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

Incidents per State

State Total
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 1069827
Sex: F
Age: 50
State: PA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: chicken nitrofurantoin shellfish sulfa histamine dihydrochloride

Symptom List:

Symptoms: Flushing, fingers tingling, fatigue and palpitations started. Benadryl 50 mg P O offered and taken. Observed for 30 minutes. Had no issues after 1st dose. Symptoms resolved and was released.

Other Meds: unknown

Current Illness:

ID: 1069828
Sex: F
Age: 71
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Had redness, soreness and itchiness for few days after initial shot.Went away in a few days with no problem.Nine days later same symptoms reappeared. Looked side effects on internet and article stated it was COVID arm and should go away in a few days.However article advised to report this to to site.

Other Meds:

Current Illness:

ID: 1069829
Sex: M
Age: 73
State: NM

Vax Date: 02/24/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: no known allergies

Symptom List:

Symptoms: Clients spouse, called to report adverse event. She reported that Medical Center directed her to call and make a report. Her spouse experienced a stoke 3 days following booster vaccination. Is currently hospitalized at Medical Center.

Other Meds: losartan ashwagandha turmeric multi vitamin

Current Illness: none

Date Died: 01/26/2021

ID: 1069830
Sex: F
Age: 87
State: MO

Vax Date: 01/08/2021
Onset Date: 01/25/2021
Rec V Date: 03/03/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NSAIDS

Symptom List:

Symptoms: From CT Scan in ED at 7:40 pm on 1/25/2021 -- There is a large intraparenchymal hemorrhage with Surrounding vasogenic edema within the left occipital lobe. There is additional subdural hemorrhage layering along the left frontal, temporal and parietal convexity which may be decompressing from the area of intraparenchymal hematoma. No visualized intraventricular hemorrhage.There is some trace hemorrhage layering along the left tentorium cerebelli. Severe associated mass effect with left-to-right midline shift of 2.1 cm. There is subfalcine and downward transtentorial herniation with complete effacement of the basilar cisterns. Evaluation of the craniocervical junction is limited due to beam hardening artifact. Near-complete effacement of the left lateral ventricle. No head trauma or fall. Deceased 1/26/2021

Other Meds: aspirin 81 mg daily; Tylenol arthritis 650 mg daily; calcium and vit d; meclizine 12.5 mg daily; Fosamax 70 mg every 7 days; Toprol 50 mg ext release daily; cozaar 50 mg daily; levothyroxine 100 mcg daily; crestor 10 mg MWF; plaquenil 400

Current Illness:

ID: 1069831
Sex: F
Age: 66
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: Patient stated about 10 minutes after receiving the vaccine she developed a lot of saliva, and also had what appeared to be a small red rash to the upper chest. Patient was looked at by M.D. and ordered Benadryl 25mg po, and XYZAL 5mg po. We then observed her for another 15 min so a total of 30 minutes she seemed to be doing better. Told if worsens to give our office a call or ER if feels like she cant breathe or severe hives. We will follow up with patient later today.

Other Meds: Amlodipine, Lisinopril, Omeprazole, Gabapentin.

Current Illness:

ID: 1069832
Sex: F
Age: 82
State: IL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: ACE INHIBITORS, NAPROXEN

Symptom List:

Symptoms: PT WHILE WAITING IN OBSERVATION AREA FOR ALOTTED 30 MINUTES STARTED TO BECOME DIZZY 20 MINUTES AFTER ARRIVAL. VITALS WNL. PT WAS PROVIDED WITH WATER AND CLOSE OBSERVATION. PT REMAINED IN AREA FOR AN ADDITIONAL 30 MINUTES WITH OBSERVING RN; SYMPTOMS RESOLVED. PT WENT HOME

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1069834
Sex: F
Age: 76
State: TN

Vax Date: 01/30/2021
Onset Date: 02/02/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin and Tetracycline

Symptom List:

Symptoms: Patient states left hand has been having intermittent throbbing pain up to wrist starting 2 days after receiving second Moderna dose.

Other Meds: Hydrochlorothiazide 25 mg

Current Illness: None

ID: 1069835
Sex: F
Age: 44
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: unspecified allergic rhinitis

Symptom List:

Symptoms: Several (>4) hours after vaccination patient started feeling fevers and severe body aches - presented to ER where she was found to be borderline hypotensive (systolic BP 80s v. baseline low 100s) - received IV fluids with resolution. Observed inpatient for 24 hours.

Other Meds: cetirizine, nasal fluticasone

Current Illness: none

ID: 1069836
Sex: F
Age: 41
State: MA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Nausea, vomiting, dizziness, headache, fever, body aches

Other Meds: None

Current Illness: None

ID: 1069837
Sex: M
Age: 80
State: RI

Vax Date: 02/16/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Clindamycin

Symptom List:

Symptoms: headach, runny nose, orange/reddish coloring in 3" circle at injection site, 14 days after injection, lasted 6 hours.

Other Meds: none

Current Illness: "C Diff" one month before

ID: 1069838
Sex: F
Age: 39
State: MA

Vax Date: 02/12/2021
Onset Date: 02/28/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Environmental, Exercise induced anaphylaxis, Sulfa medications

Symptom List:

Symptoms: May or may not be related, but found a soft, non tender, mobile, dime sized lump out of the blue over R clavicle

Other Meds: Multi Vit OCP

Current Illness: NA

ID: 1069839
Sex: F
Age: 44
State: NY

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Bee Stings/Anaphylaxis Penicillin/hives Chocolate/Anaphylaxis Shrimp/Hives

Symptom List:

Symptoms: Shaking chills and a fever of 101 on the vaccine. Fever of 103 degrees on the next day. Some Lymph node pain. Muscle aches and fatigue not much memory of that day.

Other Meds: MLodipine

Current Illness:

ID: 1069840
Sex: F
Age: 58
State: PA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: amoxicillin penicillin baby oil

Symptom List:

Symptoms: Fingers tingling and flushing. Benadryl 25 mg PO offered and taken. Stated felt much better. BP initially was 194/82, on recheck was 177/86. Does have history of hypertension. No issues with first dose, released after 30 minutes.

Other Meds: unknown

Current Illness:

ID: 1069841
Sex: F
Age: 34
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Left arm numbness; BP 141/80 (pulse 67); f/u BP 134/74 (pulse 79).

Other Meds:

Current Illness:

ID: 1069842
Sex: F
Age: 52
State: MO

Vax Date: 02/12/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Left sided facial weakness, tongue feels numb on left side, speech just a little off but no left arm weakness or anything else. Ear pain on the left side and headache. CT Head done on 2/26/21 at ER resulting in no acute intracranial process. Diagnosed with Bell's Palsy and started on 7 days of Valacyclovir HCL 1 gram - 3 times a day and Prednisone 20mg - 3 in the morning for 5 days. Completed course of Prednisone morning of 03/03/2021. Symptoms no better with medications.

Other Meds: Aleve, Citalopram 20mg, Vitamin D 5,000IU

Current Illness: None

ID: 1069844
Sex: M
Age: 30
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No known allergies

Symptom List:

Symptoms: Patient had tightness in throat, then syncope shortly after, which let to him falling to the floor from a chair and hitting his head. After patient was released from vaccine site, he developed shortness of breath, and went to the ER, where he was given diphenhydramine, which patient says helped. Patient then had 10 days of symptoms neurological and cardiovascular symptoms (slowed cognition, mood changes, somnolence/hypersomnia, palpitations) and went to ER four times and was diagnosed with a concussion/post concussive syndrome. He was referred to neurology and had an EEG conducted. He was given prednisone during this time.

Other Meds: no known medications

Current Illness: none

ID: 1069845
Sex: F
Age: 49
State: NY

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Iodine, Divan, Latex

Symptom List:

Symptoms: Pt states she got her vaccine in her left arm, and went to the waiting area. As soon as she got to the waiting area she felt like her throat was swelling. Denies SOB, changes in voice, or difficulty breathing. Pt states something similar happen after she got the flu shot this year and she took benadryl without issue. Pt was given a duoneb and 50 mg benadryl. Pt is feeling much better. VSS.

Other Meds: Trileptal, Wellbutrin, Nystatin, Dexilant, Dicyclomine, Xyzal, Singular, Pepcid, Prozac, Trilegy, Albuterol, Vit D, magnesium

Current Illness: no

ID: 1069846
Sex: F
Age: 72
State: MO

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: cumin, tape, silver sulfadiazine

Symptom List:

Symptoms: double vision, dizziness, head feeling foggy, not feeling like herself

Other Meds: Benicar 20mg, vitamin C 500mg, stool softener, albuterol sulfate HFA 90mcg, metoprolol tartrate 100mg, amiodarone 100mg, calcium 500mg, vitamin D3 5,000 units, glucosamine 500mg, Aspirin 81mg, fish oil 1,000mg, Flonase sensimist 25.5mcg, a

Current Illness: no

ID: 1069847
Sex: F
Age: 54
State: TX

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin, Sulfa, Iodine, Shellfish

Symptom List:

Symptoms: Dizziness

Other Meds: Dizziness

Current Illness: Brain seizures

ID: 1069848
Sex: F
Age: 67
State: CT

Vax Date: 02/15/2021
Onset Date: 02/25/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: All penicillins, Amoxycillin, Biaxin, Flagyll, Doxycycline, Levaquin, Heparin, Meloxicam, Keflex, Omnipaque, Cefuroxime, oxycodone, codeine

Symptom List:

Symptoms: I had severe arm pain and redness for 2 days following the injection, accompanied by fever (101 degrees), chills, and great fatigue. All resolved by the third day. But on the tenth day after the vaccination, I woke to a sore left arm with a raised bright red rash in the bicep area approximately 4 inches wide and 7 inches long . The entire upper arm area was swollen. The pain, swelling, and redness gradually reduced over the next 6 days. By the 4th day, a swath about 2 inches wide extended from wider bicep rash down to nearly the elbow. Today is the 6th day since the rash appeared. Most of the original area has cleared and the swelling is decreased, but the newer swath remains red, though lighter than originally. During this time I felt unwell and tired, often with a slight fever of 99 (usual is 97).

Other Meds: Atovastatin, Lisinopril, Montelukast, pantoprazole, Vit. D-3, and Zyrtec that morning.. Took 2 benadryl 1 hour before vaccination.

Current Illness:

ID: 1069849
Sex: F
Age: 70
State: NC

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Tylenol

Symptom List:

Symptoms: The patient vision started becoming blurry on the same side of the injection was taken. Vision blurry started an hour or two afterward. Following the vaccination, the next day, the vision was blurry up until Friday 02/26/2021. The patient vision cleared up later that night.

Other Meds: Aspirin 81mg EC Low Dose Tablets, Vitamin D3 2000unit Capsules, Amlodipine Besylate 10mg Tablets, Enalapril 20mg Tablets, Spironolactone 25mg Tablets, Rosuvastatin 10mg Tablets

Current Illness: none

ID: 1069850
Sex: F
Age: 33
State: CO

Vax Date: 01/20/2021
Onset Date: 02/13/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: LMP 1/10/2021. Moderna vaccine #2 1/20/2021. Positive pregnancy test 2/2/2021. Confirmed loss by US 2/13/2021 and decreasing quant. D&C 2/19/2021

Other Meds: Prenatal vitamin, probiotic

Current Illness: None

ID: 1069851
Sex: M
Age: 65
State: MN

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: he had monoclonal antibodies 12/10/20, he didn't report this at the time of his first Moderna dose. Prior to receiving dose 2, he noted the MAB therapy of 12/10. He had no symptoms or adverse events with the first dose.

Other Meds:

Current Illness:

ID: 1069852
Sex: M
Age: 86
State: VA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: After receiving the injection and while walking the 75 yds to my parked car I experienced shortness of breath. This has continued, along with general tiredness, and I have seen my primary care doctor who referred me to a cardiologist. Both reported low heart rate. I am seeing a Electrophysiologist tomorrow and expect to have pacemaker surgery. I have heard anecdotally now of a relative who developed low heart rate after 2nd Moderna shot . I wonder if there is a relationship between low heart rate and the vaccine.?

Other Meds: Various

Current Illness: none

ID: 1069853
Sex: F
Age: 52
State: DC

Vax Date: 02/19/2021
Onset Date: 02/28/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: After vaccination I experienced the expected soreness in my arm and general malaise for 48 hours. Eight days later, I woke up with large area of redness and warmth around the vaccination site. Visited urgent care, cause it was Sunday, and was diagnosed with cellulitis of the arm. I was given Bactrim DS 800mg BID x 7 days. On March 1st, 2021 I contacted my doctor, who said that I may not have cellulitis, but an adverse effect to the Moderna vaccine and he has seen similar reactions to Moderna with his office staff.

Other Meds: none

Current Illness: none

ID: 1069854
Sex: M
Age: 58
State: MI

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient received a third dose of the moderna covid vaccine . A VAR form was provided and staff stated this was the patients second dose and not third dose. After further investigation, it was discovered the dose we provided was the third dose. There were no immediate ADRs.

Other Meds:

Current Illness:

ID: 1069855
Sex: F
Age: 75
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient complaint of tickle/ itchiness in throat and was anxious and jittery at 1253. Then she had generalized itchy fore head ,bilateral eyes, throat and ears. Vital signs within normal. Patient was placed in recumbent position and was given apple juice. Patient stated all symptoms resolved at1312 and was discharged home.

Other Meds:

Current Illness:

ID: 1069856
Sex: M
Age: 44
State: NE

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Mental fogginess, to the point a coworker had to drive him home. In the evening became achy all over severe arm pain at injection site, and temperature. Phoned PCP who told to go to the ER and he did not. went to PCP office 2/1/21.

Other Meds:

Current Illness:

ID: 1069857
Sex: F
Age: 39
State:

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: VACCINE GIVEN @ 111O AM. APPROXIMATELY 10 MINS POST INJETION PT C/O ITCHING TO FACE. NO EDEMA, SOB, VERTIGO REPORTED. 50MG PO BENADRYL GIVEN TO PATIENT. PATIENT KEPT 50 MINUTES FOR OBSERVATION LEFT IN STABLE CONDITION.

Other Meds:

Current Illness:

ID: 1069858
Sex: M
Age: 29
State: MI

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Mild headache and heartburn five minutes after injection. No treatment. Vital signs stable. Heartburn completely resolved after about 15 minutes. Mild headache remained after 30 minutes.

Other Meds:

Current Illness:

ID: 1069859
Sex: F
Age: 64
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: hayfever-watery eyes

Symptom List:

Symptoms: Today at 12:42 patient?s companion flagged nurse down that the pt wasn?t feeling so good. Pt reported that she was feeling dizzy and was seeing flashing lights. Pt reported that she hadn?t eaten any breakfast this morning prior to getting her vaccine. Pt reported that she only had a cracker and hadn?t had water/fluids to drink today. Pt reported that she received her first Moderna vaccine today at 12:24 pm. Pt was offered some fruit to eat and tolerated food well. Pt reported she was starting to feel much better. Pt reported that her symptoms had subsided and she felt okay to leave. PHN advised pt to at least wait 30 min in total to assure that she was okay. Pt verbalized understanding and remained seated until 30 minutes passed. Pts vitals at 12:43 were 130/84 blood pressure, saturation at 96%, respirations 17, and 84 bpm. Vitals were taken again at 12:57, 122/78, 99% saturation, 80 bpm, and respirations 18. At 13:10 pts vitals were taken again, blood pressure 118/70, 97% saturation, respirations 18, and 83 bpm. Pt reported that she does not take any medications on a daily basis, but did take Tylenol this morning for a HA. Pt denied any supplements or herbal remedies. Pt denies that she has any chronic health conditions. Pt denied ever having Covid. Pt reported that she was feeling much better. Pt denied any symptoms and that her symptoms have subsided. Pt was offered some water, but stated that she had water in her car. Pt was released to go home, vitals were within normal limits, and pt was no longer having any symptoms. Pts left with her companion. Pt signed the reporting form that she was okay. PHN advised that if pts symptoms return or if she doesn?t feel well after leaving to seek immediate medical attention and/or can follow-up with her primary care provider. Pt verbalized understanding.

Other Meds: NONE

Current Illness: none

ID: 1069860
Sex: F
Age: 36
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Debilitating joint pain, fatigue. Difficulty breathing. Joint pain and fatigue did not subside. Was later diagnosed with autoimmune Rheumatic fever. Possibility this was lying dormant prior to vaccine?

Other Meds:

Current Illness:

ID: 1069861
Sex: F
Age: 50
State: NC

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
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Allergies: none noted

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Symptoms: 4 HOURS POST VACCINATION, PATIENT STATED THAT SHE BEGAN HAVING "TROUBLE GETTING HER BREATH AND HER HEART WAS RACING" . WHEN ASKED IF SHE EXPERIENCED ANY OTHER SYMPTOMS OR FACIAL EDEMA , SHE REPLIED THAT "THE MIDDLE OF HER UPPER LIP SEEMED SWOLLEN". ALL SYMPTOMS RESOLVED AFTER 40 MINUTES. SHE REPORTED THESE SYMPTOMS AT 2:00PM ON 3/3/2021 TO THE VACCINATING PHARMACY. SHE IS CONCERNED ABOUT TAKING 2NF MODERNA VACCCINE AND ALLERGIC IMPLICATIONS.

Other Meds: unknown

Current Illness: none noted

ID: 1069862
Sex: F
Age: 75
State: IL

Vax Date: 02/01/2021
Onset Date: 02/22/2021
Rec V Date: 03/03/2021
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Allergies: Mold dust sulfa drugs Pentamidine meropenim

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Symptoms: Deep red rash over injection site. Approximate size 6? x 3?

Other Meds: Levothyroxin, losartin,simvastatin, vitamin D, acyclovir, venetoclax

Current Illness:

ID: 1069863
Sex: F
Age: 59
State: IL

Vax Date: 03/01/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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Allergies: AMOXICELLIN, SULFA MEDS, AND BENADRYL

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Symptoms: PT WAS SITTING IN 15 MINUTE OBSERVATION AREA FOLLOWING HER VACCINATION AND BEGAN TO HAVE A "TINT TASTE" TO HER TONGUE. PT STATES SHE NORMAL TAKE CETIRIZINE 10 MG AT HOME PO DAILY HOWEVER DID NOT TAKE IT TODAY. HAS HAD ALLERGIES TO OTHER MEDICATIONS LISTED ABOVE WHERE HAD TO BE GIVEN SOMETHING. PT WAS GIVEN A DOSE OF CETIRIZINE 10 MG PO. PATIENT WAS OBSERVED UNTIL FULL RECOVERY OCCURRED 45 MINUTES LATER

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1069864
Sex: M
Age: 76
State: IL

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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Allergies: penicillin

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Symptoms: allergic rash all over body , itchy

Other Meds: none

Current Illness:

ID: 1069865
Sex: F
Age: 81
State: VA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 03/03/2021
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Allergies: Penicillin, sulfa Gluten, corn, legumes, nightshade plants

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Symptoms: Dizziness, lightheadedness, wheezing, chills, headache, body aches, sore arm - 6 to 8 hours Arm swelling, hard lump, redness near injection site - began on day February 15. Hardness lasted five days, redness lasted 13 days Sleep disturbances - difficulty getting to sleep, waking in middle of night with feeling of disorientation - began on February 15 and lasted for four nights. Eye pain with feeling of object in eye and red, itchy eyelids. Began February 17 and recurred intermittently for six days.

Other Meds: Mega Foods Multi-vitamin

Current Illness: None

ID: 1069866
Sex: F
Age: 77
State: TX

Vax Date: 02/08/2021
Onset Date: 02/10/2021
Rec V Date: 03/03/2021
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Allergies: none

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Symptoms: soarness of arm and discoloration at injection site, pain radiating through back of shoulder/neck to elbow. Self care at home

Other Meds: blood pressure medicine, vitamin d, vitamin b-12

Current Illness: none

ID: 1069868
Sex: F
Age: 28
State: CA

Vax Date: 02/24/2021
Onset Date: 02/28/2021
Rec V Date: 03/03/2021
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Symptoms: R axillary pain secondary to R axillary lymphadenopathy since 3/1/21 morning (x2days). the night before that, her R shoulder was hurting but that resolved with onset of R axillary pain.

Other Meds:

Current Illness:

ID: 1069869
Sex: F
Age: 70
State: NY

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 03/03/2021
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Allergies: ceftin

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Symptoms: the day after my first vaccination I woke with bilateral wrist stiffness and pain, bilateral ankle knee and swelling in my ankles. This subsided in a few days. I was holding off on taking my Orencia infusions because I wasn't sure when I would be able to get the vaccine. Orencia dosing is every 4 weeks and I am supposed to take any vaccinations two weeks post infusion. After my second vaccination, I had a full flare. Swollen joints, IBS symptoms, fatigue,fevers, decreased appetite. I went to my rheumatologist and scheduled an infusion as soon as possible. I had to stop taking NSAIDs because my creatinine became abnormal. I had my Orencia 750mg on Februray 1, 2021, but continued to feel ill and started a prednisone

Other Meds: ramipril, metoprolol,acetaminaphen, ibuprofen, hydoclorothiazi

Current Illness: sero-negative rheumatoid arthitis

ID: 1069870
Sex: M
Age: 77
State: KS

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 03/03/2021
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Allergies: Penicillin

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Symptoms: Patient states that a day after having the vaccine, he developed severe stiffness in his hips and shoulders, muscle aches, had a headache on and off, chills, felt tired, had night sweats, lost his appetite, and taste was off. There symptoms lasted 10-12 days. He was tested for Covid 19 on 2/28 with an antigen test and was negative and tested again on 3/2 with a PCR and was negative . He is starting to feel better now. Called his physician who felt that these symptoms were due to the vaccine, encouraged him to go ahead and get second dose.

Other Meds: Eloquis, Digoxin, Tamsulosin, Citalopram

Current Illness: none

ID: 1069871
Sex: F
Age: 62
State: CT

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
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Allergies: Penicillin Omeprazole IC Hyxchloredine Fluticazone

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Symptoms: Within 6 hours I was fatigued and went to bed early at 8:30. Extremely thirsty in the night and developed a Post nasal drip. Woke later than usual at 9:00 feeling very feeble- nauseated, tired, muscle twitching. Sat for two hours. No appetite. Headache developed and fever of 100.8 F at 11:00 AM. Call my doctor. Spoke to Advice nurse who said to relax if still with symptoms in 48-72 hours call back for a telehealth appointment. Took acetaminophen. Head still hurt . Went back to bed.Fever down at noon to 99.5F. Ate a popsicle at 1:00 PM and vomited it up at 1:45. Have been resting since it?s almost 5:00 PM.

Other Meds: Multivitamin

Current Illness: None

ID: 1069872
Sex: F
Age: 74
State: MI

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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Symptoms: Patient received a third dose of the moderna covid vaccine bedside at the LTCF. A VAR form was provided and staff of the LTCF stated this was the patients second dose and not third dose. After further investigation, it was discovered the dose we provided was the third dose. There were no immediate ADRs.

Other Meds:

Current Illness:

ID: 1069873
Sex: M
Age: 37
State: OH

Vax Date: 02/19/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
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Allergies: Penicillin

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Symptoms: Swollen armpit lymph nodes

Other Meds: NA

Current Illness: NA

ID: 1069874
Sex: F
Age: 62
State: VA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/03/2021
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Symptoms: Moderna Covid-19 EUA. This was reported to me by RN who tried to fax form to VAERS unsuccessfully. Client was administered the vaccine on 2/24/21, 23 days after receiving the first dose. No adverse events were reported.

Other Meds:

Current Illness:

ID: 1069875
Sex: F
Age: 65
State: PA

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 03/03/2021
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Allergies: Anchovies..ladicane...narcotics

Symptom List:

Symptoms: Headache Aches Very sore arm shot arm Lymph nodes left side neck enlarged for a few hours Note!! 2nd dose...headach ... chills..and on opposite hand and top of forearm. .numb and arthritic for 2 days!

Other Meds: Metoprolol 50 mg twice a day, losartin 50 mg 1 x day

Current Illness:

Date Died: 02/28/2021

ID: 1069876
Sex: M
Age: 73
State: OR

Vax Date: 02/20/2021
Onset Date: 02/22/2021
Rec V Date: 03/03/2021
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Allergies: NKDA

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Symptoms: Vaccinated 2/20. At that time, had symptoms of incarcerated hernia, went to ED for evaluation. Not felt to warrant hospital admission. Returned two days later with agitation, altered mental status, and incarceration. Went to OR, uncomplicated hernia repair. Postoperatively, did not recover mental status. Went into arrythmias POD 4, hypotension ensued, had multiple interventions and evaluations without satisfying answers for clinical course.

Other Meds: Albuterol , Budesonide, Clotrimazole, Levothyroxine, Lorazepam, Methadone, Nicotine 2mg gum , Polyethylene glycol, Potassium chloride, Sennosides, Tamsulosin, Tiotropium, Torsemide

Current Illness: Incarcerated ventral/incisional hernia

ID: 1069877
Sex: F
Age: 36
State: NY

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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Allergies: None

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Symptoms: Approximately 10 minutes after injecting the 2nd dose of COVID19(Pfizer-bioNTech) the patient made me aware of numbness/tingling in her feet. She explained it like her feet falling asleep. Approximately 5 minutes later she said the sensation was radiating up her right leg. She said the symptoms subsided in her leg after approximately 10 minutes. She had no trouble standing or walking. At approximately 3:15pm she proceed to her shift. I was leaving the building at approximately 3:35pm and verified with her that the symptoms did not proceed any further and at this point of time she did not feel she needed emergency medical intervention

Other Meds: Multiple vitamins and vitamin C

Current Illness: None

ID: 1069878
Sex: F
Age: 70
State: CA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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Allergies: Shellfish, environmental Currently not taking any medication for allergies. Patient stated "they tend to go away on their own."

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Symptoms: Patient stated that at 12:40 PM she began to fell itchy. Red 2 inch rash was present on the left wrist to hand area. 5 mm rash also appeared on the right forearm as well as small macular papules located on left and right antecubital areas. Vaccine site was warm to touch. No redness or rash noted in that area. Patient continued to be monitored. At 12:53 patient stated still feeling itchy. Given 10 mg tab of Zyrtec PO. As well as given ice pack to help with itching. Vitals at 12:55 PM were as follows T: 97.3, BP: 159/96, P: 86, RR:18. Patient monitored for an additional 15 minutes. At 13:10 vitals were as follows: T: 97.9, BP: 148/94, P: 76, RR: 18. No s/s of SOB or wheezing present. Patient instructed to follow up with primary care, ER, or urgent care regarding elevated BP as soon as possible and also in regards to hives and s/s of reaction to vaccine given if symptoms worsen. Patient alert and verbalized understanding and agreed to follow instruction

Other Meds: Anti-depressant and thyroid medication

Current Illness: N/A

ID: 1069879
Sex: M
Age: 73
State: KS

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
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Allergies: iodine

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Symptoms: Chief Complaint Pt here for muscle pain/stiffness. Pt stated, 'About 1d after my COVID shot, I started feeling bad. Neck pain that goes down my arm (R), extreme fatigue and achy. I've lost 5lbs in 3d.' MEDS UTD History of Present Illness "I had that COVID shot Thursday (l arm). Friday I started having cramps in my neck--base of my skull, R arm, into the base of my jaw." Worse with laying down, sleeping on L side. "Hurt too much to get up" (had wife help him up to bathroom). Tried? Bayer back and body only. Tried some topical ben gay (made worse), vibration therapy. Hot shower seemed to help. Review of Systems + for chills, HA, diarrhea. Worst yesterday. Missed work yesterday. Had been eating/drinking well until recently. Assessment/Plan 1. Adverse reaction to vaccine T50.Z95A 2. Myalgia after COVID-19 vaccination M79.10 1. Adverse vaccine response will be reported. This seems to be fairly significant due to being 5d after. 2. Will try Tyl 1000mg up to tid and Ibu 400 up to tid-qid for next 3 days--try to get dose of each at hs tonight. Push fluids. Prednisone 20mg/d x 5d. Call report tomorrow on status. 3. At this time, will likely avoid 2nd Moderna covid vax in this pt due to reaction. 4. Note provided for off work yesterday through tomorrow. Orders: predniSONE, 1 tab(s), Oral, Daily, X 5 day(s), # 5 tab(s), 0 Refill(s), 03/08/21 14:14:00 CST

Other Meds: albuterol 0.63 mg/3 mL (0.021%) inhalation solution, 0.63 mg= 3 mL, NEB, TID aspirin 81 mg oral tablet, 81 mg= 1 tab(s), Oral, Daily cyanocobalamin 1000 mcg oral tablet, 1000 mcg= 1 tab(s), Oral, Daily fluorouracil 5% topical solution, 1

Current Illness: none

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm