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: 1017258
Sex: M
Age: 34
State:

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/09/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fever, chills, body aches, headache, last about 24 hours. Treated with Tylenol and Ibuprofen.

Other Meds:

Current Illness:

ID: 1017259
Sex: F
Age: 28
State: OK

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/09/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Sore arm/ injection site, body chills, no fever, headache. Took Tylenol. Started morning of 2/6/2021 lasted until 2am of 2/7/2021

Other Meds: Birth control

Current Illness:

ID: 1017260
Sex: F
Age: 30
State: NY

Vax Date: 01/29/2021
Onset Date: 02/06/2021
Rec V Date: 02/09/2021
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: Rash. Round, hot, itchy. 5 cm under injection site

Other Meds:

Current Illness:

ID: 1017261
Sex: F
Age: 71
State: NY

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Tetracycline

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: "Moderna COVID-19 Vaccine EUA"

Other Meds: Atenolol, Montelukast Sodium, Finsacea Gel, Azelastine prn, Colace, Align Probiotic, Calcium with D3, Vitamin E, Multi Vitamin, ASA 81 mg., Melatonin, Benefiber,

Current Illness: None

ID: 1017262
Sex: F
Age: 70
State: MD

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

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

Lab Data:

Allergies: tape anesthesia amide ester (local) codeine Compazine lisinopril

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

Symptoms: patient complain of having a racing heart

Other Meds: creon albuterol alvesco Pravachol cymbalta

Current Illness:

ID: 1017263
Sex: M
Age: 76
State: CA

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/09/2021
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: Very sore L arm, red patch over upper arm, headache, low grade fever, chills

Other Meds:

Current Illness: None

ID: 1017264
Sex: F
Age: 66
State: FL

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
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, Codeine, Sulpha

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Dizziness, nausea, headache, fatigue

Other Meds: Eliquis, Sotalol, Tresiba,Trulicity, Flovent, Incruse Ellipta, Singulair, Lipitor, Micardis, Nexium, Synthtoid, Evista, HCTZ, B12, C, Zinc, Alpha Lipoic Acid, Osteo Biflex 3x, One-A-Day 50+, Os-Cal+D3

Current Illness: Runny nose, sneezing-sinus/allergies?

ID: 1017265
Sex: F
Age: 54
State: IL

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Seasonal/environmental allergies

Symptom List: Pharyngeal swelling

Symptoms: Within 4 hours of vaccine Had a rash on face, ears, chest and arms. Lasted for 30 minutes and then dissipated . 24 hours later, chills and flu like symptoms with some chest congestion/cough

Other Meds: Probiotic, CoQMax, Niacin, vitamin D, vitamin C, Magnesium, menopause formula, Flonase, 5-MTGF, zinc, Omega fish oil, L-Arginine, Amiodipine

Current Illness:

ID: 1017266
Sex: F
Age: 52
State: MN

Vax Date: 01/30/2021
Onset Date: 02/07/2021
Rec V Date: 02/09/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Development of left arm redness, itching

Other Meds: duloxetine, abilify, buspar, bupropion, lithobid, trazodone

Current Illness: none

ID: 1017267
Sex: M
Age: 87
State: SD

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
Hospital: Y

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

Lab Data:

Allergies: Aspirin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient awoke at 0600am with chest pain. He took two nitro and tried to go back to sleep. At 0800am he awoke again with the chest pain and took 2 nitro which again helped the pain. At that time he did experience shortness of breath and diaphoresis. He was found to have decreased O2 sats when the EMTs got to him and he was placed on a non-rebreather. On x-ray the patient was found to have a right pneumothorax, cardiac markers were negative. A chest tube was placed and the patient was transferred to a hospital.

Other Meds: Amlodipine, Enteric Coated Aspirin, Atorvastatin, Gabapentin, Lactobacillus Acidophillus, Lorazepam, Multivitamin, Nitroglycerin, Potassium Chloride, Primidone, Tamsulosin, Ubidecarenone, Preservision, Vitamin A, Vitamin D, Vitamin B

Current Illness: Evaluated for tremors in January

ID: 1017268
Sex: F
Age: 17
State: WI

Vax Date: 01/03/2021
Onset Date: 01/03/2021
Rec V Date: 02/09/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: arm pain

Other Meds: depo-provera

Current Illness: None

ID: 1017269
Sex: M
Age: 47
State: TX

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: Patient reports redness to chest area; no itching , no hives, no flushing. Patient was seen and cleared by EMS. HR = 88 SPO2 = 95

Other Meds:

Current Illness:

ID: 1017270
Sex: F
Age: 47
State: CT

Vax Date: 12/30/2020
Onset Date: 01/05/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Gluten, Dairy, Amoxicillin, Erythromycin, Ativan

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

Symptoms: 1/5 I woke up with really bad stomach pain and a severe headache. The stomach issues lasted about 5 days and the headache 6 so I went the Urgent Care and was given a COVID test which was negative . On Wed I woke up with a temp of 102 but it resolved that same day

Other Meds: no

Current Illness: no

ID: 1017271
Sex: F
Age: 59
State:

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: I woke up the morning after 2/4/2021 with a fever 100.3 at 7:30am, 100.9 at 10am, I took two Tylenol at 10am. 100.3 at 1:15pm, 100.7 at 2:30pm, I took two more Tylenol at 2:30pm. 101.1 at 3:30pm, 101.2 at 5:30pm, 100.8 at 6:30pm, I took two Tylenol at 6:30pm, 100.9 at 10:30pm I took two Tylenol at 10:30pm, Friday morning I took two Tylenol at 6:30am, 99.6 at 7:30am, 99.1 at 9am, 98.9 at 10am, 100.8 at 2pm, 99.1 at 6:00pm, 98.1 at 8pm

Other Meds: Lodipine 10mg, Potassium 10mg every other day, Multivitamin, Caltrate 600+D3, Vitamin D 125 mg, Vitamin E 180 mg, Vitamin C and Zinc 60mg and 15mg.

Current Illness: none

ID: 1017272
Sex: M
Age: 82
State: CA

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 02/09/2021
Hospital: Y

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: Myocardial infarction Pancytopenia

Other Meds: Was taking lisinopril asa,

Current Illness: Htn, hyperlipidemia , mi stent , brain aneurysm

ID: 1017273
Sex: M
Age: 24
State: CA

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 02/09/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Woke up the next day with body ache (arms, legs, lower back, chest). extremely exhausted. looked pale. cold sweats, fever. dizziness/headache.

Other Meds: N/A

Current Illness: N/A

ID: 1017274
Sex: F
Age: 56
State: OR

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/09/2021
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: Codeine, Amoxicillin

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

Symptoms: Per patient, bleeding at the injection site immediately after administration. Bleeding controlled with band-aid. Arm soreness developed about 2 hours after administration. Next day patient noticed knot at injection site, soreness and warm to the touch. Patient did not seek medical attention. Soreness lasted several days, 6 days after vaccine, patient developed red itchy rash at injection site. Self treated with OTC Benadryl and symptoms resolved. Arm soreness lasted about 9 days. Patient called clinic to report side effects.

Other Meds:

Current Illness:

ID: 1017275
Sex: F
Age: 64
State: WI

Vax Date: 01/20/2021
Onset Date: 01/31/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Latex and penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: January 30, 2021, began experiencing Bell's Palsy type symptoms. Went to ER on February 1, 2021 where I was diagnosed and prescribed Prednisone, Valacyclovir and Artificial tears.

Other Meds: Levothyroxine, Singular, Cozaar, Multi VItamin pack, Omega 3, Chinese herbs, Joint Care.

Current Illness: none

ID: 1017276
Sex: F
Age: 70
State: IN

Vax Date: 02/07/2021
Onset Date: 02/08/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Sulphate, Morphine, Codeine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Chills muscle aches

Other Meds: Caltrate, Relaxafin, Sertraline

Current Illness: None

ID: 1017277
Sex: M
Age: 44
State:

Vax Date: 02/05/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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, body aches, difficulty breathing and right lung hurt

Other Meds:

Current Illness:

ID: 1017278
Sex: M
Age: 38
State: CT

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/09/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none that I know of

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

Symptoms: Hives. Benadryl not helping.

Other Meds: Clonazepam

Current Illness: none

ID: 1017279
Sex: F
Age: 40
State: OR

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Folic acid, Gluten, Morphine and related, Dairy, Levaquin, Latex, wheat

Symptom List: Unevaluable event

Symptoms: The evening after she received the first dose of the Moderna vaccine she developed mild chest pressure and felt itchy. Pt took 25mg of Benadryl and when she woke up the morning after she had moderate hives on her face, neck, chest and arms. Pt took 50mg of Benadryl the morning after the vaccine and then came in to Urgent Care. Pt was prescribed prednisone, instructed to take daily Allegra, Benadryl, and prescribed an epi pen for escalating symptoms. Pt was informed to not receive the second dose until she is cleared by allergy/immunology.

Other Meds:

Current Illness:

ID: 1017280
Sex: F
Age: 34
State:

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/09/2021
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:

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

Symptoms: pain in every joint and muscle stiffness, and back night sweats, lasted about 15 hours . 48 hours after receiving vaccine still achy but tolerable

Other Meds:

Current Illness:

ID: 1017281
Sex: F
Age: 30
State: CA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/09/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Anxiety

Other Meds:

Current Illness:

ID: 1017282
Sex: F
Age: 72
State: FL

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/09/2021
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

Symptom List: Injection site pain, Menorrhagia

Symptoms: She developed new onset elevated BP, systolic BP 199 with epistaxis, required ER visit and tx for epistaxis...BP slowly normalized

Other Meds: Red Yeast Rice Multivitamin, Vitamin C, D, CoQ10, Fish Oil, Probiotic

Current Illness: none

ID: 1017283
Sex: F
Age: 27
State: CA

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 02/09/2021
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: lower back pain, worsened to thighs, spasms developed. Unable to walk, Ketorolac injection, prednison, and flexeril. 2 days later on 12/25/2021, symptoms resolved.

Other Meds: Awoke with lower back pain which worsened the next day. Developed spasms to lower legs and thighs. I was unable to ambulate. Took Tylenol and ibuprofen before bed. Symptoms continued 12/24/20, given IM shot with ketorolac, Prednisone & flex

Current Illness: None.

ID: 1017284
Sex: M
Age: 27
State: CA

Vax Date: 01/21/2021
Onset Date: 01/28/2021
Rec V Date: 02/09/2021
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: No Known Medication Allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt tested positive for COVID 19.

Other Meds: Unknown

Current Illness: Unknown

ID: 1017285
Sex: F
Age: 59
State: MA

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: chills, fatigue, low fever 99-101

Other Meds: none

Current Illness: none

ID: 1017286
Sex: F
Age: 97
State: AK

Vax Date: 01/27/2021
Onset Date: 02/07/2021
Rec V Date: 02/09/2021
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: NKDA

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

Symptoms: on day 11 post vaccine, C/O left upper back pain over shoulder blade radiating down to lower side

Other Meds: Vitamin D, Vitamin C, Miralax, Colace. Diclofenac Sodium topical, PRN: Lidoderm Patch, Acetaminophen, Famotidine, Prevacid, Gas X, Almacone DS. Imodium, Kaopectoili, Dulcolax.

Current Illness: None

ID: 1017287
Sex: F
Age: 55
State: MI

Vax Date: 01/15/2021
Onset Date: 01/19/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Lisinopril Latex Shrimp--? Ragweed

Symptom List: Nausea

Symptoms: Few days after first shot/dose in left arm, my fingers started tingling and going numb few times a day everyday since and up until second shot/dose on Feb 5th 2021 , even did it on same day while in 15 min holding period. Informed nurses they had me wait another 30 mins. Today is Feb 9th 2021 and still have the tingling and numbness in left fingers , has been only left fingers .

Other Meds: Spironolacton 25 mg one day Levothyroxine 150 mcg one day Tramadol 50 mg 4x day Metoprolol succ 50 mg one day Doxazosin 4 mg one day night Betamethasone dip 0.05% Gabapentin 400 mg 3x day Metformin 500 mg 2x day Vitamin D 1000 iu one day (

Current Illness: None

ID: 1017289
Sex: F
Age: 26
State: RI

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Antihistamines

Symptom List: Injection site pain

Symptoms: Fever- 103, vomiting, nausea, dizziness, body aches, chills, headache

Other Meds: Sertraline 50mg

Current Illness:

ID: 1017290
Sex: F
Age: 37
State: KY

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/09/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: he got her 2nd dose of the COVID vaccine at noon today. She did not have a reaction to the first vaccine. She has never had a similar rash before. Her rash began on her left hand but has now migrated to encompass her total body. Rash is described as red, blotchy, itchy. No facial or throat swelling, SOB, cough BP (!) 140/95 | Pulse 88 | Temp 99.5 ?F (37.5 ?C) (Temporal) | Resp 18 | Ht 5' 5" (1.651 m) | Wt 209 lb (94.8 kg) | LMP 01/11/2021 | SpO2 98% | BMI 34.78 kg/m? Physical Exam Constitutional: She appears well-developed and well-nourished. HENT: Head: Normocephalic and atraumatic. Nose: Nose normal. Mouth/Throat: Oropharynx is clear and moist. No oropharyngeal exudate. Skin: Skin is warm and dry. Rash noted. Rash is urticarial. Nursing note and vitals reviewed

Other Meds:

Current Illness:

ID: 1017291
Sex: M
Age: 74
State: NY

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/09/2021
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: unknown

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

Symptoms: Systemic: Other- Pain in chest, trouble breathing, 2 hours post shot.

Other Meds:

Current Illness:

ID: 1017292
Sex: F
Age: 63
State: TX

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/09/2021
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: ambien, atorvastatin

Symptom List: Tremor

Symptoms: Myalgias, fever, headache occuring 24 hours later with slow improvement, severe enough to require time off from work

Other Meds: Aspirin, albuterol, symbicort, zyrtec, vitamin d, insulin aspart, insulin glargine, metformin, metoprolol, pravastatin, Vallartan/hctz

Current Illness: COVID 12/15/21

ID: 1017293
Sex: M
Age: 67
State: NY

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/09/2021
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: Sulfa

Symptom List: Erythema, Pruritus

Symptoms: Patient saw liquid squirt out of injection (at connection site at needle and syringe) thus received incomplete second dose.

Other Meds: UK

Current Illness: UK

ID: 1017294
Sex: F
Age: 68
State: MO

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/09/2021
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: None

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

Symptoms: symptoms occured on Sunday after having the short on Friday. Swelling of upper lip and swelling on center of forehead. Eventually went away the same day. On Monday had swelling and tingling feeling again on upper and lower lip and had rash on left forearm and right forearm and hives on back of upper thigh on left leg. Took some benadryl and eventually went away. On Tuesday again had some rash on left arm around elbow and some below elbow and swelling under left eye and again hives on back of left leg and hive or rash on top of right hand.

Other Meds: Everyday: Levothyroxine 25MCG, Meloxicam 15MG, Raloxifene 60MG, Atorvastatin 40MG, Aspirin 81MG, Calcium Citrate+D3. and Vitamin D3. Every other day: Zinc 50MG, Biotin 5000mcg and Elderberry gummies

Current Illness: None

ID: 1017295
Sex: F
Age: 56
State: AZ

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Started with a headache 2/8/21 and on 2/9/21 Temp of 101.7, chills, body aches, nausea

Other Meds: Nothing until AFTER the shot. Then 800mg Ibuprofen and 500 mg Tylenol

Current Illness: Diverticulitis

ID: 1017296
Sex: F
Age: 47
State: CT

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Gluten, Dairy, Amoxicillin, Erythromycin, Ativan

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: About a half hour after the vaccination I got stomach pains and a headache which lasted until 1/21 and all symptoms subsided with no new symptoms

Other Meds: no

Current Illness: no

ID: 1017297
Sex: F
Age: 70
State: IN

Vax Date: 02/01/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: Unknown allergy to food

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

Symptoms: Vomiting, diarrhea, chills, fog head, tiredness, slight sore arm

Other Meds: Losartan, Synthroid, low dose aspirin, atorvastatin, Carvedilol, omeprazole ( script strength)

Current Illness:

ID: 1017298
Sex: F
Age: 63
State: OH

Vax Date: 01/27/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
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: Amoxicillin, phenazopyridine, lanolin, atorvastatin

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

Symptoms: Rec?d ModernaCovid vaccine. Day2-3 had headache,sore arm, fatigue and an unwell feeling. Day 9 a red rash 3? in diameter formed at injection site. Day 10 had dizziness. Day 11 a swollen lymph node size of a small egg under right arm. Day 12 &13 painful joints.

Other Meds: Dofetilide, eliquis, metoprolol, rovastatin, fish oil, vitamin d, multi vitamin, glucosamine/ condrotin, melatonin, calcium

Current Illness: None

ID: 1017299
Sex: M
Age: 55
State: CA

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/09/2021
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: subjective fever (tm 99.5), body aches, nausea, chills, headache, listless - lasted two days - slept 14 hours evening of vaccine (usually sleep 6 hours)

Other Meds: losartan hctz

Current Illness: No

ID: 1017300
Sex: F
Age: 84
State: OH

Vax Date: 01/19/2021
Onset Date: 01/26/2021
Rec V Date: 02/09/2021
Hospital: Y

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

Lab Data:

Allergies: Hives from: Meloxicam (and SOB); Sulfamethoxazole-trimethoprim; tolterodine LA (and itching); Nitrofurantoin; Oxybutynin; Potassium Iodide; Simvastatin; Sulfasalazine; Ezetimibe Itching from: rosuvastatin; butalbital-aspirin-caffeine Unknown rxn to: bisacodyl, butalbital-aspirin-caffeine; ceftriaxone; propoxyphene N-acetaminophen; oxybutynin; hydromorphone; iodine; omega-3 FA (Lovaza); Niacin; phenazopyridine; Sulfa (sulfonamide antibiotics); nitrofurantoin monohy/m-cryatal (Macrobid) Cramps in hands and stiffness of entire body: fenofibrate Pain, muscle pain, severe leg cramps: atorvastatin GI intolerance: cefdinir

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

Symptoms: EMG: Demyelinating neuropathy, possible AIDP vs developing CIDP

Other Meds: Cefdinir 300mg po BID (5 day Rx) Diphenhydramine 25mg -50mg po QAM Levothyroxine 125mcg po AM Adult MVI with FA Gummy po AM Nifedipine (Adalat CC) 24-hr tab 60mg po AM

Current Illness: hypertension, hypothyroidism, asthma, dementia, bladder repair surgery, macular degeneration, left eye blood clot hx, UTI, anemia

ID: 1017301
Sex: F
Age: 75
State: CA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/09/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: exacerbates peripheral neuropathy

Other Meds: multivitamins

Current Illness: none

ID: 1017302
Sex: F
Age: 51
State: CA

Vax Date: 01/14/2021
Onset Date: 01/26/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Joint swelling in both hands and digits. feels almost arthritic. lasting over 3 weeks now. Made an appointment to see doctor. fingers having a hard time straightening. Constant, pain and swelling.

Other Meds: none

Current Illness: none

ID: 1017303
Sex: F
Age: 25
State: MA

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: Caller states she received her vaccine today at 10am. Now experiencing charley horses in left leg. Instructed to increase fluids. rest and call PCP if condition worsening.

Other Meds:

Current Illness:

ID: 1017304
Sex: F
Age: 68
State: CA

Vax Date: 01/26/2021
Onset Date: 02/08/2021
Rec V Date: 02/09/2021
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: Z-Pak antibiotic

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Rash on arm at site of vaccine

Other Meds: Trandolapril 1 mg a day Vitamin C 500 mg a day Vitamin D 2000 a day B12 1000 a day

Current Illness: None

ID: 1017305
Sex: F
Age: 61
State: MI

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: She had an allergic reaction to an allergy shot in the past

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

Symptoms: From charting for point of care services before EMS transport: Chief Complaint: Immunization Visit: Client received Pfizer Vaccine at 11:30am. At 11:32 am client reports "throat feels a little funny" and Chest tightness. No difficulty breathing reported. Lung sounds clear bilaterally per RN at 11:38am. Pt reports that her throat still feels funny after administration of benadryl by RN. Epi was administered at 11:40am by RN. EMS arrived at 11:42am. Client has is now complaining of jaw pain. Reports shoulder pain ( residual from recent accident). Vital signs obtained by RN Her husband was present when EMS arrived and will follow client to the hospital.

Other Meds: unknown

Current Illness: no

ID: 1017306
Sex: M
Age: 75
State: CA

Vax Date: 01/29/2021
Onset Date: 02/09/2021
Rec V Date: 02/09/2021
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: After 10 days, from vaccine shot, chills and fever in middle of night. Took two extra strength Tylenol and fever went away

Other Meds: Lisinopril, amlodipine, aspirin, savastatin

Current Illness: None

ID: 1017307
Sex: M
Age: 61
State: WY

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

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

Lab Data:

Allergies: eggs

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

Symptoms: Pt began to feel dizzy and light-headed with progressing headache pain within 15 minutes. Pt BP was 170/86 at time of event and HR 74 bpm. Pt given O2 at 5 LPM . Pt lungs clear bilaterally and pt denied SOB. Pt O2 saturation at 99% on 5 LPM via mask. Pt stated vision was blurry but resolved after 15 minutes. Pt advised to go to ER via ambulance but denied transport, pt wife at facility to transport pt to ER.

Other Meds: losartan 20 mg, simvastatin 40 mg, omeprazole, levothyroxine

Current Illness:

ID: 1017308
Sex: F
Age: 71
State: MI

Vax Date: 01/19/2021
Onset Date: 01/25/2021
Rec V Date: 02/09/2021
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: no known allergies

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

Symptoms: Patient received vaccine on 1/19/2021. 5 days later had cold symptoms, chills, loss of taste and smell. positive COVID test.

Other Meds: baby aspirin, lipitor, calcium carbonate, cholecalciferol, insulin aspart, lantus, lisinopril, multivitamin,

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm