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: 1017617
Sex: F
Age: 72
State: NC

Vax Date: 01/30/2021
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: Penicillin, sulfur and levaquin.

Symptom List: Dysphagia, Epiglottitis

Symptoms: Four days after my initial injection I began to itch all over my body. This began about 30 minutes after I drank a cup of liquid yogurt. I did not have hives. This lasted about three hours. Three days later I started to experience the same thing about half an hour after eating a piece of baked chicken and half of an orange. The itching was more severe. I call my pcp and she told me to take Zyrtec and Benadryl. I have been taking both since Friday February 5. The itching continues it gets better at times, not as severe and not all over my body, but it has not subsided completely during that time.

Other Meds: Latanoprost, atorvastatin calcium, vitamin d, biotin, CoQ 10, B12.

Current Illness: Glaucoma

ID: 1017618
Sex: F
Age: 25
State: NC

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None, per patient report

Symptom List: Anxiety, Dyspnoea

Symptoms: About 20 minutes after receiving vaccine, burning arm and neck, hurting; head starting hurting, became very tired and dizzy; feeling weak and cold; temperature was normal throughout this time; side effects are not worse at this time (about 2 hours after vaccination), but about the same

Other Meds: Wellbutrin, Trintellix, Lamictal, Synthroid

Current Illness: None, per patient report

ID: 1017619
Sex: M
Age: 49
State: AZ

Vax Date: 02/05/2021
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: Pt describes limited range of motion and pain in joint area of shoulder.

Other Meds:

Current Illness:

ID: 1017620
Sex: F
Age: 27
State: OH

Vax Date: 02/01/2021
Onset Date: 02/03/2021
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: - Tree nuts (except cashews and almonds)

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I received dose 1 on 1/4/21 with relatively few side effects (no side effects I was not expecting). After receiving dose 2 on 2/1/21, I experienced more severe systemic side effects (fatigue, chills, muscle aches, headache) that started the next day on 2/2/21. On 2/3/21, I noticed I had some discomfort while sitting down. By 2/4/21, I had noticed vaginal ulcerations that had formed on the vulva. I immediately made an appt to be seen by my Obgyn the next day on 2/5/21. I shared the following information with my obgyn during the appt: this was the first time I had ever noticed this, I have rheumatoid arthritis and am currently on Rituxan (rituximab) and get every 6 months, and I have been in a monogamous relationship for 2+ years. My Obgyn and I suspected that this was herpes and possibly had been dormant for many years. However, herpes tests came back negative. I was then referred to an Obgyn who specializes in ID, and she was able to tell me by looking at the lesions that this was not an STI. She highly suspects the vulvar ulcerations are autoimmune in nature, and she mentioned that it was a Lipschutz ulcer. While the trigger is not clear at this time, I am thinking there is a possibility that the second COVID vaccine dose could be what triggered the formation of these ulcers.

Other Meds: - Spironolactone 100 mg PO daily - Synthroid 75 mcg PO daily (weekdays ONLY) - Rituxan (receive infusion 4x year in total; receive 2 infusions every 6 months [2 infusions are separated by 2 weeks]) - Lo Loestrin Fe PO QPM - Aleve 220 mg onc

Current Illness: N/A

ID: 1017621
Sex: M
Age: 53
State: KY

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None known

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

Symptoms: Pt woke near 12AM w/ intense nausea/stomach cramps. No fever - nothing new in diet. Got up to vomit, woke up on bathroom floor later in his own vomit. Intense watery stools after he came to along w/ pain/nausea all night - no other loss of counsciousness. Felt like he should go to ER, had no one to drive him. Felt somewhat better in AM, still intense nausea but no vomiting. No fever, no headache, no pain in neck/sign of head trauma from previous night. Heart rate slightly elevated 91 bpm - 113/73 at time of visit - 3:20 2/9/2021 Referred to primary care physician for a follow-up. Pt had minor issues with the first injection on 1/11/21 - palpable 1" knot around injection site for 1 week, pain & fatigue, night sweats.

Other Meds: omeprazole, zrytek, sucralfate, Vit D, Vit C, Zinc

Current Illness: Plantar fascitis, GERD

ID: 1017622
Sex: F
Age: 25
State:

Vax Date: 02/02/2021
Onset Date: 02/03/2021
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: peanuts (anaphylaxis)

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

Symptoms: 2/3/21; Approximately 12 hours post vaccine, injection site swelling and stiffness, 18 hours headache and body aches that were not diminished by 500mg ibuprofen. 2/4/21; whole body muscles aches and headaches that went away 6:00pm. 2/5/21; sore throat began pm, large and small white patches seen on tonsils 2/5/21 11:00 pm to 2/8/21 am. Care team took throat culture 2/8/21 to determine strep recurrence, culture returned as negative. White spots on tonsils diminished 2/8/21. 2/9/21 hives on extremities with certainty to no possible allergens or new product exposure.

Other Meds: birth control

Current Illness: Strep A began 12/29/2020

ID: 1017623
Sex: F
Age: 64
State: OR

Vax Date: 02/05/2021
Onset Date: 02/01/2021
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: Gluten Sensitive

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Vial had been removed from deep freezer and placed into cooler longer than prescribe timeline outlined by Pfizer. Administered into patient (employee) prior to issue being identified. Pfizer states unlikely to have harmful effect, however cannot guarantee effectiveness. ID physicians recommend offering 3rd dose ~3-4 weeks, which will be done

Other Meds:

Current Illness:

ID: 1017624
Sex: M
Age: 71
State:

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

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: bilateral numbness, tingling Narrative: Pt had received Moderna Lot 029L20A on 1/28/21. Pt endorses that he began to feel tingling in his hands, bilaterally on 2/2/2021. Pt presented to hospital on 2/4/2021 w/ CC that his arms and legs were weak and he has been having difficulties going up stairs and getting out of bed and these symptoms are not normal for patient. Pt also noticed double vision in horizontal plane lasting up to 30min and resolves spontaneously and then returns a few hours later. Pt is currently being worked up to rule out GBS

Other Meds:

Current Illness:

ID: 1017625
Sex: F
Age: 41
State:

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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: whole body aches, bones and skin, everything hurt, HA fatigue, hands and head cold but body burning up.

Other Meds:

Current Illness:

ID: 1017626
Sex: M
Age: 86
State: NE

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: PCN, NSAIDS, Aspirin, Bactrim, Diuretic-AP-ES

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Body aches 24 hours post vaccine and resolved within 24 hours

Other Meds: Eliquis 2.5mg, Hydrochlorothiazide 25mg, Metoprolol 25mg ER, Latanoprost Sol, Protonix 40mg, Tamsulosin 0.4mg

Current Illness: none

ID: 1017627
Sex: F
Age: 71
State: MO

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

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

Lab Data:

Allergies: Codeine, Lipitor, Lisinopril, metformin, amoxicillin

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

Symptoms: Shingles outbreak developed <48 hrs after vaccination

Other Meds: Protonix, rosuvastatin, Bentyl, Amlodipine, Xanax, Aspirin

Current Illness: none

ID: 1017628
Sex: F
Age: 51
State: VA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: About 45 minutes after the injection, I began to feel tingling in my tongue. It also looked like I had a sunburn. I was pink from head to toe.

Other Meds: Levothyroxine

Current Illness: None

ID: 1017629
Sex: F
Age: 42
State: OH

Vax Date: 02/05/2021
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: fluconazole

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

Symptoms: pt noted red, raised rash at injection site, approximately 2 inches x 2 inches. Area does not have increased warmth.

Other Meds: singular, xyzal, birth control,

Current Illness: n/a

ID: 1017630
Sex: M
Age: 68
State: NM

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Hospitalized overnight for anaphylactic shock 2/4-2/5/2021, unknown trigger.

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

Symptoms: Urticaria.

Other Meds: metformin, lisinopril, furosemide, carvedilol, atorvastatin, amlodipine, NPH/regular insulin, albuterol MDI (Received epinephrine IV, famotidine, methylprednisolone, diphenhydramine in ED on 2/4/2021 for anaphylactic shock)

Current Illness: lized overnight for anaphylactic shock 2/4-2/5/2021, unknown trigger.

ID: 1017631
Sex: M
Age: 54
State:

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: HA, nausea, body aches, very sore arm. Worse on day 2.

Other Meds:

Current Illness:

ID: 1017632
Sex: F
Age: 27
State: PA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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:

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

Symptoms: Received Moderna Covid -19 vaccine to the LD at 8:27 a.m. At 8:39 a.m. patient complaint of "tight" left arm. At 8:44 a.m. complaint of a sore left arm and the need to take deeper breaths, stated chest felt heavy. RN in practice consulted with Nurse practitioner and directed PO Benadryl 25 mg (10ml) administered at 8:47 a.m. At 8:52 a.m. bilateral hands are tight, swollen, bilateral upper arms are red, blotchy, and itchy. Patient reports a "weird" taste in her mouth perhaps from the oral Benadryl suspension. 9:02 a.m. patient ambulated to the ED with the RN, who was present with the patient through the duration of the above incident until she was taken to a room in the Hospital ED. Patient did have a co-worker present before she was taken to the ED.

Other Meds:

Current Illness:

ID: 1017633
Sex: F
Age: 44
State: NY

Vax Date: 02/09/2021
Onset Date: 02/09/2021
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: n.k.d.a

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

Symptoms: pt was observed for 15 minutes after receiving moderna covid-19 vaccination and was discharged home. Pt states as she was driving home she noticed hives devloping over face and chest and returned to clinic i8mmediately after (about 25 min total after receiving vaccine)

Other Meds: Biotin in the AM

Current Illness:

ID: 1017634
Sex: F
Age: 66
State: MO

Vax Date: 02/05/2021
Onset Date: 02/06/2021
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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: area of firm induration to left upper arm, overlying skin is red with vesicle formation. Area of induration is approx 10 cm in diameter. Area of redness is approx 15 cm in diameter. Vesicle patch is approx 1.5 cm in diameter.

Other Meds: protonix losartan clonidine HCTZ

Current Illness: none

ID: 1017635
Sex: F
Age: 33
State:

Vax Date: 02/08/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Caregiver received first Pfizer dose and immediately started to feel bad. Started having racing heart, nausea, abdominal pain, shaky and "pins and needles feeling." CG vitals taken, HR noted to be in 1-teens but reduced to 80s shortly after, BP was 120/80, O2 sat 99%. CG stayed for 1 hour post vaccine and states her symptoms resolved. Today just has a sore arm and a little nausea.

Other Meds:

Current Illness:

ID: 1017636
Sex: F
Age: 54
State: NY

Vax Date: 12/28/2020
Onset Date: 01/26/2021
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: Cefuroxine Axehl, Clarithromycin, fenfoxidine, psuedophedrine

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

Symptoms: Patient was given 2nd dose of Moderna by employer, Health on 1/25/21. She informed her PCP the 24 hours after receiving 2nd dose she developed right jaw pain,and shooting sensation. She was seen by dentist with no cause found. On 1/29/21 she saw a provider who placed her on an antibiotics for possible sinusitis due to facial/ear pain. Was seen by PCP on 2/5/21 and diagnosed with trigeminal neuralgia and started on gabapentin and referred to neurology.

Other Meds: None

Current Illness: None

ID: 1017637
Sex: F
Age: 59
State: WA

Vax Date: 01/27/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None Known

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

Symptoms: Day 12 Itching, warm to touch and red, ringed rash around injections site. Previous reactions on day 2 subsided about day 7.

Other Meds: Metformin, Spironolactone, Multi-vitamin, fish oil, Vit D, Wellbutrin

Current Illness: None

ID: 1017638
Sex: M
Age: 38
State: OR

Vax Date: 02/05/2021
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: Vial had been removed from deep freezer and placed into cooler longer than prescribe timeline outlined by Pfizer. Administered into patient (employee) prior to issue being identified. Pfizer states unlikely to have harmful effect, however cannot guarantee effectiveness. ID physicians recommend offering 3rd dose ~3-4 weeks, which will be done.

Other Meds:

Current Illness:

ID: 1017639
Sex: F
Age: 41
State: WA

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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: Received 2nd dose of Moderna COVID-19 vaccine on Fri. 1/22/2021 at 13:00. By 19:00 that evening, I started to feel hot and my body started to ache. Then the chills and headache started shortly after, along with a rapid heart rate followed by bouts of fatigue. It intensified overnight and continued all day Sat. 1/23. I took Tylenol and Advil to relieve some pain and reduce the fever, but it didn't help much and I just stayed in bed. It was difficult to get up. On Sun. 1/24, I could finally manage to get up without help, but felt dizzy and weak. I continued to take Tylenol to reduce my fever. At it's peak, it was 102.5 and it stayed between 101.5 - 102.5 from Friday night until Sunday morning. Then it started to range from 100.5 - 101.3 for most of the day Sun. 1/24. By Mon. 1/25, I could tolerate the aches and pains, but still had a fever for most of the day. I stopped taking Tylenol to see if my fever would finally break and it did by that Mon. 1/25 night. I returned to work on Tues. 1/26. I woke up symptom free finally.

Other Meds: Bupropion SR 150 MG 12 hour tablet - 1 a day Buspirone 5 MG tablet - 1 a day Cetirizine 10 MG tablet - 1 a day Estradiol 1 MG tablet - 1 a day Hydrochlorothiazide 12.5 MG tablet - 1 a day Omeprazole 40 MG capsule - 1 a day Triamcinolone 0.1

Current Illness:

ID: 1017640
Sex: M
Age: 31
State: NJ

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

Lab Data:

Allergies: n/a

Symptom List: Injection site pain, Pain

Symptoms: pt stated he was having chest pains, high pulse...111, high blood pressure, and felt winded

Other Meds: n/a

Current Illness: n/a

ID: 1017641
Sex: M
Age: 37
State:

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

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: Narrative:

Other Meds:

Current Illness:

ID: 1017642
Sex: F
Age: 19
State: TX

Vax Date: 01/29/2021
Onset Date: 02/07/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: TTP flare, child with history of acquired TTP that had been on remission and off treatment for 5 years

Other Meds:

Current Illness:

ID: 1017643
Sex: M
Age: 78
State: PA

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

Lab Data:

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 1) Vomit; 2) long lasting stiffness a mussel aches

Other Meds: Aspirin 81 mg Azelastine HCL (Astelin) 30ml/137mcg Guaifenesin (Mucinex) 600 mg Hydrochlorothiazine (HCTZ) 12.5 mg Losartan (Cozzar) 50 mg Levothyroxine (Synthroid) 50 mcg Montelukast (Singulair) 10mg Pantoprazole (Protonix) 40 mg Rosuvasta

Current Illness: Post nasal drip with cough. Perhaps cough cause by acid reflux

ID: 1017645
Sex: M
Age: 61
State: AZ

Vax Date: 01/27/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fever chills and a little vomiting

Other Meds: None

Current Illness: None

ID: 1017648
Sex: M
Age: 75
State: CA

Vax Date: 02/04/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: N/A

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

Symptoms: Headache, neck pain Unusual general fatigue next morning

Other Meds: blood pressure medicine

Current Illness: None

ID: 1017649
Sex: F
Age: 33
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: RA

Lab Data:

Allergies: Penicillins, Bee, Peanut

Symptom List: Nausea

Symptoms: Patient received vaccination and after approximately 20 minutes reported dizziness and "tongue feeling weird". Vital signs were obtained with BP 120/76, HR 120, RR 16, and SPO2 99%. Patient was taken via wheelchair to the emergency department where diphenhydramine, famotidine, methylprednisolone, and lorazepam was administered. Patient was monitored in the emergency department and then discharged home.

Other Meds: Ciprofloxacin 500 mg, esomeprazole 40 mg, ferrous sulfate 325 mg (65 FE)

Current Illness: Unknown

ID: 1017650
Sex: M
Age: 67
State: VA

Vax Date: 12/30/2020
Onset Date: 01/02/2021
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:

Symptom List: Injection site pain

Symptoms: I experienced dry mouth really bad. My breath has been really rough on me, very dry. I called my PCP to follow up with him on my situation. I used Biotine mouth wash since the vaccine. I will see my PCP on 02-11-2021 for follow up status. I will be going to see my dentist Monday 02-15-2021.

Other Meds: Medicine for the VA clinic (but does not remember the names)

Current Illness:

ID: 1017651
Sex: F
Age: 72
State: NC

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: meperidine (hallucinations), oxycodone (hallucinations), Clona

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

Symptoms: On 2/8/2021, 72yr old female with depressive disorder, GAD, HTN, hyperlipidemia, osteopenia was administered COVID-19 Pfizer vaccine 0.3mL in right deltoid (LOT # EM9810). Patient has several documented allergies including meperidine (hallucinations), oxycodone (hallucinations), clonazepam (hives) and prednisolone (itching). Patient initially tolerated injection without incident and was sent for post-injection 15min observation. During 15min observation period, patient developed "difficulty swallowing". Patient brought back to room to be seen by provider. Patient noted issue was "mild" and denied any difficulty breathing. Patient able to talk in complete sentences without any evidence of wheezing or stridor.

Other Meds: aspirin, atorvastatin, buspirone, cholecalciferol, Fish Oil,

Current Illness: unknown

ID: 1017652
Sex: F
Age: 89
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Codeine

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

Symptoms: Patient remained in the monitoring room for an hour after her vaccine. She had no adverse events for the first 15 minutes, but staff found her responsive only to sternal rub, slumped in her chair 1 hour after vaccine.

Other Meds: Baby aspirin, centrum silver MVI, diltiazem ER, loratadine, Senna, "MightyShakes chocolate liquid," atorvastatin, mirtazapine, Xarelto.

Current Illness: N/A

ID: 1017653
Sex: M
Age: 59
State: WI

Vax Date: 01/05/2021
Onset Date: 01/05/2021
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:

Symptom List: Tremor

Symptoms: 2:45pm less than ten minutes post vaccination c/o severe headache. BP elevated above normal greater than 180/ denies dizziness. Hx of DM currently on holter monitor. Hx of MS 2:50pm BP 179/81HR 69 SPO2 99% 2:55pm BP 180/81 HR 66 SPO2 99% 3:08pm BP 171/76 HR 64 SPO2 99% 3:25pm BP 185/79 HR 62 SPO2 100% 3:30pm EE verbalized feeling much better able to ambulate per self went home.

Other Meds:

Current Illness:

ID: 1017655
Sex: M
Age: 83
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient at facility stated that he had already received both doses of the vaccine. The pharmacist consulted with the nursing staff and reviewed the vaccine administration card. Both the staff and the card did not have record of him receiving the second dose so the pharmacist administered the vaccine. The pharmacist returned to the store for processing and found that the patient had documented both doses and was mistakenly dosed for a 3rd time.

Other Meds:

Current Illness:

ID: 1017656
Sex: F
Age: 59
State: CO

Vax Date: 01/17/2021
Onset Date: 01/30/2021
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 known.

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

Symptoms: Moderna COVID-19 Vaccine EUA - I had swelling, itching and redness from the upper L arm to just above the elbow on the outside of the arm. There was no pain and the symptoms subsided by the next day around midday. I had no other issues that I could discern.

Other Meds: Metforman; Lisinopril; Avorastatin; Vivascal

Current Illness: N/A

ID: 1017657
Sex: F
Age: 41
State: VA

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

Lab Data:

Allergies: Wheat, Latex, Certain wine, Nickel

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

Symptoms: After receiving the vaccination I had tingling in my left arm. I had a rapid heartbeat with skipped beats that took a long time to subside. Saturday and Sunday they would come in spurts. Medication was taken to help. It helped some, however the skipped beats and the rapid heart rate continued. By Monday, the 8th my heart rate was back to normal.

Other Meds: Tirosent Magnesium L-Theorate Cortistop Probiotic/Prebiotic Omegas Selenium Zinc Milk Thistle Vit. D & C

Current Illness: None known

ID: 1017658
Sex: M
Age: 28
State: ID

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: Bactrim Penicillin Seasonal allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Bumps and redness both hands. Dry mouth and tingling in roof of mouth

Other Meds: None

Current Illness: none

ID: 1017659
Sex: F
Age: 44
State:

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: 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: Slight nausea, fever of 102, severe chills, sever aches and joint pain.

Other Meds:

Current Illness:

Date Died:

ID: 1017660
Sex: M
Age: 94
State: NY

Vax Date: 01/10/2021
Onset Date: 01/26/2021
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:

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

Symptoms: Patient contracted COVID and was hospitalized. He later died- respiratory failure secondary to COVID-19 pneumonia. This was not related to a vaccine adverse event, but reporting based on requirements.

Other Meds:

Current Illness:

ID: 1017661
Sex: F
Age: 58
State: NE

Vax Date: 02/06/2021
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: Morphine

Symptom List: Pain in extremity

Symptoms: Vomiting and diarrhea started a little over 48 hours post vaccine and still not resolved as of 2/9 at 3:30pm. APRN for resident has been faxed.

Other Meds: Artificial tears, Aspirin 81mg, Lipitor 40mg, Docusate 100mg, Flonase, Gabapentin 300mg, Norco 5-325mg, Latuda 40mg, Levemir, Novolog, Lisinopril 20mg, Loratadine 10mg, Melatonin 3mg, Prilosec 20mg, Zoloft 100mg, Timolol, sevelamer 800mg, T

Current Illness:

ID: 1017663
Sex: F
Age: 64
State: AZ

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: ATENOLOL, CEPHALEXIN, CODEINE, COVID-19 VACCINE, ELM, ERYTHROMYCIN, GLIPIZIDE, INDOMETHACIN, METFORMIN, PENICILLIN, PROCHLORPERAZINE, REGULAR INSULIN PORK, SULFAMETHOXAZOLE,

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

Symptoms: Itchiness and hives within 15 min of vaccine. Took (2) 25 mg Benadryl and symptoms were improving after 30 min. Patient left feeling better.

Other Meds: ACETAMINOPHEN 325MG TAB AMLODIPINE 5MG TAB ASPIRIN 81MG ENTERIC COATED TAB BACLOFEN 10MG TAB CETIRIZINE 10MG TAB CHOLECALCIFEROL5MCG (1,000UNIT) TAB CYANOCOBALAMIN 1000MCG TAB CYCLOBENZAPRINE 10MG TAB DOCUSsate

Current Illness: DM, migraine, hypothyroid

ID: 1017664
Sex: F
Age: 48
State: WA

Vax Date: 01/07/2021
Onset Date: 01/14/2021
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: Wellbutrin

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

Symptoms: Typical "COVID vaccine arm" symptoms 1/14/21 - woke up with injection site swollen and itchy with hives. 1/15/21 - 2 inch, well demarcated hard, red, very hot. Located more in the skin than deep. No pain. Treated with ice, tylenol, 1% hydrocortisone topical cream. 1/16/21 - area still hard, HOT, redness spread toward armpit, mild joint and injection site pain. Treated with ice. 1/17 - 1/18/21 - decrease in all symptoms, though redness continued to spread toward armpit. Site now swollen deep to site rather than in skin. Treated with ice. 1/19/21 - faint redness, less swelling and heat. 1/20/21 - symptoms mostly resolved at injection site. Still some warmth and pinkness in area near armpit. Site soft.

Other Meds: Simpesse

Current Illness:

ID: 1017665
Sex: M
Age: 46
State: OH

Vax Date: 01/23/2021
Onset Date: 01/24/2021
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: maple trees

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

Symptoms: Possible symptom 1: Within approximately a day or two of the shot, I developed a severe and persistent lower abdominal/groin pain. The pain was very pin point in location and lasted for approximately 10 days before easing up. Very small isolated pain severe enough to go to the DR, but I could not afford to on account of my wife having severe unknown abdominal pain and being in the ER and DR multiple times herself (she got the same vaccine an hour before me?). Possible symptom 2: 4-5 days after the shot I developed an isolated and severe pain in a preexisting nodule/mass (lymph node?) located on my mid right thigh, it has never had any sensation before. The pain was persistently severe for approximately 7 days before easing up.

Other Meds: none

Current Illness: none

ID: 1017666
Sex: F
Age: 71
State: NV

Vax Date: 01/20/2021
Onset Date: 01/28/2021
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: Pennicillian, Night shades, mold, pollen, dust

Symptom List: Vomiting

Symptoms: Arm swollen, hot to the touch. Went to the ER. Was given steriods, benadryl and pepsid through IV. Then a 4 day prescription for 40 mgs of steriods. Arm is back to normal. Saw PCP. He said I should have a serology blood test to see if I need the second dose.

Other Meds: Benezapril, Nature Thyroid, Trazadone

Current Illness:

ID: 1017667
Sex: F
Age: 64
State: OK

Vax Date: 01/29/2021
Onset Date: 01/29/2021
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: Sulfa, Cipro, NSAID's

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Client reported metallic taste in her mouth approx. 1 minute after receiving the vaccine. She said her trouble breathing was before the vaccine, not after. " I have trouble breathing because of my COPD and my back hurting". Client says she was diagnosed this week with pneumonia. She tried to take Trilogy but she couldn't tolerate it.

Other Meds: Zohydro ER, hydrocodone, Lexapro, Nexium, Zyrtec prn, estradiol prn, centrum silver, collagen

Current Illness: Was c/o SOB due to COPD

ID: 1017669
Sex: F
Age: 56
State: NY

Vax Date: 02/05/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Developed acute onset of facial numbness and tingling following vaccination. Was evaluated by physician and nurse at vaccine center. Benadryl 50mg by mouth given. Pt developed a sharp headache, as well as shaking and vertigo. No SOB, oral or facial swelling; vitals stable throughout. Pt transferred to hospital via EMS for further observation. F/up made to pt the following day with notation of vertigo and vomiting on 2/5/21 and 2/6/21 with resolution and improvement overall by 2/7/21. ER 'released' her on 2/5/21 around 9:30pm per pt.

Other Meds:

Current Illness:

ID: 1017670
Sex: F
Age: 81
State: NY

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: penicillin, sulfa, Nexium, swiss cheese, nitrites and nitrates, MSG

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Painful neck and shoulders, right arm, followed by chills. Also lightheadedness and slight dizziness. Temp 90.1 degrees (at highest). Total lack of energy and appetite. Next day, lethargy and some diarrhea (not bad). side effects lasted from Feb. 7 evening to Feb. 8 evening. On Feb. 9, just some lightheadedness.

Other Meds: Tylenol

Current Illness: None

ID: 1017671
Sex: F
Age: 21
State: NY

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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Approximately 10-15 minutes following vaccination, patient complained of tingling in right hand and diaphoresis ("fire feeling all over"). Pt was evaluated by physician and nurse at vaccine center. At ~7:32pm, tingling resolved, still felt warm but better. Vitals stable throughout. Observed for a total of 30 mins- d/c to home. F/up made to pt the following day- no concerns offered.

Other Meds:

Current Illness:

ID: 1017672
Sex: F
Age: 53
State: VA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Codeine, percocet, dexamethozone

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

Symptoms: Fever (high of 102), body aches, nausea, diarrhea, Covid Arm rash, rash on chest area up left side of neck and ear and across forehead, overall feeling of anxiousnesd

Other Meds: 5 mg Lisinopril Vitamin C Women's multi-vitamin

Current Illness: Monthly menstrual cycle

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm