1 week. 2 weeks later rash on inner arms and legs...better but still have it on day day 18

Other Meds: Vit.d,magnesium,baby asperin

Current Illness:

ID: 1049239
Sex: M
Age: 69
State: MI

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
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: No

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

Symptoms: Sudden nasal infection which I started to take Sudafed for. I also had weakness, fatigue, heavy diarrhea for two days and of course heavy nasal infection. It did not go to my chest however. After 4 days of sickness i now feel much better. I did not have a fever or nausea during my sickness.

Other Meds: Losartan Asp. vitamin pills

Current Illness: No

ID: 1049240
Sex: F
Age: 39
State: CA

Vax Date: 02/01/2021
Onset Date: 02/02/2021
Rec V Date: 02/23/2021
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: No allergies to medications Hives with salmon

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

Symptoms: 2/2/2021- 1 day after vaccination, Pt. noted swollen upper lip (swelling greater than lower lip). Slight itching. 2/3/2021- patient noted blister on top lip open with blood and body aches started and lasted until 2/16. Pt. did mention during clinic that she does develop a similar reaction when she eats salmon- but does not have blisters on her lip. She has also never had a cold sore before.

Other Meds: Levothyroxine po daily Zyrtec po daily Gapiscon (antacid) 800 mg ibuprofen daily from 2/2-2/16 Cymax - 2 shots, 1 time per month

Current Illness: Denies

ID: 1049241
Sex: F
Age: 68
State: CA

Vax Date: 02/13/2021
Onset Date: 02/15/2021
Rec V Date: 02/23/2021
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: Penicillin, Tetanus Toxoid, percodan,

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 2/15/2021 diarrhea thru 2/20. Starting on 2/19/2021 Left side facial numbness NOT paralysis. HIGH BLOOD PRESSURE> 200/88 without intervention. Severe headache , nausea and vomiting, generally feeling very bad. No fever.

Other Meds: Fluoxetine, fenofibrate, clonodine, baby aspirin, spironolactone,vitamin d, magnesium, potassium,.

Current Illness:

ID: 1049242
Sex: M
Age: 34
State: MA

Vax Date: 02/18/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
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: nka

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

Symptoms: Patient received second dose of Pfizer vaccine at 5pm on 2/18/21 and experienced expected symptoms of fatigue, injection site pain and minor body aches. Patient began to experience difficulty breathing on the morning 2/20, at that time the patient attributed it to asthma. Patient reports that he has not had an acute asthmatic episode in 25 years and has not experienced any respiratory condion like this before. Shortness of breath, chest pain and dizziness increased in the day to follow. On Monday 2/22 at 8:30am patient was seen at family medical facility by Doctor presenting with a 02 SAT of 93%. Covid test was preformed and was negative. Dr prescribed a preventative inhaler and some prednisone and sent patient home. Patient continued to decompensate and at 6pm was seen by previously treating physician, presenting with 02 sat of 91% given a nebulizer and sent home. Patients condition worsened overnight and he was seen in the faility Urgent care at 9am on 2/23. Patient was given a repeat covid test, that was negative , flu test that was negative, and chest xrays that were clear.

Other Meds: rescue inhaler

Current Illness: none

ID: 1049243
Sex: F
Age: 34
State: MT

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
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: Injection site pain, chills, swollen lymph nodes

Other Meds:

Current Illness:

ID: 1049244
Sex: U
Age:
State: IL

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
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: Pain in extremity

Symptoms: .

Other Meds:

Current Illness:

ID: 1049245
Sex: F
Age: 49
State: GA

Vax Date: 01/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: small nodule, painful sweeling on shoulder blade area

Other Meds: Albuterol HFA Meloxicam Zyrtec

Current Illness: None

ID: 1049246
Sex: F
Age: 79
State: NC

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
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: Pollen, dander, mold

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

Symptoms: On Feb 21, fever of 101 discomfort in arm, extreme tiredness. Difficulty sleeping. On February 22, fever of 99.1 , increased redness, heat, and swelling at site (about the size of my palm). Iced site for about an hour and took citirezine antihistamine. Feb 23, today AM temp 98.6, perhaps size of swelling has decreased. Still painful to raise arm there. Can do all household activities.

Other Meds: None

Current Illness: None

ID: 1049247
Sex: M
Age: 36
State: CA

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 02/23/2021
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: Penicillin

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

Symptoms: Experienced Crohn's type symptoms subsequent to both vaccinations. Primary symptoms included blood in stool and constipation. No treatment was given after 1st vaccine and symptoms were starting to subside after 3 weeks just before 2nd dose. After second dose, symptoms immediately and started course of Prednisone 20mg/day as treatment tapering off over 3 weeks. Prednisone relieved symptoms within 3 days.

Other Meds: Prilosec, Humira, Simvastatin

Current Illness:

ID: 1049248
Sex: M
Age: 17
State: IA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 02/23/2021
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:

Symptom List: Vomiting

Symptoms: N/A

Other Meds:

Current Illness:

ID: 1049249
Sex: F
Age: 68
State: FL

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/23/2021
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: Advair, Lisinopril, Norvasc

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received vaccine around 6pm and had some swelling in her ankle around 9pm bilateral. States she thought the inside of her cheek was swollen but thinks it doesn't feel any different now than it did then and think she was just in her head about it. She forgot to take her BP meds that morning and took them the following day and swelling in her ankles went down within 24 hours.

Other Meds: Losartan, Chlorthalidone, Metoprolol tartrate, Potassium Chloride, Famotidine, Pantoprazole, Aspirin 81mg, Atorvastatin, Montelukast, Certavite SR antioxidant, Albuterol HFA PRN, Metformin, Lyrica, Nitrostat PRN (hasn't used), Ondansetron,

Current Illness: Patient was severely sick 5 weeks prior to vaccination (covid test negative and antibody negative) and thinks it was food poisoning. Dropped 8 lbs and was vomiting. 2-3 weeks prior gained back 16 lbs after sickness resolved.

ID: 1049250
Sex: F
Age: 28
State: MD

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
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: Sulfa drugs

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

Symptoms: Syncopal event 17 hours later

Other Meds: desogestrel/ethinyl estradiol

Current Illness: None

ID: 1049251
Sex: F
Age: 72
State: CT

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
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: Unavailable for review in VAMS

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt received her first dose of the Moderna COVID19 vaccine Oxygen Sat 95% HR 102 BP 190/90 BP recheck 10 minutes later 158/78 HR 78 Pt reported feeling ?queasy? and unwell about 10 minutes after vaccination. Pt was evaluated by Prospect EMS paramedic. Pt reported being very afraid and nervous that the vaccine implanted a micro chip in her and she is scared she is going to start ?.? Pt signed refusal for transport to the hospital with Prospect EMS. Pt reported feeling better.

Other Meds: Unavailable for review in VAMS

Current Illness: None

ID: 1049252
Sex: F
Age: 42
State: OH

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: none listed

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

Symptoms: Approx. 10 minutes after receiving 2nd dose of vaccine, client stated she felt nauseous and light headed. BP 142/98, P 100 at 10:16am. Placed on floor with head down/feet elevated. Ice packs applied to neck. Given water to drink. Monitored for 30 minutes with no improvement. BP 112/80 P 80 @ 10:46am. Squad called to transport to ER.

Other Meds: unknown

Current Illness: none listed

ID: 1049254
Sex: F
Age: 72
State: AZ

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
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: Vancomyacin

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

Symptoms: Migraine evening of vaccine and day after. Nausea , vertigo and dizziness everyday since

Other Meds: Prednisone, Levothyroxine, Metoprolol, Flecainide, Atorvastatin, Omemprazole, Linzess, CoQQ10

Current Illness: constipation

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm