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: 1025379
Sex: F
Age: 48
State: CT

Vax Date: 01/04/2021
Onset Date: 02/03/2021
Rec V Date: 02/12/2021
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: cherries

Symptom List: Dysphagia, Epiglottitis

Symptoms: Headache, fatigue still continuing through this date.

Other Meds: singular, albuterol,

Current Illness: none

ID: 1025380
Sex: M
Age: 50
State: MD

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 02/12/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: 2007 Chemotherapy Treatment

Symptom List: Anxiety, Dyspnoea

Symptoms: 1/12/21 Stomach started feeling uncomfortable 1/13/21 Stomach pains and by the evening I started to have a fever, chills, and sweats. 1/14/21 Stomach pains, fever, chiills, sweats, and body aches continued. 1/15/21 Severe stomach pains, fever, chills and body aches. Responded to Health Clinic. Rapid COVID test was negative and per the request of the Doctor I responded to the Emergency Room located at Medical Center. Rapid COVID test negative, Bloodwork completed, CT test conducted, Appendicitis and I had to have an emergency Laparoscopic Appendectomy.

Other Meds: Metformin, Atorvastaton, Pantoprazole, Gabapendin, Ozempic Pen, Indomethacin

Current Illness: Diabetes, High cholesterol, gout

ID: 1025381
Sex: F
Age: 67
State: VA

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/12/2021
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: Codeine

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

Symptoms: Upper lip swelling

Other Meds: Amlodipine-Benazepril/ Hydrochlorothiazide/ Lovastatin/ Metformin

Current Illness:

ID: 1025382
Sex: F
Age: 56
State: NY

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

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient developed headache and dizziness post vaccination

Other Meds: Ibuprofen

Current Illness:

ID: 1025383
Sex: F
Age: 27
State: NY

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

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

Lab Data:

Allergies: Naproxen, Ibuprofen, Tylenol

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

Symptoms: Facial redness, and itching

Other Meds: Singulair, Allegra, Vitamin D

Current Illness: none

ID: 1025384
Sex: F
Age: 73
State: IL

Vax Date: 02/03/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: Tetracycline ]; Cipro; Crestor

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

Symptoms: 2nd day post injection, the site became itchy and red. That left next day. 5th day post injection headaches came off and on. Took Advil a few times 8th day post injection the site became itchy and red once again. 9th day post injection, the site is still red and itchy. Applied Hydrocortisone cream. Some relief for the itching. Headache seems to be gone/

Other Meds: Lisinopril 30mg. 1 daily; Ergocalcife 1.25 mg. once weekly; Elder-Mune 2 gummies daily; Patriot Power Greens one scoop in water daily.

Current Illness:

ID: 1025385
Sex: F
Age: 79
State: AZ

Vax Date: 02/03/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: normal the first 5to6 days until the10th it started itching. and it was pale pink color. on Thursday morning is was burning red and itching so bad. and its hard and swollen. I had a rash on my chest also. took Benadryl

Other Meds:

Current Illness:

ID: 1025387
Sex: F
Age: 33
State: UT

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Ceclor, Sulfa, Amoxicillin, Tomatoes

Symptom List: Pharyngeal swelling

Symptoms: Extremely sore arm night of and next day. Hard lump and itching started 2-3 days later. Lump turned red, painful, and really itchy 6 days later. Today is day 8 and redness is getting larger

Other Meds: Levothyroxin 250 MCG

Current Illness:

ID: 1025389
Sex: F
Age: 63
State: MO

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

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1025391
Sex: M
Age: 79
State: NY

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: No allergies patient is aware of

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Finger numbness (middle and ring finger)- happened right after vaccination was given. Said numbness goes up the arm close to the shoulder. Patient did say this happened with other vaccinations and went away after half a day or so. Patient was seen in emergency department in the past but Dr. could not find anything wrong.

Other Meds:

Current Illness:

ID: 1025392
Sex: M
Age: 75
State: MA

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

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

Lab Data:

Allergies: strawberry,

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

Symptoms: Flu like symptoms after covid vaccination on 2/2/2021. Patient developed chills, headache, fatigue, body aches during HD. BP remained stable < 100 systolically which is relatively good for patient. He remains afebrile. He notes right arm discomfort and is cold with chills. He notes headache is generalized with no changes in vision, no dizziness, no numbness / paresthesias noted. He denies n/v/d/c, no dyspnea or chest pain, no sore throat. No loss of taste or smell. On 2/3/2021 at about 2pm patient developed fever, hypotension and tachycardia.Recevied 1 liter of NS infusion. Team decided to transfer pt to OSH for further evaluation.

Other Meds: Tylenolprn, albuterol inhaler prn, albuterol nebs prn,allopurinol,apixaban, darbepoetin,dronabinol,flonas nasal, fluticasone/vilanterol inhaler,gabapentin,insulin, ipratropium inhaler, levothyroxine,lorazepam prn, melatonin, bengay, metopro

Current Illness:

ID: 1025393
Sex: F
Age: 77
State: CT

Vax Date: 02/04/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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:

Symptom List: Rash, Urticaria

Symptoms: 6 days after receiving the vaccine the patient developed a spotty rash in multiple places on my body. Patient is saying it is itching. I examined the patient today 2/12/2021 I prescribed Benadryl Cream and Benadryl tablets.

Other Meds: Atorvastatin

Current Illness:

ID: 1025394
Sex: F
Age: 45
State:

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: biaxin, tobramycin

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

Symptoms: Shot was given around 530pm. at 12 hours nausea, dry heaving. at 24 hours 103 fever, body aches, headache, ocular pain. felt good the next morning. at 48 hours 101 fever bodyaches, not as bad and woke up with sweats in the middle of the night to feel great the next morning . Had a nightly headache around 6pm each night with constant localized redness over the injection site, no lymph nodes this time for the following week. everything gone within 1 week after. Only took ibuprofen/tylenol for fevers and bodyaches.

Other Meds: amlodipine, valsartan/hctz, crystelle, hizentra, topamax, prozac, magox, b12

Current Illness: none

ID: 1025395
Sex: M
Age: 75
State: IN

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/12/2021
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: None

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

Symptoms: Fever 101.7 - chills - malaise Starting approximately 18 hours after injection. Lasting approximately 24 hours. Multiple (5+) herpes sores on upper and lower lips and surrounding face. Started 02/09/21 and still ongoing.

Other Meds: Lisinopril/HCTZ 20/25 1 tab daily Amlodipine 10mg 1 tab daily Allopurinol 300mg 1 tab daily Carvedilol 12.5mg 1 tab twice daily Simvastatin 40mg 1 tab at bedtime ProAir as needed Symbicort 169/4.5 1 puff twice daily MultiVitamin 1 daily

Current Illness: None

ID: 1025396
Sex: F
Age: 79
State: CT

Vax Date: 01/30/2021
Onset Date: 02/02/2021
Rec V Date: 02/12/2021
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: Penicillin and Lumigan (Bimatoprost), tree nuts

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

Symptoms: slight nausea off and on for about a week, rashes on arms and back -- no treatment -- nausea still present occasionally

Other Meds: Aspirin 81mg 1/day Hydrochlorothiazide 25mg 1/day Nifedipine 60mg 1/day Simvastatin 40mg 1/day Losartan Potassium, 100 mg 1/day Combigan (both eyes) 1 drop

Current Illness: None

ID: 1025397
Sex: F
Age: 39
State: IN

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: Zithromax

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

Symptoms: Chills, badly aches and fatigue from 3:30 am for about 24 hour.

Other Meds: Levothyroxin, crestor, B vitamins and Vitamin D

Current Illness: None

Date Died: 02/07/2021

ID: 1025398
Sex: F
Age: 77
State: IL

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/12/2021
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: Latex, Abilify, Gadolinium contrast media

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

Symptoms: Patient received vaccine on 2/5. We were told on 2/9 that the patient visited another emergency department on 2/6 but no information was given as to what prompted that visit. She was sent home. Daughter found her on 2/6 or 2/ 7 unresponsive and she died.

Other Meds:

Current Illness:

ID: 1025399
Sex: F
Age: 88
State: WA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Systemic: Heart Attack-Severe

Other Meds:

Current Illness:

ID: 1025400
Sex: F
Age: 70
State: IN

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Fatigue, headache, chills, shaking for two days.

Other Meds: Benzonatate, Famotidine, Metoprolol, Pramipexole, calcium, multi vitamin, tylenol

Current Illness: Chronic cough

ID: 1025401
Sex: F
Age: 31
State:

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: Vaccine received at 8am and felt great all day. I had my IUD removed at 4pm. Symptoms began same day 12 hours later at 8pm. Body aches, chills hit hard fast. I felt like I jumped into an ice lake plus flue like symptoms. Headache came on. This last for 24 more hours, ranging in moderate to strong symptoms. Headache was the strongest and lasted 48 hours.

Other Meds: Adderall, prenatals

Current Illness: No

ID: 1025402
Sex: F
Age: 38
State: CO

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 02/12/2021
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: Animal dander

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

Symptoms: Fever 102, chills, extreme fatigue, severe left arm pain at site (unable to move arm for one day), headache

Other Meds: Multivitamin, Vit D

Current Illness: None

ID: 1025403
Sex: M
Age: 35
State: PA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, Venom-Wasp

Symptom List: Unevaluable event

Symptoms: Patient received second dose of Pfizer COVID-19 vaccine 2/5/2021. 4 days later developed mild hives at 8 am, 11 hours later developed hives again, more severe and lasting 3 hours. Spoke with his wife. She did give him 25 mg of Benadryl and 40 mg of famotidine. This seemed to help. Advised if hives do not continue to improve with measures provided to go to urgent care for evaluation, if he should develop any symptoms of anaphylaxis - heavy tongue, difficulty breathing, throat swelling to go directly to the ER. Understanding verbalized. Chart updated to reflect potential allergy due to hives after getting the vaccine. ? Widespread hives

Other Meds: None

Current Illness: None

ID: 1025404
Sex: F
Age: 52
State: TX

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: sulfa

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

Symptoms: after my injection, a few hours later, i started having a stiff shoulder. it has now become frozen shoulder. i contacted my doctor and let her know. i cant use my left arm. extremely painful. no range of motion.

Other Meds:

Current Illness:

ID: 1025405
Sex: F
Age: 57
State: NJ

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 02/12/2021
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: Demerol, Phenergan

Symptom List: Injection site pain, Pain

Symptoms: 15 hours after receiving vaccine I has chills, fever, body aches, headache, fatigue. This lasted about 48 hours, with lessening severity as time went on. About 24 hours after vaccine pain, swelling, and hot to the touch, began at the vaccine sight. This for permitted for about 7 days with lessening severity as time passed. (I reported daily to V-safe, so that is a more accurate account of actual symptoms and timeline as this is being reported more than a month after receiving vaccine.) No medical treatment was sought or required.

Other Meds: Celebrex, Plaquenil, Gabapentin, Metformin, Fenofibrate, HCTZ, Olmesartan, Rousuvastatin, Folic Acid, Esomeprazole, Duloxetine, Cyclobenzaprine

Current Illness: None

ID: 1025406
Sex: F
Age: 26
State: NY

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

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reports that she has a history of near syncope following immunization's. Patient was walked to recovery as per protocol, when she suffered a period of near syncope. Patient was moved to wheelchair and placed in fowlers position, Cardiac Monitor applied, BG was 133 at time of reaction. Patient is closely monitored in clinic with improving conditions after about 10 minutes of care. Patient reports that she now feel well and was advised to seek further medical treatment as needed and to advise Clinic of any change in condition.

Other Meds: Nuvaring

Current Illness: None

ID: 1025407
Sex: F
Age: 28
State: CA

Vax Date: 02/01/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Cipro Clindamyacin Flagyl Macrobid

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

Symptoms: Approx 11 hours after receiving vaccine, severe chills, body aches and nausea began. Lasted in severe category for approximately 2 hours and then continued in mild-moderate state ongoing during fate of 2/12

Other Meds: Mini pill Sertraline Ashwaganda capsules

Current Illness: Cold 1 week prior

ID: 1025408
Sex: F
Age: 38
State: CT

Vax Date: 01/01/2021
Onset Date: 02/09/2021
Rec V Date: 02/12/2021
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: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: stuffy and runny nose, headache loss of taste and smell body aches. Tested Positive for COVID-19

Other Meds: none

Current Illness: none

ID: 1025409
Sex: M
Age: 79
State: LA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: chills, fever, fatigue

Other Meds: Eliquis, vitamin C, B12, Ramipril, atorvastatin

Current Illness: None

ID: 1025410
Sex: M
Age: 40
State: PR

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: pt stated that he developed a bump on the fore arm of the right arm and lower part of his back. He stated is was like hives and it is very itchy . Pt states the rash is no longer there but he is still itchy. He took Benadryl, applied cream, and took prednisone for his symptoms.

Other Meds: cataflam, Xanax, metoprolol, Abilify, metformin, Lipitor, Zoloft, Buspar, vitamin D3, 1B-12, Omega 3, glucosamine

Current Illness: no

ID: 1025411
Sex: F
Age: 78
State:

Vax Date: 02/08/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: Nausea

Symptoms: cellulitis to injection site

Other Meds:

Current Illness:

ID: 1025412
Sex: M
Age: 46
State: LA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: About 1-2 days following 2nd dose, patient noticed a collection of fluid under left and right axilla. Left side more pronounced that right. Patient reported to endocrinologist during in-office visit. Patient was placed on Levaquin. Levaquin began on 2/10/22.

Other Meds:

Current Illness:

ID: 1025413
Sex: F
Age: 54
State: PA

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin

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

Symptoms: After first covid dose on 1/8/21 I had side effects : chills , fever , headache , myalgia I was off five days from work . Then my second dose COVID on 2/5/21: I started to have Ill effects on Saturday Eve 2/6/21 fever , chills , headache , nausea / vomiting , myalgia not as bad as first dose . Symptoms of headache , chills , nausea / vomiting and fatigue persisted . I was seen by my pcp on 2/11/21. I was still not feeling well and felt weak and dehydrated . I had blood work and was prescribed zofran . I am filling this out today 2/12/21 , I still am not feeling well with headache and fatigue noted . Zofran was effective . I was told to complete this form by the hospital triage nurse yesterday . Triage nurse documented my symptoms and directed by care to pcp for follow up .

Other Meds: Multivitamin daily , daily vitamin C and D supplement, prn Tylenol or Aleve . Lasix 20 mg daily PO prn ( not recently taken )

Current Illness: No, But I did have reaction to first dose now : 1/8/21 and I was off Sick with side effects , myalgia , fatigue and headache x 5 days from work . I used my work PTO .

ID: 1025414
Sex: F
Age: 70
State: IN

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: None

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

Symptoms: I was dizzy for about 10-15 seconds. No medical attention

Other Meds: Women?s multi vitamin, vitamin D, calcium

Current Illness: None

ID: 1025415
Sex: F
Age: 67
State: IL

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/12/2021
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: Lisinopril-cough

Symptom List: Tremor

Symptoms: On day 9 after the vaccine, I started to get itching and a slight rash on my right arm at the injection site. It is also red and slightly hard at the site. The symptoms are relatively mild. I looked up the reaction and they said it is called COVID arm.

Other Meds: Vitamin D Arimidex Losartan Sertraline

Current Illness: no

ID: 1025416
Sex: M
Age: 90
State: MN

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Hmg-COA-r inhibitors

Symptom List: Erythema, Pruritus

Symptoms: Following day after receiving COVID 19 vaccine patient experience strong abdominal pain and weakness requiring ER visit.

Other Meds: ASA, Keflex, Clopidogrel, Lisinopril, Nitroglycerin, Propranolol, Atorvastatin, Vitamin D3, MTV, Lutein

Current Illness:

ID: 1025417
Sex: F
Age: 48
State: MD

Vax Date: 12/24/2020
Onset Date: 12/25/2020
Rec V Date: 02/12/2021
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: NKDA

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

Symptoms: I had swollen glands in my neck and sore throat, which lasted about ten days. At day 7, painful swallowing and I was sent home rom work. Had a Covid test, which was negative. I also had a rapid strep throat done which was negative.

Other Meds: Lamecto, Wellbutrin, Lisinoprol, Atovastatin, Coumodovene

Current Illness:

ID: 1025418
Sex: F
Age: 50
State: TX

Vax Date: 01/04/2021
Onset Date: 01/31/2021
Rec V Date: 02/12/2021
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: bananas, avocado, corn, watermelon, nuts

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

Symptoms: Systemic rash - face, neck, arms - I took 4 zyrtec which finally stopped it from spreading

Other Meds: Zyrtec, trazadone, klonopin, cymbalta

Current Illness: None

ID: 1025419
Sex: F
Age: 58
State: PA

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 02/12/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient developed tingling/pins and needles twenty minutes after receiving first COVID vaccine. This lasted about 30 minutes. Her legs ached and she had difficulty walking the next am (1/7/21). Patient usually takes the steps at work, but had to take steps 1/8/21 due to pain and generalized difficulty walking. On 1/9/21 patient was exhausted. Was standing on the bed of the truck and could not lift leg over tailgate. She also fell that day. She steadily improved beginning 1/10/21 until she was back to normal 1/17/21. MD advised that she could not get second vaccine.

Other Meds:

Current Illness:

ID: 1025420
Sex: F
Age: 49
State: MN

Vax Date: 01/29/2021
Onset Date: 02/09/2021
Rec V Date: 02/12/2021
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: Iodine

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

Symptoms: Rash with itch, mild pain, slight swelling, tightness- developed 11 days later.

Other Meds: Multi vitamin

Current Illness: None

ID: 1025421
Sex: F
Age: 34
State: NC

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/12/2021
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: Doxycycline

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

Symptoms: Fever of 102 post shot. Took ibuprofen. Every 4 hours as ibuprofen wore off , fever returned, 101, 100, 99 for the next 12 hours or so. Felt extremely weak and lethargic for the next 24 hours after fever reduced. Rash at injection site appeared at time of fever. Rash disappeared after 5 days. I had a fever but no sweating. No vomiting or nausea.

Other Meds: Birth control

Current Illness: N/A

ID: 1025422
Sex: F
Age: 28
State:

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/12/2021
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: Pain in extremity

Symptoms: Fever Shortness of breath Chills Unable to move my arm My arm was swollen and red around the area where the vaccine was injected. Sore throat

Other Meds:

Current Illness:

ID: 1025423
Sex: M
Age: 73
State: MO

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Charcoal Dentine Gum Pain killer (unknown name)

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

Symptoms: The night before receiving the Moderna patient's BP was 144/74. Received shot at 9AM 2/5/2021. At 3PM felt "jittery". BP 175/75. Client states BP kept climbing so went to the ambulance station. Client states at the ambulance BP was around 215/100> Was taken to Hospital per ambulance the evening of 2/5/2021. Note: Client was on Amlodipine until 1/26/2021 when it was discontinued. There is a question if the BP elevation was related to the discontinuation of the Amlodipine or the vaccination with Moderna.

Other Meds: Eliquis 5mg twice a day Tumeric 1000 mg daily Rosuvastatin 20mg daily Cod liver oil 1 tsp daily CoQ 10 200 mg daily Vitamin D 3 5000 IU twice a d

Current Illness: Stroke 9/23/2020 Hypertension 9/23/2020

ID: 1025424
Sex: F
Age: 50
State: MN

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: bartlett pears, Simvostatin

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

Symptoms: Woke up at 2am on 2/12/2021 feeling nauseated and been vomiting since. Soreness in arm at injection site.

Other Meds: Advil, Levothyroxin 137 mcg, Lisinopril 20mg, metformin 500 mg x2, Lantus Solo Star 10 units, Victoza, 1.8mg, Jardiance 10 mg, zinc 50 mg

Current Illness: n/a

ID: 1025425
Sex: M
Age: 69
State: IN

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: Latex, Betadyne, Codeine

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

Symptoms: Soreness at injection site lasting 2+ days. Mild headache lasting about 18-20 hrs.

Other Meds: Metoprolol, Digoxin, Metformin, Xarelto, Multivitamin, Vitamin D3

Current Illness: Nasal allergies

ID: 1025426
Sex: F
Age: 42
State: OK

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 02/12/2021
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: Biaxin Tramadol

Symptom List: Vomiting

Symptoms: I started having increased pain under my left arm that increased to some chest discomfort, body aches, low-grade fever. When I woke up the morning of the 8th I had a swollen lymph node the size of a baseball under my left arm.

Other Meds: Diltiazem, valacyclovir, estradiol, Rabeprazole, Triamterene 37.5/hctz

Current Illness: None

ID: 1025427
Sex: F
Age: 71
State: DC

Vax Date: 01/21/2021
Onset Date: 01/28/2021
Rec V Date: 02/12/2021
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: NSAIDs Sulfa drugs

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Cluster of pustular, typical H. Zoster lesions over left scapula. causing itching and local pain. Treated within 24 hours with Valcyclovir 1 gm every 8 hours for 7 days. Lesions gradually resolved over the next seven days.

Other Meds: None

Current Illness: None

ID: 1025428
Sex: F
Age: 48
State: PA

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Covid-Arm: hard, swollen, red rash at injection site. Appeared 9 days after vaccination.

Other Meds: Prescription: Sulfasalazine; OTC: Tylenol (night before)

Current Illness: None

ID: 1025429
Sex: M
Age: 66
State: IN

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Slight Headache & Chills, Did not require treatment, Next day I was fine

Other Meds: None

Current Illness: None

ID: 1025430
Sex: F
Age: 36
State: OH

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: Pain 5 out of 10 upper R arm. Burning sensation from the injection site to my fingertips x24 hours. Skin cold to the touch even with attempts to warm with hot compresses x24 hrs.

Other Meds: Motegrity 2mg DIM complex Vitamin K Vitamin D3 L-Tyrosine

Current Illness: n/a

ID: 1025431
Sex: F
Age: 27
State:

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/12/2021
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: Penicillin

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

Symptoms: I took my second dose of the vaccine (Pfizer) on February 8, 2021. I started to get a headache later that evening and later that night I started to get chills and feel very cold with aches. I was exhausted and still had a headache as well. That morning on the 9th I had to call out, I still felt achy with a headache that lasted all day. I contacted my supervisor and also employee health. I then again had to call out on the 10th because of nausea and a headache that persisted that morning. It wasn't until later that day on the 10th that I felt better than the previous day. I also contacted my supervisor again and employee health.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm