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: 1069873
Sex: M
Age: 37
State: OH

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

Lab Data:

Allergies: Penicillin

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
Hospital:

Lab Data:

Allergies:

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
Hospital:

Lab Data: None

Allergies: Anchovies..ladicane...narcotics

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
Hospital:

Lab Data: Too numerous to list

Allergies: NKDA

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
Hospital:

Lab Data: none

Allergies: None

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
Hospital:

Lab Data: Vitals as listed above

Allergies: Shellfish, environmental Currently not taking any medication for allergies. Patient stated "they tend to go away on their own."

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
Hospital:

Lab Data: none

Allergies: iodine

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

ID: 1069880
Sex: F
Age: 76
State: NY

Vax Date: 01/22/2021
Onset Date: 02/22/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Sulpha, Penicillen

Symptoms: Schamburg's Cappillarits

Other Meds: Valtrex, Lamisil, Calcium, Multi-Vitamin, Biotin, Progestin, Estrogen transdermal patch.

Current Illness: None

ID: 1069881
Sex: F
Age: 87
State: MN

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

Lab Data: EKG

Allergies: unknown

Symptoms: Several minutes after vaccine patient stated that she felt dizzy and felt tachycardia.

Other Meds: unknown

Current Illness: unknown

ID: 1069883
Sex: F
Age: 71
State: AR

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

Lab Data:

Allergies: codeine, sulpha, formaldehyde, latex

Symptoms: Moderna Covid 19 Vaccine EUA- First signs after getting the injection on Friday were injection site soreness and a softball size redness around the site. Later that evening, this was followed by fever and chills, headache, nausea, severe muscle aches and pains, and dizziness and weakness. The fever and nausea were gone after about 36 hours. Then after about 48 hours, I began to have a gradual diminishment of head and body aches and, fatigue. Since it was the weekend, I could not reach my regular doctor or clinic and I assumed that the symptoms would get better and by Monday, I was generally just fatigued. I did not take any of my own meds or pain relievers as I was unsure how they might affect the vaccine.

Other Meds: estradiol, fenofibric, cetirizine, omega 3, lansoprazole

Current Illness: tested positive for covid 12/28/20 mild fatigue with loss of t

ID: 1069884
Sex: F
Age: 19
State: OK

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

Lab Data:

Allergies: Hay fever, cats

Symptoms: Mild Nausea, dry mouth, muscle tenderness near injection site and muscle stiffness in the entire arm

Other Meds:

Current Illness:

ID: 1069885
Sex: F
Age: 36
State: CA

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

Lab Data:

Allergies:

Symptoms: Anxiety; BP 113/76 (pulse 86), O2 sat 96%. Juice given to patient.

Other Meds:

Current Illness:

ID: 1069886
Sex: M
Age: 0
State: TX

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

Lab Data: no

Allergies: NKDA

Symptoms: infant went into a "trance" spell for 6 seconds and would not respond to any form of stimulus.

Other Meds: no

Current Illness: no

ID: 1069887
Sex: U
Age: 20
State:

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

Lab Data:

Allergies:

Symptoms: PT NOTICED SWELLING START TO OCCURE AT 0950. HAD VACCINE AT 0930. EMPLOYEE THEN MENTIONED WITH FIRST DOSE TONGUE/THROAT ITCHED FOR 2 WEEKS. PT. HAD SORE TOUNGE (BLISTERED), SWELLING OF THROAT/TOUNGE, DIZZINESS, HEADACHE, AND FAST HEARTBEAT. PT. SENT TO THE EMERGENCY ROOM.

Other Meds:

Current Illness:

ID: 1069888
Sex: M
Age: 86
State: MI

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

Lab Data:

Allergies: none

Symptoms: Nausea Dizziness Had slight seizure (lasted approximately 5 seconds- arms up and shaking, eyes closed, fell back in chair) Cold sweats (still nauseous 3 1/2 hours after injection, unable to keep anything down (including water)

Other Meds: Effexor 150mg Donepezil 5 mg Furosemide 40 mg Simvastatin 10 mg Lisinopril 10 mg Seroquel 25 mg Latanoprost (eye drops for Glaucoma) Acetaminophen 500 mg

Current Illness: none

ID: 1069889
Sex: M
Age: 75
State: MI

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

Lab Data:

Allergies:

Symptoms: Patient received a third dose of the moderna covid vaccine bedside at a medical facility. A VAR form was provided and staff of the medical facility 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: 1069891
Sex: F
Age: 58
State: IA

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

Lab Data: 2/21/21 lab tests in ER

Allergies: no

Symptoms: High temp, ache all over, severe headache,, head to toe all over body edema, systemic body rash and itching. Took Benadryl and caused elevated b/p. Went to ER and had steroids.

Other Meds:

Current Illness: may have been at the end of mild case of COVID

ID: 1069892
Sex: M
Age: 45
State: MO

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

Lab Data: Cbc 3-1-21

Allergies: Na

Symptoms: Extreme fatigue, Joint Pain full body, muscle pain, rapid heart rate, chest discomfort onset within 2-3 hours. Progressive joint pain and headache within 24 hours, chest discomfort in and around the heart. Sought medical treatment after pain discomfort dis not alleviate within 3 days, on 3/1/21. Dr. prescribed steroid injection for inflammation, ordered cbc (negative) with follow up. Possible indications of possible Pericarditis. Follow up within 24-48 hours. Joint pain has lessened from total body to being located in wrists, knees, ankles, toes. Pressure/discomfort around heart/chest has lessened but not been eliminated. Awaiting possible ECG/EKG

Other Meds: Na

Current Illness: Sinusitis

ID: 1069893
Sex: M
Age: 72
State: CO

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital: Y

Lab Data: Please contact Dr.

Allergies: None

Symptoms: Transported to Emergency by ambulance. Ran blood work, MRI, CAT, hard ECHO, administered antibotics and ran extensive testing to identify potential sources that could cause illness after vaccination.

Other Meds: Lisinopril-HCTZ 20-12.5 MG TAB

Current Illness: None

ID: 1069894
Sex: F
Age: 54
State: CO

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None performed

Allergies: grass, pollen, ragweed

Symptoms: Moderna COVID- 19 Vaccine EUA: Patient presents to clinic ten days after receiving vaccine. Reports enlarged, painful right axiallary lymph node (size of a golf ball), fever, and chills one day after vaccination. Three days after vaccination symptoms improved but four days after vaccination noticed right arm bruising. Ten days after vaccination patient reports axiallary tenderness and soreness but lymphadenopathy has resolved per provider. Vital signs all within normal ranges and patient discharged from clinic to home stable.

Other Meds: estradiol

Current Illness: None reported

ID: 1069895
Sex: F
Age: 17
State: NM

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

Lab Data: None

Allergies: None

Symptoms: Patient 1st dose was Pfizer-COVID 19 and for second dose, Moderna COVID-19 was inadvertently administered by the nurse.

Other Meds: None

Current Illness: n/a

ID: 1069896
Sex: F
Age: 52
State: CO

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

Lab Data:

Allergies: Tramadol, thimerosal

Symptoms: Almost immediately, within 5 minutes of injection got metal/burning sensation & taste in throat. Turned into kind of a sore throat within the hour, persisting a couple more hours. Sore arm within an hour (much quicker to start being sore than on dose #1). Fatigue already setting in, just 8 hours later.

Other Meds:

Current Illness:

ID: 1069897
Sex: F
Age: 58
State: NY

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

Lab Data:

Allergies: None

Symptoms: Severe headache, dizziness, buzzing in head, sore muscles, back pain

Other Meds: Tamoxifen 20mg 1x day Paxil 30mg 1x day

Current Illness: None

ID: 1069899
Sex: F
Age: 61
State: CA

Vax Date: 01/11/2021
Onset Date: 01/16/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Brain MRI w/contrast (normal). Cervical spine MRI w/contrast (normal). All the blood and urine tests are normal. Tests and imaging performed on 2/5 and again on 2/25/21

Allergies: none

Symptoms: First headache, vertigo, dizziness, nausea, neck tension, left arm weakness. Progressed in the course of several weeks to both legs weakness, and then the right arm, tension in the jaw and the face (altered facial sensation). Poor balance. Symptoms continue getting worse. Unable to work.

Other Meds: nexium, atorvastatin

Current Illness: none

ID: 1069900
Sex: F
Age: 67
State: AZ

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

Lab Data: My doctor was able to drain my wound, please contact her for the results.

Allergies: None

Symptoms: I received the 1 dose on Feb 2nd at 10:30pm. I came home and went to bed. I slept in but when I woke up I had a small red bump on the outside of my left breast. That bump continued to grow larger. I went in to my Radiologist a week later and was put on antibiotics. I saw my doctor, my breast surgeon (Lumpectomy Mar 3, 2020). I had the Bracey Therapy for my Radiation. The diagnosis is that I have MRSA in my left breast. I am on a coctail of non-penicilin antibiotics. My Dr said I was ok to get the second dose so I had that on Feb 23, 2020. I didn't think this was related but I'm not sure. I think I would have noticed if I had it prior to the shot.

Other Meds: Letrozole 2.5mg, Citalopram 20mg, L-Thyroxine 75 mcg, Alleclear, Calcium, D3

Current Illness: None

ID: 1069901
Sex: F
Age: 66
State: CA

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Blood tests all normal, Covid ( rapid and hologic)and flu test negative. CRP 27.9 Done on Feb 19,2021

Allergies: no

Symptoms: nausea, low-grade fever - never more than 101.8, muscle aches, headache

Other Meds: Celebrex 200 bd, aria simposi (infusion),Synthroid .125d, folic acid 3mg d, aspirin 80mg d, rovustatin 10mg d, Zyrtec,rhinocort, multivitamin, probiotic

Current Illness:

ID: 1069902
Sex: F
Age: 72
State: IL

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

Lab Data:

Allergies: Iodine, Pretnizone, Antihistamines

Symptoms: Headaches began later in the afternoon after getting vaccine. Loss of sleep that is abnormal and worrisome due to seizure condition. Sore arm at injection site and general body aches present.

Other Meds: Levitria Sedom for seizures 1000mg, Amolatro 20mg for high blood pressure, Hydrocorithiaziate for high blood pressure

Current Illness:

ID: 1069903
Sex: F
Age: 46
State: SC

Vax Date: 02/22/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Covid test waiting for results

Allergies:

Symptoms: Rest

Other Meds:

Current Illness:

ID: 1069904
Sex: F
Age: 20
State: TX

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

Lab Data: none

Allergies: None

Symptoms: post vaccination, pt fainted. bp 132/84, HR 66. pt. aao x 3 almost immediately after fainting episode. Nurses kept patient on the floor, w/ legs elevated above pt.'s chest, and head on pillow. Mom stated, "this is just like when you had the Gardasil." 2n d bp 130/82, HR 62. Mother repeated the statement regarding the Gardasil, and also stated that "it was like she was having a seizure, but it was in the doctor's office so they just took care of everything." Note: Before vaccination, employee reviewed pre-vaccination checklist questions w/ Pt. Pt denied any previous reactions to vaccines.

Other Meds: None

Current Illness: None

ID: 1069905
Sex: F
Age: 78
State:

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

Lab Data:

Allergies:

Symptoms: SOB, nausea checked by EMS. 11:32am symptoms abating- breathing easier. Sent home

Other Meds:

Current Illness:

ID: 1069906
Sex: M
Age: 73
State: TX

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

Lab Data:

Allergies: None

Symptoms: Arm is red and warm approximately 3X5? area beginning about 24 hrs after injection and continues as of today (1 week) so far

Other Meds: Lisinipril Hydrochlorthoridade Simvastatin

Current Illness:

ID: 1069907
Sex: F
Age: 38
State: WA

Vax Date: 02/25/2021
Onset Date: 02/28/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Penicillin; sulfas

Symptoms: Onset: 3 days post vaccine. Nausea, vomiting, diarrhea. Headache, mild fever.

Other Meds: Seyeda; Duloxetine

Current Illness: None

ID: 1069908
Sex: F
Age: 38
State: MS

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Currently do not have medical insurance and therefore, have not been to clinic. But very concerned and will have to seek medical attention soon if pain and weakness to arm continues.

Allergies: No known allergies.

Symptoms: First was a large 1.5 inch diameter, red welp at site. For the next 60 hours, experienced severe migraine and joint pain. Red welp at site eventually turned purple with a large 4inchx1 inchx0.5 inch deep indention into muscle tissue at vaccine site. Arm has a constant dull ache that worsens with use and on palpation at site with noted weakness.

Other Meds: Melontin 2.5mg (2-3x a week)

Current Illness: None

ID: 1069909
Sex: F
Age: 79
State: MA

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

Lab Data: None

Allergies: Sulfa,keflex

Symptoms: Red warm,pain at inj site

Other Meds: Lipiter 10mg, lisinopril 20mg, metoprolol xl 25mg prolia q6 mo ,sertraline 100mg,calcium witth vit d 1200

Current Illness: None

ID: 1069911
Sex: M
Age: 71
State: MI

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

Lab Data:

Allergies:

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: 1069912
Sex: F
Age: 69
State: TX

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

Lab Data:

Allergies:

Symptoms: I experienced pain, body pain and swelling, red blotchiness for three weeks. I had extreme fatigue which messed up my potassium levels, had infrequent bowel movements and diarrhea. I had left arm pain and it was painful when doing my exercises. I had no fever, a horrible headaches that I was not hungry and felt very nauseated. I also experienced horrible chills but did not go to the hospital.

Other Meds:

Current Illness:

ID: 1069913
Sex: F
Age: 70
State: AZ

Vax Date: 02/10/2021
Onset Date: 02/19/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: NO

Symptoms: COVID ARM. SWELLING AND REDNESS OF INJECTION SITE

Other Meds: Vitamin D, Promethazine, omeprazole prn, fish oil, indapamide, pravastatin

Current Illness: No

ID: 1069914
Sex: F
Age: 65
State: IN

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

Lab Data:

Allergies:

Symptoms: Moderna COVID-19 Vaccine EUA fatigue, aches, weakness, dizziness, fainting, headache mostly the morning after receiving the shot symptoms gradually subsided during the day

Other Meds:

Current Illness:

ID: 1069915
Sex: F
Age: 49
State: MS

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

Lab Data: None as of now

Allergies: Shell Fish Demerol Codeine Pencillin

Symptoms: Severe headache, sore throat, ear ache/ear pain, coughing, fever, chills, arms ache. Feel horrible.

Other Meds: Lexapro, Vitamin C & D, Allegra 180

Current Illness: None

ID: 1069916
Sex: F
Age: 37
State: KS

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

Lab Data:

Allergies: Cefadroxil Eggs Corn Soy Honey Walnuts Wheat Chia seeds

Symptoms: Developed itching of left underarm and left upper back approx 5-10 min following injection and then sensation of throat swelling. Improved about20 minutes sheet taking Benadryl and then resolved

Other Meds: Omega 3 Probiotic Multivitamin Zyrtec Pepcid Singulair

Current Illness: None

ID: 1069917
Sex: M
Age: 78
State:

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

Lab Data:

Allergies:

Symptoms: During administration of vaccine, pt. turned head away from vaccinator and did not answer any questions would not respond to his name. A rapid response was called and pt. transported via ambulance to ER. Pt. had a history of seizures. "Not controlled with medications" per pt. Pt. discharged stable.

Other Meds:

Current Illness:

ID: 1069918
Sex: F
Age: 69
State:

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

Lab Data:

Allergies:

Symptoms: Pt did report some tingling to tip of tongue and declined staying past her 30 minute time frame with itching to rt leg. She stated that she had both tingling in her tongue at times and has had "Itchy skin jthis winter" patient states she has no other signs/symptoms of reaction. Staff encouraged her to stay longer than 30 minutes but she continued to decline. Bp was 153/67 p 80, RA sats of 99% per RN at 1315 and at 1324 bp was 158/75, pulse 87 and 97%RA. Patient states minimal itching to leg, no tingling and continues to decline being monitored at this time even with staff conversation/encouragement to stay additional 15 to 30 minutes. Encouraged her to notify her PCP of events and signs/symptoms to call 911

Other Meds:

Current Illness:

ID: 1069919
Sex: F
Age: 24
State:

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

Lab Data:

Allergies: no

Symptoms: feeling dizziness and faint apx 5 min post vaccination. no s/s of airway obstruction, breathing patent, lung sound clear. skin at injection site appears clear, no redness, no s/s of allergic reaction. v/s at 1339: 112/84, 74/m, 18/m, 98%. At 1349: 112/82, 68/m, 18/m, 99%. Patient stated that she drove one hour for vaccine clinic and had taken food 2 hr earlier and had not drank anything since then. she normally reacts to vaccines.

Other Meds: no

Current Illness:

ID: 1069921
Sex: F
Age: 48
State: NY

Vax Date: 02/27/2021
Onset Date: 02/28/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: pt presented with urticaria day after vaccination on 2/28/2021 which is persistent now 3/3/2021

Other Meds:

Current Illness:

ID: 1069922
Sex: F
Age: 69
State: MN

Vax Date: 02/18/2021
Onset Date: 02/25/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: bee stings, bites by insects,

Symptoms: After a week my arm started itching badly and swelled up. I had a red rash down the arm from the site of the vaccination to almost the elbow. My arm was very hot and red. I started taking Benadryl and am still taking it. The rash is still there but not as bad as it was. Wondering about the the second dose?

Other Meds: clonazepam, meteprolol, trazadone, Tylenol, and Zetia, CoQ10, Vitamin D3, Biotin. Miralax

Current Illness: none

ID: 1069923
Sex: F
Age: 73
State: AZ

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

Lab Data: N/A

Allergies:

Symptoms: Redness & swelling at the injection site & itchey

Other Meds:

Current Illness:

ID: 1069924
Sex: M
Age: 66
State: CA

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

Lab Data: See Hospital

Allergies: No

Symptoms: On 02/12/2021 around 11:00am I was assigned to have Covid 19 shot at the table#6. At that time I saw the Vaccine was already in the syringe which was in the plastic bag with zipper. Ten days after the shot I felt well, no pain nor swell on my left shoulder. But in the morning of 02/23/2021 after waking up I started to feel hurt to my left arm and the pain was transmitted to the left of my back (left lung). During these 3 days 23,24,25 my pain reached the maximum intensity 10/10 even I took 3 times a day Ibuprofen which was each time 2x200mg. On 02/26/2021 I went to Hospital in the Emergency Unit and after diagnosis the Doctors found that I had 3 heart arteries clog-up. How can I be sure that the liquid in the syringe is the Pfizer Vaccine or something else? I used to see the TVs broadcast on the Covid 19 shot that the nurse inserts the syringe in the small Pzifer bottle, suck the Vaccine into syringe and inject the vaccine into the shoulder of the patient. Can CDC require that all Covid 19 providers show the vaccine to all patients before the shot? In 2017 I had an Angiogram and my 3 bypasses were not clogged why they are all clogged now? I don't change my every day diet and I'm very careful with eating fat, cholesterol and salt in my everyday food.

Other Meds: None

Current Illness: No

ID: 1069925
Sex: F
Age: 32
State: WA

Vax Date: 01/11/2021
Onset Date: 02/05/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: NA, telemedicine visit to determine medication plan for second dose (contact information provided earlier) .

Allergies: Penicillin: rash

Symptoms: Within 5 minutes of 1st injection, flushed skin (chest arms and face) and feeling warm. No impact on breathing. Given 50 mg of Benadryl and monitored for 30 minutes by RN. BP went to 140/90 but all other vitals WNL. Typical BP is 115/70s. With Benadryl redness decreased over the next couple of hours. Needed to take Zyrtec next morning as still had redness and facial flushing

Other Meds: Prenatal vitamins, fish oil supplements and probiotics

Current Illness: No illness, but postpartum hives and pupps infection Date of birth of child 12/18/2020. Breastfeeding mother.

ID: 1069926
Sex: M
Age: 71
State: IL

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

Lab Data:

Allergies: "8. Have you ever had a serious reaction to a vaccine (e.g., anaphylaxis)?" "9. Have you ever has a serious reaction to an injectable medication (e.g., anaphylaxis)?" "10. Are you allergic to any ingredients in the COVID vaccine?"

Symptoms: Was conducting IM shot in Client's left deltoid when muscle twitched. Client confirmed that his muscle did twitch and he did not voluntarily move his muscle. Stopped injection. 0.1 ml was administered into left deltoid. Client denied any pain, tingling, burning, numbness, or other sensation. Educated client that there is a chance of hitting a nerve and to reach out to his Provider if he had any concerns. Client verbalized understanding. Completed administration of IM shot in right deltoid (original dose discarded/wasted appropriately. New syringe and needle used, 0.5 ml administered in right deltoid). Client denied any pain, numbness, tingling, or other sensation. Attempted to contact patient on 3/3/2021 at 9:14 AM to follow up. No answer. Left voicemail to return call. No return call as of 3/3/2021 4:12 PM. Will attempt to contact again within this week.

Other Meds: "7. Do you have a bleeding disorder or are you taking anticoagulants (Aspirin/Warfarin/Coumadin)?"

Current Illness: "3. Are you currently in quarantine or isolation?" "5. Are you experiencing moderate or severe acute illness with or without fever including any COVID symptoms?" "6. Have you tested positive for COVID?" "7. Do you have a bleeding disorder or are you taking anticoagulants (Aspirin/Warfarin/Coumadin)?"

ID: 1069927
Sex: F
Age: 69
State: MN

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

Lab Data: None

Allergies: Morphine - get a rash after 3 days

Symptoms: 3-1-21 After 30 minutes arm became itchy, after about an hour site became warm. Took Benedryl and Ibuprofin. 3-2-21 When I woke up had a headache, chills and slight fever. Arm still warm - Took Tylenol and Ibuprofen better in the evening. 3-3-21 Severe headache and chills when I work up. took Tylenol and Ibuprofen. Chills went away after an hour but headache stayed most of the day. Injection site very red and somewhat hot. More than warm.

Other Meds: Vitamin D3 and Focus for my eyes

Current Illness: N/A

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm