VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 1069104
Sex: M
Age: 56
State: OH

Vax Date: 02/27/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None.

Allergies: None.

Symptoms: Sunday, 2/28/21 he was very tired during the day. On Monday 3/1/21 started to develop a sore throat very quickly, and progressed from nothing until full appearance. He has a severe sore throat, severe cough and runny nose, aches and pains in his joints, back, neck, arms. He was fine up until Monday when these symptoms occurred. He has been taking Benadryl for the nasal symptoms and Motrin for the pain. He has notified his doctor and was told to wait it out and see if it gets any worse.

Other Meds: Prozac, Lisinopril.

Current Illness: None.

ID: 1069105
Sex: F
Age: 66
State: MO

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

Lab Data:

Allergies:

Symptoms: About 3 minutes after COVID-19 Injection, patient started to have numbness in lips, tongue felt swollen, chest and abdomen tingling and tightness. Lasted about 5 minutes and then resolved.

Other Meds:

Current Illness:

ID: 1069106
Sex: F
Age: 73
State: NY

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Day of the vaccine Soreness in arm receiving vaccine lasting less than 24 hours. Next morning extreme fatigue the morning after lasting about 8 hours. 6 days later woke at 5 AM with a severe headache that last on and off for 24 hours.

Other Meds: Early AM meds: Bupropion, Carvedilol, Eliquis, Benazepril. calcium, vitamin D

Current Illness:

ID: 1069107
Sex: F
Age: 42
State: NY

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Ear crackling noise

Other Meds:

Current Illness:

ID: 1069108
Sex: F
Age: 56
State: MN

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: On 2/27/21, Client said she began feeling very dizzy as soon as she woke up that morning. Episodes of vertigo were on and off all day, each time lasting several seconds. When this occurred, she needed to hold onto a fixed chair/table to steady herself. She has had NO headaches or nausea associated with this vertigo, and states she has never had vertigo in the past. Each day since then, the vertigo has become less intense but the symptoms were still occurring at the time she called our agency to report it on 3/2/2021. The vertigo caused her to not drive her car to work, but she has been able to go to work.

Other Meds:

Current Illness:

ID: 1069109
Sex: F
Age: 58
State: ID

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Sp02 94%, HR 72

Allergies: sulfa anaphylaxis, oxycodone anaphylaxis

Symptoms: Patient described feeling of tightening in posterior oropharynx, palpitations

Other Meds: fluoexitine, gabapentin, lisinopril, melatonin, meloxicam, propanolol

Current Illness: none

ID: 1069110
Sex: F
Age: 34
State: MO

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Sulfa drugs

Symptoms: headache worsening over 24 hours, body aches, chills, and fever on day 2. Sore and itchy injection site, headaches on day 3.

Other Meds: Vitamin D, Fish oil, Women's multi vitamin, zyrtec

Current Illness: None

ID: 1069111
Sex: F
Age: 71
State: FL

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: Sulfa, dust

Symptoms: 02/13/2021 evening started to feel cold and tired, slightly sore arm. 02/14/2021 woke up with fever, chills, achy, lethargic, slight sore throat, decreased appetite. These symptoms continued the entire day. Slept most of the day and night. Took ibuprofen for symptoms. (Did not take prophylactically as had seen could reduce effectiveness of vaccine). 02/15/2021 symptoms improved, still achy and lethargic. Was awake most of day. 02/16/2021 woke up feeling well. Knew immediately that the symptoms were gone.

Other Meds: Metropolol succinate ER, losartin, atorvastatin, adult multivitamin, vitamin d, tums for calcium, daily 85 mg ASA, loratadine, ibuprofen at bedtime, lactaid

Current Illness: None

ID: 1069112
Sex: F
Age: 65
State: IL

Vax Date: 02/20/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: NKDA

Symptoms: Herpes Zoster developed on 2/26/21

Other Meds: losartan, hydrochlorothiazide, allopurinol

Current Illness: N/A

ID: 1069113
Sex: F
Age: 50
State: NY

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

Lab Data: n/a

Allergies: doxycycline

Symptoms: 1st vaccine: felt dizzy on drive home, just lasted 3 hours. 2nd vaccine: ok for 4 hours, then took 2.5 hours to increase symptoms of total body ache, skin tenderness all over, headache, fatigue, balance/dizziness: I went to bed for 11 hours, and skipped work next day as I woke with headache and inability to focus. Those intense symptoms went away almost exactly after 24 hours, and I was just tired for 24 hours more. However, the dizziness has persisted. IT doesn't feel like vertigo, but is amplified with head positional changes sometimes. It feels more like when we have been on a boat for 1 day, and get off, come onshore and feel that walking on the land produced unsteadiness of gait, perceptual challenge with walking. I keep bumping into things, like I am not judging the distances correctly. A competitive athlete, I am a little concerned and a bit bothered on a daily basis with basic daily activity, never mind higher demand function, and hope these symptoms resolve soon.

Other Meds: n/a

Current Illness: n/a

ID: 1069114
Sex: F
Age: 81
State: WI

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: EKG, Thiroid Scan, Lung X-Ray, Blood Work, Urin Test, 4 hrs Observation at this facility

Allergies: Sensitive to all medication, Anaphylactic Shock to Bee Sting and Penicilline in combination with Streptomicine

Symptoms: immediately after vaccine injection upper body went into convulsion, uncontrolled jerking and tremor of all extremities. Difficulty Breathing

Other Meds: Losartan 50 mg, Amlodipine 2mg, Warfarin 4mg Multi Vitamin, Potassium, Fish Oil Omega 3, Vitamin D3, Glucosamine + Chondroitin Sulfate, Lutein + Zeaxanthion.

Current Illness: chronic Afib, Ostero Arthritis

ID: 1069115
Sex: F
Age: 54
State: PA

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: General Anesthesia

Symptoms: The first couple days exp pain at injection site. After next days having pain around the left shoulder for about 3 weeks. I seen my PCP and Neurologist stated it might been nerve pain was prescribed Gabapentin.

Other Meds: Lisinopril 20 mg, Vit D,Zyrtec, Nasal Spray

Current Illness:

ID: 1069116
Sex: M
Age: 60
State: TX

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

Lab Data: Pt's blood sugar and pressure were checked. Pt's heart was also listened too.

Allergies: Colchicine, Latex, Lisinopril, Alopurinol, Lanolin, Nsaids, Uniretic, and HCTZ

Symptoms: Pt received his 2nd Covid vaccine. After waiting for 15 mins pt stated that he felt very weak. Pt was seen by FNP. She listened to the pt's heart. She asked for his blood pressure and blood sugar to be checked. She also asked for him to wait an additional 15 mins. After wait time was over pt stated that he felt well enough to leave. He still had weakness but stated it wasn't worse.

Other Meds: N/A

Current Illness: N/S

ID: 1069117
Sex: F
Age: 39
State: MI

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

Lab Data: SEE ABOVE

Allergies: Allergy status to other drugs, medicaments and biological sub

Symptoms: Patient had chest pain, non-cardiac. Onsite EMS was called vitals BP 150/100 99% O2 HR 89. Patient Treated, Transported by the EMS to the hospital.

Other Meds: Eliquis Pill

Current Illness:

Date Died: 03/01/2021

ID: 1069118
Sex: F
Age: 72
State: IL

Vax Date: 02/25/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: N/A

Allergies: codeine, Zithromax

Symptoms: Within 10 minutes following the second vaccination, patient reported dizziness and nausea, had an episode of vomiting but recovered within 30 minutes. It was reported to our clinic that the patient was found deceased on March 1, 2021 at approximately 10 pm. Cause of death is not determined at this time.

Other Meds: albuterol sulfate, Aspir-81, bethanechol chloride, Bevespi, Aerosphere, cholestyramine (with sugar), citalopram, clopidogrel, duloxetine, famotidine, gabapentin, lisinopril, magnesium oxide, megestrol, metoprolol tartrate, mupirocin, nitrog

Current Illness: First covid vaccine received 1/28/2021 without incident. Had been hospitalized prior to vaccination for intractable vomiting.

ID: 1069119
Sex: M
Age: 72
State: VT

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

Lab Data:

Allergies: penicillin

Symptoms: Slight tingling in my lips. It went away in about an hour.

Other Meds: None

Current Illness: none

ID: 1069120
Sex: F
Age: 65
State: NY

Vax Date: 02/17/2021
Onset Date: 02/24/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: No

Allergies: ativan-memory loss

Symptoms: I had a hard lump in my arm that was very red that spread about 4-5 inches. It itches and burns and is swollen.

Other Meds: omeprazole 40 mg daily rosuvastatin 10mg daily triamterene 37.5mg/hctz 25mg daily amlodipine besylate 5mg daily metoprolol ER Succinet 25mg daily Zinc 25mg daily D3 1000IU daily Vit C 1000 daily

Current Illness: NO

ID: 1069121
Sex: M
Age: 67
State: CA

Vax Date: 01/23/2021
Onset Date: 02/12/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: MRI/MRA neg, ESR, CRP, CBC wnl

Allergies: eggs, lisinopril

Symptoms: Pt received first COVID vaccine on 1/23 and on 2/12 developed persistent periorbital headache and on 2/14 developed OS ptosis and diagnosed w/CN3 palsy

Other Meds: Biktarvy, omeprazole, HCTZ, symb icort, fluticasone, levothyroxine, losartan, ferrous gluconate, atorvastatin, aspart, creon, sertraline

Current Illness: n/a

ID: 1069122
Sex: M
Age: 72
State: AZ

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Report: CT head. Partial C and 3 posterior right-sided. TECHNIQUE: Axial images from vertex to upper neck with reformatted sagittal and coronal images. No IV contrast. Report: No acute intracranial hemorrhage. No intra-axial or extra-axial fluid collection. No shift of midline structures. Normal size ventricular system. Minimal peripheral atrophy. There is white matter changes from small vessel disease. Pons and medulla are unremarkable. Minor calcifications of the right basal ganglia. There is calcification of vertebral arteries and internal carotid arteries. Globes and orbits are unremarkable. Calvarium is intact. Base of skull including sella turcica is normal. There is intrasellar calcifications. Paranasal sinuses are clear. Impression: No acute intracranial hemorrhage. No mass lesion. White matter changes from small vessel disease. Minor peripheral brain atrophic changes. ================================================================= Report: CT angiogram of head and neck. TECHNIQUE: Axial images were obtained of the head and neck after the IV injection of 19 90 cc of Omni 300. Report: Minimal calcification at left carotid bifurcation with no stenotic changes. Multiple small calcified plaque at the bifurcation of right carotid with some narrowing of less than 30%. There is calcification of the ophthalmic arteries just after exiting the internal carotid arteries. There is plaque calcification of right ophthalmic artery with narrowing of the less than 30%. Plaque calcifications of left ophthalmic artery with narrowing between 30-50%. There is minor calcifications of intracranial vertebral arteries with no significant stenosis. No dominant right vertebral artery. Impression: Small plaque formation as described with no obstructive process. Calcification of ophthalmic arteries at takeoff internal carotid left lateral right with narrowing between 30-50%. No poststenotic dilatation. Res Site Test name Result Flg Units Ref. range Code Result Dt/Time WBC 5.58 K/cmm 4.80 - 10.80 [3745] 02/01/21 13:36 LY% 32.4 % 20.5 - 51.1 [3745] 02/01/21 13:36 MO% 5.6 % 1.7 - 9.3 [3745] 02/01/21 13:36 NE% 58.3 % 43.0 - 75.2 [3745] 02/01/21 13:36 EO% 2.2

Allergies: none

Symptoms: Partial Cranial Nerve 3 Palsy, right side Symptom: Diplopia, Ptosis

Other Meds: 1) ACCU-CHEK GUIDE ME GLUCOSE TEST STRIPS USE 1 STRIP TO ACTIVE MONITOR GLUCOSE DAILY TO MEASURE BLOOD SUGAR 2) ALCOHOL ISOPROPYL 70% PADS APPLY 1 PAD TO AFFECTED ACTIVE AREA AS DIRECTED TO CLEAN INJECTION SITE. 3)

Current Illness: 12/30/2020: viral disease Z11. 59: "Pt is here c/o of one cough w/ pink mucus yesterday. He denies any other coughing, h/a, b/a, rhinitis, myalgia, fever, SOB or exposure to anyone that is positive for COVID. He reports no other coughs, PND, sore throat, h/a, etc. "

ID: 1069123
Sex: F
Age: 76
State:

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

Lab Data:

Allergies:

Symptoms: Pt had Pfizer for her first dose of COVID vaccine but mistakenly received Moderna for her second dose. She went home with no adverse reaction noted.

Other Meds:

Current Illness:

ID: 1069124
Sex: F
Age: 53
State: NJ

Vax Date: 02/08/2021
Onset Date: 02/14/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Not known

Symptoms: On 2/15/2021 individual advised staff that she received second COVID-19 vaccine on 2/8/2021 and on 2/14 experience symptoms of fever of 99 with a headache and body ache. She indicated she does get migraines. SHe did see her PCP and it was reported that PCP was concerned this may have been a reaction to the vaccine. She was COVID-19 negative on 2-17-21. I believe she also recently went to the ER / hospital for her symptoms, but am unclear on this.

Other Meds: Not known

Current Illness: Not known

ID: 1069125
Sex: F
Age: 76
State: MD

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: Patient was admitted with impression of COPD exacerbation and hypoxia. She was treated with antibiotic and bronchodilators. Her symptoms gradually improved and she was discharged. Per the EUA, hospitalizations are to be reported irrespective of attribution to vaccine.

Other Meds:

Current Illness:

ID: 1069126
Sex: F
Age: 61
State: MI

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Medications: Penicillin, Demurral, Brethine, morphine, phenobarbital, novocaine, sulfates, latex, wheat, molds; alternaria, aspergillus, tree mix, dust mites, ragweed mix,

Symptoms: about 20 minutes after the injection my cheeks got red and warm, 5 minutes later my chin turned red. after about 30 minutes or so my chin and lower lip felt numb. this feeling was irritating but did not get worse, just very noticeable for about 5 hours. The next day my chin was a little tingly but was gone by the afternoon. My arm was very sore for 3 days.

Other Meds: Singular, Doxazosin, Progesterone, L-Lysine, Vitamin B12, Lipo Flavonoid Plus

Current Illness:

ID: 1069127
Sex: U
Age: 37
State: TX

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Extreme sore arm at injection sight. Headache. Joint ache (both ankles). Extreme fatigue. All symptoms began 4 hours after receiving injection. All symptoms subsided within 24hrs after side effects began. No treatment required.

Other Meds: None

Current Illness: None

ID: 1069128
Sex: F
Age: 44
State: NC

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Went to urgent care. provide handouts on studies of patients with prior covid and reaction to vaccine, recommended to treat with Tylenol for pain up to 650 mg every 4 to 6 hours and ibuprofen for aches and pains, and cold compress on injection site. recommended to contact publis health department to extend 22nd does beyond 28 days.

Allergies: latex

Symptoms: chills, difficult maintina body heat in extremities (feet and hands), joint pain, boady aches, eye dryness, rash and welt the 4cm x 7 cm at injection site displaying swelling and heat, and itch. at 15 hour post injection started intermittent rounds of ibuprophen and acetaminophen. now at 43 hours post injections symptoms same and upper respirator and congestion and post nasal drip has started.

Other Meds: omeprazole, ranitidine, vitmain c

Current Illness: no,

ID: 1069129
Sex: M
Age: 21
State: OK

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

Lab Data:

Allergies:

Symptoms: Fatigue, Full body aches, reduced lung capacity

Other Meds:

Current Illness:

ID: 1069130
Sex: F
Age: 60
State: MD

Vax Date: 02/27/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: Amoxicillin (some formulations); honeydew; cantaloupe

Symptoms: 3.5 days after 1st shot: Full-body burning skin (feeling like a severe sunburn, but not itching; no urge to scratch) accompanied by chills that lasted about 3 hours (3am-6am). No elevated temperature. My arm became very sore at 6.5 hours after the shot, but the soreness went away after about 1.5 days. At 3.5 days, the arm soreness returned accompanied by the full-body burning skin and chills. The skin burning lessened about 6 hours after initial onset, but remains No visible rash or skin change of appearance. Eyes do not appear yellow/jaundiced. No treatment as yet

Other Meds: Omeprazole delayed release tablets 20 mg daily; Vitamin D3 10 mcg (400 IU) daily.

Current Illness: None

ID: 1069131
Sex: F
Age: 19
State: AZ

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: No

Allergies: No

Symptoms: Fever headache body aches Fatigue body felt heavy sore arm

Other Meds: Tylenol

Current Illness: No

ID: 1069132
Sex: M
Age: 74
State: LA

Vax Date: 02/19/2021
Onset Date: 02/20/2021
Rec V Date: 03/03/2021
Hospital: Y

Lab Data: CBC WITH DIFFERENTIAL Collection Time: 02/20/21 6:59 PM Result Value Ref Range WBC 5.5 4.5 - 11.0 K/uL RBC 4.31 (L) 4.50 - 5.90 M/uL HEMOGLOBIN 13.6 13.5 - 17.5 g/dL HEMATOCRIT 39.9 (L) 40.0 - 51.0 % MCV 92.7 80.0 - 100.0 fL MCH 31.6 26.0 - 34.0 pg MCHC 34.1 31.0 - 37.0 g/dL RDW 14.2 11.5 - 14.5 % PLATELETS 85 (L) 130 - 400 K/uL MPV 9.2 7.4 - 10.4 fL NEUTROPHILS 59 % LYMPHOCYTES 23 % MONOCYTES 14 % EOSINOPHILS 3 % BASOPHILS 1 % NEUTROPHIL ABSOLUTE 3.30 1.80 - 8.00 K/uL LYMPHOCYTE ABSOLUTE 1.30 1.10 - 5.00 K/uL MONOCYTE ABSOLUTE 0.80 0.20 - 1.10 K/uL EOSINOPHIL ABSOLUTE 0.20 0.00 - 0.60 K/uL BASOPHILS ABSOLUTE 0.00 0.00 - 0.20 K/uL COMPREHENSIVE METABOLIC PANEL Collection Time: 02/20/21 6:59 PM Result Value Ref Range SODIUM 135 135 - 146 mmol/L POTASSIUM 4.0 3.6 - 5.2 mmol/L CHLORIDE 101 96 - 110 mmol/L CO2 26 24 - 32 mmol/L CALCIUM 9.4 8.4 - 10.3 mg/dL BUN 15 7 - 25 mg/dL CREATININE 1.00 0.70 - 1.40 mg/dL GLUCOSE 79 65 - 99 mg/dL TOTAL PROTEIN 7.1 6.0 - 8.0 g/dL ALBUMIN 3.7 3.4 - 5.0 g/dL BILIRUBIN TOTAL 1.1 0.0 - 1.3 mg/dL ALKALINE PHOSPHATASE 75 20 - 120 U/L AST 25 <=45 U/L ALT 22 <=46 U/L GFR >60 mL/min/1.73 sq meter GFR, AFRICAN AMERICAN >60 mL/min/1.73 sq meter TROPONIN Collection Time: 02/20/21 6:59 PM Result Value Ref Range TROPONIN I 0.03 <=0.05 ng/mL MANUAL DIFFERENTIAL Collection Time: 02/20/21 6:59 PM Result Value Ref Range PLATELET EST. Slightly Decreased RBC MORPHOLOGY Normal PROTIME-INR Collection Time: 02/20/21 7:04 PM Result Value Ref Range PROTIME 41.9 (H) 9.2 - 12.5 Seconds INR 3.7 (H) 0.9 - 1.2 Narrative PT-INR Therapeutic Range: INR Indication --------------------------------------------------------------------------------------- 2.0 - 3.0 Routine Oral Anticoagulation 2.5 - 3.5 Oral Anticoagulation in Recurrent Thromboembolus and/or Mechanical Heart Value URINALYSIS WITH REFLEX MICROSCOPIC Collection Time: 02/20/21 7:50 PM Result Value Ref Range COLOR UA Yellow Pale to dark yellow CLARITY UA Clear Clear SPECIFIC GRAVITY UA 1.019 1.010 - 1.030 PH UA 7.0 5.0 - 8.0 LEUKOCYTE ESTERASE UA Negative Negative NITRITE UA Negative Negative PROTEIN UA Negative Negative GLUCOSE UA Negative Negative KETONES UA Negative Negative UROBILINOGEN UA 4.0 (A) <2.0 mg/dL BILIRUBIN UA Negative Negative BLOOD UA Negative Negative 2019 NOVEL CORONAVIRUS (COVID-19) PCR DETECTION Collection Time: 02/20/21 8:38 PM Specimen: Nasopharynx; Upper Respiratory Result Value Ref Range COVID-19 PCR Not Detected Not Detected PERFORMING LAB OLOA Narrative This test has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories. This test has been validated in accordance with the FDA's guidance regarding Coronavirus Disease-2019 testing. Optimum specimen types and timing for peak viral levels during infection have not been determined. A negative RT-PCR result does not rule out infection with the 2019

Allergies: Levofloxacin Diarrhea Other reaction(s): diarrhea ? Sulfa (Sulfonamide Antibiotics) Hives and Rash ? Dronedarone Nausea and Vomiting and Other (See Comments) diarrhea diarrhea ? Orange Blossom Hives ? Penicillins Hives

Symptoms: Generalized weakness, unable to walk. Chills. Temp 99.4 Admitted to hospital given IV saline and supportive care. Discharge on second day.

Other Meds: mupirocin (BACTROBAN) 2 % Ointment Apply to affected area daily. 30 Gram None ? lactulose (ENULOSE) 20 gram/30 mL Take 30 mL by mouth daily. 250 mL 0 ? polyethylene glycol 3350 (MIRALAX) 17 gram/dose Powder Take 1 SCOOP (17 Grams) by mouth

Current Illness: none

ID: 1069133
Sex: M
Age: 71
State:

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: 12 led - EKG

Allergies:

Symptoms: Patient was grey, diaphoretic, and syncopal x2, palpated irregular slow HR - 38. EMS called arrived at 1011 with ALS and BLS support. Patient was observed and assessed with 12 led EKG - showed irregular rhythm. Patient continued to be symptomatic and transported to local ED via EMS. Patient remained AAO x 3 with notation of transient color changes at time of transport

Other Meds:

Current Illness:

ID: 1069134
Sex: M
Age: 76
State: OR

Vax Date: 02/21/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: None - Just to grasses, pollen

Symptoms: COVID ARM - Swollen 8 days after vaccine, red, itching

Other Meds: Statin: Atorvistatin

Current Illness: None

ID: 1069135
Sex: F
Age: 68
State: PA

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Headache, fever, body aches, fatigue, nausea, insomnia

Other Meds:

Current Illness:

ID: 1069136
Sex: F
Age: 70
State: SC

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

Lab Data:

Allergies:

Symptoms: PATIENT REPORTED ITCHING OF ARM AT INJECTION SITE WITHOUT REDNESS LASTING 4 WEEKS. SKIN WAS TOUGH DURING INJECTION OF 2ND DOSE, PATIENT DID NOT REPORT ADVERSE EVENT UNTIL AFTER INJECTION.

Other Meds: dexilant, gabapentin, Lexapro, fioricet, crestor, Benicar, fenofibrate, trazodone

Current Illness:

ID: 1069138
Sex: F
Age: 54
State: PA

Vax Date: 02/04/2021
Onset Date: 02/08/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: I got really feverish, bad headache,extremly exhausted for few days.Since second dose I have exp headaches off and on.

Other Meds: Lisinopril, Vit D,Zyrtec,Gabapentin 300 at night

Current Illness:

ID: 1069139
Sex: M
Age: 54
State: CA

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Pain Left shoulder,swelling,weak

Other Meds: None

Current Illness: None

Date Died: 02/11/2021

ID: 1069140
Sex: M
Age: 75
State: PR

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None reported

Allergies: None reported

Symptoms: The day after the administration of the vaccine, the fever began, the patient claim that he had no blood pressure problems. He was given acetaminophen every 4 hrs. and vitamin C and D. On February 11, he was stabilized, he had his regular meals without any problem but in the afternoon his temperature rose again and they put him to bed. The patient died that same afternoon around 4:00 pm

Other Meds: Bacofleno, Agrenox, Synthroid, Fenofibrate, Busoiron, Lasix, Lipthol, Amiodarone, Clonopin

Current Illness: None reported

ID: 1069141
Sex: F
Age: 36
State: OK

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Penicillin, Amoxicillin, egg yolk, Latex

Symptoms: After 12 hours started a fever of 101F and a sever headache, chills, body aches, nausea and fatigue. Lasted for 32 hours. After that it was still severe headache and joint pain, and fatigue for another 12-16 hours. After 3 days I still experienced fatigue and brain fog.

Other Meds: Zirtec, Vitamin D, Lexapro, Probiotic

Current Illness: 3 days earlier had a sore throat.

ID: 1069142
Sex: M
Age: 37
State: VA

Vax Date: 01/10/2021
Onset Date: 01/13/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Second dose of Pfizer vaccine was given 1/10/2021 around 9:30 AM. I woke up at around 6:30 AM on 1/13/2021 feeling well. While I was changing, I noticed a diffuse maculopapular rash on my torso back thighs and upper arms. The rash was very pruritic. I took some Benadryl which did not seem to help the itchiness and made me sleepy. By Thursday, most of the rash on the torso was gone, but the rash had spread more to my forearms, lower legs, feet and hands. There was some mild edema of the hands, I had some mild fatigue, and temperature check was slightly elevated around 99 degrees F. By Friday, most of the rash was gone and I had some remaining itchiness of feet and hands. Saturday I was back to normal.

Other Meds: Men's Multivitamin, Vitamin D, Loratadine

Current Illness: None

ID: 1069143
Sex: F
Age: 31
State: MA

Vax Date: 02/10/2021
Onset Date: 02/20/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Amoxicillin

Symptoms: Developed shingles infection 10 days after second covid vaccine

Other Meds: Prenatal vitamins, baby aspirin daily

Current Illness: None

ID: 1069144
Sex: F
Age: 82
State: IN

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

Lab Data: While at the E R I had a c t scan, chest xray and blood draw on November 21st Am scheduled for a stress test on the 9th and they are ordering a heart monitor

Allergies: None

Symptoms: I started having chills and loss of energy. The second day really felt very tired. When I took my blood pressure it was very high. Twice in the next few days I went to the ER with over 200 over 79 I saw my family doctor and they did a k g and said my heart was out of rhythm and they sent me to the cardiologist. I still feel light headed and blood pressure still high and heart rate low.

Other Meds: Lovastatin and Lisinopril

Current Illness: None

ID: 1069145
Sex: F
Age: 53
State: IL

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Excruciatingly painful migraine started 6.5 hrs after the vaccine on Friday and lasted 72 hrs straight. Tried an Imitrex on Sunday and it did not work. Tried again on Monday night and it helped and ended up taking another one before bed. Woke up Tuesday without a migraine but have had a headache since. So it was not a "headache" as side effects say. It was a migraine that had me down for 72 hrs with no relief. Now I have a lingering headache.

Other Meds: Omeprazole, Lexapro, Singulair, B12, Vitamin D, Vitamin C

Current Illness: Covid started November 12 and lasted 2 weeks

ID: 1069146
Sex: M
Age: 28
State: MI

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

Lab Data: SEE ABOVE

Allergies:

Symptoms: Patient had general malaise unknown cause. Onsite EMS was called vitals 99% O2 HR 116. Patient refused evaluation/care and released agianst medical advice.

Other Meds:

Current Illness:

ID: 1069147
Sex: F
Age: 67
State: GA

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: Sulfa

Symptoms: Moderna COVID-19 Vaccine EUA -- Arm not sore at all on 3/1/2021. Next morning 3/2/2021 right deltoid was sore, and got more sore as day went on. Nausea, fatigue and low fever 99.5 (normal temp 96.8-97.6 degrees) afternoon starting at noon . Took Ibuprofen 400 mg and Tylenol 1000 mg at 3:30 p.m. and 200 mg Ibuprofen and 500 Tylenol at 9:00 p.m. 3/3/2021 - 7:30 am fatigue Body aches esp right hip. Right deltoid Injection site much less sore on 3/3/21. Took Ipubrofen 400 mg on 3/3/2021. Symptoms were similar to a mild case of Covid 19 which I experienced in July 2020. I had to stop work at 3:30 p.m. on 3/2/2021 and stayed home due to fatigue on 3/3/2021. Symptoms improving on 3/3/2021 at the time of filling out this form.

Other Meds: Prozac 40 mg, Garlic, Lion's Mane, Cordyceps and Reishi , B-Vitamin, Multi Vitamin, Vitamins, C, A, D3, Glucosamine Chondroitin, digestive enzymes, Calcium, Magnesium

Current Illness: None

ID: 1069148
Sex: M
Age: 83
State: IL

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

Lab Data: None.

Allergies: None.

Symptoms: He got the vaccine yesterday, woke up nauseated, dizzy, feeling like he is going to throw up but has not eaten anything. Not other reaction other than being very weak and development of a bad cough. Has not taken anything and has not called his doctor.

Other Meds: None.

Current Illness: None.

ID: 1069149
Sex: F
Age: 70
State: KS

Vax Date: 02/16/2021
Onset Date: 02/24/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: food, scallops antibiotics- levaquin, biaxin, sulfa, penicillin

Symptoms: initial redness at injection site similar to what I get with a flu shot. That resolved in 3 days. Nine days after the vaccination my injection site became red agin and itchy, hot and swollen. Very itchy, hot and swollen. The irregular circle was about 3 inches by 4 inches. That lasted one week and is now very faintly red.

Other Meds: synthroid, 2 low dose aspirins, multivitamin, vitamin D, fish oil, turmeric

Current Illness: none

ID: 1069150
Sex: M
Age: 66
State: NJ

Vax Date: 02/24/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Negative rapid CV test. PCR pending

Allergies: NONE

Symptoms: Developed fatigue, myalgias, and loose stool on the evening of 3/1. On 3/2 developed hoarse voice and sore throat. Mild fatigue and myalgias persisted.

Other Meds: NONE

Current Illness: NONE

ID: 1069151
Sex: F
Age: 29
State: PA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Chlorahexadine

Symptoms: Rash on arms and legs, itchy, currently has lasted 7+ days

Other Meds: N/A

Current Illness: N/A

ID: 1069152
Sex: M
Age: 71
State: IN

Vax Date: 01/16/2021
Onset Date: 01/31/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Shingles. Blisters scabbing pain burning itching. Am still experiencing burning itching

Other Meds:

Current Illness:

ID: 1069153
Sex: F
Age: 28
State: NJ

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

Lab Data:

Allergies:

Symptoms: Post vaccine in monitoring area, reported feeling hot and anxious. Fell out of chair and hit forehead on floor. Witnessed by staff. No loss of consciousness. Post fall. Immediately alert and oriented x3. Vitals within normal limits. PERRLA. Neuro exam normal. no swelling at site of impact. No dizziness reported. Ice pack applied. Denies pain. Advised to follow up with emergency room if anything changed.

Other Meds:

Current Illness:

ID: 1069154
Sex: F
Age: 75
State: MD

Vax Date: 02/28/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: The following tests were performed in the ER on March 2, 2021: Hematology General Chemistry COVID Test ICD Test

Allergies: Codeine Lipitor Lisinopril Isosorbide Hydralazine Ibuprofen Adhesive Tape

Symptoms: I am a 75 year old female with severe Cardiomyopathy with an ejection fraction of less than 20% and an implanted defibrillator. I had my first COVID vaccine on Sunday, February 28. I had had sinus problems with a little runny nose the week before...no fever, no chills, normal temperature. Other than my arm being a little sore, i took two Tylenol the night of the vaccine and had no problems until Tuesday afternoon, March 2, 2021. i felt perfectly Sunday after =noon, all day Monday and Tuesday. However while shopping at a nearby store as I got to the checkout counter I started having shortness of breath, It was hard for me to walk and I was very shaky. I have an apple watch so I was able to check my heart rate. The heart rate was anywhere from 58BPM to 177BPM and all over place in between, i got in my car, trying to calm myself then called the EMTs. They took me to hospital to the Emergency Room. Several tests(see below) were performed. The final diagnosis was hear palpitations. They did a COVID test and I did test positive for the Rhino virus. The doctors didn't know if my incident was related to receive the COVID vaccine and my defibrillator was checked, and a test was run that indicated it wasn't bad enough to activate the defibrillator.

Other Meds: Amiodarone 1 per day Entresto 24/26mg 1 in the am and 1 in the pm Carvedilol 6.25mg 1 in the am and 1 in the pm Spironolactone 23mg - 1 in am Furosemide 20mg 1 in am

Current Illness: Cardiomyopathy Sinus

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm