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

Date Died: 02/02/2021

ID: 1006316
Sex: M
Age: 78
State: GA

Vax Date: 01/28/2021
Onset Date: 02/02/2021
Rec V Date: 02/05/2021
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: death- 2/2/2021

Other Meds: see nursing home record

Current Illness: none

ID: 1006317
Sex: F
Age: 36
State: CO

Vax Date: 01/13/2021
Onset Date: 01/23/2021
Rec V Date: 02/05/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Since receiving my first covid vaccine on January 13th - ten days after my vaccine (1/23) I became violently ill with chills, cough, headache, fever, fatigue, nausea, aches and pains and was tested for covid, which came back negative. I recovered very quickly, the illness lasted about 24 hours. Five days later (1/28) the same exact thing happened only worse, I experienced all symptoms listed above in addition to vomiting and extreme dizziness. Again, my symptoms subsided pretty quickly but then 24 hours later I became achy, fatigued and developed a minor cough with shortness of breath.

Other Meds: Ibuprofen

Current Illness: none

ID: 1006318
Sex: F
Age: 45
State: OK

Vax Date: 01/14/2021
Onset Date: 01/16/2021
Rec V Date: 02/05/2021
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: Adhesive, Inapsin

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

Symptoms: My arm at the injection site got very swollen and red and I had red streaks across my back. Symptoms began 14 hours after injection. I had the normal fever, nausea, chills, body aches, also had severe ear pain in my left ear same as when I had Covid. Dizziness began 14 hours after but increasingly got worse. My blood pressure went up to 200/118 with my HR 131 with the dizziness. I have NEVER had high blood pressure!! I still have some dizziness. Not completely resolved. BP is better but still high at times. I have been monitoring it closely. I did go to the ER where my BP continued to be high.

Other Meds: HRT

Current Illness: NONE

ID: 1006319
Sex: F
Age: 0
State: GA

Vax Date: 04/08/1973
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: patient had back spasms after being given vaccine. She was watched for extra 15 minutes and given Tylenol. She stated she no longer had back pain and left

Other Meds: none known

Current Illness: none

ID: 1006320
Sex: F
Age: 19
State: PA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: Rash/hives on torso

Other Meds:

Current Illness:

ID: 1006321
Sex: F
Age: 0
State: IN

Vax Date: 02/05/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Headache Body aches Fever Chills Sick stomach Diarrhea Fatigue Loss of appetite

Other Meds: Spironolactone Levothyroxin Welbutrin Lexapro Zyrtec Vitamin C Vitamin D Biotin Align probiotic

Current Illness: None.

ID: 1006322
Sex: F
Age: 22
State: OR

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Penicillin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I experienced moderate body aches, a mild headache, and moderate-to-severe fatigue. These started when I awoke around 10am the morning after 2/4/21 getting the dose at 3pm the day before (2/3/21). By the end of the evening (8pm) on 2/4/21, I had mostly recovered from all of the symptoms and at 10am on 2/5/21, I felt fully recovered.

Other Meds: NA

Current Illness: NA

ID: 1006323
Sex: F
Age: 65
State: FL

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

Symptom List: Pharyngeal swelling

Symptoms: Roughly 8 hours later: Felt what seemed like Severe acid reflux in belly, chest neck and head. Then I felt left arm muscle where injection; then I noticed whole body aching; fatigue,; then nose bleed; then I was super chilled/shaking; then legs aching. Dry mouth, thirsty. Today, roughly 22 hours later, all body aching, glands tender, neck achy, small headache; extreme weakness and feeling like flu and still queasy. Not functional for normal task.

Other Meds: Multi, c, e, Rhodiola, Sam-e, omega, b complex, gamma linoleic acid

Current Illness: None

ID: 1006324
Sex: F
Age: 35
State: CA

Vax Date: 01/14/2021
Onset Date: 01/24/2021
Rec V Date: 02/05/2021
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: Vaccine administered 1/14... Day 2 (1/15): Experienced nausea and jitteriness for the day, had injection site and muscle soreness that lasted 3 days Day 5-9: Felt fine but developed sore lymph node under left armpit day 5 (2/18) that lasted a few days Day 9 (1/18) : Injection site and surrounding muscle became spontaneously sore again Day 11 (1/24) : Developed headache, hearing issues (sounds are muffled), joint pain and stiffness, brain fog and fatigue which have persisted through today (2/5) with bouts of tachycardia, jitters, and hot flashes Day 15 (1/28): Developed intense nausea which has persisted through today but has lessened since 2/3. Currently: Still have muffled hearing, brain fog, joint pain and stiffness, fatigue, headache, and intermittent nausea. Due for second dose 2/11.

Other Meds: D3, B12, Aller-Tec

Current Illness:

ID: 1006325
Sex: F
Age: 40
State: MS

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/05/2021
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: Bentyl, Axid, Erythromycin, NuLev, Pamine, Prosom, Codeine, Omnicef, Sulfa, Bees, Seafood

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Covid Arm?red splotch, warm to touch, knot under skin

Other Meds: Please contact me for full list. I have sooooo many

Current Illness: Sinus infection

ID: 1006326
Sex: F
Age: 70
State: FL

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

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

Lab Data:

Allergies:

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

Symptoms: Initially patient had fever of 100.7, chills, malaise, symptoms have resolved Patient took Advil now symptoms have resolved

Other Meds:

Current Illness:

ID: 1006327
Sex: F
Age: 54
State: KY

Vax Date: 02/01/2021
Onset Date: 02/02/2021
Rec V Date: 02/05/2021
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: N/A

Symptom List: Rash, Urticaria

Symptoms: HEADACHE, TEMPERATURE 101.4, DEEP MUSCLE ACHES, FATIGUE. AFTER DAY TWO AFTER INJECTION I STILL HAD A HEADACHE THAT I COULD'NT GET RELEIF FROM WITHOUT MIGRAINE MEDICATION. DAY 3 I HAD A VERY SORE AND SWOLLEN ARM BUT OTHER SYMPTOMS SUBSIDED. DAY 4 A LITTLE FATIGUE BUT FEELING GOOD.

Other Meds: LEVOTHYROXINE 75 MCG PANTOPRAZOLE 40 MG EC TABLET LISINOPRIL 10 MG

Current Illness: NONE

ID: 1006328
Sex: M
Age: 62
State: IN

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: Chills with low grade temp 100.4 F starting about 18 hours after the injection Generalized malaise lasted about 18 - 24 hours Profuse sweating the last 6 hours 2.5 pounds weight loss overnight

Other Meds: Lisinopril 40mg daily

Current Illness: None

ID: 1006329
Sex: F
Age: 81
State: MD

Vax Date: 01/30/2021
Onset Date: 02/02/2021
Rec V Date: 02/05/2021
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: Cats

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

Symptoms: Muscle aches, indigestion, gas and bloating, ELEVATED BLOOD PRESSURE and Rapid Pulse

Other Meds: Levothyroxin;multivitamin and mineral supplement.

Current Illness: None

ID: 1006330
Sex: F
Age: 66
State: TX

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Lips starting tingling , then tongue and then continued down her throat

Other Meds: Vitamin D3 Niacin B12 Calcium Carvedilol 12.5mg tab Dilt-XR 120 mg

Current Illness: none

ID: 1006331
Sex: F
Age: 56
State: TN

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: Cipro

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

Symptoms: Post - injection waited recommend minimum 15 minutes walked out of vaccination area and had syncopial episode. BP 180/110. Pulse 62. Respiratory Rate 20. O2 sat 99% on room air. EMS transfer to Medical Center.

Other Meds: Vumerity, Paxil, and Vescare

Current Illness:

ID: 1006332
Sex: F
Age: 63
State: NY

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Latex

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

Symptoms: I was fine until I woke up at 12 am feeling sick ....I felt very achy, joint pains both knees, jaw and back. Headache and skin tender These lasted for at least 36 hours. The next day very tired and a a slight headache which lasted only a few hours. I did start taking Tylenol at 12:15 at night on 2/4/21 every four hours.

Other Meds: Metformin Meloxicam Omeprazole Vitamin D

Current Illness: None

ID: 1006333
Sex: M
Age: 89
State: WV

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

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

Lab Data:

Allergies: cipro, levaquin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 2/4/21 Vaccinated at 1:15 pm. At 5:30 pm patient's throat began to swell and he could not hardly swallow water. At 10:00 pm, he noticed that his face was a little numb but proceeded to go to bed. 2/5/21 Patient feels better. He can swallow and eat. Face is not longer numb.

Other Meds: 81 mg aspirin

Current Illness: none

ID: 1006334
Sex: F
Age: 23
State: CA

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After the vaccine was given, Patient stated her heart became racing. Pulse taken at the time listed it as 180. Patient also said she felt like she could not talk as if the words would not come out. She felt like she could not feel her arms and legs and felt numbness in her chest. Dizziness also occurred. Vision became blurry. That night after being released from the hospital she still had trouble walking . To this day she suffers from intense brain fog. She says she has so much to say but it wont come out. She still is having trouble walking, her gait is very unsteady. She finds herself unable to work like before and suffers from confusion.

Other Meds: unknown

Current Illness: none

ID: 1006335
Sex: F
Age: 56
State: MI

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 02/05/2021
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: fever 100.6 fatique

Other Meds:

Current Illness:

ID: 1006336
Sex: F
Age: 77
State: CA

Vax Date: 01/16/2021
Onset Date: 01/24/2021
Rec V Date: 02/05/2021
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: Racemic epinephrine, codeine

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

Symptoms: 8 days after vaccination, patient experienced new erythematous patch at the injection site which was painful, swollen, warm, and pruritic. Also had generalized body aches and fatigue x 10 days. This eventually resolved on its own.

Other Meds: triamterene 37.5mg/hctz 25mg, Premarin 1.25mg, simvastatin 40mg, trazodone 100mg, loratadine 10mg, multivitamin, calcium and vitamin D (Citracal)

Current Illness: None

ID: 1006337
Sex: F
Age: 84
State: IN

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: No none allergies

Symptom List: Unevaluable event

Symptoms: I just got done going to the bathroom (2-4-2021) and was zipping up my pants when I fainted. I fell backwards into the bathtub knocking down both shower doors. My legs were hanging over the edge of the tub. One shower door fell on my upper right chest area. This happened just over 24 hours from when I received the vaccine. I had not felt bad at all from the vaccine. Didn't sleep too well that night (2-4-2021) because I hurt due to the fall. I called my doctor on 2-5-2021 to let her know I fainted 24 hours after receiving the vaccine and wondered if that was due to it. I do feel weak today (2-5-2021).

Other Meds: Simvastatin, Fluoxetine, Metoprolol succinate, Warfarin, baby aspirin, Caltrate, Centrum Silver for women over 50, Vitamin B Complex, generic Align probiotic

Current Illness: No illnesses

ID: 1006338
Sex: F
Age: 49
State: OH

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Latex

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

Symptoms: Shot received approx. 11:45 am on 2/3/2021. No I?ll effects besides slight injection site pain in evening. 6am on 2/4/2021, slight headache, muscle ache, and dizziness. 11am, increased dizziness. 2pm, tiredness, dizziness, increased muscle pain. (2/4/21) 6pm, tiredness, no appetite, fell asleep in chair. 10pm, awoke chilled and with dizziness and went to bed. Woke from sleep with difficulty breathing/catching a breath (2/5/21) and nauseous. 8am, chills, minor breathing issues, elevated temp (98.1) and headache. Slept upright until 1:30pm.

Other Meds: 100 mg Zoloft 10 mg Zyrtec

Current Illness: Multiple Sclerosis

ID: 1006339
Sex: F
Age: 71
State: IN

Vax Date: 02/01/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Sulfa

Symptom List: Injection site pain, Pain

Symptoms: Chills, muscle and joint pain, and fatigue from 11:00am. Till 5:00pm the day following the injection

Other Meds:

Current Illness:

ID: 1006341
Sex: M
Age: 68
State: SC

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Moderna COVID 19 Vaccine EUA The day following the vaccine I had a fever, headache, significantly higher than normal blood pressure, increased heart rate, chills/sweats intermittent throughout the next 24 hours. Very much like a severe case of the flu. They subsided somewhat today, but to the loss of being able to sleep pretty weak today.

Other Meds: Allorpurinol. Simvastatin, Diclofenac, COQ10

Current Illness: None

ID: 1006342
Sex: M
Age: 20
State: TX

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: None

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

Symptoms: After receiving vaccine, pt walked into the post vaccine observation room located outside the door of the vaccination room. Pt. sat down in chair, went to put his head down towards his knees, then patient slid out of chair and onto the floor. This RN was immediately at the patients side, and pt. immediately responded to his name. Pt. insisted on standing up against this RN's advice, and got back into the chair. Pt stated he didn't know what happened, so I explained to him that he had fainted. His mother and father were present. Pt stated he ate no breakfast today. Pt. states he has no health concerns, allergies, or issues. Pt.s stated that he is very afraid of needles and thinks he was just nervous. BP readings: 09:45 90/75 HR 60, 09:50 90/75 HR 60 10:00 BP 113/72 HR 65. Pt stated he was feeling fine. Pt. released to go home w/Parents at 10:30. This RN called this pt. to f/u at noon today, and patient stated he was feeling good and thinks he was just really nervous. Pt. thanked this RN for the phone call and call was ended.

Other Meds: None

Current Illness: None

ID: 1006343
Sex: F
Age: 49
State: OK

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 02/05/2021
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: Lortab, Ultram, Dermabond, Latex

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 103.3 Fever started 19 hours after injection lasting until Tuesday AM around 6. Chest wheezing and burning started on day 2 post vaccination lasting for 3 additional days past fever ending. Extreme tiredness and body aches until the fever went away on Tuesday am.

Other Meds: Vesicare 5 mg, Prilosec 20mg, Hydroclorithiazide 25mg

Current Illness:

ID: 1006344
Sex: M
Age: 71
State: FL

Vax Date: 01/17/2021
Onset Date: 01/27/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 10 days (1/27/2021) after my Covid19 (Moderna) shot, my left arm around the shot location became a pinkish rash and was a little sore. The rash and minor soreness continued until yesterday (2/4/2021). My left arm is fine now.

Other Meds: Atorvastatin 20mg, Carvedilol 3.125mg, Amlodipine 2.5mg, Nexium 20mg, Claritin 10mg

Current Illness: N/a

ID: 1006345
Sex: F
Age: 97
State: NY

Vax Date: 01/28/2021
Onset Date: 01/30/2021
Rec V Date: 02/05/2021
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: None

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

Symptoms: Joint pain in arms and back, increased pulse, (120-135) slight fever 100.4 - my temperature is usually around 97, the next morning temperature was 94.4. cough. These symptoms lasted, off and on for about a week. I had fever once. Feeling limp as a rag. No energy.

Other Meds: Eliquis, Cardizem, Rosuvastatin, Metoprolol Zuccina as needed for Atrial Fibrillation, Magox, Pepcid, Vitamin D3, Biotin, Multiple vitamin

Current Illness: Infrequent fibrillation, Gerd.

ID: 1006346
Sex: F
Age: 80
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: My arm was sore the next morning, and it still sore as of today. My arm is red, puffy and hot now, I noticed it this morning. The evening after receiving the vaccine I felt really cold all over my body and went to bed.

Other Meds: Levothyroxine daily, Lovastatin 20 MG every night, Lisinopril 5MG, Probiotic chewable twice a day, Magnesium, Vitamin C, Garlic 2000 MG daily, Zinc 50 MG daily, (Vitamin for hair, skin and nails), Vitamin B complex, Apple Cider Vinegar 3

Current Illness:

ID: 1006347
Sex: M
Age: 45
State: IL

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Injection site pain

Symptoms: Patient finished observation period and went to his car 50 minutes post vaccine where he then started feeling tingling to tongue and fat and fuzzy feeling. Returned to site - received Benadryl IM with good resolve. DC'd home to care of friend for further observation.

Other Meds:

Current Illness:

ID: 1006348
Sex: M
Age: 52
State: CA

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: lethargic, muscle pain, joint pain.

Other Meds: none

Current Illness: none

ID: 1006349
Sex: F
Age: 43
State: MO

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: latex, viaxin

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

Symptoms: fever, chills, body pain

Other Meds: lantus, humolog, valium, metformin, allopurnol, prozac, gabapentine, loratadine, solifenacin, depo shot, trulicity

Current Illness: n/a

ID: 1006350
Sex: M
Age: 83
State: VA

Vax Date: 01/20/2021
Onset Date: 01/31/2021
Rec V Date: 02/05/2021
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: PATIENT SOUGHT EVALUATION WITH PCP ON 2/5/21. PCP STATES THAT PATIENT REPORTS MINOR RASH BEGAN ON 1/31/21 THAT HAS CONTINUED TO WORSEN DAILY. PCP REPORTS THAT PATIENT HAS A RED RAISED BLISTERING RASH OVER MULTIPLE BODY SURFACE AREA THAT RESEMBLES SHINGLES. NO OTHER SYMPTOMS. PCP REPORTS THAT HE PLANS TO TREAT PATIENT WITH STEROIDS.

Other Meds: METROPROLOL 100 MG QD, VESCEPA 1 GM 2 CAPS BID, LEVOCYRTIZINE 5 MG QD, GLYPISIDE 5 MG QD, GABAPENTIN 800 MG TID, NEXIUM 40 MG QD

Current Illness: None

ID: 1006351
Sex: M
Age: 64
State: TX

Vax Date: 01/20/2021
Onset Date: 01/23/2021
Rec V Date: 02/05/2021
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: codeine

Symptom List: Erythema, Pruritus

Symptoms: He states that he received the vaccine on 2/20 and three days later developed a red rash on his chest and back that has not completely gone away. He states that on 1/25 he developed nausea and vomiting to the extent that he missed work both of those days - this has resolved.

Other Meds: None

Current Illness: No

ID: 1006352
Sex: F
Age: 37
State: IN

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Na

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

Symptoms: Chills, fever, incredibly severe muscle aches for all the day after the vaccination

Other Meds: Cymbalta Tizanidine Meloxicam Gabapentin

Current Illness: Na

ID: 1006353
Sex: F
Age: 33
State: TX

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Report fever (101.1) HA, body aches, left arm pain 10 hours post vaccination and funny taste in mouth 10 minutes after vaccination. Funny taste resolved. Treatment: Tylenol with mild improvement. Outcome does not interfere with ADLs.

Other Meds:

Current Illness:

ID: 1006354
Sex: M
Age: 67
State: CT

Vax Date: 01/23/2021
Onset Date: 01/26/2021
Rec V Date: 02/05/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine was received on 01/23/2021 at ~4:00 PM. My wife was notified that she was exposed while administering vaccines at a site on the same day. On the afternoon of the 26th I began to feel a sore throat, headache and low grade fever. By the 27th. I continued with intermittent headaches, sore throat and fevers of between 99.8 and 101. On 01/28/2021 I was tested for Covid and it came back negative. I continued with the same symptoms and on 02/02/2021 I was retested and the results again came back negative. My symptoms have not deminished and today 02/05/2021 I had a virtual meeting with my primary PA. She has prescribed Zythromax and asked me to follow up with her in a few days.

Other Meds: Montellukast 10mg, Zolpidem 10 mg, Fluoxitine 40 mg, Losarton

Current Illness: None

ID: 1006355
Sex: F
Age: 44
State: CA

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 02/05/2021
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: None

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

Symptoms: Patient reported feeling heart racing; Assessed as tachycardic, HR 130, BP 134/64 @11:40, BP 150/80 @11:55, BP 167/105 @12:03, BP 181/96 @12:24; O2 sat 99%. Transported to the ED. Spent 3 hours in the ED BP down to 130/ Then discharged home. No recurrent episodes. Does not have history of high blood pressure.

Other Meds: Takes diary supplements but not sure she took that day

Current Illness: None

ID: 1006356
Sex: F
Age: 53
State: CT

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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: pt states later in the day after the vax she noticed her neck, arm and upper back was sore. She went to bed since she wasn't feeling well. She woke up feeling a little dizzy and foggy. Pt got up next day but fainted after getting out of bed. After coming to she stood up and then passed out again. She had intense fatigue and headache. Pt states that she is better but still has fatigue but has not appetite. Pt has not contacted her PCP since her symptoms were getting better.

Other Meds: Multivitamin

Current Illness: none

ID: 1006357
Sex: F
Age: 42
State: PR

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

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

Lab Data:

Allergies: Aspirin and latex

Symptom List: Pain in extremity

Symptoms: Inflammation in the trachea , headache, stomach pain , body pain

Other Meds:

Current Illness:

ID: 1006358
Sex: F
Age: 47
State: PA

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Codeine, Clindamycin

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

Symptoms: Metallic taste in mouth since vaccine

Other Meds:

Current Illness:

ID: 1006359
Sex: F
Age: 36
State: IL

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/05/2021
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: Peanuts, tree nuts

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

Symptoms: 9:00pm - headache. Took Tylenol. 2/3 6:30am. Woke with mild body aches and muscle aches. Headache. Took ibuprofen at 7:00am. Felt fatigue all day. Continued with body/muscle aches and intermittent headache all day 2/3. Alternated ibuprofen and Tylenol every 4 hours. Had hard time sleeping Wednesday night. Continued with body aches and fatigue on 2/4 with intermittent headache. Alternate ibuprofen and Tylenol every 5-6 hours. Symptoms Continued until 2/5. Mild body aches and headache. Treated with Tylenol.

Other Meds: Nuva ring

Current Illness: None

ID: 1006360
Sex: F
Age: 39
State: VA

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/05/2021
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: N/A

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

Symptoms: 102.4? fever the evening following vaccination (Saturday PM), fever fluctuating between 99.5-101.8? pretty consistently ever since. Most of the time it's been 100-101.4?. Headaches intermittently. Today is seven days since receiving the vaccine. Have taken acetaminophen fairly regularly - it reduces the fever some, usually not completely, and then it goes right back up.

Other Meds: Multivitamin daily, Imitrex as needed

Current Illness: N/A

ID: 1006361
Sex: F
Age: 22
State: IN

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Penicillin

Symptom List: Vomiting

Symptoms: High fever, chills, aches, nausea, headaches

Other Meds: Humalog and adderall

Current Illness: None

ID: 1006363
Sex: F
Age: 54
State: PA

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 02/05/2021
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: Iodine, Latex, Penicillin, Sulfa, oranges

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt states took prophylactic Benadryl prior to vaccine dose 1 reaction 9AM received IM injection @ let deltoid sat in waiting area 9:10 states "tongue feels weird" to Pharmacist. Pharmacist administered Pepcid 40 mg PO. Tongue continued to feel "tingly" generalized itching, anxious 0925-Taken to ED via wheelchair by LPN and pharamcist

Other Meds: Synthroid ,Norvasc, Hydrodiuril , Benadryl 50 mg prior to appointment

Current Illness: 12/24/20-Reaction to first COVID vaccine

ID: 1006364
Sex: M
Age: 78
State: FL

Vax Date: 01/31/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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, cipro

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

Symptoms: pruritic rash on left forearm, right calf, right medial aspect of lower leg bruising/petechiae

Other Meds: phenazopyridine, flomax, alprazolam, losartan

Current Illness: none

ID: 1006365
Sex: F
Age: 33
State: PA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: Amoxicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Facial swelling, self-resolving.

Other Meds: Amlodipine Sertraline

Current Illness:

ID: 1006366
Sex: M
Age: 73
State:

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Progress Notes Nurse Practitioner Cosign Needed Expand All Collapse All Patient: DOB: 10/1/1947 Date: 2/4/2021 Subjective Patient is a 73 y.o. male who was seen at COVID Vaccine Clinic today for his first dose of the COVID 19 vaccination. He was given the Pfizer vaccination in the right deltoid muscle. During his 15 minute waiting period after the injection, the patient began to experience SOB and throat tightness and abdominal pain. He denied rash, hives, welts, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, dizziness, facial swelling, lip swelling and tongue swelling. This provider was notified of patient reaction and he was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to abdominal pain, blood pressure abnormality , chest pain, collapse, drooling, hypotension, increased swelling, rapid progression of symptoms, respiratory distress, skin changes, tongue swelling and vomiting. Pt is a diabetic ate last at 8 am. Blood sugar 234 at 15:12. ALLERGY REVIEW OF SYSTEMS: Patient complains of shortness of breath and abdominal pain Previous Reactions: None Objective Vitals There were no vitals filed for this visit. Blood Sugar 234 collected at 1512 Physical Exam Constitutional: Appearance: Normal appearance. He is well-developed. HENT: Head: Normocephalic and atraumatic. Right Ear: External ear normal. Left Ear: External ear normal. Nose: Nose normal. Eyes: Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Neck: Musculoskeletal: Normal range of motion and neck supple. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds. Abdominal: General: Bowel sounds are normal. Palpations: Abdomen is soft. Musculoskeletal: Normal range of motion. Skin: General: Skin is warm and dry. Capillary Refill: Capillary refill takes less than 2 seconds. Neurological: Mental Status: He is alert and oriented to person, place, and time. Assessment/Plan Treatment included: no therapy Follow up response to treatment: excellent. Patient discharge: Stable to go home and follow up with PCP. Differential Diagnosis: Vaccine-Related Anxiety (include misc mental health) Pt left at 15:28

Other Meds:

Current Illness:

ID: 1006367
Sex: F
Age: 62
State: NJ

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: chills, fever, fatigue, headache, arm soreness

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm