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: 1017465
Sex: F
Age: 37
State: IL

Vax Date: 01/25/2021
Onset Date: 02/02/2021
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: Shellfish

Symptom List: Dysphagia, Epiglottitis

Symptoms: Redness and swelling at site. Started on 8 th day after injection and continued to get redder and grow in size. Also began to itch. It was as large if not somewhat larger than the circumstance Of a Ping pong ball.. it was also raised. Multiple pictures of site sent to dr over 3 days. He prescribed AMOX/K CLAV 875-125 which is helping reduce size and color. Taking since 2/5/2021

Other Meds: Adderall Trazadone

Current Illness: None

ID: 1017466
Sex: F
Age: 29
State: MN

Vax Date: 02/07/2021
Onset Date: 02/09/2021
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: Cow's milk Skin of apples

Symptom List: Anxiety, Dyspnoea

Symptoms: Today I began experiencing nausea, body aches, diarrhea, and chills.

Other Meds: Stelara Multi vitamin B12 D3 Fish Oil Probiotic

Current Illness: No illnesses. Fell on the ice, wound got infected after healing poorly (due to being immunosuppressed from Stelara), was on Keflex for 10 days. Last dose was 02/05/2021.

ID: 1017467
Sex: F
Age: 52
State: OK

Vax Date: 01/28/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Antibiotics, chocolate

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

Symptoms: Shortly after the vaccine my right arm was red, swollen, hard and painful. I had shivers and chills, nausea and extreme back and leg pain all which lasted about 36 hours with the pain level easing up throughout that time. But to date the fatigue is still hanging on but all other symptoms has subsided

Other Meds: Ivermectin

Current Illness: Nothing besides the AE to COVID

ID: 1017468
Sex: M
Age: 74
State: OH

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Within 12 minutes of receiving vaccine patient with c/o lightheadedness and nausea. Pt states he hadn't eaten prior to appt. Crackers and Pepsi provided. Excessive perspiration noted. Emesis x1 noted. Patient became unresponsive to questions and had 15 second period of unconsciousness. EMS called and arrives on scene. Patient alert/oriented x3 after brief loss of consciousness. 1:20pm- pt reports complete relief of sx and leaves ambulatory with driver. Pt refuses further medical attention at ER although highly encouraged. Risks explained by EMS personnel and understanding voiced.

Other Meds: Cholesterol and HTN medication

Current Illness: N/A

ID: 1017469
Sex: F
Age: 74
State: WI

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: Penicillin, Statins

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

Symptoms: Patient initially stood up and walked around the pharmacy after the vaccine administration. After a few minutes, she felt dizzy and had to sit down. Patient was under observation for 30 minutes.

Other Meds: None

Current Illness: None

ID: 1017470
Sex: M
Age: 87
State: OH

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

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: nka

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

Symptoms: My dad had the covid vaccine on Thursday & Friday morning we couldn't wake him up. He had a significant change in mental status. An ambulance needed to be called & he was hospitalized for a week. He is currently in a rehabilitation hospital.

Other Meds: Tafamidis 61mg Monday & Friday Potassium Chloride 10meq bid Simvastatin 20mg daily Omeprazole 20mg daily Toresemide 20mg 4 tabs daily Ferrous Sulfate 325mg daily INSPRA 50mg daily Eliquis 2.5 mg bid Metoprolol 25mg 1/2 tab daily Metformin

Current Illness: none

ID: 1017471
Sex: F
Age: 77
State:

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Diffuse pruritic full body rash

Other Meds: amlodipine 5 mg, atorvastatin 80 mg, jardiance 25 mg, zetia 10 mg, Flonase, Lantus 30 units daily, lisinopril 20 mg, metoprolol tartrate 12.5 mg twice daily, omeprazole 40 mg daily, Januvia 100 mg daily

Current Illness: None

ID: 1017472
Sex: M
Age: 69
State: MI

Vax Date: 01/29/2021
Onset Date: 02/01/2021
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: no

Symptom List: Pharyngeal swelling

Symptoms: I first noticed swelling under my left armpit and its the size of a baseball. I have some pain when I sleep and when I raise my arm up.

Other Meds: blood pressure medicine

Current Illness: no

ID: 1017473
Sex: F
Age: 33
State: WI

Vax Date: 01/04/2021
Onset Date: 01/04/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: 1:15pm HR 99 SPO2 100% BP 130/68 1:20pm HR 100 SPO2 100% EE SOB, flushed/hot, Heart racing, facial tingling 1:22 Benadryl 1 tablet 25mg po given 1:24pm complaint of dizziness and vertigo 1:25pm HR 103 SPO2 100% BP 133/69 1:33pm HR 92 SPO2 100% BP 128/62 1:49pm HR 102 SPO2 100% 1:55pm HR 88 SPO2 99% BP 119/59 2:00pm went to restroom 2:05pm returned to work

Other Meds:

Current Illness:

ID: 1017475
Sex: F
Age: 74
State: AL

Vax Date: 01/29/2021
Onset Date: 02/06/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: None stated.

Other Meds: Met form in,lisenafril

Current Illness: None

ID: 1017476
Sex: M
Age: 69
State: CA

Vax Date: 01/27/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
Hospital:

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

Lab Data:

Allergies: Codeine

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

Symptoms: A small itchy rash showed up 9 days after the injection. The rash was at the injection site on my left arm.

Other Meds: Medication Strength Per Day Lamivudine (3TC): 300mg x1 Tivicay (dolutegravir) 50mg x2 Coreg (Carvedilol) .3125mg X2 Valacyclovir 500mg x2 Aspirin 81 mg x1 Eliquis (apixaban) 5 mg x2 Furosemide 20mg 1X a day Entresto 24/2

Current Illness: none

ID: 1017477
Sex: F
Age: 73
State: NJ

Vax Date: 02/06/2021
Onset Date: 02/07/2021
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: Adhesive tape silicones like Band-Aids, Lidocaine, Medrol, Morphine, Percocet.

Symptom List: Rash, Urticaria

Symptoms: I have metastatic melanoma, my 3rd melanoma was in my right lymph nodes after they were removed I became part of a vaccine program in Hospital in 1997. Over a time period I received 15 or 16 vaccines on my left arm. At this point because it is now 24 years later they are not visible, after my second vaccine they are all ringed, the skin is pink around all of them and you can see all of them with the pink skin. They are all highlighted now. This was not an overly large experimental group so this happening to other people it's going to be like 1 in several million but I felt like the agency should be aware that it happened. The arm is sore and a little itchy and a little warm, again nothing that is debilitating and nothing I cant handle. The vaccine has obviously reacted with these old vaccine sites. I do know that the vaccines that I received had cells from the tumor taken from my body, essentially cleaned up and connected to the tuberculosis vaccine and then injected back into me. The idea of that particular vaccine like any was to get my body to build antibodies to the cancer, at this point I believe they have been successful with that.

Other Meds: Allopurinol, Eliquis, Klor-Con potassium, Zaroxolyn, Metoprolol, Pravastatin, Aldactone, calcium supplement.

Current Illness: No

ID: 1017478
Sex: F
Age: 44
State: AZ

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: PEANUTS

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

Symptoms: Provider stated patient had anaphylaxis (facial swelling) at around 2:16, 1 dose epi pen was administered and rapid response called. Patient was transported to the ed . Per providers note, developed sensation of Facial swelling, lip swelling, tongue swelling and difficulty breathing

Other Meds: LEVOTHYROXINE

Current Illness:

ID: 1017479
Sex: F
Age: 63
State: CA

Vax Date: 01/27/2021
Onset Date: 02/03/2021
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:

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

Symptoms: ?Covid Arm? Three inch circular redness, slight itching

Other Meds: Duloxetine , Deplin

Current Illness:

ID: 1017480
Sex: F
Age: 40
State:

Vax Date: 02/02/2021
Onset Date: 02/03/2021
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:

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

Symptoms: Migraine headache, body aches, chills, fatigue.

Other Meds:

Current Illness:

ID: 1017481
Sex: F
Age: 60
State: NJ

Vax Date: 01/17/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: I developed hives on arms, torso and legs. I was given prednisone for the condition and it has immediately improved.

Other Meds: none

Current Illness: none

ID: 1017482
Sex: F
Age: 79
State: CA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
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: None

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

Symptoms: About 30 minutes after the shot, sudden very weird feeling, visual distortion, confusion, disoriented (now believe was sudden drop in blood pressure), followed by mouth feeling odd, tongue felt too big, difficult to swallow, followed by sensation of intense heat. This all lasted about 5-10 minutes. Resolved on its own. Felt a little shaken but OK afterwards.

Other Meds: Daily multivitamin, Dailey Citrucel

Current Illness: None

ID: 1017483
Sex: M
Age: 45
State: IA

Vax Date: 02/03/2021
Onset Date: 02/04/2021
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: no

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 12 hours after receiving the shot I began to have severe chills, sweats, body aches, headaches, and fever. Fever reached a high of 101 degrees. These symptoms last approx 30 hours.

Other Meds: warfarin

Current Illness: none

ID: 1017484
Sex: F
Age: 90
State: CA

Vax Date: 01/23/2021
Onset Date: 02/04/2021
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: penicillin, codeine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Day 12 post-vaccine - both arms red and swollen, swelling in extremities, irritation in vagina. Swelling worse in Right arm. Both legs had rashes, particularly the knees, feet red to the end of the toes. Top of legs were extremely dark. The symptoms are still present as of 2/9/2021

Other Meds: Cozarr Lanoxin Atenolol Lipitor Zinc, magnesium, Vitamin C, E, Multi-supplement. MInerals, COq10, glysen, Glucosamine, Fish Oil, cinnamon

Current Illness: None

ID: 1017485
Sex: F
Age: 39
State: CO

Vax Date: 02/05/2021
Onset Date: 02/05/2021
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: pork (breathing problems)

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: Site: Pain at Injection Site-Mild, Systemic: Rash (other than injection site)-Mild, Systemic: Chills-Medium, Systemic: Headache-Mild, Systemic: Nausea-Medium, Systemic: Other- slight pain in left thoracic area followed by chills and fluctuation in blood pressure and pulse-Medium; lasted 1 day.

Other Meds:

Current Illness:

ID: 1017486
Sex: F
Age: 43
State: MD

Vax Date: 02/06/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA, food: raw apples, raw celery

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

Symptoms: Mild case of Shoulder injury related to vaccine administration (SIRVA) Intense joint pain, increasing intensity +2hr after, difficult to raise arm, at 2/6/21 at 2100 hour pain 7/10 scale. Next day 2/7/21 pain 4/10 limited movement. On 2/8/21 pain scale 2/10.

Other Meds: Cetirizine, Adderall XR

Current Illness: None

ID: 1017487
Sex: F
Age: 46
State:

Vax Date: 02/01/2021
Onset Date: 02/01/2021
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: Unevaluable event

Symptoms: Several hours after getting the vaccine, I developed a fever, terrible fatigue, and dizziness. the fatigue was the worse, as I could hardly get out of bed.

Other Meds:

Current Illness:

ID: 1017488
Sex: F
Age: 46
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: LA

Lab Data:

Allergies: no

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

Symptoms: Patient reported throat tightness and itchy throat at 3:02pm. Patient administered Benadryl 25mg at 3:05pm. Patient denied Epipen. Patient reported important improvement 10 min after Benadryl administered. Patient monitored for an additional 30 minutes, a total of 45 minutes. VS WNL and she reported symptoms are "much better." She was educated to monitor for additional symptoms. She is going home where her husband is.

Other Meds: Vit. D2, Vit. C

Current Illness:

ID: 1017489
Sex: F
Age: 45
State: OR

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Chills, fatigue, fever of 102.9, headache injection site swelling and pain, malaise, nausea

Other Meds:

Current Illness:

ID: 1017490
Sex: M
Age: 69
State: WI

Vax Date: 01/31/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: red, raised area at injection site; itchy; "covid arm"

Other Meds: allapurinol; lisinopril

Current Illness:

ID: 1017491
Sex: F
Age: 72
State: NE

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

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

Lab Data:

Allergies:

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

Symptoms: Extreme headache in eye evening after, next day, and still happening. Drooping eyelid and eyeball on left side.

Other Meds: Osphena, Levothyroxine, Meloxicam, Ezetimibe

Current Illness:

ID: 1017492
Sex: M
Age: 58
State: TX

Vax Date: 12/29/2020
Onset Date: 12/30/2020
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: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: soreness at the injection site for a couple days heating pad and hot shower treatment

Other Meds: atorvastatin amlodipine/benazepril baby aspirin B complex vitamins D3 vitamin fish oil 2000mg vitamin e

Current Illness: none

ID: 1017493
Sex: F
Age: 63
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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Administration error - 0.1 mL administered. Patient returned to POD and was administered additional 0.4mL on the same day.

Other Meds:

Current Illness:

ID: 1017494
Sex: M
Age: 78
State: MS

Vax Date: 02/05/2021
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: cinnamon

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

Symptoms: weakness, clammy, low blood kpressure, treated with rest and hydration sudden wide spread red rash with severe itching on day 3 treated with steroid injection, Benadryl and steoid cream

Other Meds: lisinopril, prevastatin, preservision, vit d, vit b 12, allopurinol, testosterone, baby asa

Current Illness: high blood pressure, low testosterone, osteo-arthritis, low back pain,

ID: 1017495
Sex: M
Age: 55
State: MA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
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: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1017496
Sex: F
Age: 66
State:

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

Symptom List: Injection site pain

Symptoms: Typical- headache, muscle pain, slight chills, slight nausea Atypical- 14 hours after injection- (no more headache, muscle pain or chills) BUT full-body itching(including ears, eyes and head), slight numbness in lips and slurred speach, full-body minor rash (relieved with only one dose of Benadryl) Throughout the night and into Day 2- slight full-body itching (as stated above) but no numbness and no need for Benadryl

Other Meds: only 1 prescription-alendronate, typical vitamins+D3 and

Current Illness: NONE

ID: 1017497
Sex: F
Age: 55
State: CA

Vax Date: 01/24/2021
Onset Date: 01/24/2021
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: I have sensitivity to Morphine and cilantro (a food)

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

Symptoms: Elevated heart rate, this came and went for the remainder of the day, and for the 72 hours after the shot. I also had serious mental fog, nearly fugue level as I lost time (on the drive home I ended up 2 hours off track in an unfamiliar location, with no recollection as to how I got there). I was foggy for about a week. I had a fever the night after the vaccine (102). This has all mostly resolved now at the 2 week mark, and I've only had a little body ache that seems to be holding on (nothing unmanageable). I am prone to anxiety and I'm sure that made the dissociation worse, but it is new to me at that level. I was concerned about the irregular heartbeat but am told this is not dangerous. I did not take any medication or anything to offset the symptoms as I want to make sure the vaccine works best.

Other Meds: None

Current Illness: None

ID: 1017498
Sex: F
Age: 39
State: NY

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Penicillin, Amoxicillin, Morphine, Hydrocodone, Codeine, OxyContin, Percocet, Oxymorphone, Fentanyl

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

Symptoms: Site where injected swelled up to the size of an orange, had 102.7 temp from 2/6/21 till 2/8/21, extreme sweating while freezing, severe headache, body aches to the point I could not walk, nausea/vomiting, shakes, dizziness and lightheadedness along with shortness of breathe. On 2/8/21 fever broke and now extremely cold to touch, temp is at 96.4 continued shakes, shortness of breathe, lightheadedness, dizziness and arm is still swollen( Size of an orange) at the site. 2/9/21 continued adverse effects.

Other Meds: None

Current Illness: none

ID: 1017499
Sex: F
Age: 69
State:

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: IM
Vax Site: LA

Lab Data:

Allergies: Indomethacin, Lisinopril, Metformin

Symptom List: Tremor

Symptoms: Lot # EN6201 exp 2/13/2021 Approximately 30 seconds after pt received vaccination pt c/o her neck glands "locking up." Described it as feeling a knot in her neck glands with pain. Pt states this has happened to her in the past and is unable to determine what causes it to happen. Also c/o mild headache and dizziness. Pt hasn't eaten yet today. Denies any respiratory issues. Episode lasted approximately 10 min then pt denied "tight neck glands" is now feeling fine. Was monitored for additional time in waiting area before going home in no apparent distress. 1028 BP 154/73, HR 86, 97% O2 sats on room air 1037 BP 156/66, HR 80, 97% o2 sats on room air

Other Meds: Oxybutynin, Lorazepam, Advair, Nortriptyline, Codeine, Pradaxa, Diclofenac, Alendronate, Amlodipine, Baclofen, Atorvastatin, Prilosec, Ventolin, Pepcid, Gabapentin, Glipizide, Losartan

Current Illness: none

ID: 1017500
Sex: F
Age: 82
State: AL

Vax Date: 01/26/2021
Onset Date: 02/05/2021
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: no

Symptom List: Erythema, Pruritus

Symptoms: red rash at the site of the injection about the size of a base ball

Other Meds: Zestiril, Coreg, Norvasc, Zetia, Crestor. Calcium, coto-10, vit d 3, vit b complex, vit. c, Zinc

Current Illness: no

ID: 1017501
Sex: M
Age: 48
State: UT

Vax Date: 01/27/2021
Onset Date: 01/27/2021
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: Unknown.

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

Symptoms: Shortly after receiving vaccine, patient began to feel intense pain in their joints and elbow on right arm.

Other Meds: Unknown.

Current Illness: Unknown.

ID: 1017502
Sex: F
Age: 3
State: CA

Vax Date: 09/23/2020
Onset Date: 10/30/2020
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: Amoxicillin

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

Symptoms: Diagnosed with ITP with extremely low platelets; symptoms include bruising, nose bleeds and petechia

Other Meds: None

Current Illness: None

ID: 1017503
Sex: F
Age: 63
State: MO

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: IV contrast dye, Demerol

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Severe head pain started at about 4 am on 1/29 and progressively got worse. By 7 am it led to nausea, vomiting, and incapacitating pain. I would rate this a 10 out of 10 on pain scale. My Dr. was contacted and I was prescribed Zofran for nausea and Imitrex for the migraine about 11 am. The medications eased the symptoms to a manageable level. I have no current history of migraines, and have had two subsequent migraines, but not as severe.

Other Meds: Nothing the morning of the vaccine. The day prior Celebrex and 81 mg of aspirin.

Current Illness: Knee arthroscopy surgery 1/21/2021

ID: 1017504
Sex: M
Age: 15
State: IA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
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:

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

Symptoms: No A/E reported, patient is just under the age limit.

Other Meds:

Current Illness:

ID: 1017505
Sex: F
Age: 47
State: ME

Vax Date: 02/06/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

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

Symptoms: ADR- Chills, sweats, body aches, tachycardia with near syncope and a fall in the shower this am.

Other Meds: Iron supplement

Current Illness: Positive Covid test on Dec 17, 2020, returned to work Jan 4, 2021.

ID: 1017506
Sex: F
Age: 31
State: WI

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: none noted

Symptom List: Pain in extremity

Symptoms: 1133-vaccine given 1140-Layed person done with legs raised. Epi given due to dizziness, nausea and hypotensive. Cool rag placed. 1142- BP 80/60, P 69, spo2-93% 1146-110/58, 97 pulse, spo2-79% 1151-118/62, 98%, 95 pulse 1153 EMS called 1155-142/60, 99 %, 99 pulse 1158-132/70, 99 %, 97 pulse Patient had blood sugar taken by EMS, 212. Patient refused to go with EMS, She was willing to take a Uber to her place of employment. She was able to sit up while EMS was still here. She left the observation area at 1210 and was able to walk downstairs on her own power. She did tell me that she gets faint when she listens to things about venipunctures or anything about needles. I was talking to her about what the z track method was, then she got faint.

Other Meds: insulin

Current Illness: no illness at time of vaccine

ID: 1017507
Sex: M
Age: 43
State: NY

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/09/2021
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: Administration error - 0.1mL administered. Patient returned to POD and was administered additional 0.4mL on the same day.

Other Meds:

Current Illness:

ID: 1017508
Sex: F
Age: 38
State: CA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none known

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

Symptoms: At 5:30 pm started feeling off with a mild headache. Progressed to nausea and more pronounced headache. By 7:30 pm, chills (really just feeling cold and unable to warm up) and fever. Fever reduced with medicine. Woke up with headache and fatigue. Fatigue lasted almost entire next day; I slept almost all day after vaccine and that night. Woke up 2 days after vaccine largely ok, but my heart would beat very hard during strenuous activities (exercise, going up the stairs). Felt same significant increase in my heart rate during exercise 3 days after vaccine. By 4th day, was able to exercise as normal. However, on Monday 2/1, had sore throat for the day my external throat muscles, like the SCM, vs something internal)

Other Meds: none

Current Illness: none

Date Died: 02/07/2021

ID: 1017509
Sex: F
Age: 80
State: NH

Vax Date: 02/04/2021
Onset Date: 02/06/2021
Rec V Date: 02/09/2021
Hospital: Y

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

Lab Data:

Allergies: penicillins

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

Symptoms: Day after receiving the vaccine, the patient complained of abdominal pain which worsened over the day. She went to the ED and was hospitalized. Abdominal pain complaints increased and continued, she decompensated rapidly, was intubated and subsequently died 3 days later. Imaging results showed, progressive ovarian cancer in the bowels. Blood culture revealed that she had E.Coli in her blood. It is thought that this is NOT related to the vaccine.

Other Meds: Amlodipine vitamin c calcium vitamin D cetirizine questran vit b12 estradiol gabapentin MOM Magnesium oxide potassium chloride Avastin, Carboplatin, Gemcitabine

Current Illness: Advanced Ovarian Cancer

ID: 1017510
Sex: F
Age: 47
State: PA

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

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: per employee vomiting times 4 days then a 4 day hospital stay now with dizziness

Other Meds:

Current Illness:

ID: 1017511
Sex: M
Age: 25
State: MO

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Bee stings

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fever began overnight with chills, headache, fatigue and upset stomach. Did not resolve until about 12 hours later. Minor headache still present. Sore arm at injection site.

Other Meds: Fish oil

Current Illness:

ID: 1017512
Sex: F
Age: 87
State: FL

Vax Date: 01/25/2021
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: RA

Lab Data:

Allergies: N/A

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

Symptoms: Purpuric lesions on lower extremities, one each leg

Other Meds: levothyroxine, donepezil, memeantine, clacium, Vitamin D

Current Illness: N/A

ID: 1017513
Sex: F
Age: 75
State: TN

Vax Date: 02/03/2021
Onset Date: 02/06/2021
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: MRS. RECEIVED HER 1ST DOSE OF THE COVID-19 VACCINE ON 2/3/21 AND REPORTED WAKING UP ON SATURDAY 2/6/21 WITH HER RIGHT EYE COMPLETELY BLOOD RED. THE ENTIRE WHITE OF HER EYE APPEARED THAT THE BLOOD VESSELS HAD RUPTURED. UPON REPORTING THE EVENT TO OUR PHARMACY ON TUESDAY 2/9/21 THE CORNER OF HE R RIGHT EYE STILL APPEARS RED BUT HAS IMPROVED SINCE ONSET.

Other Meds: OXYCODONE/ACETAMINOPHEN 10/325MG; CYCLOBENZAPRINE 10MG; ALPRAZOLAM 0.5MG; DICLOFENAC 0.1% OPTHALMIC DROPS; BRIMONIDINE 0.2% OPTHALMIC DROPS; TIMOLOL 0.5% OPTHALMIC DROPS; GABAPENTIN 300MG; ATORVASTATIN 40MG

Current Illness:

ID: 1017514
Sex: F
Age: 28
State: NY

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: none

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

Symptoms: patient went to her car after observation and took her mask off and noticed some erythema and itching on her face. no swelling, no hives, no difficulty breathing, no coughing, no vomiting

Other Meds: vitamin D and advil x1 yesterday afternoon

Current Illness: none

ID: 1017515
Sex: F
Age: 81
State: MA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
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:

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

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm