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: 1020202
Sex: F
Age: 25
State:

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient in observation, reported feeling left arm numbness, tingling. Patient state feeling left hand and forearm red and splotchy, no hives. Vital at 1430- BP 122/80, HR 122 (patient is anxious), RR 24, O2 100. Patient denies any SOB, swelling of face or tongue, no trouble swallowing, chest pain or hives. Patient calling provider, as patient is waiting for provider to reach back vital were assessed again at 1442, BP 118/74, 02 100, HR 95, RR 20. Provider called back, nurse reports provider would like for the patient to stay at site for additional site hour and monitor. Provider any severe symptoms to see ED. Provider okay to for patient to take Benadryl. Patient refused Benadryl at this time wants to take it at home do to concern of drowsiness. Patient denies any new symptoms. V/S check at 1512- 114/80, 02 99%, HR 93, RR 20, Temp 98.5. No changes. V/S check- 1548 BP 112/78, 02 99%, HR 91, RR 16, patient no worsening or new symptoms. After hour, patient reports feeling fine and safe to drive home. Called patient in the evening, patient reports feeling fine and took some Benadryl.

Other Meds:

Current Illness:

ID: 1020203
Sex: F
Age: 38
State: TN

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 02/10/2021
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: No

Symptom List: Anxiety, Dyspnoea

Symptoms: With the second dose my symptoms started late evening on 01/13/2021. I started feeling bad, but finished my shift. Felt drained, headache to start. By next morning (01/14) I had fever (101.5F) and the whose body aches, nausea, diarrhea, horrible horrible headache, like a migraine, severe congestion, runny nose and some days later I started having an earache on my right ear. I would like to mention I also had a vaginal discharge with an unpleasant odor that started with the first dose and had not resolved by the time I received the second dose and this time the odor is much stronger, it is awful, I already made an appt with my GYN. The odor got much stronger about a week after the second dose. I kept self medicating at home with Tylenol, Ibuprofen, but the fever would return as soon as the dose was weaning off. The 101.5F fever lasted for about 9 days. I also experienced shortness of breath from 01/14 until the 22nd and I never had to use my rescue inhaler before. I had to use it and had to even call for a second one. I am very athletic and active and never need it even after my runs and workout activities. I consulted with my PCP on the 19th and again she gave me a covid test. Negative. She diagnosed me with inner ear infection (right ear). Prescribed me Levaquin and in 2 days I was much better. On the 22nd I finally started seeing the symptoms subside and started feeling better. Also, I wanted to tell that I had a gas pain episode that almost sent me to the ER. My chest, my left shoulder hurt really really bad. I called a friend who is a physician and he told me to take some gasex first and if that did not work to go to the ER. Fortunately it worked. But the pain was excruciating.

Other Meds: Adderall 20 mg. Albutren 300mg, Ambien, Valium 10m mg, Glucofenac Sodium, Allegra D 24 hrs. metoprolol 25mg, sultrex 500 mg, albuterol 90mcg

Current Illness: No

ID: 1020204
Sex: M
Age: 39
State: GA

Vax Date: 01/27/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
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: None

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

Symptoms: I developed severe body wide urticaria. It is unclear whether or not this is a delayed reaction to the vaccine or secondary to a new onset food allergy. It was responsive to cetirizine and lasted for about six to eight hours with severe pruritus but no airway symptoms.

Other Meds: Baby aspirin, multivitamin

Current Illness: None

ID: 1020205
Sex: F
Age: 39
State: WA

Vax Date: 01/02/2021
Onset Date: 01/02/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: no but have had anaphylaxis after fire ant bite

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Arm pain was pretty severe - reminded me like what you get from a tetanus shot and a little burn-y. It did clear up with Advil. Arm pain was gone by the 7th. On Wednesday, the 6th, I was tired and didn't have an appetite. Regular foods that I would like to eat didn't sound good. Would feel hunger pains but didn't know what to eat. I had abdominal pain - on lower right of abdomin. On Friday, I went to urgent care - when Dr pressed one area he said it was my ovary. My mom passed away from Ovarian cancer so dr ordered Pelvic ultrasound. Loss of appetite was starting to get better on Sunday. On Tuesday or Wednesday it was back to normal (appetite).

Other Meds: Sertraline 150 mg daily; Pantoprazole 40 mg daily; Marina IUD; Flonase - nasal

Current Illness: no

ID: 1020206
Sex: F
Age: 49
State: CO

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Client presented for second COVID vaccine on 2/10/21 and reported nausea and vomiting which occured 5 minutes post-vaccination from the first COVID dose on 1/13/21. The client did not report this to staff during the observation period on 1/13/21. Client referred to a hospital setting for assessment and possible administration of the second dose.

Other Meds: unknown

Current Illness: none

ID: 1020207
Sex: F
Age: 34
State:

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
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:

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

Symptoms: Tongue feels tingly and swollen. Felt hot then it went away. No shortness of breath, respirations even and unlabored. Skin pink warm and dry. b/p 146/108 pulse 88 10:17 pulse 89 ps02 98% 10:35 reports no tingling and feels like there is no swelling of tongue. b/p150/110. Informed her blood pressure was high. She stated she was ready to go home. informed to seek medical attention for any further problems and to have her blood pressure monitored.

Other Meds:

Current Illness:

ID: 1020208
Sex: F
Age: 78
State: OR

Vax Date: 02/02/2021
Onset Date: 02/04/2021
Rec V Date: 02/10/2021
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: Codeine,

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Flashes of lights in my eyes, burning pain in my legs, my ankles were on fire. Totally fatigued, could hardly walk and had to walk with a cane and hold onto wall. Just plain pain all over, I felt nauseated but never threw up. I took anti-nausea pills and pain pills.

Other Meds: Levothyroxine, Vitamin D supplement, Probiotic, Amlodipien, Apixaban once a day, daily baby aspirin, Gabapentin

Current Illness: No

ID: 1020209
Sex: F
Age: 49
State: MI

Vax Date: 01/27/2021
Onset Date: 01/29/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, mold, smuts, grasses, trees, dogs, laundry soaps, lotions, fabric softeners, bee stings, bug bites

Symptom List: Pharyngeal swelling

Symptoms: I had issues for 7 days including, rapid heartbeat, high blood pressure (146/96), facial swelling, random bruising and swelling on my left arm (not by the injection site), rash on face and body (small red dots), dizziness, weakness, nauseous, fatigue, vomiting, injection site pain/tenderness, night sweats.

Other Meds: Fluoxetine, Trazodone, synthroid, atorvastatin, baby aspirin, Multivitamin, Vit B complex, Vit C, Vit D, probiotic, Biotin

Current Illness: None

ID: 1020210
Sex: F
Age: 41
State: FL

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: Ibuprofen

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Around 11 hours after 2nd shot I woke up with chills, full body tingling, nausea, and couldn't get comfortable. About 5.5 hours later I had spiked a fever (101.1 temporal) and bad headache. The fever and headache continued all day. Around 7pm on 2/3 I took 1 extra strength Tylenol. The fever broke by Thursday morning and I was feeling better though I still had a headache. I did take 1 extra strength Tylenol around the clock Thurs into Friday. The headache continued to improve Thursday and finally went away by Saturday evening.

Other Meds: Juice Plus fruit, vegetable, berry, and omega blend. Had taken Meloxicam and Flexeril up until the day before vaccination.

Current Illness: None

ID: 1020211
Sex: M
Age: 74
State: FL

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 02/10/2021
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: The day after I received the vaccine, I felt weak, sweating, chills, and low grade fever. I was so weak that I had to have help walking and moving around all day Sunday. I needed help being fed. I felt dizzy. Monday I was started to feel better. I spoke with my primary care team and they told me to call VAERS and make a report.

Other Meds: Lisinopril 12.5 MG daily, Finasteride 5MG daily, Tamsulosin 0.4 MG twice a day, Latanoprost eye drops daily,

Current Illness:

ID: 1020212
Sex: F
Age: 58
State: OH

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: azithromycin, ceftin

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

Symptoms: started on the 15th at 7pm had a red itchy burning rash on my breast and then it spread to my other breast it is very painful . Went to the express care on the 16th and was told i had shingles and the rash got worse so went to the ER. Dr said I was misdiagnosed it was not shingles. But that the vaccine had flared up my auto immune disease, have me IV dexamethasone and 40 mg prednisone and it did not help. Went to the ER yesterday with the same rash but Had terrible chest pains and pain in my back and lightheaded and felt jittery. Was told i have inflammation in my chest and skin.

Other Meds:

Current Illness:

ID: 1020213
Sex: F
Age: 24
State: IN

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
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: PCN

Symptom List: Rash, Urticaria

Symptoms: soreness around the injection site (started around 2pm) Muscle aches (around 4pm) Headache (around 5pm) fever 100.3 F (around 5pm) Extreme fatigue (around 5pm)

Other Meds: Prozac- 20mg

Current Illness: none

ID: 1020214
Sex: M
Age: 51
State: TX

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Patient's wife reported shaking for a few seconds and passed out. Patient reports lightheadedness. EMS performed EKG, HR = 40s to 60s; blood pressure = 99/58. Refused transport to ambulance

Other Meds:

Current Illness:

ID: 1020215
Sex: F
Age: 36
State: CA

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
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: Coconut Fatty Acids Anaphylaxis Includes coconut water/milk (avoid all coconut products for pt safety) ? Fentanyl Unspecified PATCHES CAUSE Hallucinations ? Nortriptyline Dry mouth and nightmare ? Seroquel [Quetiapine Fumarate] Anaphylaxis ? Amoxicillin Vomiting ? Erythromycin Vomiting ? Grapefruit Extract Headache ? Latex Rash . ? Nsaids history of ulcerative colitis

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

Symptoms: female presenting with dizziness, nausea, vomiting, shortness of breath after receiving her second Covid vaccination, Pfizer. She had no adverse reactions with the first vaccination. She reports that approximately 10 minutes after the vaccination, she started to feel dizzy and "drunk". She felt that the room was spinning. She then became very nauseated and started dry heaving. No emesis but she arrives dry heaving. She reports that she started having shortness of breath after the nausea and dry heaving but feels like it is more because she is feeling very panicked. No cough. No wheezing. She has some throat soreness. No syncope or fall. She does have several allergies and carries an EpiPen for coconut allergy

Other Meds: ALPRAZolam (XANAX) 1 MG Tab amitriptyline (ELAVIL) 25 MG Tab BLISOVI FE 1/20 1-20 MG-MCG per tablet busPIRone (BUSPAR) 10 MG Tab Calcium Citrate-Vitamin D (CALCIUM + D PO) dicyclomine (BENTYL) 20 MG Tab EPINEPHrine (EPIPEN)

Current Illness: Irritable Bowel Syndrome Hypothyroidism Anxiety

ID: 1020216
Sex: F
Age: 47
State: TX

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 02/10/2021
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: body aches and pains with overall feeling of getting the flu without any fever

Other Meds:

Current Illness:

ID: 1020217
Sex: F
Age: 68
State: NC

Vax Date: 02/01/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
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: levaquin

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

Symptoms: vaccine of Feb 1; started amoxicillin and metronidazole on evening of Feb 2; early morning hours of Feb 8th had intense itching and rash. Called pharmacist who told me i was probably allergic to one of the antibx, even tho i had been taking them >5 days and to stop one of the antibx. Also told her i had had covid vaccine on 2/1. I stopped metronidazole but itching/rash continued whole day. Next day stopped amoxicillin and restarted Metronidazole. This is also day i had root canal surgery. Again itching and rash continued. Today, 2/10, I have stopped both antibiotics and itching/rash is still present but seems to be lessening. Resesarched online; called CDC, etc- no one knows about antibx and covid reactions occurring

Other Meds: lipitor; krill oil, 81mg aspirin; melatonin, vit d, vit c, calcium On Feb 2, approx 5 pm, started amoxicillin and metronidazole for tooth abscess.

Current Illness: toothache, had seen dentist but not identified as infection, etc at time of vaccination

ID: 1020218
Sex: F
Age: 64
State: MD

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/10/2021
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: Penicillin, Cipro

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

Symptoms: Mild muscle aches starting three hours after receiving the vaccine. Severe chills beginning seven hours after receiving the vaccine. Fever of 101.9 which slowly dropped down over the course of four days. Fatigue- I slept 34 hours, only briefly waking up every 5-6 hours during that time period. Arm was sore.

Other Meds: Levothyroxine 75 mg daily, Prednisone 2.5 mg daily, one Aleve daily, Rosuvastatin calcium 5 mg daily

Current Illness:

ID: 1020219
Sex: F
Age: 66
State: NJ

Vax Date: 01/31/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: sulfa drugs coumadin naproxen cipro

Symptom List: Ear pain, Hypoaesthesia

Symptoms: circular inflammation, itching on the 9th day after injection at the injection site. Not severe, just the timing seems odd . I was under the impression that this could happen the first few days after injection. No fever or intense pain. Hopefully nothing further to report

Other Meds: dicyclomine - 10 mg 2x daily raberprazole 20 mg 2x daily Centrum silver multivitamin Fiberchoice 2 tablets 1x daily vitamin D3 50 mcg 1x daily melatonin 2 gummies 1x daily

Current Illness: slight sinus headache

ID: 1020220
Sex: F
Age: 58
State: GA

Vax Date: 01/27/2021
Onset Date: 02/06/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: IV contrast dyes, SULFA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patients stated that arm was red, warm to touch, swollen, and painful on Saturday 02/06/21. Patient was seen at the ER on 02/09/2021 and prescribed antibiotic for cellulitis. Patient states arm is feeling better today, 02/10/2021 but not completely resolved.

Other Meds: antetenol, amlodapine, metformin, glipizide, omeprazole, loraz

Current Illness: Sinus infection

ID: 1020221
Sex: F
Age: 50
State: FL

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 02/10/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: Gluten, FODMAPS

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

Symptoms: Post vaccination I had severe joint pain and swelling. This is still occurring and it is now 2/10/21. 3 days after vaccination I also developed UTI symptoms. Those symptoms increased for 2 days and I sought medical attention. There is no other reason for me to have developed a UTI. Another co-worker that had the vaccination the day prior had the same symptoms.

Other Meds: Magnesium Glycinate, Riboflavin, B Complex, Magnesium Threonate, propranolol, tumeric

Current Illness:

ID: 1020222
Sex: F
Age: 79
State: PA

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/10/2021
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: Levaquin IV Contrast

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

Symptoms: Patient observed for a total of 30 minutes. Stated headache and some chest discomfort, back aches as well. stated pain 1/10. BP 151/86, HR 71 and 98% on room air. after 30 minutes stated feels achy and slight headache. Denied chest discomfort. Able to be released to home.

Other Meds: Unknown

Current Illness: unknown

ID: 1020223
Sex: F
Age: 73
State: OR

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/10/2021
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

Symptom List: Unevaluable event

Symptoms: Vaccine at 12:20 pm. Side effects started out with arm pain and then chills and nausea.the same as when had first dose. 4:30 pm -acetaminophen 500mg 10:30pm severe right arm and shoulder pain 8/10. Nausea 11:30 acetaminophen 500 mg. Was trying to not take any medication for fear it would effect negatively the vaccine efficacy. continued nausea Did not sleep first night kept waking groaning in pain/R arm shoulder 5:00 am acetaminophen 500 mg body aches and continued severe arm pain. 10:40 am acetaminophen 500 mg " and " and nausea 11:30 am severe body aches, chills and fever 99* with 500mg Acetaminophen. my Normal temp (96.8) 3:30 pm "

Other Meds:

Current Illness: none

ID: 1020224
Sex: F
Age: 64
State: TX

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/10/2021
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: flu like symptoms

Other Meds:

Current Illness:

ID: 1020226
Sex: F
Age: 29
State: IN

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 02/10/2021
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: NKDA

Symptom List: Injection site pain, Pain

Symptoms: significant body aches, L Arm tenderness/stiffness, fever, nausea and lymph node edema on L Side

Other Meds: Fish oil, women's multivitamin, Allertec allergy medicine, Mucinex

Current Illness: None

Date Died: 02/07/2021

ID: 1020227
Sex: M
Age: 96
State: NM

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: Allergies: CODEINE

Symptom List: Injection site pain, Menorrhagia

Symptoms: This is the patient who passed away 2d after his second COVID vaccine. Of note, the 2/8 telephone note makes it sound like he was hospitalized at time of death - that is incorrect. His daugther listed as EM contact works in the eye clinic here. He had mild illness, completed 10d isolation but missed his scheduled booster dose on 2/2 due to isolation. He was called on 2/5 when there was a booster visit cancellation and received his booster dose on that day. His daugther reported that he was doing fine and looking well on 2/7 AM, ate breakfast, shortly after stood up and just collapsed.

Other Meds: ALENDRONATE SODIUM 70MG TABLET (4'S) TAKE ONE (1) TABLET ACTIVE BY MOUTH ONE TIME EACH WEEK WITH WATER 30 MINUTES BEFORE EATING OR TAKING OTHER MEDICATIONS CALCIUM W/ VITAMIN D 600/500 SLOW RELEASE TAKE 2 TABLETS ACTIVE BY MOUT

Current Illness: Pt had COVID with symptom onset 1/27/21, pos test 1/28/21 admitted to Hosptial and was treated w/ remdesivir at , discharged 1/30 on Dexamethasone 6mg daily, no need for O2 supplement. First moderna COVID vaccine was 1/5/21.

ID: 1020228
Sex: F
Age: 62
State: CA

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 02/10/2021
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: Augmentin

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

Symptoms: She called the health department with questions about receiving the 2nd dose. The initial reaction occurred during monitoring after the vaccine, her heart was racing and she had a hard time catching her breath. After nourishment and the end of the monitoring she felt better and was able to drive home. On 1/11/2021, 4 days later, she was sitting and started feeling hot inside. Her left chest and left arm became numb and tingly. She went to the ER within 30 minutes of onset. After the examination she was told the reaction was likely a side effect from the vaccine. The numbness and tingling remained most of the day and she felt better the next morning and has had no other episodes.

Other Meds: A Statin; Singulair; meds for acid reflux, antidepressant

Current Illness: none

ID: 1020229
Sex: F
Age: 66
State: TX

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
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: Allergic to codeine and penicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Rash on inside of both elbows and beneath chin. Rash itches and burns. Rash first presented about 10 p.m. and worsened overnight. Managing symptoms with OTC Benadryl.

Other Meds: Ibuprofen 400 mg

Current Illness: none

ID: 1020230
Sex: F
Age: 75
State: IN

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
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: Work up with a headache and sore arm and fatigue. Took 2 Tyneol, which helped. Later in mid morning started getting the chills which lasted until 8:00 p.m. on the same day. Am fine now.

Other Meds: Lovastatin, Lisinopril, Hydrochlorothi, Vitamin D3, Omega 3-6-9, CO Q-10 Plus, Turmeric

Current Illness: Thought i was getting a cold

ID: 1020231
Sex: F
Age: 63
State: MN

Vax Date: 01/26/2021
Onset Date: 01/29/2021
Rec V Date: 02/10/2021
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

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

Symptoms: Blood pressure went up to 180/90 and has been high since first detected. Lifelong BP has been 120/70.

Other Meds: Hormone Replacement therapy

Current Illness: None

ID: 1020232
Sex: F
Age: 74
State: NC

Vax Date: 01/31/2021
Onset Date: 02/01/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: Clinoril

Symptom List: Nausea

Symptoms: rash at injection site, right arm. red, itchy, burning rash; and joint pain. At the mpment taking Benadryl. Seeing doctor this afternoon.

Other Meds: Synthroid, Lisinopril, Omeprazole, baby aspirin, womens Centrum Silver vitamin, Citracal, Fish oil, Glucosimine Chondritin, Vitamin D, Magnesium,

Current Illness: Psoriactic Arthritis. Psoriasis, underactive Thyroid

ID: 1020233
Sex: M
Age: 83
State: NC

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: Isosorbide

Symptom List: Injection site pain

Symptoms: Upper left arm is red and still is. Itches some of the time.

Other Meds: Metoprolol ER Succinate, Eliquis, Simvastatin, Tamsulosin HCL, Aspirin 81mg, Multivitamin, B12, D3, Claritin

Current Illness:

ID: 1020234
Sex: F
Age: 16
State: OH

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Moderna vaccine was administered to a 16 year old in error. This was missed in our screening process. There were no adverse events. Reporting because this administration did not meet the EUA requirements. We will also follow-up with the agency for guidance on administration of 2nd vaccine.

Other Meds: none

Current Illness: none

ID: 1020236
Sex: F
Age: 71
State: CA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: fever chills

Other Meds:

Current Illness:

ID: 1020237
Sex: M
Age: 74
State: FL

Vax Date: 01/16/2021
Onset Date: 01/17/2021
Rec V Date: 02/10/2021
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: The day after receiving the vaccine I had weakness, fever, chills. I felt really tired. All day Sunday I laid in the bed, I was sore and sweating so bad that my shirt and bed linens were wet. I felt better the next morning. I talked my doctor on the phone.

Other Meds: Lisinopril 12.5 MG daily, Finasteride 5MG daily, Tamsulosin 0.4 MG twice a day, Latanoprost eye drops daily, Bupropion (I recently stopped taking this and am not sure of the exact date I stopped taking it)

Current Illness:

ID: 1020238
Sex: F
Age: 81
State: OR

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: pollen, dust

Symptom List: Erythema, Pruritus

Symptoms: cough, slightly dizziness, gave 50 mg Benadryl po, took vital signs every 5 mins patient recovered and walked out with friend to her car

Other Meds: none

Current Illness: none

ID: 1020239
Sex: F
Age: 45
State: IN

Vax Date: 02/08/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: None

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

Symptoms: Swollen lymph node

Other Meds: Losartan. Atorvastatin, Aspirin, Omeprazole

Current Illness: None

ID: 1020240
Sex: M
Age: 37
State: IN

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Just the side effects that literature said I might have. I had COVID last June, and I was very fatigued and had muscle aches. For about 36 hours, I felt exactly like that after receiving the shot. I?m fine today. I plan to get shot #2. This was NOT an allergy and I?m not even sure it qualifies as a reaction. They were side effects that I was told I might have. I?m reporting I had them.

Other Meds: Lisinopril, Hydrochloriziade (diuretic, for BP) SYNTHROID

Current Illness:

ID: 1020241
Sex: F
Age: 49
State: SD

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: shellfish - anaphylaxis; CT dye-anaphylaxis; Taxatene Abolakine - anaphylaxis

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Shortly after injection, she became light headed with nausea, lip tingling, SOB and felt as if throat was closing. Moved her to the ER where she was given EPI, Benadryl, Pepcid, Steroids, and Zofran Was later discharged home

Other Meds:

Current Illness:

ID: 1020242
Sex: U
Age: 66
State: AK

Vax Date: 02/09/2021
Onset Date: 02/09/1954
Rec V Date: 02/10/2021
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: Codeine, Sulfa, oxycodone, Rubber, Neosporin,decongestant

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

Symptoms: Moderna covid-19 vaccine given by right deltoid IM infection. Swelling at the injection site within 1 minute of injection. Ice pack applied. 5 minutes later, patient felt lightheaded, elevate her legs on a chair. She had waves of on and off nausea throughout the 30 minute monitoring period. Her and her husband felt confident enough to go home.

Other Meds: pepcid, baby aspirin, estradiol, probiotic, claratin

Current Illness: none

ID: 1020243
Sex: F
Age: 27
State:

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: Sore arm, lymph node in armpit is swollen of the same side as injection, neck lymph nodes "a little swollen"

Other Meds:

Current Illness:

ID: 1020244
Sex: F
Age: 39
State: OR

Vax Date: 02/01/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Patient developed body aches 2/08/21 and loss of taste. She is covid+ today.

Other Meds: None

Current Illness: No

ID: 1020245
Sex: F
Age: 39
State: WA

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: no but have had anaphylaxis after fire ant bite

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

Symptoms: A little bit of arm pain - mild; went away in a day or two. That night about 7 or 8 pm I felt muscle achy and tired. Next day I was really tired and spent the whole day in bed. I was feeling feverish. I took my temp. and it was around 100.1 degrees f and that is high for me as I am around 96-98 usually. I took Advil and Tylenol which helped but still didn't feel great and I was still muscle achy. I stayed home from work the next day as well because of the fever. Went back to work the following day, I was functional but not feeling great - felt brain foggy and my forgetful. I ended up taking Thursday off work because I didn't feel functional or with it. Loss of appetite started day after vaccine and it lasted a good week or so. No abdominal pain this time. Muscle aches cleared my by Monday the third day after the vaccine and so did the fever. ALl my coworkers got second dose the day after I did and we all agreed it felt it like we got hit by a busy.

Other Meds: Sertraline 150 mg daily; Pantoprazole 40 mg daily; Marina IUD; Flonase - nasal

Current Illness: adverse reaction to first dose of Moderna COVID-19 Vaccine

ID: 1020246
Sex: F
Age: 72
State: CO

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/10/2021
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: Pencillin

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

Symptoms: Burning sensation when vaccine was injected & the shot hurt. During the rest of evening my left arm was sore. During the night, I couldn't get comfortable because my left arm pit started to hurt and could tell it was somewhat swollen. Woke up next morning and I had a low grade fever and my lymph nodes were tender and hurt to touch. Fever lasted all day & into the late night day after vaccine, but the arm pit lymph nodes lasted three and a half days. They are still a bit tender but not swollen today (02/10/2021). I had NO body aches but a little chills.

Other Meds: Alendronate Tab 70mg (1xweek) taken on 01/31/2021 Calcium 1200 mg (1xdaily) last taken on 02/04/2021 D3 50mcg (1xdaily) last taken on 02/04/2021

Current Illness: NONE

ID: 1020247
Sex: F
Age: 54
State: TX

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/10/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: body aches and pains with overall feeling of getting the flu without any fever

Other Meds:

Current Illness:

ID: 1020248
Sex: M
Age: 61
State: CA

Vax Date: 02/07/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
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: Sulfa-based medications

Symptom List: Vomiting

Symptoms: Muscle pain at the site, very minor flu-like symptoms lasting about 48 hours.

Other Meds: Multi-vitamin, Benedryl

Current Illness: Seasonal Allergies

ID: 1020249
Sex: F
Age: 73
State: VA

Vax Date: 01/26/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
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 drugs

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Extreme fatigue, sleepiness, chills, hot flashes, ache tailbone

Other Meds: Fluoxetine 40mg, calcium 1500 mg, basic 5 Preventive Caps, pro DHA, b12, coq10, l-Lysine, D-3, unique e, probiotics, cholestoff

Current Illness: None

ID: 1020250
Sex: F
Age: 28
State: IN

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 02/10/2021
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

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

Symptoms: dizziness, light headedness, fainting (loss of consciousness for a few seconds) 5 hours after receiving the first dose of Moderna

Other Meds: Sertraline 75mg Vitamin D3 1000 IU Womens Multivitamin Kyleena IUD

Current Illness: anxiety depression

ID: 1020251
Sex: F
Age: 47
State: CO

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
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 clindomyacin gluten

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Headache fatigue high temp chills body aches nausea

Other Meds: Zyrtec montuklast prozac

Current Illness: none

ID: 1020252
Sex: F
Age: 30
State: GA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: swelling and tingling of tongue VS 124/88 97 HR 100% RA SpO2

Other Meds: no

Current Illness: no

ID: 1020253
Sex: F
Age: 37
State: NY

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/10/2021
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: None

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

Symptoms: Passed out approximately 24 hours after second dose of vaccine.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm