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: 0928943
Sex: F
Age: 64
State: NY

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
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: NSAIDS including buprofen and Naproxen Shellfish Contrast Dye

Symptom List: Dysphagia, Epiglottitis

Symptoms: within about 10 minutes I felt terrible, hot, flushed, tachycardic, and developed significant hives on my face and neck and swelling around my eyes. I was taken to a room and had vitals and was hypertensive and tachycardic with a worsening headache, I was given 50 mg Benadryl and put ice on my face and neck for about 20 minutes as I felt I was burning up. I remained at the clinic for an hour for monitoring. I never had difficulty breathing , and it was mostly resolved in about 45 minutes except for the mild headache and my face was still red and my eyes were swollen for at least an hour.

Other Meds: Vitamin D, B12

Current Illness: none

ID: 0928944
Sex: F
Age: 42
State: CO

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
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: Wednesday evening I began noticing some aching and irritation in my right deltoid. It was swollen, hot and firm to palpation. This has persisted since then and the skin is red (see attached photo). I have been taking 25mg of benadryl every 4-6 hours and don't seem to have other symptoms although my shoulder and arm ache and are uncomfortable.

Other Meds:

Current Illness:

ID: 0928945
Sex: F
Age: 41
State: MT

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
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:

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

Symptoms: body aches, fever, nausea, sore arm, up all night

Other Meds:

Current Illness:

ID: 0928946
Sex: F
Age: 22
State: AZ

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

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

Lab Data:

Allergies: N/a

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Throat swelling, fatigue, dry throat, some trouble breathing

Other Meds: N/a

Current Illness: N/a

ID: 0928947
Sex: F
Age: 26
State: CA

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/08/2021
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: Tuesday started having body aches felt weak coughing in the middle of the night sore throat slight congestion

Other Meds:

Current Illness:

ID: 0928948
Sex: F
Age: 49
State: MI

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
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: Mild skin allergy to soy, maple, milk per scratch test over 10 years ago. No reactions to any. Excema

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

Symptoms: Left sided parentheses and numbness sensation which then spread to right side. Strong headache initially then resolved, rapid heart rate, confusion, dizziness, high blood pressure,

Other Meds: Hydrochlorothiazide 25mg, Losartan 25 mg, Norethindrone . 35mg, Omeprazole 20 mg once a week

Current Illness: None.

ID: 0928949
Sex: F
Age: 40
State: TX

Vax Date: 12/23/2020
Onset Date: 12/30/2020
Rec V Date: 01/08/2021
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: NKDA NKFA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Approximate 3 in x 3 in erythematous, warm, slightly raised urticaric appearing irritation

Other Meds: Excedrin migraine OTC prn

Current Illness: None

ID: 0928950
Sex: M
Age: 72
State: TX

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/08/2021
Hospital:

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

Lab Data:

Allergies: Morphine

Symptom List: Pharyngeal swelling

Symptoms: fatigue, chills , fever, muscle pain, joint pain, nausea onset 16 hours after shot lasting 2 days. No treatment sought

Other Meds: None

Current Illness: None

ID: 0928951
Sex: F
Age: 38
State: AL

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
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: nausea, tingling in hands, states slight airway restriction, Benadryl 25mg given po at 11:40am, Pulse 72, O2 SAT 100%, Patient was observed for 20 minutes, patient left at 12pm stating feels better returning to work.

Other Meds:

Current Illness:

ID: 0928953
Sex: M
Age: 37
State: CA

Vax Date: 12/24/2020
Onset Date: 12/31/2020
Rec V Date: 01/08/2021
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: Prednisone

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Very sore armpit and groin areas. Likely lymph node soreness

Other Meds: None

Current Illness: None

ID: 0928954
Sex: M
Age: 41
State: SD

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

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

Lab Data:

Allergies: NKDA, seasonal allergies ie hayfever

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

Symptoms: Injection site pain and tenderness (3/10 worsening to 6/10 within 24 hours then 0/10 at 48 hours). Chills developed at 24 hours post injection and lasted 30 mins. Fatigue onset at 24 hours, persisted through 48 hours post administration. Headache onset at 24 hours (pain rate 8/10 and persisted for 6 hours).

Other Meds: Ventolin, Dulera, MVI

Current Illness: NA

ID: 0928956
Sex: F
Age: 44
State: NY

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Reported chills,body aches, fever 100.3

Other Meds:

Current Illness:

ID: 0928957
Sex: F
Age: 58
State: TN

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

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

Lab Data:

Allergies: Unknown

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

Symptoms: Patient stated that she had a metallic taste and headache after receiving the Moderna COVID-19 vaccine

Other Meds: Unknown Patient stated that she had a metallic taste and headache after receiving the Moderna COVID-19 vaccine

Current Illness: Unknown

ID: 0928958
Sex: F
Age: 35
State: MN

Vax Date: 12/18/2020
Onset Date:
Rec V Date: 01/08/2021
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:

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

Symptoms: EE called to report L axilla swelling x 5 days, not improving. VEARS completed. Advised her to see MD as this is most likely from the injection, but could also be from another cause .

Other Meds:

Current Illness:

ID: 0928959
Sex: F
Age: 37
State: KY

Vax Date: 12/23/2020
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
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: NKDA

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

Symptoms: Patient states on 1/3/21, she started to notice redness on her arm around the injection site which has continued to worsen over the last few days. On 1/6/21, she noticed some raised areas within the redness that looked like welts and the redness has continue to spread down the arm. The area has been reviewed by her primary care physician who told her to just continue to monitor. I instructed her to continue to monitor and seek further medical attention if it continue to cause issues.

Other Meds:

Current Illness: NONE

ID: 0928960
Sex: F
Age: 29
State: CA

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
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: I got the shot on the top of my right arm but on my right elbow area was really painful it was like a broken arm because I couldn't use it I couldn't do anything with it but it got better after 4 days. Seen doctor on 12/24/2020.

Other Meds: Just a protein shake

Current Illness: A week in half before vaccine I was expose to Covid but I tested negative but I was having symptoms.

ID: 0928961
Sex: F
Age: 26
State: CA

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/08/2021
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:

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

Symptoms: body aches fatigue coughing in the middle of the night sore throat slight congestion

Other Meds:

Current Illness:

ID: 0928962
Sex: F
Age: 42
State: MT

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/08/2021
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: 24 hours post: sore arm mild headache, achy joints, fatigue, low grade temp (99-100) this lasted for 78 hours 6 days post: redness around injection site, itchy, warm to touch this lasted up to day 8 post injection

Other Meds:

Current Illness:

ID: 0928963
Sex: F
Age: 62
State: MT

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
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: Initially tired. After 15 hours, intermittent pain in joints and muscles throughout the body. Tiredness

Other Meds: Metformin 500mg, losartan potassium 50mg, atenolol mg, hydrochlorothiazide mg, aspirin 1300 mg.

Current Illness: Seasonal allergies

ID: 0928964
Sex: F
Age: 43
State: MT

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
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: headache , body aches, fatigue, injection arm pain

Other Meds:

Current Illness:

ID: 0928965
Sex: F
Age: 42
State: IN

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/08/2021
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: Septra DS, Augmentin, sensitive to Latex, IV Benadryl, Lortab

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

Symptoms: I felt fatigue, soreness and redness at injection site, and muscle aches the next morning (1/1/21). Noted a red area that was 1.5 inches around. The redness started to improve on 1/5/21. On 1/6/21 the redness came back worse. I felt pain and itching at the site. It began welting. By that afternoon it was 3 inches around, dark red, small blister on top of the welting. I called my doctor's office, they had me call the COVID-19 number. The COVID-19 Nurse stated it sounded like a typical reaction. He recommended Benadryl cream and heating pad. Today is 1/8/21. The redness is at 4 plus inches around. Still sore and itchy. I still have some muscle aches and a headache. I haven't been seen by a doctor, but I may go to urgent care for evaluation.

Other Meds: None

Current Illness: No

ID: 0928966
Sex: M
Age: 38
State: AZ

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
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: Unevaluable event

Symptoms: Fatigue, body aches

Other Meds: None

Current Illness: None

ID: 0928967
Sex: F
Age: 51
State: WI

Vax Date: 12/29/2020
Onset Date: 01/03/2021
Rec V Date: 01/08/2021
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: 5 days post vaccination, patient developed rash on central abdomen. 6 days post vaccination, rash on abdomen resolved and rash appeared on bilateral forearms. Patient took Benadryl and rash subsided by day 8 post vaccination.

Other Meds: n/a

Current Illness: None

ID: 0928968
Sex: M
Age: 42
State: NY

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
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: Previous one-time allergic reaction to flu vaccine (2015)

Symptom List: Injection site pain, Pain

Symptoms: Fever (100.6) chills, very bad body aches, fatigue, dizziness Lasted for about 18 hours. Woke up the next day feeling fine.

Other Meds: None

Current Illness: None

ID: 0928969
Sex: F
Age: 30
State: CA

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
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: Injection site pain, Menorrhagia

Symptoms: Pain from left arm and up to left shoulder Lymph node is enlarged and tender Diarrhea Body Aches

Other Meds:

Current Illness:

ID: 0928970
Sex: F
Age: 21
State: KS

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
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:

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

Symptoms: After receiving vaccine about 30 minutes, she felt dizzy. 45-50 minutes after receiving vaccine she felt itchy throat, cough, and swollen throat *Treatment: 50 mg of benadryl, 1 pen of Epipen 0.3 mg. Called EMS

Other Meds: Lamictal

Current Illness: No

ID: 0928971
Sex: F
Age: 37
State: AL

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
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 Kepflex, Flagyl, and morphine

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Tingling finger and toes, loss of sensation on injection arm, loss of motor function left arm and legs, numbness hands and feet, hands and feet became ice cold, headache, joint pain, muscle spasms, feeling drunk and dizzy, loss of consciousness 3x (reported by friend). confusion, inability to focus and complete thoughts and sentences. 911 called @12:04 PM by friend. At time of paramedics evaluation BP 175\100, O2 SAT 100%, loss of consciousness 2x(reported by friend) before being transported to University of Alabama at Birmingham (UAB) ER. No treatment except basic vitals taken, Held in waiting area for several hours then basic eval by ER doctor (unknown name) asked to attempt to stand, could not. Moved to ER room for couple hours, second eval by nurse to see of i could stand, had difficulty standing, asked to walk, shuffled feet to move and notified that i could go home

Other Meds: Gabapentin; Equate Women's multivitamin

Current Illness:

ID: 0928972
Sex: F
Age: 36
State: HI

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
Hospital:

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

Lab Data:

Allergies: Macrobid (rash)

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 12:15pm: c/o itching in throat BP: 102/60 P: 68 O2: 100% No rash or other sxs Benadryl 25mg 1 PO given 12:45pm: itching of throat, (L) chin itchiness, small red bumps on (L) side of face forming No SOB BP: 122/80, P: 72 Benadryl 125mg 1 PO given 1:00pm itching of throat, lump in throat, decreased face itching decreased bumps 1:15pm decreased sxs overall BP: 118/62 let got home, ok to drive

Other Meds: unknown

Current Illness: None

ID: 0928973
Sex: F
Age: 46
State: CA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/08/2021
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: Pain, redness and swelling in the injection site, also reporting rash for 3 days and now it has not gone away.

Other Meds: Multivitamins

Current Illness:

ID: 0928975
Sex: F
Age: 21
State: WA

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
Hospital:

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

Lab Data:

Allergies: unknown, denied at check in

Symptom List: Nausea

Symptoms: developed systemic hives and itching approx 15 minutes after receiving first dose vaccine

Other Meds: unknown

Current Illness: unknown

ID: 0928979
Sex: F
Age: 47
State: CA

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
Hospital:

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

Lab Data:

Allergies: Remicade Pork

Symptom List: Injection site pain

Symptoms: Throat very hot Swollen Eye lids, Chest Tighten Tested positive for covid 12/31/2020

Other Meds: 15mg Benadryl Premera Injection 1 every two weeks mesalamine medication

Current Illness: None

ID: 0928981
Sex: F
Age: 36
State: UT

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Severe migraine x10+ days

Other Meds: Wellbutrin, Effexor, Latuda, Lamictal, Spironolactone, Zyrtec, Aimovig, Gabapentin, Cyclobenzaprine

Current Illness: URI

ID: 0928983
Sex: F
Age: 1
State: LA

Vax Date: 12/15/2020
Onset Date: 12/15/2020
Rec V Date: 01/08/2021
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:

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

Symptoms: Cheeks & forehead flushed. Inj. site with mild erythema. Mom instructed to apply cool compresses & give Benadryl 6 hrs x 3days if itching. May give OTC Motrin/Tylenol x 48 hrs. RTC to ER if gets distressed

Other Meds:

Current Illness:

ID: 0928985
Sex: F
Age: 62
State: KY

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/08/2021
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: Penicillin Sulfa

Symptom List: Tremor

Symptoms: Fever 104.8 for 24 hours Severe bone pain for 24 hours Intermittent dizziness Arm soreness continues

Other Meds: Zoloft Provera Norvasc Estrace Synthroid

Current Illness: None

ID: 0928986
Sex: F
Age: 56
State: CA

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/08/2021
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: Erythema, Pruritus

Symptoms: The next say I exp headache I was warranted cause on of my coworkers tested positive Covid. I went to ER high BP and got tested for Covid results negative. On that Saturday my BP was still high and left calf pain. Since I'm usually hypotensive I monitored my BP however it has continued to elevate.

Other Meds:

Current Illness: No

ID: 0928988
Sex: M
Age: 11
State: TX

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
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: N/A

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

Symptoms: Patient passed out in office while waiting 15min after shots.

Other Meds: N/A

Current Illness: N/A

ID: 0928991
Sex: M
Age: 34
State: CA

Vax Date: 01/06/2020
Onset Date:
Rec V Date: 01/08/2021
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: developed fever 101.0, body ache, fatigue at 0400 1/7, relieved with Tylenol. symptoms improved slightly by 1/8 to mild body ache, fatigue and temp 100.0

Other Meds:

Current Illness:

ID: 0928994
Sex: F
Age: 29
State: CA

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
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: No

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I got the injection on my right arm & on my elbow area it was really painful it was like a broken arm because I couldn't do anything with it. Seen doctor on 12/24/2020

Other Meds: Just a protein shake

Current Illness: A week in half before vaccine I was expose to Covid but I tested negative but I was having symptoms.

ID: 0928997
Sex: F
Age: 46
State: NY

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
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:

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

Symptoms: Reported temp.101F Resolved with Tylenol (99.9F)

Other Meds:

Current Illness:

ID: 0928999
Sex: F
Age: 27
State: IN

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
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: I received vaccine at 2:50 pm on Wednesday January 6th. I felt upper respiratory symptoms around 3:30 pm the same day. By the second day, I felt the pain in my back. On a scale of 1-10 the pain level has been at a consistent 6.

Other Meds: None

Current Illness: None

ID: 0929001
Sex: F
Age: 56
State: TX

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
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: Pain in extremity

Symptoms: Tingling lips 1100am, mild chest tightening 1115am

Other Meds: Estrogen, Progesterone, Multivitamin, Vit D

Current Illness: "Not feeling well" per patient

ID: 0929004
Sex: U
Age: 50
State: CA

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 01/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt felt very anxious, states initial dizziness that resolved in 30 minutes. Onset was 15 minutes after vaccination. PT monitored, VS at released from observation area were normal for this patient.

Other Meds:

Current Illness:

ID: 0929008
Sex: F
Age: 36
State: OH

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
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: Doxycycline, sulfa

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

Symptoms: Patient reports left pectoral pain. Patient suspects the injection was given a little higher than it should have been. She has limited ROM of her left shoulder and is tearful during exam. Normal ROM of neck.

Other Meds: Cytotec, metronizadole cream, Prevacid

Current Illness:

ID: 0929012
Sex: M
Age: 38
State: UT

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
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: Unknown.

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

Symptoms: Wife called and stated that her husband received the Pfizer vaccine on 01/06/2021 at 4pm and since receiving vaccine has been experiencing possible side effects. Wife states that patient has been excessively throwing up and having diarrhea. Wife has been encouraging husband to go to E.R. or seek medical attention, but he is refusing.

Other Meds: Unknown.

Current Illness: No.

ID: 0929015
Sex: U
Age: 50
State: CA

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 01/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Pt felt very anxious, states initial dizziness that resolved in 30 minutes. Onset was 15 minutes after vaccination. PT monitored, VS at released from observation area were normal for this patient.

Other Meds:

Current Illness:

ID: 0929019
Sex: M
Age: 69
State: CA

Vax Date: 12/29/2020
Onset Date: 12/31/2020
Rec V Date: 01/08/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: swelling and redness around both eyes, rash/hives on left arm, upper chest and abdomid I was given an oral steriod (unknown) given a pepcid, and perscriptions for pepcid, benedryl, and calamine lotion eye swelling was partially reduced, itching could be controled wit benedryl and calamine, as of today 1/8/2021 I still have some redness and swelling around the eyes and also still have the hives and itching

Other Meds: metformin, levothyroxine, lisinopril, glimipride, atorvastatin, chlorthalidone,fenofibrate

Current Illness: none

ID: 0929022
Sex: F
Age: 24
State: CA

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
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: Denies

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

Symptoms: Pt. felt dizzy and lightheaded and slumped out of observation chair. Pt. was arousable, but sluggish in response. No SOB, LOC, or rashes noted. Pt. placed supine in trendelenberg position. Paramedics arrived @ 0853 and transport to hospital was declined by pt. Pt. continued to be observed and stated she felt 100% better and called lyft to drive her home @ 0925. Pt. was advised to call an acquaintance to drive her home but she was unable to find anyone and chose to call lyft.

Other Meds: Prozac

Current Illness: Denies

ID: 0929031
Sex: F
Age: 20
State: KY

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: dizziness, labored breathing, hyperventilation, increased pulse and blood pressure, O2 sat of 80% briefly passing out. O2 applied per nasal cannula.

Other Meds: None known

Current Illness: Post COVID positive

ID: 0929043
Sex: U
Age:
State: CA

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: No additional AEs reported; Varivax was administered during temperature excursion; Information has been received from a nurse concerning to a patient (age and gender not reported). No medical history, concurrent conditions nor concomitant medications were reported. On 28-DEC-2020, the patient was vaccinated with a temperature excursion (product storage error) dose of varicella virus vaccine live (oka/merck) (VARIVAX) (lot No. T014309, exp. date 24-APR-2022) (route of administration not reported) for prophylaxis. No adverse evenst reported. Temperature: 12F Time frame: 30 minutes Previous temperature excursion: No Call because of data logger.

Other Meds:

Current Illness:

ID: 0929044
Sex: M
Age: 1
State: AL

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/08/2021
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: no additional AE; expired MMR-II vaccine was given; This spontaneous report was received from a registered nurse and refers to a 12-month-old, male patient (reported also as a child). His medical history, concurrent conditions, concomitant medications, drug reactions or allergies were not provided. On 05-JAN-2021, also reported as "today", the patient was vaccinated with expired measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II), rHa, 0.5 ml, lot # R028004 (valid lot #), expiration date reported and validated as 01-OCT-2020 (strength, route of administration and anatomical location were not provided) for prophylaxis (expired vaccine used). The nurse was calling to inquire about revaccination or if it was supported. There was no previous temperature excursion reported (no mention about the data logger). No additional adverse event (AE) was reported (no adverse event).

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm