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: 1049929
Sex: F
Age: 50
State: IL

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

Lab Data: Patient was encouraged to notify her physician. She said she cannot miss work, but will call her.

Allergies: No Known Allergies

Symptoms: The next day after receiving the vaccine, at 9:15 am her hand became numb and she was unable to control or move it. She could not grip the steering wheel or hold anything. She shook her hand and it returned to normal. At 10:15 itjhappened again. It happened a few more time while at work. She also had a few epidsodes in which her jaw became slack and off to the side and she had to close her mouth with her hand, because she could not control her jaw. The episodes lasted about 10 seconds and then they would disappear. She reported her symptoms to the us at about 12:30 PM, 2/23/2021.

Other Meds: Takes multiple medications

Current Illness: None reported

ID: 1049930
Sex: M
Age: 80
State: UT

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

Lab Data: NONE

Allergies: unknown

Symptoms: LOST OF TASTE AFTER RECEIVING THE SECOND DOSE

Other Meds: unknown

Current Illness: None

ID: 1049931
Sex: F
Age: 66
State: NM

Vax Date: 01/22/2021
Onset Date: 01/24/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Doppler right leg metabolic screen and CBC

Allergies: Aleve, avocados

Symptoms: 2 days after vaccination right thighs and right leg started to have pain similar to pain I got with polymyalgia rheumatica that I have had in past and I though it was a flare up. A couple of days after that right leg started to swell and was warm. Went to ER on 1/29/2021 and had doppler which showed blood clots from groin area to below the knee. I was placed on Xarelto at that time. Got 2nd dose and about 24 hours latter back of thighs started to hurt again. Called doctor and applied heat and elevation and had no new swelling but I remain on Xeralto. Not sure if it was related but I have had no history of blood clots. 2 years previously broke my right patella and was with brace and no weight bearing for about 8 weeks and brace for 12 weeks without clot issues. Traveled by car a couple thousand miles last year and no issues.

Other Meds: atorvastatin, CoQ10,multivitamin, vitamin D3,prilosec

Current Illness: ? slight discomfort in back of thighs ? polymyalgia flare up

ID: 1049932
Sex: F
Age: 77
State: PA

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

Lab Data:

Allergies: Prednizone

Symptoms: None stated.

Other Meds: Anoro metformin glipside ozempic flauticasone ramipril atorvastatin Effecsor doneprazol pabtoorazoke Trulance Fish oil calcium vit d vi t b complex Co q 10

Current Illness: Stomach virus

ID: 1049933
Sex: F
Age: 81
State: NC

Vax Date: 02/14/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: ibandronic acid, aspirin, penicillin, sulfa, doxycycline

Symptoms: Shingles rash, right ear and neck

Other Meds: famotidine, LASIX, amiodarone, Tylenol, Lipitor, Eliquis, hydralazine, Toprol-XL, nifedipine, Prilosec, Coreg, timolol ophthalmic, omega-3 fatty acid

Current Illness: None

ID: 1049934
Sex: F
Age: 78
State: OH

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

Lab Data: Went to the ER on 2/21/21 for treatment.

Allergies: Bactrim and Orphenadrine

Symptoms: Developed urticaria within 2 hours of vaccine. Rash began on chest and spread to her neck and on her face.

Other Meds: Lipitor, Vitamin D, Norco, Vitamin C, Paxil, Xalatan, Imitrex, Restasis

Current Illness: Left thumb carpometacarpal arthroplasty on 2/18/21

ID: 1049935
Sex: F
Age: 59
State: NY

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 1/4 left shoulder pain, rigors, joints pain and pain between shoulder blades, fever 100.8, fatigue, took tylenol100mg and Advil 400mg 1/5 shoulder pain subsided a little

Other Meds:

Current Illness:

ID: 1049936
Sex: F
Age: 80
State: IL

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: Levothyroxine flagyl Shellfish Cipro Iodinated diagnostic agents Iodine Iron Sulfa antibiotics Tetracycline Zocor

Symptoms: "within 24 hours after the vaccine, my heart started racing and my blood pressure went up"

Other Meds: aspirin carvedilol dicyclomine ezetimibe hydrocodone linagliptin losartan lutein nitroglycerin pantoprazole pioglitazone pramoxine-CH

Current Illness:

ID: 1049937
Sex: F
Age: 26
State: NY

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

Lab Data:

Allergies:

Symptoms: Pt came in to have 2nd vaccine pt started to notice her arm itching and saw hives PT alerted us and was taken in medical evaluation room where she was given 50 mg of benadryl Pts hives went away with no other reaction Pt left via POV

Other Meds:

Current Illness:

ID: 1049938
Sex: F
Age: 65
State: AL

Vax Date: 02/03/2021
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: sulfur

Symptoms: None stated.

Other Meds: venlafaxine hcl 75 mg Montelukast sodium 10 mg progesterone 100 mg

Current Illness:

ID: 1049939
Sex: F
Age: 68
State: CA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: n/a

Allergies: none

Symptoms: First, the shot hurt when I got the injection. Most people say they don't even feel it, but I definitely felt the needle go in and then felt the fluid go in. By late afternoon, my left arm was very sore . By evening, I couldn't lift my arm at all due to pain in that muscle at the top of my shoulder. I think by that night but perhaps by the next morning I still couldn't lift my arm and the pain had gone into my neck on the left side. After about 36 hrs, it started getting better but it was extremely sore for at least 4 days. I still have some residual pain in my left arm and the base of my neck on that side. About 4 days ago, I noticed a round bruise about the size of a quarter about 1.5 inches away from where I think the shot was administered. I am not aware of anything that might have caused it, but Im pretty sure it wasn't where the shot was administered. It seems to be growing a bit from when I first noticed it.

Other Meds: Rizotriptan (for a migraine the night before and then again after the shot when the headache got worse)-- Herbals--"Migravent" and feverfew for migraine prevention taken daily "Ecodrink", a daily vitamin supplement

Current Illness: I had a migraine the night before the injection, and took a dose of rizotriptan the day before and another later in the day after the shot when my headache did not go away

ID: 1049940
Sex: F
Age: 22
State: IL

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

Lab Data:

Allergies:

Symptoms: Vaccine administered past 6hr post puncture of vial. No adverse reaction occurred. Per Moderna, no actions required at this time, proceed with 2nd dosing as scheduled.

Other Meds:

Current Illness:

ID: 1049941
Sex: F
Age: 67
State: NY

Vax Date: 02/16/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Covid test 12/23/20 positive

Allergies: No

Symptoms: Note: this was a POSITIVE effect worthy of study! I was resigned to being a long hauler after 8 werks of 100 degree fever and fatigue, but on 3rd day after first Pfizer vaccine, I woke up totally symptoms free. Did the vaccine give me something my body couldn?t produce, or just push my immune system to kick out a new round of fresh antibodies? This could be extra good news for longhaulers. Should be studied.....

Other Meds: Levothyroxin Hormone replacement Multivitamin 5000 vit D 50 Zinc

Current Illness: Lingering fever ~100 after covid virus since Christmas day

ID: 1049942
Sex: F
Age: 40
State: TX

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

Lab Data:

Allergies: Allergic to hay

Symptoms: Excess gas after 2 hours of injection and nausea. 20 hours - lower abdominal pain with feeling of having to use the bathroom

Other Meds: None for 24 hours

Current Illness:

ID: 1049943
Sex: F
Age: 55
State: MI

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

Lab Data: None

Allergies: Many, many environmental allergies, no foods, Oxycodone

Symptoms: Persistent, intense pain at injection site and up into shoulder and neck

Other Meds: None

Current Illness: No illnesses

ID: 1049944
Sex: F
Age: 52
State: CA

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

Lab Data:

Allergies: unknown

Symptoms: Patient arrived and stated she had an appointment for COVID-19 vaccine #2. After the vaccine was administered, the vaccine card to stamp the date/lot number on it. It was then realized the Pfizer was given to the patient instead of Moderna (which was her first dose on 1/15/2021. She then had a consult with a Physician, waited 15 minutes, and then went home for the day without incident. Follow-up call make to patient on 2/18 to review stability post vaccine, which she confirmed to be feeling well on this date. Internal processes for member check-in and vaccine history reviewed, revised as result of the above. All patients presenting for vaccine will have their vaccine card reviewed prior to 2nd vaccination.

Other Meds: unknown

Current Illness: unknown

ID: 1049945
Sex: F
Age: 64
State: OR

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

Lab Data: observation and VS

Allergies: Sulfa, various food allergies like soy

Symptoms: 10 mins after 2nd dose, pt started having upper back itchy feeling. Came to nurse observation area. no rash observed. BP elevated.

Other Meds: unknown

Current Illness: unknown

ID: 1049946
Sex: F
Age: 43
State: AZ

Vax Date: 02/12/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Starting February 18 - today (Feb 23) soreness under left arm --most painful 19-21 Feb 20-22 -developed large 3-4 inch pink circle over injection site, itchy at some times but not often -under left eye became red/pinkish then became slightly swollen, almost similar to a stye. Both are clearing and are almost gone but not 100% took benadryl and tylenol 1-3 times a day throughout feb 20-22

Other Meds: folic acid, vitamin D, xyzal, levothyroxine

Current Illness: UTI - 4 weeks before

ID: 1049947
Sex: M
Age: 38
State: IL

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

Lab Data:

Allergies:

Symptoms: Vaccine administered past 6hr post puncture of vial. No adverse reaction occurred. Per Moderna, no actions required at this time, proceed with 2nd dosing as scheduled.

Other Meds:

Current Illness:

ID: 1049948
Sex: F
Age: 66
State: FL

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Low grade fever, lethargy, sore arm

Other Meds: None

Current Illness: None

ID: 1049949
Sex: M
Age: 34
State: TX

Vax Date: 12/01/2020
Onset Date: 12/01/2020
Rec V Date: 02/23/2021
Hospital:

Lab Data: N/A. I told provider this has happened in the past, but was advised to take it again.

Allergies: Augmentin, mold

Symptoms: in response to item 17. I have no idea what flu shot it was brand, manufacture, ect. I just know injection site was hard and had red blotching, extremely painful, difficult to move arm, lasted about 7 days. pretty extreme pain. Body aches, headache, nausea, dizziness, 102 fever.

Other Meds: none

Current Illness: none

ID: 1049950
Sex: F
Age: 73
State: UT

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

Lab Data: None

Allergies: Codine, tetanus

Symptoms: Friday, 2/19/21 Received 2nd Modurna shot at 1:50 PM. No adverse symptoms Saturday, 2/20/21 Woke up with inflamed left art, area around shot bright red and swollen and approximately 2" X 3". Extreme pain in joints, hips and back lasting the entire day. Entire body uncontrollable shaking, lasting approximately 1 hour, over entire body. Started at 10:00 AM. Took ibuprofen every two hours the entire day, starting at 9 AM Sunday, 2/21/21 Woke up with redness and swelling in left arm much larger than previous day, approximately 3" by 4". Other symptoms much reduced Monday, 2/22/21 Woke up with swelling and redness increased to 4" X 5". Took Benadryl at 10PM for swelling Tuesday 2/23/21 Woke up with swelling and redness almost completely gone

Other Meds: None

Current Illness: Fibromyalgia and chronic fatigue

ID: 1049951
Sex: F
Age: 82
State: AK

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: Morphine, codeine

Symptoms: Long term well controlled Type 1 diabetic, on insulin pump -- on day following vaccination blood sugar spiked to 399, remained elevated for 48 hours, then normal since.

Other Meds: Humalog,Eliquis, Toprol XL, Xanax, folic acid, Avapro, Zocor,

Current Illness: None

ID: 1049952
Sex: F
Age: 86
State: NC

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

Lab Data:

Allergies:

Symptoms: On 2/14 the patient describes the typical symptoms of a sore arm at the injection site. The patient reports an expected decrease in symptoms until 2/22/21, when the injection site became itchy and swollen, and developed a slight rash. I advised the patient to take Tylenol for pain/fever (especially for her second dose on 2/24/21), to take Benadryl at nighttime for the rash, and to use some OTC topical lidocaine for the itching/discomfort as needed.

Other Meds:

Current Illness:

ID: 1049953
Sex: F
Age: 44
State: NY

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

Lab Data: chest x-ray normal: labs normal but with low pottasium which was told that was due to vomiting

Allergies: none

Symptoms: 5:30pm 2/22/21 started feeling ache ate dinner: 7:30pm started vomiting with fever of 100: 9pm sever chills with sweats: 9:30pm vomited layed down: 1am woke sweating shivering fever still 100 took a shover started extreme body aches with chest pain: drove myself to Stony Brook ED: labs ran covid swabbed still with all symptoms: chest xray preformed: released at 6am was told to monitor symptoms and if I can not keep anything down like water and or still with chest pain after 24hrs return to ED

Other Meds: paroxetine 20mg, atenol/chlor50-25mg, lisinopril 10mg

Current Illness: none

ID: 1049954
Sex: F
Age: 70
State: WA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: none

Allergies: Kelp, Iodine

Symptoms: Developed urticaria 1 week following vaccination

Other Meds: Celexa, Famotidine

Current Illness: Anxiety

ID: 1049955
Sex: F
Age: 28
State: IL

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

Lab Data:

Allergies:

Symptoms: Vaccine administered past 6hr post puncture of vial. No adverse reaction occurred. Per Moderna, no actions required at this time, proceed with 2nd dosing as scheduled.

Other Meds:

Current Illness:

ID: 1049956
Sex: F
Age: 80
State: CA

Vax Date: 02/14/2021
Onset Date: 02/16/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Slight headache, chills, loss of appetite. Gone in 24 hours

Other Meds:

Current Illness:

ID: 1049957
Sex: F
Age: 22
State: CA

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

Lab Data:

Allergies: no known

Symptoms: Facial rash/pruritus

Other Meds: Ibuprofen, cyclobenazaprine

Current Illness: N/A

ID: 1049958
Sex: F
Age: 68
State: FL

Vax Date: 02/18/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Arm soreness and hot since injection. On day 5 swollen rash developed with itching.

Other Meds:

Current Illness:

ID: 1049959
Sex: M
Age: 36
State: KS

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

Lab Data: None

Allergies: None

Symptoms: Patient started experiencing lymphodema under left arm. Arm is painful to touch. Slightly red. Encouraged warm compress, Tylenol alternating with ibuprofen.

Other Meds: None

Current Illness: None

ID: 1049960
Sex: F
Age: 66
State: WY

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

Lab Data:

Allergies: sulfa meds, Bee Stings(anaphylaxis)

Symptoms: 2/17/21-Anaphylaxis-15:17pm (within 30 min waiting period post vaccine), throat scratchy, moved to assessment area, HR 100, labored resp, O2 6L NRmask initiated. (ct reports similar reaction as previous anaphylaxis). 15:22pm-911 called, HR 120, Epi 0.5ml admin. 15:37pm transfer via ambulance to hospital. 02/18/2021 evening, f/u call to client by PHN, throat still feels 'weird', ct reports had 2nd Epi in ambulance, 3rd Epi in ER, plus Benedryl gel, Ct then recalled had anaphylaxis reaction in past to bee sting had ER visit, tx w/ steroids at that time. PHN recommended ct talk with PCP re epi pen order.

Other Meds:

Current Illness:

ID: 1049961
Sex: F
Age: 66
State: CA

Vax Date: 02/08/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: none

Allergies: codeine

Symptoms: Blotchy Rash covering the upper arm about 6 inches in length and about 5 inches wide. It is a little bit warm to the touch. very mild itching from time to time. It may have appeared before this report but I was wearing long sleeves until the weather got warmer yesterday so never notices it.

Other Meds: Synthroid, Daily vitamin, Calcium w/D, Vitamin B-12, Vitamin D, Magnesium Citrate, Co-Q10

Current Illness: none

ID: 1049962
Sex: F
Age: 74
State: CA

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

Lab Data: None

Allergies: No

Symptoms: Felt ugh, fuzzy headed next day, got chills and had mild fever (99.2), took 2 Tylenol, sucked in couple ColdEeze and felt better within few hours. Red area on sot arm by that evening - next day (2nd day after shot) developed red rashes by outside of each breast, larger spot by left side (where shot was given), spot on left side of my neck also. Not a raised or bumpy rash at all, not sore or itchy. Called advise nurse to determine taking a benedryl was ok and took one last night. This morning rash less noticeable but still there - also new little mark on inner left elbow. Feeling fine this whole time, just concerned because I haven?t read of this reaction much for second Moderna.

Other Meds: Levothyroxine Lexpapro 10 mg 4 days a week baby aspirin

Current Illness: Had a small squamous cell removed from left leg between vaccines

Date Died: 01/22/2021

ID: 1049963
Sex: M
Age: 56
State: CA

Vax Date: 01/12/2021
Onset Date: 01/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: NKA

Symptoms: Found lying face down without respiration or pulse, believed to be within 5 minutes of event. ACLS procedures unsuccessful. Unable to get autopsy. Believed to be heart attack secondary to COVID infection, but unconfirmed. Relative contribution of recent vaccination unknown.

Other Meds: chlorpromazine 800mg QHS amantadine 100mg BID divalproex 1000mg QAM, 1500mg QHS haloperidol decanoate 225mg Q2weeks amlodipine 5mg QHS carvediol6.25mg BID docusate sodium 250mg BID fluticasone propionate 1 spray each nostril BID lisinopril

Current Illness:

ID: 1049964
Sex: M
Age: 97
State: IA

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient's daughter reported that the day after vaccination, patient had facial droop, some slurred speech, and her legs hurt/were week. This resolved on it's own, and it does not sound like they sought treatment for this.

Other Meds:

Current Illness:

ID: 1049965
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: RN within our mass vaccination center drew Moderna vaccine from vial prior to the 15 minute room temperature recommendation. The vial, Lot# 043L20A, was pulled from the refrigerator at 1:34pm CST. The dose was drawn at approximately 1:45pm CST and was subsequently administered at approximately 1:47pm or 1:48pm CST. This would have resulted in administration 2-3 minutes in advance of the 15 minute recommended wait time. The timing error was discovered by this RN and another RN within the vaccination team approximately 2-3 minutes after the vaccination was administered. We were unable to identify, with certainty, the patient within the mass vaccination center who received the dose. We had no adverse reactions reported in the patient monitoring/observation area during the 15 minutes subsequent to our discovery of the early administration. Our physician lead in the patient monitoring/observation was notified of the error.

Other Meds:

Current Illness:

ID: 1049966
Sex: M
Age: 60
State: IL

Vax Date: 01/27/2012
Onset Date: 01/28/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: -Sore muscle around injection site lasting for about 24hours -approximately 24 hours after injection I had muscle, joint and skin aching all over my body that lasted about 7 hours

Other Meds:

Current Illness: none

ID: 1049967
Sex: F
Age: 66
State: MA

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

Lab Data:

Allergies:

Symptoms: Caller stated that she received her vaccine on 02/23/21 and an hour later her face became numb and became lightheaded. She went home and took 2 benadryl liquigels and her light headedness went away, but was still feeling the numbness in her face. She denies fever, aches or chills. Patient advised to monitor and calll PCP if symptoms don't get better or call for help if experiencing SOB.

Other Meds:

Current Illness:

ID: 1049968
Sex: F
Age: 63
State: MS

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

Lab Data:

Allergies: unknown antibiotic

Symptoms: Client received dose of vaccine at approx 1225. Was sitting in parking lot for monitoring. Summoned attendance d/t report of heart racing, slight SOB, "weird feeling in chest". RN and NP were called. By their arrival, pt reported s/sx beginning to resolve. At 1240 BP 100/78, HR 72. At 1250: BP 100/78, HR 80. At 1300: BP 108/70, HR 72, R 18. Pt was instructed to go home and rest. Was allowed to leave site. RN called pt at 1435. Pt reported all symptoms had resolved. Was doing fine. RN

Other Meds: synthroid, ArmourThyroid, Wellbutrin, Prozac, Estradiol Patch, pregesterone, omeprazole, myrbetriq, zyrtec, trazodone, adrevine, probiotic, B-12 Vitamin C, melatonin, magnesium, Vitamind D-3, Calcium, L-Theanine, B-2.

Current Illness:

ID: 1049969
Sex: M
Age: 71
State: TN

Vax Date: 01/10/2021
Onset Date: 01/19/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: I have not sought medical care because it is slowly resolving.

Allergies: None

Symptoms: Approximately 1 week after the Pfizer dose I had a small lump and soreness over my right flank at the kidney level. Over the next two days that pain migrated to my right buttock and radiated down my right leg. With full weight applied to my right leg the leg had weakness and would occasionally buckle. I am due for my second injection but am considering not taking the second injection fearing permanent nerve involvement. As of today 2/23 the pain in my right leg and buttocks is lessened but still present.

Other Meds: Eli quiz 2.5 bid

Current Illness: None

ID: 1049970
Sex: F
Age: 59
State: TN

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

Lab Data: Did not have any, just spoke with dr and advised to take zyrtec and Benadryl and see him if not gone in a couple of days

Allergies: Floxin

Symptoms: Moderna COVID-19 Vaccine EUA Had the normal side effects on 2-20-21, chills, fever, body aches, but on 2-21-21 I woke up with a rash all over torso and arms, sneezing, scratchiness in throat and a spot under the vaccine that is a knot and red, very itchy. Today, the 23, there is still some sign of the rash and the place on my arm is still there.

Other Meds: Progesterone, Estradiol, Lisinopril, Synthroid, Montelukast Sodium, Valacyclovir HCL, Wixela, multi vitamin, aspirin 81, magnesium, Vitamin B

Current Illness:

ID: 1049971
Sex: F
Age: 64
State: CA

Vax Date: 01/20/2021
Onset Date: 01/25/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Visual examination, history.

Allergies: ace inhibitors

Symptoms: Onset of Bell's Palsy about 5 days after immunization.

Other Meds: Chlorthalidone, Losartan, Oyster shell calcium, vitamin d,

Current Illness: none

ID: 1049972
Sex: F
Age: 43
State: HI

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

Lab Data: Sent to the Emergency Room, requested to call 911, pt refused

Allergies: NKDA prior to vaccine

Symptoms: Patient presents for evaluation of encounter for immunization. Here for moderna COVID-19 vaccine #1. See scanned vaccination screening form and post vaccine questionnaire.@1713 Patient reports that her lungs "felt tight". She denies mouth swelling, facial swelling, tongue swelling, throat tightness, difficulty breathing or speaking. Denies GI distress, nausea. Denies rashes, itching or other symptoms. She denies allergies. Denies chronic conditions. Denies daily medications. She reports her only medical history is "childhood asthma" and does not take any medication currently. (1715) Patient escorted to exam room for privacy and monitoring. Patient able to ambulate without difficulty or distress. She reports her "chest tightness" is a 6 (0-10 scale). And denies other symptoms including chest pain, itching, mouth swelling, SOB. Patient reports she prefers to sit in chair, vs lying on exam table, VS monitored by RN. ROS: CONSTITUTIONAL: Negative for chills, fatigue, fever, and weight change. EYES: Negative for blurred vision, eye pain, and photophobia. E/N/T: Positive for Denies mouth, tongue swelling. Denies throat tightness.. CARDIOVASCULAR: Negative for chest pain, palpitations, tachycardia, orthopnea, and edema. RESPIRATORY: Positive for Denies cough, distress, endorses "tight chest". GASTROINTESTINAL: Positive for Denies nausea, vomiting, GI distress, diarrhea. INTEGUMENTARY/BREAST: Positive for Denies rashes, lesions, changes to skin.. Vitals: Current: 2/19/2021 4:48:38 PM T: 97.9 F (temporal); BP: 174/104 mm Hg (right arm, sitting); P: 81 bpm (finger clip, sitting)O2 Sat: 100 % (room air) Repeat: 5:38:26 PM BP: 182/108mm Hg (left arm, sitting, 5:17pm) 5:38:59 PM BP: 158/97mm Hg (right arm, sitting, 5:26PM) 5:40:22 PM O2 Sat: 100% (room air, 5:26PM) 5:39:56 PM P: 73bpm (finger clip, sitting, 5:26PM) Exams: Initial Exam completed by NP at 1713, 1720, 1730, 1740 and 1746. No changes from baseline GENERAL: well developed, well nourished, in no apparent distress;; well developed; well nourished; well groomed; no apparent distress EYES: lids and conjunctiva are normal; pupils and irises are normal; E/N/T: normal external ears and nose;; Hearing: grossly normal Lips, Teeth and Gums: normal; Oropharynx: normal mucosa; NECK: Neck is supple with full range of motion; RESPIRATORY: normal respiratory rate and pattern with no distress; even and unlabored, no wheezing; CARDIOVASCULAR: normal PMI placement; no thrills, heaves, or lifts; normal rate and rhythm without murmurs; normal S1 and S2 heart sounds with no S3, S4, rubs, or clicks;; normal rate; regular rhythm; irregular rhythm; Radial pulses +2 CR< 3 seconds BUE; GASTROINTESTINAL: no masses or tenderness; SKIN: no ulcerations, lesions or rashes no skin thickening, induration, or subcutaneous nodules; NEUROLOGIC: AOx3, awake, alert, calm PSYCHIATRIC: mental status: alert and oriented x 3; appropriate affect and demeanor; recent and remote memory are intact; good insight and judgement; Procedures: Encounter for immunizationBenadryl 50 mg tab given PO per, NP at 5:14pm 1. Epinephrine given IM, in the right thigh; administered by: employee; ( lot #0GM147; exp. 11/2021 ) 5:37pmVS were monitored closely by RN and NP during reaction, see chart for RN's VS **Requested RN to chart her VS: see "Post COVID-19 Vaccination Questionnare for VS completed by employees 1714 Benadryl given PO 1726: VS: Ox 100% on RA RR 16 HR 73 BP 158/97 1731 VS: Ox 98% RA RR 16 HR 84 - patient reports chest tightness is worsening: Ordered IM epi, given by RN 1738 VS:Ox 99% RA RR 16 HR 83 BP 167/114 1742 VS: Ox 100% RA RR 16 HR 89 1746 VS: Ox 100% RA RR 16 HR 80 167/98 Plan: Encounter for immunizationvaccine given per protocol.30 minutes after vaccine, patient c/o chest tightness. PO benadryl and IM epi given per protocol, VS monitored per protocol and documented by RN and NP 1) Protocol followed for anaphylaxis 2) Patient remained stable under care. Patient AOx3, awake, no respiratory distress, talking and smiling. 3) (1537) Informed patient we are calling 911 due to administration of Epi and patient's reported symptoms. Patient refused. Re-educated to the importance of calling 911. Patient refused x 3. 4) Husband presented to drive patient to the emergency room. Re-educated to the importance of calling 911 for anaphylaxis. Patient and husband refused. Husband committed to taking patient straight to Emergency Room, and to call 911 on the way if she gets worse in any way. Patient and husband both agreed to this. 5) Educated patient that she must seem emergent medical attention for anaphylaxis. Educated patient to NOT get second vaccine. 6) (1746) Patient reports her chest tightness has gone from a 6 to a 2 (0-10 scale) 7) Patient and husband v/o and agrees to POC. 8) (1746) Patient left in stable condition, under the care and supervision of husband with plan to go straight to the Emergency Room and to call 911 immediately if anything changes or worsens. 9) Case and chart reported to Medical Director.

Other Meds: No meds

Current Illness: N/A

ID: 1049973
Sex: F
Age:
State: MI

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

Lab Data:

Allergies: cat

Symptoms: None stated.

Other Meds: Plavix, Throid, Chhol, BP,

Current Illness:

ID: 1049974
Sex: F
Age: 54
State:

Vax Date: 01/31/2021
Onset Date: 02/05/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: none

Allergies:

Symptoms: Bilateral subcutaneous swelling in each arm that has persisted for 1 month following vaccine (had doses in separate arms and nodules developed after each vaccine)

Other Meds: Advair

Current Illness:

ID: 1049975
Sex: F
Age: 86
State: VA

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

Lab Data:

Allergies:

Symptoms: Pt. c/o of cramping all over & shortness of breath.

Other Meds:

Current Illness:

ID: 1049976
Sex: F
Age: 76
State: MA

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

Lab Data:

Allergies:

Symptoms: Caller stated that she received her vaccine on 02/20/21 and the next day the injection site became red and oval in shape measuring 1x4 inches, not sore or discomfort of any nature. Then today 02/23/2021 the redness extended to the rest of the arm and still no discofort of any nature. Patient asked to follow up with her PCP for further evaluation.

Other Meds:

Current Illness:

ID: 1049977
Sex: M
Age: 87
State: NY

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

Lab Data:

Allergies: Sulphur

Symptoms: Rash at the site of the vaccine, about 2 inches in diameter, appeared 10 days after vaccine administered,

Other Meds: Norvasc, Eliquis, Atenolol, Lexapro, Zetia, Protonix, Crestor, Glucosamine, Centrum MultiVitamin, Vitamin C, Vitamin D, B-complex vitamins

Current Illness:

ID: 1049978
Sex: F
Age: 53
State: PA

Vax Date: 02/09/2021
Onset Date: 02/14/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: NSAID's, Penicillin, Bactrum, Sulfas Asparagus Seasonal

Symptoms: Covid arm. Swelling, redness, warmth at the site of the injection. Started 5 days after injection and lasted 7 days. Treated with antihistamine and warm compress.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm