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: 1018087
Sex: M
Age: 65
State: GA

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

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fatigue and mild nausea

Other Meds: Blood pressure meds and cholesterol meds. Don't know the names.

Current Illness: I had an upper respiratory infection a few weeks ago but have recovered.

ID: 1018088
Sex: F
Age: 33
State: TX

Vax Date: 02/02/2021
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

Symptom List: Anxiety, Dyspnoea

Symptoms: Red, itchy, circular lump at injection site with some tenderness

Other Meds: Prenatal

Current Illness:

ID: 1018089
Sex: F
Age: 74
State: CA

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Ciprofloxacin, Motrin, Sulfa, Dye, Latex, Diclofenac

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

Symptoms: Tingling of the lips, mouth without any weakness or muscle deficit or any after neurological deficit. part 21. only if symptoms persist.

Other Meds: Losartan, Atenolol, Acyclovir, Diazepam, Centrim, Ayr, Hydrocream

Current Illness:

ID: 1018090
Sex: F
Age: 74
State: NJ

Vax Date: 02/07/2021
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: Cats, dogs, and some grasses, nothing else

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I have a large 1 1/2 inch diameter red ..slightly swollen but hot to touch. It itches and seems harder than other parts of my arm.

Other Meds: Zyrtec D, 2 Advil, one daily vitamin, one collagen supplement, one 3 milligram of estrogen (Premarin).

Current Illness: None

ID: 1018091
Sex: F
Age: 41
State: UT

Vax Date: 12/29/2020
Onset Date: 01/27/2021
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: Cipro and Bactrim

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

Symptoms: Itchiness, headache

Other Meds: Mobic, Zoloft

Current Illness: none

ID: 1018092
Sex: F
Age: 58
State: IL

Vax Date: 02/02/2021
Onset Date: 02/08/2021
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: no

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

Symptoms: Pain at the base of skull. It went to her forehead and pain in temples, stomach cramps, nausea. Has not eaten anything. Felt better this morning.

Other Meds: Multivitamins, Diclosenac

Current Illness: no

ID: 1018093
Sex: F
Age: 55
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: LA

Lab Data:

Allergies: Allergic to shellfish

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Slight swelling and tingling of lips, cheeks, and tongue. Lasted about 20 - 30 minutes from onset. Consulted EMTs onsite but as no difficulty breathing and symptoms were reducing, nothing administered by EMTs.

Other Meds: None

Current Illness: Flu like symptoms 3 weeks prior to vaccine. Tested negative for COVID-19.

ID: 1018094
Sex: M
Age: 63
State: UT

Vax Date: 02/05/2021
Onset Date: 02/05/2021
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: None.

Symptom List: Pharyngeal swelling

Symptoms: Patient experienced a grand mal seizure approximately 4 hours after receiving his first dose of the Moderna vaccine.

Other Meds: AFLUZOSIN SULFAMETHOXAZOLE MOTOPROLOL

Current Illness: None.

ID: 1018095
Sex: F
Age: 45
State: MI

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: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient claimed felt lightheaded about an hour after vaccinated. Around 3 hours after vaccine administered she fainted and EMS came.

Other Meds: N/A

Current Illness: N/A

ID: 1018096
Sex: F
Age: 56
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: fatigue arm hurt at site fever

Other Meds:

Current Illness:

ID: 1018097
Sex: F
Age: 80
State: TX

Vax Date: 02/04/2021
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: none known

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

Symptoms: Three days after first dose, I awoke in the early morning hours to go to bathroom. I lost all strength in my body and fell injuring my rib, arms, head and shoulder I have been hospitialized for two days now.

Other Meds: motoprelol; warfarin

Current Illness: heart arythmia; excessive fluid buildup, blood pressure elevated

ID: 1018098
Sex: F
Age: 70
State: AZ

Vax Date: 02/03/2021
Onset Date: 02/05/2021
Rec V Date: 02/09/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Codeine

Symptom List: Rash, Urticaria

Symptoms: Swollen lymph nodes and breast pain. Only lasted the day.

Other Meds: Lipitor, Synthroid, Eliquis, flecainide. anastrozole, metformin, metoprolol, lisinopril, zinc, vitamin D.

Current Illness: None

ID: 1018099
Sex: F
Age: 78
State: CA

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: Sulfa

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

Symptoms: Approx 5 min after injection complained of lip swelling. Denied any sob or throat tightness. Resp even/nonlabored. Speaks full sentences. Doctor notified. VO given for Benadryl 50 mg IM. Benadryl 50 mg given in L glute and patient was taken to Urgent Care for evaluation Doctor. Taken to Urgent Care via wheelchair for evaluation. Symptoms improving upon arrival and report given to Doctor and LVN.

Other Meds: n/a

Current Illness: n/a

ID: 1018100
Sex: F
Age: 78
State: SC

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

Lab Data:

Allergies: CYCLIZINE, ZOFRAN ZINC OR SULFA

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

Symptoms: Late Saturday I noticed my lip dropping to the right and by morning my right eye was dropping. On the way to theER my eye felt like it had sand in it and I had to hold my hand over it and my mouth and lips felt like I had a shot of novicane and it was hard to pronounce certain words. I have to eat small things because it is difficult puttinng food in my mouth and I can not feel the food in my mouth on the right side and if food gets over there it gets between my gums and my cheek, to drink I have to position a straw in my mouth on a certain point and some goes back down in the straw.

Other Meds: Venlafaxine 150mg Zoloft 100mg Quetiapine 400mg Propranolo 140mg Gabapentin 400mg Metformin 500mg Hydrochlorothiazide 25mg. Byspirone Hydroxyzine HCL 25mg Preseer Vision Ar

Current Illness: NONE

ID: 1018101
Sex: F
Age: 30
State: CA

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: LA

Lab Data:

Allergies: latex- facial swelling

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

Symptoms: Pt's hands are swollen and red, and felt numbness to face. Pt also c/o feeling a scratchy throat, like she swallowed something. Pt went to the UC -received benadryl 50mg IM occurred 15 minutes after the second administration of the covid 19 vaccine. Given methylprednisolone 125mg IV, benadryl 50mg IV. Prescribed zyrtec x 3 days and medrol dose pack and discharged home.

Other Meds: none

Current Illness:

ID: 1018102
Sex: F
Age: 74
State: CA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA, NKFA

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

Symptoms: Received Pfizer vaccine on 2-3-2021, checked blood pressure on Saturday 2-6-2021, she noticed her blood pressure was a bit elevated. Later 2/8/2021 went to ER due to home systolic BP in 200s, no other symptoms reported. Discharged from ER same day, reports was told by hospital staff possibly from recent vaccine. Did not have labs or other testing while at ER she states. Today 2/9/2021 blood pressure improving 150s systolic, pending to restart her blood pressure medication.

Other Meds: Pravastatin, aspirin, omeprazole, folic acid, vitamin D, topical diclofenac, calcium carbonate.

Current Illness: UTI 1/29/2021, completed Levofloxacin 500mg

ID: 1018103
Sex: F
Age: 44
State: MO

Vax Date: 02/06/2021
Onset Date: 02/07/2021
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: Latex, soy (food), Peanuts (food)

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

Symptoms: Injection was in non-dominant UE. 2 days post vaccine, redness and swelling increasing in non-dominant (LUE) 3CM greater than RUE at deltoid insertion, along with pain at 3-4/10 on 0-10 pain rating scale. Pain at post vaccine day 2 not related to movement or pressure. Regular ibuprofen use at 600 mg TID to alleviate pain, unsure of impact on inflammation and edema. Redness and swelling noted from scapula to mid humerus, lateral aspect of UE. Tenderness to touch migrating from injection site on day one, through scapula-deltoid-triceps region through biceps and anterior aspect of UE on day 4, without redness noted, appears to be mild swelling day 4 of biceps with discomfort in palpation. Symptoms at this time reported by patient, who is a physical therapist - doctor, Plan to consult MD tomorrow if symptoms are not improved. Similar clinical presentation to progressing cellulitis or response to allergic reaction to bee-sting. Plan to follow up with MD on 2/10 if symptoms do not significantly resolve.

Other Meds: Birth Control, flonase, zolpidem

Current Illness: None

ID: 1018104
Sex: M
Age: 62
State: CA

Vax Date: 02/08/2021
Onset Date: 02/09/2021
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: Blue crab

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Muscle cramps through body, hot flashes, sore throat, and upset stomach.

Other Meds: Benazepril 10 mg

Current Illness: None

ID: 1018105
Sex: F
Age: 64
State: NV

Vax Date: 02/01/2021
Onset Date: 02/06/2021
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: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: What is being described as Covid arm. Red itchy rash at site of injection as well as swelling and bruising. Rash and swelling began around 5 days after injection. No treatment has been needed.

Other Meds: Ocuvite

Current Illness: none

ID: 1018106
Sex: F
Age: 36
State: MI

Vax Date: 01/28/2021
Onset Date: 02/01/2021
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: Ceclor, morphine, pineapple

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

Symptoms: It?s been 12 days and for the past 9 days I?ve had a red, warm, dense, itchy, painful lump at my injection site that is about 2 inches in diameter. It is mostly round with what looks like a 2 inch wide paintbrush stroke coming off of the side of it that wraps around my arm towards my body to my under arm. The swelling, warmth and firmness has gone down slightly over the past few days. I put triamcinolone on it and it reduced the symptoms slightly.

Other Meds: Iron and magnesium

Current Illness: Migraines, common cold

ID: 1018107
Sex: F
Age: 31
State: CA

Vax Date: 02/07/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Vicodin, shrimp, and mushrooms

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

Symptoms: Adverse event: Within minutes of the patient receiving the Moderna vaccine she became dizzy and then began coughing. Following those symptoms, patient then began having difficulty swallowing and breathing. Treatment: Patient was given water for her cough. When she could not tolerate PO fluid it was decided to take her to the hospital ED. Outcome: Patient was treated with Benadryl, Solumedrol, and Pepcid. She was monitored and released from the ED to home with follow-up with her PCP.

Other Meds: None known

Current Illness: None known

ID: 1018108
Sex: F
Age: 39
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: While PT was waiting during her 15 minutes observation period post covid-19 vaccine administration PT began to experience siezure like activity lasting about 5 minutes. PT has a PMH of seizures, is compliant with her prescribed medications, and suffered a seizure a week prior. An IV was established and PT VS were monitored while PT was transported to the hospital. Prior to transport PT was COAX4 and remained stable through out transport. Run # 21-0766

Other Meds:

Current Illness:

ID: 1018109
Sex: F
Age: 35
State: NC

Vax Date: 01/13/2021
Onset Date: 01/20/2021
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: NKA

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

Symptoms: On seventh day following vaccination, I was awoken at 4am by severe right deltoid pain. The area was extremely hot to the touch. I had full body aches that day as well as the following day (day 8 post vaccine). On day 8, a large red rash appeared on the upper third of the arm. The rash did not extend over the site of the injection. Day 27 post vaccine, the rash is still present and itchy at times. All other adverse effects subsided by day 10 post vaccine.

Other Meds: bupropion, eszopiclone, lo loestrin

Current Illness: none

ID: 1018110
Sex: F
Age: 55
State: OR

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

Lab Data:

Allergies: Sulfa medication

Symptom List: Injection site pain, Pain

Symptoms: Fever over 102F, muscle ache, headache, ear ache, weakness and fatigue. Tylenol 500 mg tabq 8 hrs, and 650mg suppository( one time, when higher fever of 106F), and Ibuprofen 600 mg tab.

Other Meds: Vitafusion Women's vitamins

Current Illness:

ID: 1018111
Sex: F
Age: 15
State: OR

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: 15 year old minor received first and second doses of Pfizer vaccine. No adverse effects

Other Meds:

Current Illness:

ID: 1018112
Sex: F
Age: 35
State: NY

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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Erythromycin

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

Symptoms: Fever of up to 102.5 F, convulsions (with absolutely no control over my muscles), migraine, chills, extreme fatigue, stomach cramps and nausea.

Other Meds: N/A

Current Illness: N/A

ID: 1018113
Sex: U
Age: 73
State: KY

Vax Date: 02/04/2021
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: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: On 2/7 new bilateral leg weakness and progressive inability to walk x several days. Legs weak and cannot hold her. She fell 2-3 days ago bruising her right chest and left knee. Denies loss of consciousness. At baseline she states she was able to get around within her home.

Other Meds:

Current Illness:

ID: 1018114
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: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Upper left arm extremely red, soreness, hot to touch with approx 4 inch circular redness, dark center approx 3/ 4 inch, with small blister like area at center and site of injection

Other Meds: Losarten, Hctz, Protonix

Current Illness: NONE

ID: 1018115
Sex: F
Age: 75
State: NC

Vax Date: 01/20/2021
Onset Date: 01/21/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Numbness in lower extremities, not able to walk independently, headaches, dizziness, hypertensive, sleeping 16+hours a day, and poor to no reflexes.

Other Meds:

Current Illness:

ID: 1018116
Sex: F
Age: 65
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: My right arm at the injection started aching during the first night. The next day my underarm and shoulder started hurting and feeling stiff. Hurts to raise my arm.

Other Meds:

Current Illness:

ID: 1018117
Sex: F
Age: 67
State: PA

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

Lab Data:

Allergies: Cocaine, Procainamide, Succinylcholine

Symptom List: Injection site pain

Symptoms: Patient stated that she experienced a rash across her chest, face (specifically around her mouth and cheeks), as well as on both hands and around her knuckles within 24 hours of receiving the vaccination. Patients rash has since subsided.

Other Meds: Citalopram 20 mg and Hydrochlorothiazide 25 mg

Current Illness: None

ID: 1018118
Sex: F
Age: 51
State:

Vax Date: 01/02/2021
Onset Date: 01/01/2021
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: No

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

Symptoms: I am sicklemic, and after two doses and 5 days later started a painful acute crisis, everywhere, thorax. The first dose in January was on my left deltoid and after some days my arm hurt and thorax, I thought after years without a crisis due to my illness, this was an isolated event but after the second dose, received in my right deltoid, I had a repeat crisis on my thorax which made me think the vaccine could have caused it. I had spent years without a crisis that required me to rest for three days and taking analgesics at a maximum dose and 3 liters of water daily.

Other Meds: No

Current Illness: No

ID: 1018119
Sex: F
Age: 61
State: IN

Vax Date: 12/22/2020
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: none

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

Symptoms: I got Bell Palsy after 3 weeks (#2) vaccine.

Other Meds: none

Current Illness: none

ID: 1018120
Sex: F
Age: 40
State: CA

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

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: Feeling fatigue and arm pain. 02/06/21 - Woke up with body shakes, chills, muscle ache and pain. 02/07/21 - Vomitting & fatigue 02/08/21 - Chest tightness

Other Meds: Advair, Albuterol as needed, Lisinorpril and Singulair

Current Illness: None

ID: 1018121
Sex: F
Age: 45
State: IN

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Body aches.

Other Meds: Vitamin D Luvox Welbutrin Trazadone

Current Illness: Covid in April 2020

ID: 1018122
Sex: F
Age: 42
State: FL

Vax Date: 02/03/2021
Onset Date: 02/03/2021
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: Codeine (rash), sulfa meds (vomiting), flu vaccine (vomit, flu like symptoms), quinoa (vomiting)

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

Symptoms: Red, itchy face with mild burning feeling, swollen throat with itch, and tingling in tongue.

Other Meds: Ultimate omegas, D3, probiotics

Current Illness: No

ID: 1018123
Sex: F
Age: 30
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: latex, cinnamon and sulfa

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

Symptoms: The pt drank a tea with cinnamon in it which she has a known allergy to. Once she realized this she took two 25mg Benadryl. She did not inform us of this until after the shot was given and she was under observation. As her signs of difficulty breathing and allergic blotches on her face increased 911 was called and an Epipen was used.

Other Meds: She had drank a tea with cinnamon in it 20 minutes prior to the Moderna vaccination. She has a known allergy to cinnamon.

Current Illness: unknown

ID: 1018124
Sex: F
Age: 40
State: CT

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Red rash distal to injection site, hot to touch.

Other Meds: Probiotics daily

Current Illness: None

ID: 1018125
Sex: F
Age: 25
State: NY

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

Lab Data:

Allergies: No

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

Symptoms: Fever & chills starting at 9/10 pm on the day of the vaccine. Body aches, headache & joint pain by midnight . Fainted around 5:30 the following morning within 24 hours of the vaccine.

Other Meds: Vitamin C, multivitamin, vitamin D, B12, birth control

Current Illness: None

Date Died: 02/08/2021

ID: 1018126
Sex: M
Age: 72
State: FL

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: na

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

Symptoms: Patient received vaccination on 2/4. Patient's wife reported that he felt a slight soreness in his arm the day following the shot, but had no other symptoms. On 2/8 he passed away. Wife reports that it was related to his heart and they never made it to a hospital. The wife also reported that the patient had been in poor health prior to the vaccination

Other Meds:

Current Illness: chronic conditions listed below

ID: 1018127
Sex: F
Age: 44
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: While PT was in her 15 minute observation period PT began to experience weakness with a near syncope, later complaining of chest pain. PT was found to be hypertensive BP 200/100. PT advised she has a PMH of HTN but did not take her prescribed medication in the morning. PT remained hypertensive and was found to have an irregular heart rhythm with no history of cardiac issues. IV was established, 325 mg of aspirin via PO was and 0.4 mg of nitroglycerin was administered via sublingual with PT chest pain improving from 8 of 10 chest pain to pain completely subsiding. Run #21-0766

Other Meds:

Current Illness:

ID: 1018128
Sex: F
Age: 68
State: FL

Vax Date: 01/28/2021
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: none

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

Symptoms: No initial adverse effects. 8 days after injection, 2" diameter sore, itchy, inflamed area at injection site developed . Treated with ice pack and Tylenol. Did not seek medical attention. Reaction gone in 4 days.

Other Meds: Irbesartan 150 mg Ibandronate 150 mg Escitalopram 10mg Vitamin D 2000 units Centrum Silver Womens Vitamin

Current Illness: none

ID: 1018129
Sex: M
Age: 76
State: CA

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

Lab Data:

Allergies: none

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

Symptoms: The left hand/fingers (injection site was left deltoid) became very swollen which lasted for about 3 days. Initially the hand was very warm but that dissipated after day #2. There was no pain or loss of function at any time.

Other Meds: vitamins

Current Illness: none

ID: 1018130
Sex: M
Age: 72
State: CO

Vax Date: 01/21/2021
Onset Date: 02/02/2021
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: 10 days after my vaccination, the cornea transplant I had done it my right eye was rejected. My ophthalmologist and I believe there is a correlation between the vaccine and my cornea rejection incident since vaccines fight foreign matter in the body and the transplant is a foreign material. In addition, the cornea had be perfectly accepted for 4.5 years and only got rejected after the vaccine. This is only a suspected adverse reaction but seems to be the most likely cause for the rejection. We are treating it with large doses of steroid drops. After one week of the drops there appears to be no improvement. If there is no improvement over the next week we are considering surgery to redo the transplant with a new cornea.

Other Meds:

Current Illness: None

ID: 1018131
Sex: F
Age: 65
State: MI

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: Tetracycline - swelling and rash on knees, morphine - rash at IV site, Phenergan - psychosis

Symptom List: Vomiting

Symptoms: The patient had a headache within 5 minutes of receiving the vaccine. The patient was monitored and her blood pressure taken three times, 5 minutes apart; the readings were 95/65 SBP/DBP, then 106/64, and finally 93/67. The patient was counseled by a pharmacist that since her headache was not severe she was able to leave if she wanted to. She did leave and upon follow up 6 hours later, the patient reported taking over the counter Tylenol to treat the headache that still persisted. The patient was asked to please report back to the pharmacy if the headache persists to tomorrow.

Other Meds: lisinopril, Lexapro, amlodipine, metoprolol, Lipitor, Wellbutrin, Xanax, vitamin D, multivitamin

Current Illness:

ID: 1018132
Sex: F
Age: 61
State: CA

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

Lab Data:

Allergies: NA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: patient complain of itchiness and rash. Treatment was Benadryl 50mg IM to Left arm

Other Meds: NA

Current Illness: NA

ID: 1018133
Sex: F
Age: 52
State: WA

Vax Date: 01/19/2021
Onset Date: 01/23/2021
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: None Reported

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

Symptoms: Patient experienced breathing problems beginning 4 days after vaccine administration and continuing for another day. Patient went to an urgent care clinic and was given a prednisone shot.

Other Meds: Unknown

Current Illness: None Reported

ID: 1018134
Sex: F
Age: 67
State: CA

Vax Date: 01/26/2021
Onset Date: 02/02/2021
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: Macrodantin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Rash: red, itchy, hot, raised, 3x5?; appeared 1 week post vaccine, lasted 3 days.

Other Meds: Baby aspirin, digoxin .125, estradiol .5, Prometreum

Current Illness: None

ID: 1018135
Sex: F
Age: 67
State: GA

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Fever 102 degrees aching.

Other Meds:

Current Illness:

ID: 1018136
Sex: F
Age: 48
State: NC

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

Lab Data:

Allergies: Penicillin

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

Symptoms: 1/31- Left arm muscle hurt beginning the night of the first injection. Muscle sore and tender to touch for 3 days. All pain went away. 2/7- In the late afternoon, the muscles in my left arm started with a burning and itching sensation. Became more painful to the touch as the hours passed. No redness but firmness under the skin. Continued itching and painful to touch on 2/8. Itching has subsided but painful to touch and still firmness at the site of the injection as I report this at 7:45pm on 2/9/21. Discomfort but am able to continue to work and do regular activities.

Other Meds: Synthroid Hydrochlorothiazide Dupixent Finasteride Women's multivitamin Vitamin D

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm