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: 1021747
Sex: F
Age: 33
State: WA

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/11/2021
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: swollen lymph nodes on left side, same side as the shot was administered. Swollen back of armpit, hurts to touch. Swollen lymph in neck, left side, same side as shot was administered.

Other Meds: Seasonale birth control, vitamin D supplement, Zyrtec

Current Illness: none

ID: 1021750
Sex: F
Age: 39
State: VA

Vax Date: 02/08/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: Penicillins Rocephin

Symptom List: Anxiety, Dyspnoea

Symptoms: Burning, tingling parasthesias all over body.

Other Meds: Effexor XR 75 mg LoLoestrin FE Women?s multivitamin

Current Illness: None

ID: 1021754
Sex: F
Age: 81
State: CA

Vax Date: 01/25/2021
Onset Date: 02/03/2021
Rec V Date: 02/11/2021
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: Sulfur drugs erythromycin hay fever

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

Symptoms: soreness increased to redness, hardness and severe itching at the injection site. Began around 9 days after the shot was given and the hardness under the skin felt like a plate and the skin looks raised and discolored. The hardness has subsided a little but the itching has gotten progressively worse.

Other Meds: Hydrochlorothiazide, Losartan, Potassium CL Women's Silver One a Day Vitamin, Vitamin C, D3, Magnesium, Probiotics

Current Illness: Pace-maker inserted

ID: 1021758
Sex: F
Age: 49
State: CO

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: bananas, Neurontin, gabapentin, Darvocet, hydrocodone, anaprox, Tylenol, all Sulphur drugs, claritan, codeine, oxychodone, penicillin, Sudafed

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: nausea, migraine, hot/cold sweats, chills, fever of 103.5 for over 30 hours, muscle and joint pain.

Other Meds: daily multi vitamin, quinapril 40 mg, metoprolol succinate 25 mg

Current Illness: had reaction to first Covid shot on 1/7/2021

ID: 1021762
Sex: F
Age: 28
State: ID

Vax Date: 02/08/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: After I received my second vaccine shot, approximately 12 hours later I started experiencing symptoms such as: headache, chills, body aches, fatigue, and was lightheaded. Then approximately 24 hrs later a red mark started appearing on my right arm below the injection site. The red mark has become swollen and painful.

Other Meds: n/a

Current Illness: n/a

ID: 1021765
Sex: F
Age: 46
State: WI

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
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: NA

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

Symptoms: Muscle aches, red swollen warm and itchy at injection site

Other Meds: Ceterizine, duloxetine, lantus,trulicity,advil pm,melatonin,lansoprazole

Current Illness: NA

ID: 1021768
Sex: M
Age: 22
State: PA

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

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

Lab Data:

Allergies: none known

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient had increased frequency of seizures (6 in the same day of vaccination), treated with Clorazepate bridge

Other Meds: Onfi, Tegretol, CBD extract, Lamictal, melatonin, multivitamin, MiraLax, stool softener, diazepam rectal

Current Illness: epilepsy, acne

ID: 1021775
Sex: F
Age: 63
State: AZ

Vax Date: 02/01/2021
Onset Date: 02/07/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: Oxycodeine Hydrocodone Demerol Fentanyl Versed Mimocline Solodyn Vicodin Reactions to above listed medication is to pass out Epinephrine causes racing heart

Symptom List: Pharyngeal swelling

Symptoms: Discomfort first few days and then fine On Day 7, redness, pain, swelling, and tightness occurred . Today is day 9. Symptoms still persist. I will send a picture but not sure how to attach to form

Other Meds: Ezetimibe 10 mg Atenolol 25 mg, bid Lisinopril 20mg Escitalopram 20 mg Cuturelle Stellara injection every 90 days

Current Illness: None

ID: 1021779
Sex: F
Age: 50
State: CT

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Left axillary lymphadenopathy

Other Meds:

Current Illness:

ID: 1021783
Sex: M
Age: 68
State: GA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: sulfa drug allergy

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Fever, chills muscle ache, nausea, shivering

Other Meds: aspirin 81 mg/day Olmesartan 40 mg/day

Current Illness: no

ID: 1021786
Sex: F
Age: 39
State: FL

Vax Date: 02/01/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: At 12 hour post vaccine a began feeling achy. Within an hour I had chills and felt feverish. I went to bed. Woke up at 12:30 am on 12/11 and took my temp. 101.4 with a sweatshirt on. Infection site arm is very sore. Overall I just feel really lousy. My husband is fine.

Other Meds: Lexapro Zinc Multivitamin Vitamin D B 12 Magnesium calcium

Current Illness:

ID: 1021791
Sex: F
Age: 50
State: CA

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
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: Sulpha

Symptom List: Rash, Urticaria

Symptoms: Sever underarm pain after 24 hours. Pain subside with Tylenol dose. pain keep coming back after every 8-10 hours. Redness and itchy reaction after 48 hours.

Other Meds: Thyroxine

Current Illness: None

ID: 1021794
Sex: F
Age: 71
State: FL

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 02/11/2021
Hospital: Y

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

Lab Data:

Allergies: Renografin 76 - Iodine - Vitamin C - Bioxin - Cipro.

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

Symptoms: Admitted to the Emergency Room. Reason for visit: Allergic Reaction. Diagnosis: Adverse effect of drug, initial encounter. Following issue addressed: High priority for COVID-19 virus vaccination. Three (3) hours in the emergency room. Short of breath/Yawning/Difficulty breathing/Trouble with breathing/Dried mouth. Blood pressure sky rocked. Muscles pain days after. Due to my reaction, after first dose, Dr recommend me not to take the second dose of the vaccine.

Other Meds: Vitamin D 2000

Current Illness: None

ID: 1021797
Sex: M
Age: 78
State: CA

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/11/2021
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: Latex adhesive

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

Symptoms: Sore and inflamed left arm and red rash. headache medium, fever 100.4 thru 100.8 for about 42 hours starting early Saturday morning after a Friday inoculation, and ending Sunday evening. Woke up Monday feeling well and no after-effects. Took some tylenol during the event.

Other Meds: Metformin, Aspirin, Farxiga, Creon, Warfarin, Vitamin D, CQ10, Multi-vitamins, Januvia, Lipitor

Current Illness: None

ID: 1021802
Sex: F
Age: 26
State:

Vax Date: 02/02/2021
Onset Date: 02/07/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: delayed induration, redness. Brief numbness to hand x 1 day.

Other Meds: none

Current Illness: none

ID: 1021805
Sex: F
Age: 25
State: HI

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/11/2021
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: Dairy intolerance

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

Symptoms: Symptoms include fatigue, headaches, redness, tender, itchy, welted, warm to the touch.

Other Meds: Birth Control (Loryna)

Current Illness:

ID: 1021808
Sex: F
Age: 72
State: CA

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

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None

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

Symptoms: slight numbness around jaw and down sides of neck, heart beat racing ( it lasted about 10 minutes)

Other Meds: Olmesartan, Metoprolol, Jardiance, Metformin, Bupropion, Duloxetine, Atorvastatin, Cephaloxin

Current Illness: sinus infection

ID: 1021812
Sex: M
Age: 31
State:

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

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Chills, fever (100.2F), headaches, body ache

Other Meds: None

Current Illness: None

ID: 1021816
Sex: F
Age: 34
State: CA

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

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

Lab Data:

Allergies: Cats, Ragweed, mold

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 5 minutes after injection, I felt tingling in my fingertips and toes. Two and a half hours after injection, I had an insatiable craving for cheese and other dairy products that lasted approximately 12 hours after injection.

Other Meds: Singulair, Mirena, multivitamin, fish oil, chia seed capsules, and not so tall

Current Illness: None

ID: 1021819
Sex: F
Age: 49
State: CA

Vax Date: 02/01/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: Tramadol and blue food coloring

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

Symptoms: On 2/9/21, I noticed a bump at the exact injection site. It was red, raised and about the size of a large pimple. It was itchy and warm. The next day, around 1pm, the bump had flattened and a large rash had appeared around and below the injection site. The rash is red, blotchy, itchy, tingly and warm. My skin in the area feels right. I emailed my doctor and have not heard back yet. It is currently about 9 hours after the appearance and of the rash.

Other Meds: Estradiol 2mg; progesterone micronized 100mg; loratadine 10mg; Sudafed 24 hour; fluticasone propionate 50mcg; cequa .09; gabapentin 100mg; centrum silver women multivitamin; vitamin c 1000mg; CoQ10 200mg; vitamin d 5000 iu; l-lysine 1000mg

Current Illness: Seasonal respiratory allergies

ID: 1021825
Sex: M
Age: 68
State: CA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: Cats, dogs, horses, hey fever, iodine

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

Symptoms: White part of right eye has broken blood vessels. 1/2 of eye is bright red. Eye is scratchy but no other problems. Has never happened before. Noticed about three hours after injection

Other Meds: prozac Atenolol Lisinopril

Current Illness: None

ID: 1021829
Sex: F
Age: 28
State: NY

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: lamictal, gabapentin, iodine

Symptom List: Unevaluable event

Symptoms: After first shot on 12/24/2020, I noticed a small rash on my right arm that was quite itchy. After my second dose on 1/14/2021, my rash and itching grew and now I am covered from my neck down to my ankles. I am covered in a red rash/hives, and this is incredibly itchy.

Other Meds: Metoprolol tartrate, Hydrochlorothiazide

Current Illness: none

ID: 1021833
Sex: F
Age: 32
State: OR

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/11/2021
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: N/A

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

Symptoms: First day after receiving my second vaccination at 12:30, I became very puky and threw up the rest of the day along with my arm that the vaccination was received went dead. The following day I regained feeling in my left arm off and on throughout the day and had body aches, chills, and had shortness of breath. Day three I began to feel better with occasional shortness of breath and I had feeling in my arm again. I was completely back to normal by day four.

Other Meds: N/A

Current Illness: N/A

ID: 1021835
Sex: F
Age: 52
State: WA

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/11/2021
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: Prescription pain medication causes uncontrollable vomiting

Symptom List: Injection site pain, Pain

Symptoms: Initial not concerning: Bad headache the next morning which passed by the end on the day. Injection site swelling and discomfort for a few days. The reason I am submitting this form is fatigue, mild diarrhea, moderate nausea, and vomiting starting 8 days after the vaccine. So far it's nothing serious. I haven't been out to catch anything so it seems related. I thought you may want the data because of the strang delay in gastrointestinal symptoms.

Other Meds:

Current Illness:

ID: 1021837
Sex: F
Age: 28
State: IN

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: Azythromycin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Muscle aches, severe chills, dizziness, fatigue, temperature of 101.7 and severe injection site pain all resolved 24 hours from onset. Treated with Ibuprofen and Naproxen Sodium

Other Meds: Advair, Sprintec, lexapro

Current Illness:

ID: 1021839
Sex: F
Age: 28
State: CA

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 02/11/2021
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: N/A

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

Symptoms: After my 2nd dose administration, I sat in an observation tent with 4 resident doctors. This is protocol at my hospital to assess for any adverse reactios. About 10 minutes later, I started to feel both of my arms (from should all the way to tips of my fingers) start to get tingly with an intense vibrating sensation. I tried to calm myself down, however numbness began to occur to both BUE seconds after. Next thing that happened, bilateral fingers became visually contracted however numb and I could not move my fingers. I also got a tingly/prickly sensation to my cheeks all the way down to my chin after the hand numbess. The resident doctors quickly took me by wheelchair to a private room where they checked my vital signs. BP was elevated with systolic in 190's, HR around 120s, and my limbs were all cold. By this time it was around 6pm and they were trying to calm me down as I started to have a panic attack. My parents came to pick me up at 7pm when my vitals were stable. I rested at home, and the contraction to my fingers/numbess did not subside until 8:30pm. The following day, my left arm (injection site) had a soreness level of 9/10. Tylenol was used to relieve pain.

Other Meds: N/A

Current Illness: N/A

ID: 1021842
Sex: F
Age: 36
State:

Vax Date: 02/03/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: latex, shellfish, bee venom

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: At the time of injection, experienced light headedness and chest pain on the right side. One week after injection, the injection site became itchy, red and warm to the touch.

Other Meds: N/A

Current Illness: N/A

ID: 1021843
Sex: F
Age: 81
State: CA

Vax Date: 02/01/2021
Onset Date: 02/08/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: No known

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: COVID ARM Inflammation, itching of vaccine site beginning on the 8th day after vaccine was administered. Used Anti-itch cream Still in progress

Other Meds: None

Current Illness: None

ID: 1021846
Sex: M
Age: 45
State:

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

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

Symptoms: general malaise, headache, body ache, shivering, joint pain, pain at injection site

Other Meds: stratterra, tylenol, celebrex, vit d, multi vit, ambien, probiotic,

Current Illness: none

ID: 1021847
Sex: F
Age: 70
State: CA

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: lump just above injection site, one inch diameter

Other Meds: lisinopril; floxetine; nature's blend multivitamin with mineral; omeprazole; ocuvite; good sense allergy relief

Current Illness: none

ID: 1021850
Sex: F
Age: 24
State: CA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/11/2021
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

Symptom List: Injection site pain

Symptoms: 101 fever, chills, body aches, fatigue, arm soreness, sore throat last 8 hours

Other Meds: None

Current Illness: None

ID: 1021852
Sex: F
Age: 41
State: CA

Vax Date: 02/02/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: 8 days after the vaccine, I?ve developed a red itchy spot at the injection site

Other Meds: None

Current Illness: None

ID: 1021855
Sex: F
Age: 36
State: NY

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/11/2021
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: Contrast dye for CT scan/MRI

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

Symptoms: FEVER (103.5F peak) AND CHILLS = 02/05/21 7pm-02/06/21 9am SLIGHT DIZZINESS = 02/05/21 10pm-02/05/21 11pm HEARING FADING IN AND OUT = 02/05/21 10pm-02/05/21 11pm DIARRHEA = 02/06/21 7pm-02/07/21 1pm OVERALL BODY ACHES = 02/05/21 7pm-02/09/21 9am HEADACHE (Intermittent) = 02/05/21 7pm-Present INJECTION SITE PAIN = 02/05/21 7pm-Present NO APPETITE = 02/05/21 7pm-Present FATIGUE (Extreme to Medium) = 02/05/21 7pm-Present TREATMENT: Stayed at home and rested, drank lots of water, took Ibuprofen as needed for fever and body aches/headaches. Did not go to the doctor.

Other Meds: Zyrtec, Lansoprazole, Montelukast, Duloxetine, and multivitamin

Current Illness:

ID: 1021857
Sex: F
Age: 50
State: WA

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: No

Symptom List: Tremor

Symptoms: Swollen lips where filler has been Swollen lymph nodes Headache fatigue muscle pain

Other Meds: Spironolactone

Current Illness: None

ID: 1021860
Sex: F
Age: 79
State: LA

Vax Date: 02/04/2021
Onset Date: 02/08/2021
Rec V Date: 02/11/2021
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: COVID ARM. Huge red area below the injection site of the Deltoid muscle darkening all the way down to the elbow and pooling there as a huge red arc. Painless with no itching.

Other Meds: curcumin

Current Illness: n0ne

ID: 1021864
Sex: M
Age: 65
State: MI

Vax Date: 01/31/2021
Onset Date: 02/07/2021
Rec V Date: 02/11/2021
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: No known allergies

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

Symptoms: On day seven after receiving the vaccination, a rash appeared on the back of the neck that progressed around the entire neck by day eight. On day nine rash appeared on the back of both arms and significant left arm pain distal to the injection site accompanied by inflammation. The inflammation appears to be present all over.

Other Meds: Synthroid, multivitamin, glucosamine/chondroitin, coq10

Current Illness: None

ID: 1021867
Sex: F
Age: 35
State: IN

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: Septra- hives

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

Symptoms: headache, lightheadedness, and muscle soreness

Other Meds: SlimVance Multivitamin

Current Illness: none

ID: 1021871
Sex: F
Age: 38
State: HI

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: Crustaceans.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Client reported being anxious prior to vaccination, but did some deep breathing which she felt helped calm her down. After the injection, she felt dizzy, "the room was spinning" and she was not able to focus on what the vaccinator was saying. She reported feeling dizzy to the vaccinator who kept her seated and provided bottled water. Clinic Manager and Vaccine Group Supervisor took initial vital signs. Client also appeared to be shaking. 10:20am: BP: 130/96, HR: 90. At about 10:25am, client reported feeling better. VGS moved client to a seat near the clinic staff area to complete her 30 minute waiting period. VGS took vital signs. 10:30am: BP: 120/90, HR: 88. Client was no longer visibly shaking. She reported that her husband was waiting in the car to take her home. Client's condition improved and was released from the clinic to return to her home. Client was escorted to her car by the Deputy Safety Officer.

Other Meds:

Current Illness:

ID: 1021874
Sex: F
Age: 35
State: CA

Vax Date: 02/02/2021
Onset Date: 02/11/2021
Rec V Date: 02/11/2021
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: Penicillin Sulfa drugs

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

Symptoms: Hard, itchy bump at injection site. Cannot see if discolored due to tattoo. Bump is approximately 1cm wide.

Other Meds: Triamcinolone .1%

Current Illness: None

ID: 1021878
Sex: F
Age: 30
State: GA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 02/11/2021
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: None

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

Symptoms: Severe right arm pain, chills, low grade fever, body aches, nausea. Most severe symptoms lasting 24 hours

Other Meds: Adderall, escitalopram

Current Illness:

ID: 1021881
Sex: M
Age: 84
State: CO

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies: Zestril, Tramadol

Symptom List: Pain in extremity

Symptoms: Nausea, Night sweats, Joint Pain in legs and lower back, Headache, fever (99.3 to 100.9), fatigue. Treated with Tylenol , Naproxen , Lidocaine patch, fluids, heating pad and rest. Reduced fever, reduced joint pain, headache persisted. Time course: 24 hour period

Other Meds: Atorovastin Lemoelthyroxin Flomax Vit C Multi Vitamin

Current Illness: Melanoma

ID: 1021884
Sex: F
Age: 65
State: CA

Vax Date: 02/03/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: Redness, itching, swelling (hardness) at injection site

Other Meds: Levothyroxine; ibuprofin; vitamin D3; zinc; potassium; magnesium; multivitamin

Current Illness: None

ID: 1021888
Sex: F
Age: 24
State: GU

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

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

Symptoms: Rash and bruised appearance around injection site, one week after vaccine was administered. Experiencing tight muscles and soreness.

Other Meds: No

Current Illness: No

ID: 1021890
Sex: F
Age: 53
State: WI

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 02/11/2021
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: Bee venom

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

Symptoms: Terrible headache that lasted 3 days

Other Meds: None

Current Illness: None

ID: 1021896
Sex: F
Age: 37
State: OR

Vax Date: 02/02/2021
Onset Date: 02/08/2021
Rec V Date: 02/11/2021
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: None

Symptom List: Vomiting

Symptoms: Days 1-3: Headache, nausea, weakness, low-grade fever, chills, limited neck movement, limited left arm movement, bone pain in both legs and hips, full back pain Days 4-6: Headache, nausea, fatigue and poor activity tolerance Days 7-9: Hives/rash first appeared on upper arms, then progressed to lower arms and neck. Hives increased to mid and upper back, and both legs. Leg rash not raised, look like petechiae. Pruritus most severe in shoulders, neck, back.

Other Meds: Melatonin

Current Illness: None

ID: 1021898
Sex: M
Age: 36
State: HI

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/11/2021
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: Shellfish (reaction: hives)

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Client in post vaccination waiting area. Approximately 6 minutes after arriving, a felt flushed, anxious feeling. Reports dizziness and lightheadedness. Patient requests to use nearby cot. Staff escorted patient to cot to lie down. BP on palpation 100. At 10:20am, BP 108/76 HR68 R18. Requests to stay lying down. At 10:38am, patient is ready to sit up. BP120/76 HR72 R 72. Patient reports "feeling normal." Continues to sit and drink offered water. Reports did not eat breakfast this AM. Ready to depart at 1050. Final BP 110/76 HR 76, R18. No complaints

Other Meds: Venlofaxin QD

Current Illness: None

ID: 1021899
Sex: F
Age: 78
State: CA

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/11/2021
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: Allergies to sulfur and sulfides. Asthma to wood fires, hay

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

Symptoms: Exhaustion onset about 8:00 PM 1/26/21 lasting over 36 hours before starting to feel better. I literally slept all of the next day only getting up occasionally and most of the day after that. I started to become more normal feeling the late afternoon of 1/28/21. I also felt very stiff and uncomfortable. Sore neck and joint pain and a slight headache. I had a sore area across my arm (felt like a bruise although there was no discoloration) about 1 inch inch below the injection sight which was on my upper left arm. That persisted for several days. I slept and took 1 800 mg Ibuprofen (on 1/27/2021). Am feeling better but still not feeling 100 %. That may be due to increased allergies due to time of year of etc a

Other Meds: 1 ea Dextroamphetamine ER 15 mg cap am, hyaluronic acid, MSM,

Current Illness: No other illnesses.

ID: 1021903
Sex: M
Age: 70
State: IN

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/11/2021
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: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: chills, aches, and nausea.

Other Meds: crestor, blood pressure medication

Current Illness: none

ID: 1021914
Sex: M
Age:
State: FL

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 02/11/2021
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: having trouble bending his right elbow; swollen right elbow; very painful; This is a spontaneous report from a contactable consumer, based on information received by Pfizer from Bristol-Myers Squibb (manufacturer control number: US-BRISTOL-MYERS SQUIBB COMPANY-BMS-2021-010782), license party for apixaban (ELIQUIS). This case was received via Pfizer Inc (Reference number: 2021102713) on 26-Jan-2021 and was forwarded to BMS on 02-Feb-2021. This spontaneous case was reported by a consumer and describes the occurrence of arthropathy (having trouble bending his right elbow), joint swelling (swollen right elbow) and pain (very painful) in 79-year-old male patient who received apixaban (ELIQUIS) tablet for cerebrovascular accident prophylaxis. Co-suspect products included COVID-19 vaccine injection for prevention. Concurrent medical conditions included congestive heart failure, type II diabetes mellitus and hypertension. On an unknown date, the patient started ELIQUIS (oral), 1 tab twice a day. On 21-Jan-2021, the patient started COVID-19 vaccine (intramuscular). On 22-Jan-2021, an unknown time after starting ELIQUIS, the patient experienced arthropathy (having trouble bending his right elbow), joint swelling (swollen right elbow) and pain (very painful). The dose of ELIQUIS (oral) was not changed. At the time of the report, arthropathy outcome was unknown, joint swelling did not resolve and pain was resolving. For ELIQUIS (oral), the reporter did not provide any causality assessments.

Other Meds: ALLOPURINOL; SPIRONOLACTONE; BUSPIRONE HYDROCHLORIDE; FINASTERIDE; GLIPIZIDE; VALSARTAN; DOXAZOSIN MESILATE; LOPERAMIDE; COLECALCIFEROL; PRAVASTATIN SODIUM; FUROSEMIDE; CARVEDILOL

Current Illness: Congestive heart failure; Hypertension; Type II diabetes mellitus

ID: 1021915
Sex: U
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 02/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: felt dizzy; VIRAL INFECTION FOLLOWING; This case was reported by a physician via sales rep and described the occurrence of dizziness in a patient who received Men B NVS (Bexsero) for prophylaxis. Co-suspect products included meningococcal B recom vaccine + aloh + omv pre-filled syringe device (Bexsero Pre-Filled Syringe Device) injection syringe for prophylaxis, Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent unspecified season) for prophylaxis and MENACTRA for prophylaxis. On an unknown date, the patient received Bexsero, Bexsero Pre-Filled Syringe Device, Influenza vaccine Quadrivalent unspecified season and MENACTRA. On an unknown date, unknown after receiving Bexsero, Bexsero Pre-Filled Syringe Device and Influenza vaccine Quadrivalent unspecified season, the patient experienced dizziness and viral infection. On an unknown date, the outcome of the dizziness and viral infection were unknown. The reporter considered the dizziness and viral infection to be related to Bexsero and Bexsero Pre-Filled Syringe Device. It was unknown if the reporter considered the dizziness and viral infection to be related to Influenza vaccine Quadrivalent unspecified season. This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences. Additional details were reported as follows: The case was reported by the mother. The age at vaccination was not reported. The patient felt dizzy, followed by viral infection. The mother of the patient looked up Meningococcal B and was convinced that it was pulled up adverse reaction. She did not want to report it because it was 3 vaccines. It was unknown if the reporter considered the dizziness and viral infection to be related to Menectra. This case had been linked with US2020AMR261157 reported by same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2020AMR261157:Same reporter

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm