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
92,076
AK1,880
AL6,345
AR4,151
AS46
AZ14,991
CA66,887
CO12,550
CT8,943
DC1,795
DE2,009
FL42,724
FM4
GA17,031
GU124
HI2,580
IA4,919
ID2,892
IL22,128
IN24,197
KS5,047
KY9,111
LA5,500
MA15,718
MD13,434
ME3,351
MH8
MI20,971
MN13,585
MO10,747
MP30
MS3,198
MT2,477
NC18,051
ND1,501
NE3,109
NH3,218
NJ20,216
NM4,218
NV4,728
NY37,667
OH20,793
OK6,692
OR9,244
PA25,607
PR2,588
QM2
RI2,163
SC7,261
SD1,282
TN10,445
TX39,890
UT4,618
VA15,980
VI67
VT1,830
WA16,071
WI12,042
WV2,571
WY926
XB5
XL1
XV2

ID: 1073909
Sex: F
Age: 48
State: IN

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

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

Lab Data:

Allergies: sulfa

Symptom List:

Symptoms: woke up in night with a lot of pain in my left arm. 3 days later and my upper arm is red, very sore from shoulder to elbow and underneath my arm-armpit area, and a raised area. i have been taking ES tylenol every 5 hours and icing it. if im late taking a dose, my arm starts throbbing. if not better in next couple days, I will make dr apt to have evaluated.

Other Meds: premarin allegra tylenol

Current Illness: none

ID: 1073910
Sex: F
Age: 78
State: CO

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: Yes

Symptom List:

Symptoms: When I got the vaccine it hurt so much that I jumped. It felt like it burned for like 3min. The next day I had shortness of breath & I fainted the next thing I seen when I woke up was the paramedics taking me in to the ambulance to do an EKG. Everything was good except my blood pressure dropped. I was not taken to the hospital.

Other Meds: Yes

Current Illness: No

ID: 1073911
Sex: F
Age: 19
State: CA

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

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

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: 11A1 19 y old pt received 1 st dose Moderna vaccine, after 5 mins she had episode of syncope, fell from her chair and bump her head. She had seizure for about 10 seconds. After seizure she was A/O x4 , neurologically intact, good PERRLA. Her BP was 95/65, HR 59, O2 sat 98 RA. Pt able to speak and was aware of the situation. 911 was called to take the pt to the hospital for head injury to R/O any abnormality.

Other Meds: No

Current Illness: None

ID: 1073912
Sex: F
Age: 69
State: MN

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

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

Lab Data:

Allergies: Bee venom, tramadol, hydrochlorothiazide, contrast media, poppy, codeine

Symptom List:

Symptoms: Throat swelling, dysphagia, shortness of breath

Other Meds:

Current Illness:

ID: 1073913
Sex: M
Age: 28
State: WA

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: I have felt horrible since receiving the second dose of Moderna. I felt profoundly fatigued, sore all over, and nauseated for 18 or so hours. Since then I have been feeling nauseated after I eat. I cannot eat like I normally do and it has been almost five days. If this persists through the weekend I will visit my doctor next week.

Other Meds: None

Current Illness: None

ID: 1073914
Sex: F
Age: 31
State: NY

Vax Date: 02/24/2021
Onset Date: 03/04/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: sulfa drugs

Symptom List:

Symptoms: Covid Arm- large red hive at injection sight 8 days after injection. Itchy and warm to the touch.

Other Meds: birth control.

Current Illness:

ID: 1073915
Sex: F
Age: 70
State: WA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: 0805 pt received second dose pfizer vaccine 0810 pt reports "right afterward" noticing that her tongue felt numb. denies respiratory distress. No previous history of anaphylaxis with any vaccine or medication or other source. No problem with first dose pfizer other than sore arm, fatigue. 0825 pt states numbness progressing toward back of tongue 0830 pt escorted to ED Per ED note: Patient received second Covid vaccine at 8:05 AM, noted onset of central, not lateralized, tongue tingling without swelling/pain after receiving the shot, still notes able to feel pressure on tongue. Has never had a reaction to previous vaccines, including first dose of Covid vaccine 3 weeks ago. Denies any tongue biting or recent trauma to the tongue. She does feel as if the tingling is extending further back since onset...Patient states she can swallow fine without pain, no vision changes, hearing changes, taste changes, lesions in her mouth, facial asymmetry, shortness of breath, headache, rashes, swelling. Denies fevers, chills, URI symptoms, chest pain, palpitations, lightheadedness, nausea, vomiting, abdominal pain, change in bowel habits, change in urination. Vitals stable, no evidence of anaphylaxis on exam. Ruled out CVA, atypical MI, migraine, GERD, trauma. Thought possibly vaccine reaction. Patient was monitored in the emergency department for 4 hours after vaccine, without airway swelling or compromise. Discharged home but still with continued tongue tingling with preserved sensation.

Other Meds: Alendronate, budesonide nasal spray, cholecalciferol, ibuprofen (PRN)

Current Illness:

ID: 1073916
Sex: F
Age: 69
State: LA

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

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

Lab Data:

Allergies: codeine

Symptom List:

Symptoms: laryngitis - I haven't been able to talk all week.

Other Meds: pantaprozole, omega 3, magnesium, turmeric, boswellia, acetaminophen, Loratadine

Current Illness: nonw

ID: 1073917
Sex: M
Age: 31
State: NY

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Chills started 14 hours after and lasted for 4 hours.

Other Meds: None

Current Illness: None

ID: 1073918
Sex: F
Age: 84
State: CA

Vax Date: 02/27/2021
Onset Date: 02/28/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Son/caregiver called to report patient was experiencing a decreased mental acuity accompanied with fatigue and loss of appetite after receiving her 2nd dose of Moderna Covid 19 vaccine since Febuary 27th, 2021. Son describer the symptoms as progressive starting after receiving the vaccine. It was recommend the patient's primary care provider be contacted to receive further advice.

Other Meds:

Current Illness:

ID: 1073919
Sex: F
Age: 64
State: AL

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

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

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: Blurred vision left eye

Other Meds: Durizol eye drops Cocopt eye drops Ilevro eye drops Zetia 10 mg Vitamin D. OTC Immune -C. OTC

Current Illness:

ID: 1073920
Sex: F
Age: 63
State: CA

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

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

Lab Data:

Allergies: PCN Lisionpril-cough

Symptom List:

Symptoms: 3/4/21 1005am pt started complaining of feeling flush, restless, and anxious. pt states that she does not feel right and that there is something wrong. then pt reported that her legs felt numb.First RN and Second, RN was present to assist pt. pt was put on 4L of O2 by mask. Dr was called to assist. pt was moved from sitting in chair to laying on floor with legs elevated. pt reporting that her hands and legs were feeling numb. per Dr pts lungs were clear with good air exchange. pt alert and oriented to self, place, and time. 1012am BP 141/81 P 71 SaO2- 100% BS 99 pt still feeling flush and restless with anxiousness increasing. upper lip swelling. questionable tongue swelling. hand and feet numbness. pt states does not feel right. V.O. Dr 25mg Benadryl IM now administered to the right deltoid IM, RN 1020am BP- 162/100 P- 72 SaO2- 100% pt still feeling flush and restless with anxiousness. still with some upper lip swelling. questionable tongue swelling. hand and feet numbness is still reported. pt states she still does not feel right. husband is now with pt at her side and trying to calm her. pt is c/o some SOB, per Dr pts lungs are still clear. pt remained alert to self, time, and place. V.O. Dr. Albuterol neb treatment now attempted to start neb treatment however pt was not tolerating neb. ok by Dr to stop neb treatment. 1025am called AMR V.O. Dr 1mg Epinephrine now administered 1mg Epinephrine IM right deltoid. P. , RN 1027am pt wanting to sit up. states cannot get comfortable laying down. assisted pt to sit up. pt is less anxious. reports to feel less restless. decrease upper lip swelling and tongue swelling. pt reports that she is starting to feel a little better. pt is feeling less numbness in hands and feet. BP-141/58 P-99 SaO2-100% 1037am pt starting to complain of feeling flush, restless, and anxious again pt states that she does not feel right and that there is something wrong again. pt again reporting that her hands and feet felt numb. per Dr - pts lungs still clear with good air exchange. pt remains alert to self, place, and time. per Dr draw up another dose of Epi while waiting for AMR, AMR arrived prior to drawing up second dose of Epi. 1039am AMR arrived. transferd pt from floor to gurney and trnsported pt to ER. ................................................................... RN March 4, 2021 3:20 PM

Other Meds: Norco 10-325 Duloxetine Amytriptyline Rosuvastiatin dicolfenac baclofen patnoprazole gabpentin ferous sulfate montelukast Fluticasone albuterol neb and MDI combinvent dulera

Current Illness: none

ID: 1073921
Sex: F
Age: 64
State: FL

Vax Date: 02/09/2021
Onset Date: 02/16/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: wool polyester borax

Symptom List:

Symptoms: "moderna COVID-19 vaccine " 7 days acute right kidney pain for 24 hrs

Other Meds: losartan 50mgX2 meloxicam15mgX1 tramadol hcl 50mgX2 isosorbide mononitrate er 120mgX1 magnesium250mgX1 hydralazine 100mgX 3 carvedilol 3.125mgX2 colesevelam625mgX4 glucosamine&chondroitin 500mgX1 aspirin 81mgX1 turmeric500mgX1 fish oil 1000

Current Illness: 0

ID: 1073922
Sex: F
Age: 49
State:

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

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

Lab Data:

Allergies: penicillin, sulfa antibiotics

Symptom List:

Symptoms: After about 2 minutes of receiving the vaccine, patient started to feel itchy, developed hives, and had an "itchy throat"... about a minute later she went into anaphylaxis

Other Meds:

Current Illness:

ID: 1073923
Sex: F
Age: 64
State:

Vax Date: 02/25/2021
Onset Date: 02/27/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: levaquin

Symptom List:

Symptoms: Tightness in left bicep (front?not where shot administered) and forearm and tingling in hand (left side where shot administered. Tightness has dissipated somewhat, but tingling in hand continues to be present Sore throat right after administration Extremely sore arm for 2 days after administration

Other Meds: synthroid, miralax, vitamin d. Had completed a course of Auge

Current Illness: sinusitus, root canal on 2/22/2021

ID: 1073924
Sex: F
Age: 65
State: CA

Vax Date: 02/27/2021
Onset Date: 03/01/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: none known

Symptom List:

Symptoms: On the 3rd day after the vaccine, I noticed a splotchy red rash on my left buttock after getting out of the shower. It was not itchy. This is the same side where I experience herpes breakouts. Also, my neck and throat are very itchy, and have been since the first dose of Moderna. I think that itchiness started prior to the vaccine, but can't be certain. After the vaccine, however, it became more red and now the skin is starting to be flakey.

Other Meds: probiotic, Vit D3 500 IUs, Acyclovir 400 mg 1x/day for approx 3 days

Current Illness: herpes breakout L glut

ID: 1073925
Sex: F
Age: 57
State: OK

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

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

Lab Data:

Allergies: N/A

Symptom List:

Symptoms: patient stated she had rash at injection site, and on the opposite arm and rash on legs and under eyes

Other Meds: N/A

Current Illness: NONE

ID: 1073926
Sex: M
Age: 34
State: CA

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

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

Lab Data:

Allergies: None reported by patient.

Symptom List:

Symptoms: Patient had just received the vaccine. I walked by and he indicated that he was feeling light headed. I asked my pharmacy staff to call 911 and attend the patient. I was attending a patient who was feeling faint after her vaccination. Staff was in contact with 911 and were attending patient. His initial blood pressure reading was 138/92. He was sweating profusely. He was no longer talking. his next blood pressure reading was higher in the 160's according to our other pharmacist who was attending him. The paramedics were here very quickly and took the patient to a local hospital. I believe the attending pharmacist will also be reporting this.

Other Meds: Unknown.

Current Illness: None reported by patient.

ID: 1073927
Sex: F
Age: 69
State: CA

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

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

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: Patient administered 1st covid 19 moderna dose on 2/11/2021 and administered 2nd dose on 3/4/2021. Patient was notified and informed to contact clinic if she develops any adverse reaction , also advised on ER precautions. Patient verbalized understanding.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1073928
Sex: F
Age: 71
State: MA

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: Many, including petroleum-based products; odors; Many medications, many foods

Symptom List:

Symptoms: Chest tightness, Asthma, difficulty breathing

Other Meds: Cromolyn?, Ventolin; Pulmicort Flexhaler, Singulair, many others

Current Illness: Mast Cell Activation Disease, Severe Allergic Asthma, Multiple Chemical Allergies; Multiple Sclerosis; Crohn's Ileitis & Crohn's Colitis; Autonomic Dysfunction & Small Fiber Neuropathy, Bilateral Carotid Stenosis & TIA's; Hypothyroid; Severe Osteoporosis; others

ID: 1073929
Sex: F
Age: 48
State: MO

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Red bump at injection site that is painful and hard.

Other Meds:

Current Illness:

ID: 1073930
Sex: M
Age: 85
State: TX

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

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

Lab Data:

Allergies: Unknown.

Symptom List:

Symptoms: Patient received 3rd dose of Covid19 Pfizer vaccine due to facilities incomplete record keeping. Patient condition unknown at the time of reporting.

Other Meds: Unknown.

Current Illness: Unknown.

ID: 1073931
Sex: M
Age: 71
State: IL

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

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

Lab Data:

Allergies: no known allergies

Symptom List:

Symptoms: Nausea, headache- constant pressure, feet feel like blocks of ice, temperature is 2degrees above normal, chills, fever blisters inside mouth, sore arm at injection site, pins and needles feeling in my fingers and fingers are swollen- can close my fingers but tight and lightheaded .

Other Meds: Zinc, Tamsulosin .4mg cap 1x daily

Current Illness: none

ID: 1073932
Sex: F
Age: 26
State: NY

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

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: My eyes began watering and began to burn. This lasted 5 minutes. It has happened two more times since I got the vaccine.

Other Meds: None

Current Illness: None

ID: 1073933
Sex: F
Age: 66
State: WA

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

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

Lab Data:

Allergies: Shellfish, Citalopram, codeine, Compazine, citalopram, fluoxetine, milnacipran, morphine, sulfa, tramadol, naltrexone, pregabalin, terbinafine

Symptom List:

Symptoms: Patient had numbness and tingling on the left side of her face

Other Meds: Albuterol, vitamin C, Qvar, vitamin D3, DHEA, Flonase, Januvia, lisinopril, magnesium, oxybutynin, riboflavin, simvastatin

Current Illness: None

ID: 1073934
Sex: F
Age: 37
State: MA

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

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

Lab Data:

Allergies: Bactrim, shellfish

Symptom List:

Symptoms: Diarrhea

Other Meds: Metformin, glyburide, lysynopril, Synarel

Current Illness: N/A

ID: 1073935
Sex: M
Age: 73
State: NM

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

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

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: Started sweating at 10:30 pm 3/3/2021, fever started 3/4/2021 around 2 pm 400 mg taken at that time. At 5:00 pm 3/4/2021 fever seemed to be rising., 400 mg ibuprofen taken. At 5:30 pm fever was 105.7, additional 500 mg extra strength Tylenol, and 25 mg Benadryl. At 6:09 pm temperature was 104.

Other Meds:

Current Illness:

ID: 1073936
Sex: F
Age: 47
State: CA

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Within 2 minutes of Pneumovax, pt felt strong stomach pain, became lightheaded and feeling faint, started to develop hives on face, flushing and itching on arms, started to see spots Immediately treated with epinephrine IM, followed by Zyrtec 20 mg PO, Pepcid 20 mg PO, Depo-medrol 80 mg IM Pt declined ambulance, was observed for 30 minutes with improvement in symptoms, stable vitals and discharged to care of her husband

Other Meds:

Current Illness:

ID: 1073937
Sex: F
Age: 49
State:

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Started to experience anxiety and dizziness approx 1 hour after receiving vaccine. BP elevated at time of observation (168/102). Obesrvation time extended to 1.5 hours. Provided hydration and light meal. Discharged per team member request after she stated she felt better. Encouraged to take BP meds as directed per PCP. Encouraged to go to ER for symptom return or additional adverse reactions per handout/Agency guidelines.

Other Meds:

Current Illness:

ID: 1073938
Sex: M
Age: 45
State: CA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: Latex Fruit (tropical fruit) Pollen Dust Mold Tropical Nuts

Symptom List:

Symptoms: Went into anaphylactic shock with 5 minutes. Throat started to itch, ears were popping and the left side of my face began to feel pressure. My wife injected me with my EpiPen. Within 10-15 minutes, the symptoms began to recede.

Other Meds: (2) 1000mg Metformin Extended Release (1) 300mg Invokana (1) 25mg Losartan (1) 10mg Montelukast (1) tablet Sulfamethoxazol-E-TMP (1) 108mg Allegra 24hr (1) 81mg Aspirin (2) D3 (1000 IU) (2) 1000mg Wild Alaskan Fish Oil (1) 600mg Red Yeast R

Current Illness: None

ID: 1073939
Sex: F
Age: 69
State: MI

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

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

Lab Data:

Allergies: No known allergies

Symptom List:

Symptoms: PATIENT GOT ADVERSE REACTIONS 10 MINUTES AFTER SHOT. SHE FEEL FACE FLUSHING. PULSE RATE 88 PER MINUTES. BLOOD PRESSURE 189/89. SHE STATES SHE DOES NOT HAVE ANY HYPERTENSION.

Other Meds: Moderna Covid vaccine

Current Illness: no

ID: 1073940
Sex: M
Age: 23
State:

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: symptoms: cold sweats, headache, dizziness, light-headed, chills, body aches, drowsiness time course: 24 hrs.

Other Meds:

Current Illness:

ID: 1073941
Sex: F
Age: 44
State: NJ

Vax Date: 01/27/2021
Onset Date: 02/11/2021
Rec V Date: 03/04/2021
Hospital:

Vax Type:
Manufacturer:
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Lab Data:

Allergies: Sulfa drugs

Symptom List:

Symptoms: Pain started in left underarm area and radiated to left breast causing breast and nipple sensitivity. That resolved in about a week, then after started to have pain, tightness in left side of neck area that still persists. My dr advised she doesn?t feel any swollen lymph nodes and it?s likely a reaction to the vaccine. Taken Tylenol and naproxen with limited relief.

Other Meds: Tamoxifen, almodapine

Current Illness: NA

ID: 1073942
Sex: F
Age: 40
State: MD

Vax Date: 02/25/2021
Onset Date: 02/28/2021
Rec V Date: 03/04/2021
Hospital:

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Lab Data:

Allergies: N/A

Symptom List:

Symptoms: Sore, painful and swelling aroubd injection site. Painful lump in right armpit.

Other Meds: Botox (Migraines) Motrin Maxalt Unisom

Current Illness: None

ID: 1073943
Sex: F
Age: 55
State: MN

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

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Lab Data:

Allergies: None known

Symptom List:

Symptoms: Fever - 100.7, Chills, Mild Headache Taking ibuprofen and acetaminophen , and rest

Other Meds: Chlorthalidone, Amitriptyline, Multi-vitamin, ibuprofen

Current Illness: None

ID: 1073944
Sex: F
Age: 74
State: CA

Vax Date: 02/26/2021
Onset Date: 03/02/2021
Rec V Date: 03/04/2021
Hospital:

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Lab Data:

Allergies: None

Symptom List:

Symptoms: Enlarged painful lymph node in left arm pit. Node still enlarged but maybe smaller and no longer painful after two days.

Other Meds: Rousatatin, multivitamins

Current Illness: None

ID: 1073945
Sex: F
Age: 20
State: CA

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

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Vasovagal reaction.

Other Meds: None

Current Illness: None

ID: 1073946
Sex: F
Age: 34
State: IL

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/04/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: Numbness and tingling to right side of face began 20 minutes after vaccine. The next day had tingling in muscles of right arm and leg.

Other Meds: Levothyroxine

Current Illness: None

ID: 1073947
Sex: F
Age: 40
State: MO

Vax Date: 02/25/2021
Onset Date: 02/27/2021
Rec V Date: 03/04/2021
Hospital:

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Lab Data:

Allergies: Cefdinir Augmentin Penicillin Mucinex D

Symptom List:

Symptoms: I woke up on 2/27/2021 with a red rash on my neck, chest, stomach, back, arms, legs, bottom and pelvic area. I called the on call physician. Took over the counter Benadryl. The rash cleared up on Monday, 3/1/2021. Still feel itchy on 3/1/21, 3/2/21, 3/3/21, 3/4/21. Used over the counter hydrocortisone cream.

Other Meds: Sertraline, Calcium and Vitamin D Supplement, Vitamin C, Multi-Vitamin, Hair Skin and Nails vitamins

Current Illness: None

ID: 1073948
Sex: F
Age: 32
State: MO

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

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Symptom List:

Symptoms: Within seven minutes of vaccine administered, patient cried out that she thought she would pass out. She was lightheaded, arms tingling, felt hot then cold. We had her lay down on the floor and held her feet in the air. Within three minutes of doing this, she felt much better. She sat up on the floor and ate some Chex-mix and drank some water. She stayed thirty minutes and felt good. She left and we made sure she made it home.

Other Meds:

Current Illness:

ID: 1073949
Sex: F
Age: 64
State: NY

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 03/04/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: No

Symptom List:

Symptoms: 24 hours of Fever from 100.2 to 102 degrees Enlarged lymph node near collarbone Migraine (most days) Vestibular migraine (14 days after vaccine - 12 hours) Nausea (with vestibular migraine on 2/29)

Other Meds: Lexapro Atorvastatin Magnesium Calcium Riboflavin

Current Illness: No

ID: 1073950
Sex: F
Age: 55
State: NJ

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

Vax Type:
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Lab Data:

Allergies: Powder in latex gloves

Symptom List:

Symptoms: Raised rash with hives on thighs. Took Benadryl will go to hospital if hives get worse

Other Meds: Synthroid Claritin

Current Illness: Na

ID: 1073951
Sex: F
Age: 80
State: IN

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

Vax Type:
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Lab Data:

Allergies: PCN

Symptom List:

Symptoms: Currently no adverse event reported after 3 hours and 45 minutes. Vaccine diluted with 1.3 ml instead of 1.8 ml or 38 mcg instead or 30 mcg dose.

Other Meds: Sertraline 25 mg once daily

Current Illness: I do not know.

ID: 1073952
Sex: M
Age: 74
State:

Vax Date: 02/01/2021
Onset Date: 02/04/2021
Rec V Date: 03/04/2021
Hospital: Y

Vax Type:
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Lab Data:

Allergies: Ciprofloxacin, Erythromycin, Heparin, NSAIDs

Symptom List:

Symptoms: new onset severe thrombocytopenia, unexplained by extensive hospital work-up by hemotologist

Other Meds:

Current Illness: UTI with sepsis

ID: 1073953
Sex: F
Age: 41
State: CA

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

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Lab Data:

Allergies: All seafood

Symptom List:

Symptoms: Painful red rash at injection site appeared the next morning.

Other Meds: Omeprazole Hydro chloroquine Wellbutrin

Current Illness:

ID: 1073954
Sex: F
Age: 79
State: CO

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 03/04/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Yes

Symptom List:

Symptoms: The next day of the vaccine I had fever, felt really fatigued, I felt very low of energy, my head felt like I had brain freeze it felt was worse every time I stood up, I saw my doctor he ordered lab work & urine test my urine test comeback as I was a little dehydrated & lab work came back normal. This has not resolved as it right now I still feel very low of energy. My energy is still not the same.

Other Meds: Yes

Current Illness: No

ID: 1073955
Sex: M
Age: 84
State: CA

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

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Lab Data:

Allergies:

Symptom List:

Symptoms: mixed series administered- second dose administered 3/4/21 Pfizer, first dose received Moderna 4 weeks ago. Administration nurse stated they did not confirm manufacturer of first dose prior to administration of second dose, assumed it was asked earlier in the process. Pt. did not have vaccination card at time of second appt to confirm manufacturer, caregiver stated "it was too big to fit in his wallet so we didn't bring it." Site manager called Regional Medical Consultation Coordinator, to verify next steps. Advised per CDC not to re-vaccinate.

Other Meds:

Current Illness:

ID: 1073956
Sex: F
Age: 66
State: PA

Vax Date: 02/27/2021
Onset Date: 02/28/2021
Rec V Date: 03/04/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: PCN

Symptom List:

Symptoms: pt called pharmacy on Monday March 1 and stated that she visited her orthopedic doctor who stated that she suffered a minor Bursa injury from the vaccine injection. Pt stated she "was fine though."

Other Meds: unknown

Current Illness: unknown

ID: 1073957
Sex: M
Age: 47
State: WA

Vax Date: 02/16/2021
Onset Date: 02/27/2021
Rec V Date: 03/04/2021
Hospital:

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Lab Data:

Allergies: None

Symptom List:

Symptoms: Rash few weeks later formed on left elbow where moderna vaccine was injected. Small red bumps that after few days turned to small red circle. Bumps now forming on right arm elbow on 3/4/21. No pain. only itching at location site of bumps. I have pictures if needed email me

Other Meds: None

Current Illness: None

ID: 1073958
Sex: F
Age: 31
State: MN

Vax Date: 01/31/2021
Onset Date: 02/15/2021
Rec V Date: 03/04/2021
Hospital:

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Allergies: None

Symptom List:

Symptoms: This was an IVF pregnancy. My 2nd pregnancy. I got my first positive pregnancy test on Jan. 27th at exactly 4 weeks pregnant. I received my first vaccine at 4 weeks 4 days. I then went in for my first ultrasound at 6 weeks 5 days. The doctor told me the baby wasn?t developed normally and a miscarriage had already started. I believe the gestational sac measured about 5 weeks 3 days.

Other Meds: Progesterone in oil, estradiol patches, baby aspirin, prenatal vitamin, vitamin D

Current Illness: None

Total 2021 VAERS Injuries: 704,237

Page last modified: 03 October 2021 5:28pm