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: 1052547
Sex: F
Age: 31
State: FL

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/24/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: received the 2nd dose of the Moderna vaccine on Wednesday, February 3rd. The injection was given much higher than the muscle area as the first dose, closer to the shoulder bone. I started that evening with a very intense sore upper arm and tingling in the bottoms of my feet. On yesterday 02/04, I started noticing it in my legs as well and unable to raise my arm above my head without extreme pain. This morning I woke up with the same symptoms and noticed I am dragging my feet slightly as I do not have much feeling in them accompanied by the tingling. I have made an appointment with my PCP for today, 02/05 at 11:30am. I do not have any of the following symptoms: fever, body aches, cough, sore throat, runny nose, loss of taste or smell, SOB, fatigue, chills, or headache. I can be contacted if needed. Dx with MS

Other Meds:

Current Illness:

ID: 1052548
Sex: F
Age: 74
State: IL

Vax Date: 02/01/2021
Onset Date: 02/22/2021
Rec V Date: 02/24/2021
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: melon

Symptom List: Anxiety, Dyspnoea

Symptoms: Red itchy rash at site of injection 2 X 4 inches

Other Meds:

Current Illness:

ID: 1052549
Sex: M
Age: 71
State: TN

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/24/2021
Hospital: Y

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

Lab Data:

Allergies: Bee stings

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

Symptoms: Tongue and lip swelling on one side (left) and throat closure, admitted to ER then ICU 2/17/2021. Discharged from ICU on 2/19/2021.

Other Meds: Metoprolol 25mg QD Metronidazole 250mg QD Wixela Inhub Diskus 250/50mcg BID Gabapentin 600mg TID Cilostazol 100mg BID Lisinopril 40mg QD Citalopram 40mg QD Fenofibrate 145mg QD Atorvastin 80mg QD Amlodipine 10mg QD Famotidine 40mg QD Aspi

Current Illness: None

ID: 1052550
Sex: M
Age: 80
State: KY

Vax Date: 01/25/2021
Onset Date: 02/04/2021
Rec V Date: 02/24/2021
Hospital: Y

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: fever, ongoing fatigue, cough, bilateral LE edema, loss of taste and smell

Other Meds:

Current Illness:

ID: 1052551
Sex: F
Age: 83
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Pfizer-BioNTECH COVID -19 vaccine reconstituted with 1.7 ml of 0.9 ml NS instead of 1.8 ml. As a result only 5 doses were obtained for adminstration.

Other Meds:

Current Illness:

ID: 1052552
Sex: F
Age: 52
State: CA

Vax Date: 02/03/2021
Onset Date: 02/24/2021
Rec V Date: 02/24/2021
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: none

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

Symptoms: Cuyamaca team 2 was notified of a potential adverse reactions of a patient whom just received the second dose of vaccine. The patient was found in her car with husband onscene appearing to be in minor distress. Per the patient she has a history of anxiety and feels that she is having a anxious epsiode. Patient admits to having a similar effect post first dose. Patient admitted to " fluttering in the chest" as well as numbness in the fingers, patient was slightly tachypnic upon inital contact. Patient was advised of calming measures and symptoms began to subside. A full 911 response was started and performed a AMA, Heartland CAD # 2021-00012209. "PFIZER COVID 19 VACCINE EUA"

Other Meds: none

Current Illness: none

ID: 1052553
Sex: M
Age: 73
State: FL

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/24/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Red patches on left leg (about 6 inches high of left ankle)

Other Meds:

Current Illness:

ID: 1052554
Sex: F
Age: 47
State: NH

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

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

Lab Data:

Allergies: none per client

Symptom List: Pharyngeal swelling

Symptoms: Observation volunteer called clinic rapid response team. This RN assessed the client; VSS, no dificulty breathing. Client states bilateral upper extremities felt 'tingly'. Sensation resolved within 5 minutes of oberservation, but began to feel nauseious. Requested that client move to vaccination area for closer observation for a longer observation period. Client cooperative. After about 15 minutes client vomitted small amount. No other symptoms. Client monitored for additional 30 minutes. Nausea resolved. Advised client she should call 911 if any s/s return. Client verbalizes understanding.

Other Meds:

Current Illness:

ID: 1052555
Sex: M
Age: 48
State: TX

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: ACEI, lorazepam, NSAIDs

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 2/24/21 at 12:00, received call from PCP, noting patient had mottled, purple skin on arms and legs (sun exposed areas). No rashes or other side effects noted on 2/24/21 01:54 Nursing Progress Note, but 2/24/21 12:01 Nursing Progress Note stated ?There is a purple discoloration/rash/splotches on his arms and legs that PCP came to assess this morning?. PCP noted in retrospect, a similar event happened soon after his 1st vaccine dose - he received his first COVID-19 vaccine dose 1/26/21 at 13:00. Nursing Progress note from 1/27/21 at 18:05, stated patient was transfered to ER for ??cool clammy skin and discoloration all over body?? (he was admitted for UTI, so it was thought his clammy discolored skin was associated with this acute illness) - He recovered from this first event without issue.

Other Meds: Medications (19) Active Scheduled: (18) bisacodyl 10 mg rectal suppository 10 mg 1 supp, Rectal, HS busPIRone 10 mg tablet 10 mg 1 tabs, Oral, BID busPIRone 10 mg tablet 5 mg 0.5 tabs, Oral, NOON denosumab 60 mg/mL syringe 60 mg 1 mL, S

Current Illness: UTI

ID: 1052556
Sex: F
Age: 46
State: TX

Vax Date: 01/20/2021
Onset Date: 01/27/2021
Rec V Date: 02/24/2021
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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Exactly 7 days after receiving the Moderna vaccine I began to have itching in my arm in the evening. It was similar to having a mosquito bite where you itch like crazy. I didn't do anything about it and the next morning I had a huge blotch on my arm that I now know to be "covid arm." It was like a huge red blotch that hurt to the touch.

Other Meds: birth control pills

Current Illness: none

ID: 1052557
Sex: F
Age: 31
State: UT

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: About 2 days after the shot an oval red mark showed up on my upper chest. Over the next 2 weeks more no more spots showed up mostly on my chest and back. A few were on my neck, legs, and arms. Since it kept getting worse I decided to contact my doctor after 2 weeks. My doctor diagnosed it as Pityriasis Rosea. It is now 2 week 5 days post shot & my rash is still present.

Other Meds: Bupropion

Current Illness: No

ID: 1052558
Sex: F
Age: 62
State: SC

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/24/2021
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: ALL NUTS, PENICILLIN, SULFA, LATEX, VICODEN, DILAUDID, VERSED, IV DYES, CARFATE, VIOXX

Symptom List: Rash, Urticaria

Symptoms: PATIENT RECEIVED DOSE AND ABOUT 30 MINUTES POST VACCINATION, PATIENT COMPLAINED OF THROAT SWELLING AND TROUBLE SWALLOWING. 911 WAS CALLED, PAIENT REFUSED EPI-PEN, WAS GIVEN 20 ML OF LIQUID BENADRYL AND PICKED UP BY AMBULANCE

Other Meds: KEPPRA, MAGNESIUM, GABAPENTIN, POTASSIUM, ATORVASTATIN,FUROSEMIDE, PIOGLITAZONE, PROPAFENONE, METOPROLOL, ELIQUIS,

Current Illness: UNKNOWN

ID: 1052559
Sex: F
Age: 69
State: TN

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

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

Lab Data:

Allergies: none known

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

Symptoms: Approx 15 minutes after injection said she felt hot and dizzy and came in to our waiting room to lie down. She c/o feeling hot, dizzy, lips numb, nausea and indigestion. BP 134/75, HR 75, RR 16, SPO2 99%RA, FSBS 118. EMS was on standby and while assessing her she began vomiting and c/o feeling weak. She agreed to be transported to the hospital and care was turned over to EMS.

Other Meds: unknown

Current Illness: unknown

ID: 1052560
Sex: M
Age: 73
State: WA

Vax Date: 02/09/2021
Onset Date: 02/15/2021
Rec V Date: 02/24/2021
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: Penicillin.

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

Symptoms: On 2/15/21 upon wakening both of his thighs, the front of them had a serious ache to a moderate pain that lasted for about 4-5 days and then dissipated. Today, 2/24/21 there are no effects from it. Duration was from 2/15/21 to 2/20/21. He had no swelling or reaction at the injection site just this reaction that popped up and then left. He did not take anything for it, and did not seek medical attention.

Other Meds: Neurontin, Finasteride, Flomax. Vitamin B, Vitamin D3.

Current Illness: None.

ID: 1052561
Sex: F
Age: 27
State: WA

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: Bactrim

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

Symptoms: Fever, Body aches, and chills. Loose stool. Started about 14 hours after receipt of 2nd vaccine dose.

Other Meds:

Current Illness: No

ID: 1052562
Sex: F
Age: 49
State: PA

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/24/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No

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

Symptoms: Body aches, chills, migraine, 102 fever, nausea, vomiting.

Other Meds: Metoprolol and Levothyroxine

Current Illness: None

ID: 1052563
Sex: F
Age: 77
State: WV

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: Unknown

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

Symptoms: According to all the paperwork that we have received, this patient has received 3 doses of the Moderna vaccine. 1st on 12/20/20, 2nd on 1/20/21, and 3rd on 2/23/21

Other Meds: Unknown

Current Illness: Unknown

ID: 1052564
Sex: F
Age: 30
State: FL

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: TMcontacted regarding her COVID results. TM reports ongoing diarrhea and HA and is not cleared to RTW at this time. TM informd she had to be without diarrhea for 24 hours to be cleared for work. TM provided and employee injury report to complete for ongoing symptoms

Other Meds:

Current Illness:

ID: 1052565
Sex: F
Age: 58
State: WI

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt developed symptoms 15 minutes after 1st dose of Moderna. Tiching, tongue tingling (denies swelling, troubles breathing or swallowing) Pt was brought back to treatment area, 1325 given diphenhydramine 50mg for itching, vitals taken- BP elevated (171/89, 175/88, 179/82). Tongue tingling improved (not resolved) with diphenhydramine, itching worsened, diaphoretic. Emergency response called 1340. BP Checked 180/102. Pt transported to ER via Emergency Response Team

Other Meds:

Current Illness:

ID: 1052566
Sex: M
Age: 79
State:

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 02/24/2021
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: Vaccine vial diluted with 0.8mL normal saline and should have been diluted with 1.8mL normal saline

Other Meds:

Current Illness:

ID: 1052567
Sex: M
Age: 90
State: OH

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/24/2021
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: none

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

Symptoms: fatigue and tiredness for about 30 hours very low grade fever 99.5 - 100.2

Other Meds: atenolol amlodipine loratadine Vit D

Current Illness: None

ID: 1052568
Sex: F
Age: 37
State: GA

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: Darvocet. Morphine. Shellfish. Grapefruit. Chocolate. Lactose.

Symptom List: Unevaluable event

Symptoms: 1/28/21 I had fogginess of the brain, fever of 102.3, chills, body aches, joint stiffness, light sensitivity, nausea/vomiting. Headache, decreased appetite. Moderate swelling at the injection site and swollen lymph nodes. I was seen in the ER 1/30/21 as I was not improving and diarrhea was persistent and again on 2/5/21. At the 2/5/21 visit I was given prednisone as on 2/4/21, I broke out into a rash with hives and had severe itching. I was seen again today 2/24/21 and was given a dexamethasone 10mg injection, more prednisone and Atarax. I have a rash on my face, arms, and legs with itching.

Other Meds: Zyrtec 10mg. Calcium and Multivitamin supplements.

Current Illness: Anemia. Asthma.

ID: 1052569
Sex: F
Age: 56
State: VA

Vax Date: 01/26/2021
Onset Date: 02/20/2021
Rec V Date: 02/24/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: I had chills, weakness and then fever; weakness; sore arm and soreness under armpit

Other Meds: Metformin, vitamins B12, D, Biotin, glimepiride, elderberry with echinacea and propolis

Current Illness: N/A

ID: 1052570
Sex: F
Age: 71
State: TX

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/24/2021
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: Lisinopril

Symptom List: Injection site pain, Pain

Symptoms: Sore arm starting day of vaccine, ending 2 days later.

Other Meds: Levothyroxene, multivitamins, calcium, probiotic, tylenol (as needed)

Current Illness: None

ID: 1052571
Sex: M
Age: 84
State: MN

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
Hospital: Y

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

Lab Data:

Allergies: Lactose Intolerant

Symptom List: Injection site pain, Menorrhagia

Symptoms: Resident came up to staff and approximately 1400 and said, "I have a fever" - temperature was assessed and was 98.4 resident came back several minutes later and stated again, "I have a fever" - temperature assessed again and was 98.2 - staff asked if resident had his window open, he stated no - staff suggested maybe he open up his window because it is quite warm in the building at this time. Resident said ok - went back into room - staff told writer he had c/o "I have a fever" while staff was in change of shift report and they assessed fever and it was 97.1. Around 1525, Resident noted to have sudden SOB. PRN albuterol neb given. RR before neb was 40 and did not improve. BP 136/66, pulse 158, temp 101.7 tympanic, and O2 sats 76% RA. Placed on supplemental O2 and sat came up to 86% on 3 L. Resident then started to complain of chest pain. Resident was weak and unsteady and insisted on standing but was guided to his chair to sit down. Resident said he wished to go to ER and daughter in agreement. 911 called. Writer assisting with transferring resident out to hospital. While waiting for ambulance, patient restless and visibly short of breath. Lips with blue discoloration, pale appearance, and breathing with accessory muscles. Changing positions frequently from lying to sitting and standing due to being uncomfortable. Temp 103.2 in left hear and 102.5 in right ear. Respirations 36. Blood pressure unable to be checked due to restlessness and moving around. Pulse 167. O2 92% with nasal cannula on 3L. Asked him to point to the pain and he pointed to his upper abdomen, but describes it as chest pain. Per EMTs he is being sent to clinic instead of the other clinic due to abnormal EKG readings. Received update from EMT around 1700 that patient arrived to ER and heart attack was confirmed so patient was being sent to cath lab for angioplasty procedure.

Other Meds: Spiriva Respimat Aerosol Solution 1.25 MCG/ACT (Tiotropium Bromide Monohydrate), Levothyroxine Sodium Tablet 25 MCG, Divalproex Sodium Capsule Delayed Release Sprinkle 125 MG, Aspir-Low Tablet Delayed Release 81 MG (Aspirin), rOPINIRole HCl

Current Illness: N/A

ID: 1052572
Sex: F
Age: 66
State: AZ

Vax Date: 02/12/2021
Onset Date: 02/15/2021
Rec V Date: 02/24/2021
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: Penicillin

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

Symptoms: Rash and swelling near vaccine site. has not gone away

Other Meds: Gabapentin-600 mg 2X day, Venlafaxine 150mg 1X deay, bupirone 10 mg 3X Day, Calcium, Vitamin D

Current Illness: none

ID: 1052573
Sex: F
Age: 31
State: NY

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/24/2021
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: Intolerant to Gluten and Dairy

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I had hives all over my body starting around 1am and continuing for the day as well as not feeling well for multiple day after.

Other Meds: None

Current Illness: None

ID: 1052574
Sex: M
Age: 70
State: MS

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: Cortisone

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient received 2nd dose Moderna vaccine early (day 20) following initial dose. Patient has had no evidence of adverse reactions at present. Patient is being monitored by caregivers and daily per agency and has been instructed to notify home health of any adverse reactions noted in the future.

Other Meds: Allopurinol, Amlodipine, Vitamin C tablet, Probiotic, Vitamin D3, Famotidine, Levsin, Irbesartan, memantine, MiraLAX, valproic acid

Current Illness: No illness noted/reported

ID: 1052575
Sex: F
Age: 59
State: MI

Vax Date: 02/01/2021
Onset Date: 02/22/2021
Rec V Date: 02/24/2021
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:

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

Symptoms: Sore lymph node in neck on left side.

Other Meds: Ibuprofen

Current Illness:

ID: 1052576
Sex: F
Age: 60
State: WA

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: Codeine, transdermal patches

Symptom List: Nausea

Symptoms: Morning after the shot was woke up with severe vertigo. It hasn't stopped since. Currently on day 22 of vertigo. I've seen my regular doctor and we tried the Epley maneuver. I've been to a chiropractor for three visits with a little relief. Next I'm scheduled to go to ENT doctor. Nothing so far has stopped the vertigo.

Other Meds: Aripiprazole, Duloxetine, Omeprazole DR, Losartan

Current Illness: None

ID: 1052577
Sex: M
Age: 52
State: PA

Vax Date: 02/20/2021
Onset Date: 02/22/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Injection site pain

Symptoms: 2 days after 2nd dose patient developed a hot rash on arm about 8 inches in size. Starting taking Tylenol and antihistamine. Will observe to see if diminishes.

Other Meds: N/A

Current Illness: N/A

ID: 1052578
Sex: F
Age: 48
State: TN

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: The day after I got the second COVID-19 vaccine, I had substantial muscle aches throughout my entire body and it became impossible to stand and / or walk without significant assistance. On the recommendation of my neurologistI took Tylenol at 5pm and the symptoms started to resolve within 2-3 hours. The symptoms seem to have completely resolved within 48 hours after onset.

Other Meds: Gabapentin Dicyclomine Omeprazole Gilenya alpha lipoic acid Prenatal vitamin with iron and folic acid Multivitamin Biotin Caltrate

Current Illness: None

ID: 1052579
Sex: M
Age: 61
State: MO

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/24/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Moderna COVID 19 vaccine ADR. Approximately 14 hours after receiving the vaccine on 01/29/21 the patient starting experiencing extreme confusion, shaking, and then subsequently fell. EMS was called and was taken by ambulance to Hospital where he was admitted for 6 days. I called up follow up 02/16/21 and he still reports a daily persistent headache that migrates around the circumference of his head.

Other Meds:

Current Illness:

ID: 1052580
Sex: F
Age: 67
State: ID

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/24/2021
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: none

Symptom List: Tremor

Symptoms: pt reports dehydration.

Other Meds: Ropinirole, Losartan, Sumatriptan, Atenolol, HCTZ, Oxybutynin, Cyanocobalamin, Metformin, Amlodipine.

Current Illness: none

ID: 1052581
Sex: M
Age: 74
State: NY

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/24/2021
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: None

Symptom List: Erythema, Pruritus

Symptoms: About 8-10 hours after injection, I had chills, low grade fever and body aches and pain at injection site. These lasted through the night. round 10 the following morning, chills and fever slowly subsided and, aside from tiredness, I returned to my normal self by late afternoon. Pain at injection site lasted 3 days.

Other Meds: Tamsulosin Advair

Current Illness: None

ID: 1052582
Sex: F
Age: 42
State: KS

Vax Date: 01/12/2021
Onset Date: 01/22/2021
Rec V Date: 02/24/2021
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: NKA

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

Symptoms: Patient stated that her reactions started on January 22, 2021 (10 days later) with symptoms of red, itchy area that had enlarged over next two days but started putting benadryl ointment on it and it went away. Patient was not previously diagnosed with COVID-19 in the past.

Other Meds: Levothyroxine

Current Illness: None

ID: 1052583
Sex: M
Age: 53
State: MT

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/24/2021
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 Known Allergies.

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

Symptoms: Red itchy rash present on both legs. Methylprednisolone injection was given

Other Meds: Ibuprofen as needed, multivitamin, simvistatin 40mg, triamcinolone acetonide 0.1%

Current Illness: None.

ID: 1052584
Sex: M
Age: 70
State:

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 02/24/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine vial diluted with 0.8mL normal saline and should have been diluted with 1.8mL normal saline

Other Meds:

Current Illness:

ID: 1052585
Sex: M
Age: 82
State: MN

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 02/24/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin, Iodine

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

Symptoms: Severe stabbing heart pain. Called 911. In hospital 2/19 thru 2/22. Chest x-ray, EKG, and ultrasound indicated no heart attack and heart looked good. Doctor stated ordeal was result of 2nd dose of vaccine. Person had previously suffered with Covid and was hospitalized from 10/26/20 thru 11/5/2020

Other Meds: 300 mg Allopurinol, 81 mg aspirin, 10 mg Atorvastatin, 500 mg Cephalexin, 75 mg Clopidogrel, 50 mg Metoprolol tartrate, Vitamin B complex, Preservision Areds 2 PO

Current Illness: Aneurysm in groin with partial blockage

ID: 1052586
Sex: M
Age: 78
State: WA

Vax Date: 01/20/2021
Onset Date: 01/27/2021
Rec V Date: 02/24/2021
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: none

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

Symptoms: Head to toe hive like rash which started seven days after received first dose of the Moderna COVID-19 vaccination.The rash spread over entire body within twenty four hours

Other Meds: Metoprolol Tartrate,Losartan Potassium,Amlodipine Besylate

Current Illness: none

ID: 1052587
Sex: F
Age: 59
State: NC

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 02/24/2021
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: Mild headache, muscle aches, nausea, low grade fever, explosive diarrhea for about 2 hours.

Other Meds: Tylenol

Current Illness: None

ID: 1052588
Sex: F
Age: 58
State: NY

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

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

Lab Data:

Allergies: Sulfur

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

Symptoms: After receiving her 2nd dose of the Moderna COVID-19 vaccine, approx. 1 hour later she complained of a tingling and numbing feeling at the back of her tongue on the left side. She denied any difficulty breathing or eating. She denied any shortness of breath or acute respiratory distress.

Other Meds: Daily vitamin

Current Illness: N/A

ID: 1052589
Sex: M
Age: 16
State: NC

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/24/2021
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: UNKNOWN

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

Symptoms: NONE

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1052590
Sex: F
Age: 44
State: KS

Vax Date: 02/19/2021
Onset Date: 02/21/2021
Rec V Date: 02/24/2021
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: Amoxicillin Allopurinol

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

Symptoms: Patient called on 02/22/2021 and states that she got her vaccine on 02/19/2021. On 02/21/2021 when she woke up in the morning realized that she was itching all over and had a pink splotchy rash all over. She took Benadryl. Advised her to call her PCP. She called PA and was advised to take Pepcid and Claritin for possible allergic reaction to the vaccine. She states that she had no other side effects other than a sore arm. She has had renal failure for quite a few years, not yet on dialysis. She states that she talked to her nephrologist and they encouraged her to not get a second vaccine. She states that she has reacted to illnesses like this in the past and thinks that it is just her body flaring up trying to fight off the immune response. When talking to her today 02/24/2021 she states that she is doing much better. Rash is almost gone and itching is less.

Other Meds: Levothyroxine Sodium BiCarb

Current Illness: Possible sinus infection?

ID: 1052591
Sex: M
Age: 17
State: OK

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/24/2021
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: nkda

Symptom List: Vomiting

Symptoms: Patient was contacted twice and no reactions or complaints were voiced. Advised patient wait for second dose on or after 18th birthday.

Other Meds: none

Current Illness: none

ID: 1052592
Sex: F
Age: 15
State: IL

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 02/24/2021
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: no known allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient is 15 yrs of age and was given 1st dose of COVID vaccine

Other Meds: unknown

Current Illness: unknown

ID: 1052593
Sex: F
Age: 65
State: NY

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 02/24/2021
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: rash to: IV contrast ciprofloxacin sulfa

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

Symptoms: sudden onset severe mid abdominal pain x hours, one episode of vomiting, then persistent pain which then also radiated to back. Whole episode lasted about 12 hours.

Other Meds: synthroid citalopram ASA

Current Illness: none

ID: 1052594
Sex: F
Age: 83
State:

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 02/24/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vaccine vial diluted with 0.8mL normal saline and should have been diluted with 1.8mL normal saline

Other Meds:

Current Illness:

ID: 1052595
Sex: F
Age: 72
State: CO

Vax Date: 02/02/2021
Onset Date: 02/12/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: Aspirin, Naldecon, Bactrin DS perfumes

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

Symptoms: On Friday (02/12) my upper arm, just below the injection site became red and itchy. With pressure I could feel some lumps nearby. The next morning (2/13) the area of redness and itchiness had expanded in all directions and and was also swollen and felt hot to the touch. By afternoon it had expanded to about an inch or more above the injection site, and was also expanding downward and around the sides of my arm. By bedtime, it was about the size of my hand. Still red, swollen, hot to the touch, itching, and still had some deep lumps that were only noticable when rubbing deep. Over time, I realized that where I could feel the lumps was the direction of the spread. On 02/14 it was still spreading and the itching was worse. (Don't gasp, or laugh, but spit did more to relief the itching more than water) Feb. 15 it started getting better, and by 02/17 it was almost gone, except for the blotchy redness.

Other Meds: Symbicort 160/4.5 -- Glucosamine HCI with MCM -- sometimes Meloxicam,15 mg or Aleve

Current Illness: None

ID: 1052596
Sex: F
Age: 35
State:

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/24/2021
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:

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

Symptoms: Increased BP, Confusion, Facial Droop

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm