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: 1025600
Sex: F
Age: 45
State:

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient states 12 hours after 2nd injection she reported fever of 101.5, extensive shaking with chills, whole injection arm tingling, nauseated, and metal taste in mouth. Admits to be taking Tylenol and Benadryl. At the time of her reporting effects she continues to have stated effects.

Other Meds:

Current Illness: Has history of Lyme's disease and RA

ID: 1025601
Sex: F
Age: 39
State: CO

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Bactrim

Symptom List: Anxiety, Dyspnoea

Symptoms: Migraines, body aches, chills, no appetite swollen lymph nodes in neck, low grade fevers. Redness swelling of injection site as well as heat No treatment given.

Other Meds:

Current Illness:

ID: 1025602
Sex: F
Age: 45
State: MA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
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: nka

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

Symptoms: Moderna Vaccine Covid -19. Pt had shortness of breath with tight feeling in throat. Pt was treated with IM Epinepherine 0.3mg, and 50mg Benadryl IV. Pt was transported to hospital for observation.

Other Meds: n/a

Current Illness: no

ID: 1025603
Sex: F
Age: 78
State: FL

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fever and chills (severe shaking) starting around 5 p.m. on the day of the vaccination (Feb. 10). Took 2 Tylenol around 9:30 p.m. and went to bed. Had a temperature of 100.2 on Feb. 11; no chills. Stayed in bed the whole day. By about 5 p.m. the fever was gone and I was feeling much better. Today (Feb. 12) pretty much back to normal.

Other Meds: Simvastatin (10 mg), calcium, vitamin D, Citrucel, 81mg aspirin (3-4 times weekly)

Current Illness: None

ID: 1025605
Sex: F
Age: 42
State:

Vax Date: 02/09/2021
Onset Date: 02/09/2021
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: Shellfish, iodine

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

Symptoms: Significant arm pain that has lasted 3 days now. Tylenol not effective in touching the pain. It is difficult to move my arm.

Other Meds:

Current Illness:

ID: 1025606
Sex: F
Age: 69
State: IN

Vax Date: 02/10/2021
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: None

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

Symptoms: Injection site sore for 24 hours, slight headache beginning 12 hours after injection that resolved after acetaminophen, and fatigue 24 hours after injection that lasted 8 hours.

Other Meds: Lisinopril 20 mg Simvastatin 20 mg Omeprazole 20 mg

Current Illness: None

ID: 1025607
Sex: F
Age: 51
State: CA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Compazine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I was up most of the evening with chills and a severe headache. Today, I still have chills, headache and my left arm is extremely sore. I am also slightly nauseous, but not too bad.

Other Meds: Pro-air Albuterol inhaler, Multi-vitamin, B12, L-Glutamine, Propanalol.

Current Illness: No

ID: 1025608
Sex: M
Age: 36
State:

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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: Pharyngeal swelling

Symptoms: Developed hives and facial itching, eyelid swelling 12 hours after dose

Other Meds:

Current Illness:

ID: 1025609
Sex: M
Age: 61
State: TX

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: Morphine Sulfate

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 5 minutes after injection, patient started complaining of sever chest pressure, shortness of breath. EKG was done and EMS was called. Patient was transported to ED since he continues to exhibit shortness of breath and still complaining of chest pain/pressure.

Other Meds: Albuterol sulfate HFA 90 mcg inhaler every 4 hours as needed Hydroxyzine HCL 25 mg tablet at bedtime Symbicort 80 mcg inhaler twice a day

Current Illness: none

ID: 1025610
Sex: M
Age: 37
State: TX

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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Contractor presented for Dose 2 of Moderna Covid Vaccine. Immediately following vaccination, contractor reported feeling hot and nausea. 0927 VS 132/56 HR 69 02SAT 98% RA. Contractor placed in w/c and delivered to observation area and seated in a recliner. Given ice pack for comfort. Immediately, contractor reported symptoms resolved. VS@0935 BP 121/66 HR 75 02sat 99% RA. T 97.1. Contractor remained in observation area until 1020 and ambulated from area without incident.

Other Meds: none

Current Illness: none

ID: 1025611
Sex: F
Age: 46
State: KY

Vax Date: 02/04/2021
Onset Date: 02/04/2021
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: shellfish, coconut, soy hops, doxycycline-rash, reglan-anaphylaxis, Wellbutrin-seizure

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

Symptoms: pt reported dizziness, tingling tongue, swollen tongue and neck, harder breathing. epipen was administered and ems transported spouse notified

Other Meds:

Current Illness:

ID: 1025613
Sex: M
Age: 54
State: CA

Vax Date: 01/26/2021
Onset Date: 02/04/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Itchy, burning, hot rash over chest, clavicles, and neck. Spreading slowly and have had for over a week.

Other Meds: None

Current Illness: None

ID: 1025614
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: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Body aches, not just in injection site, dizziness, nausea, fainting. Lasted 30 hours after beginning of symptoms

Other Meds: none

Current Illness: none

ID: 1025615
Sex: F
Age: 58
State: WI

Vax Date: 02/09/2021
Onset Date: 02/10/2021
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:

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

Symptoms: HEADACHES BODY ACHES FEVER

Other Meds:

Current Illness:

ID: 1025616
Sex: F
Age: 71
State: CO

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: possible seafood - not diagnosed

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

Symptoms: 6 hours after injection - began low grade fever - body, muscle aches- weakness- 12 hours after injection - high fever 102 for 3 hours chills sweats - all other symptoms persisted and I began to have a very strong METALLIC TASTE in mouth. Very ill; 3 days after Metallic taste still present still not feeling well. missed 3 days work; By Friday 4 days after- feeling much better - Metallic taste still present but seems to be a bit less.

Other Meds: 1x daily: Clopidogrel 17 mg- Astorvastatin 40 mg - Ezetimbe 10 mg 2x daily : Carvedilol 12.5 mg 3X weekly : Estrodiol .5mg 1x daily over counter: Aspirin 81 mg - COQ10 100 mg - Vit D 2000 units - Prevagen

Current Illness: None

ID: 1025617
Sex: F
Age: 25
State: VA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: 1st dose: crippling fatigue 24 hours after receiving the vaccine. Pain and tenderness that lasted for 3-4 days 2nd dose: Headache and severe pain at the injection site, slight swelling at injected site, severe tenderness at the injection site and shoulder (all within 24 hours of receiving the dose. Body aches everywhere and flu-like symptoms

Other Meds: Albuteraland symbicort

Current Illness: n/a

ID: 1025618
Sex: F
Age: 40
State: MN

Vax Date: 02/11/2021
Onset Date: 02/11/2021
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: none known

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

Symptoms: It started with left arm pain and throughout the evening arm pain increased and I have been unable to move my arm. Also, experience a burning feeling in the injection site but when touching didn't feel warm. Had sweats and extreme cold feels along with mild fever, 89.6. Body aches, lethargy, headache, and mild dizziness. Currently taking Advil to help with symptoms and noticed mild improvements however still experiencing symptoms.

Other Meds: verapamil, spironolactone, magnesium and probiotic, melatonin at night

Current Illness: none

ID: 1025619
Sex: F
Age: 72
State: MS

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

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

Lab Data:

Allergies: Sulfa drugs

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Side effects - Headache, Muscle pain, Chills, Joint pain, Fast Heartbeat

Other Meds: Atorvastatin; Vitamin D

Current Illness: None

ID: 1025620
Sex: F
Age: 53
State: NY

Vax Date: 02/12/2021
Onset Date: 02/12/2021
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: strawberries

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: throat and tongue tingling, HA

Other Meds: synthroid

Current Illness: hypothyroid

ID: 1025621
Sex: F
Age: 54
State: MD

Vax Date: 01/28/2021
Onset Date: 01/28/2021
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:

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

Symptoms: Patient reports itching, and hives. Epi Pen administered and patient escorted to the ED She did receive epi prior to arrival but required no epi in the ED. She received corticosteroids. She was monitored for period time with no deterioration of symptoms. She is discharged stable condition she will complete prednisone and use Benadryl as needed

Other Meds:

Current Illness:

ID: 1025622
Sex: F
Age: 69
State: OH

Vax Date: 02/08/2021
Onset Date: 02/08/2021
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: Nitrofurantoin Microcrystal

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

Symptoms: chills, diarrhea, sick to stomach, overall unwell feeling

Other Meds: Prednisone 2.5 mg, Leflunomide 20 mg , Folic Acid, Lisinopril 20 mg, Omeprazole 40 mg, Methotrexate

Current Illness:

ID: 1025623
Sex: F
Age: 48
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Rigors, Severe Body aches, nausea, fever for 12-13 hrs, took tylenol with minor relief. Symptoms improved after 12-13 hrs and have since stopped

Other Meds:

Current Illness:

ID: 1025624
Sex: F
Age: 72
State: GA

Vax Date: 02/09/2021
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: Celebrex

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

Symptoms: 24 hours after receiving the 2nd dose of the Moderna vaccine, the injection site began to itch, then progressed to hot, red, raised, round, extremely itchy area about 2" in diameter. Progressed over the next 24 hours until it became a red, itchy band 1 1/2" wide encircling 3/4 around the upper arm. Has now been 72 hours since vaccine and symptoms are still present, but subsiding. I did have a slight itching 24 hours after the first dose on January 12, 2021, but the area affected was only about the size of a quarter and subsided within 24 hours.

Other Meds:

Current Illness: none

ID: 1025625
Sex: F
Age: 67
State: MN

Vax Date: 02/09/2021
Onset Date: 02/10/2021
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: phenol

Symptom List: Injection site pain, Pain

Symptoms: On 02-10-21 at 6 PM I started having a reaction when both my ears felt plugged and within a short time noted decreased hearing. By 9 PM I also had a severe headache with eye pain and dizziness and started to have chills and fever. The chills and fever lasted during the night even with the use of tylenol and ibuprofen. The highest the fever was 100.6. On 02-11 continued with ear problems, headache and eye pain and dizziness. Also at about 10 AM I thought I had an episode of hallucinating when I saw a man walk into our house. When I asked who he was he disappeared. I have had no more episodes like this. This morning I continue with headache and eye pain, dizziness and ear problems. My left arm at the site is pink about quarter size and itches. The symptoms are less painful than 02-11-21.

Other Meds: chlorthalidone 25 mg daily hydroxychloroquine 200 mg bid metoprolol succinate 100mg daily simvastatin 20 mg daily calcium 600 mg with vitamin D daily voltaren ointment bid

Current Illness: none

ID: 1025626
Sex: F
Age: 34
State: VA

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: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Elevated blood pressure (156/109) and chest pain.

Other Meds: Labetalol Birth control mini pill

Current Illness: None

ID: 1025627
Sex: F
Age: 23
State: WI

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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: 5 min after receiving , she started getting pain in her arm (right side) Hands felt like they were cramping. Fingers then started to feel tingly into her arms. Then lead to hard time swallowing. Did have some dizziness. Legs felt weak as well. She was given epinephrine per Doctor order. Was transferred to ER. They did give her Benadryl she had some slight bumps around mouth and neck.

Other Meds: Sertraline, buspirone, IUD/Mirena, imitrex

Current Illness: None

ID: 1025628
Sex: F
Age: 71
State: MI

Vax Date: 01/26/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: An itchy rash 4-5 inches around the administration site. Using Benadryl cream to help. Redness from rash is going down, itchiness has not changed.

Other Meds:

Current Illness:

ID: 1025629
Sex: M
Age: 81
State: SC

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient was inadvertently given saline instead of vaccine. No untoward event. Patient was called the next day, 2/12/2021, to have the vaccine administered.

Other Meds: unknown

Current Illness: unknown

ID: 1025630
Sex: F
Age: 48
State: IL

Vax Date: 01/29/2021
Onset Date: 02/12/2021
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: iodine

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

Symptoms: Moderna COVID-19 Vaccine, Covid Arm 13 days post vaccine

Other Meds: none

Current Illness: none

ID: 1025631
Sex: M
Age: 66
State: NY

Vax Date: 01/26/2021
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: RA

Lab Data:

Allergies: Penicillin, Phenothiazines

Symptom List: Nausea

Symptoms: Severe, intractable left lateral cervical pain, regardless of body or neck position (approx. C5,6,7 region) with radiation intermittently to proximal LUE

Other Meds: Aleve/ NSAIDS Vitamin D, Aspirin

Current Illness: Migraine Headache, Myalgia, Left Arm pain at injection site

ID: 1025632
Sex: F
Age: 66
State: NJ

Vax Date: 02/03/2021
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: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: chills, cough, swollen glands in neck, sore throat, just didn't feel right

Other Meds: trellegy ellipta, losartan, loratadine, low dose aspirin,omega 3, multi vitamin, mucinex, probiotic calcium, albuterol

Current Illness: none

ID: 1025633
Sex: F
Age: 48
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin, latex, bee stings

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

Symptoms: COVID-19 Vaccine EUA; Got vaccine around 5:30pm 2/11/21. About half hour later, face felt a little weird like when you are coming off of novocaine at the dentist. Tip of nose & cheeks sort of numb. Head felt heavy/pressure. Didn't think much of it, but still feeling it the next day (19 hours after shot). Face just feels funny. I feel the same way when I am around a lot of balloons or rubber tires since I have a latex allergy. Sort of affecting my vision as well, seems to go out of focus every now and then.

Other Meds: B12 injection Multivitamin (Equate One a Day), Biotin, Vitamin D, Calcium w/Magnesium

Current Illness: None

ID: 1025634
Sex: F
Age: 21
State: CA

Vax Date: 01/09/2021
Onset Date: 01/10/2021
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:

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

Symptoms: Soreness to injection site next day along with body and stomach ache, Missed one day of work.

Other Meds:

Current Illness:

ID: 1025635
Sex: F
Age: 71
State: SC

Vax Date: 01/28/2021
Onset Date: 01/30/2021
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: Penicillin, strawberries, Sulfa drugs,

Symptom List: Tremor

Symptoms: I presented at ER with burning, throbbing right leg pains at upper calf and upper thigh area. The ER doctor said it was not a blood clot, but was the beginning of Shingles on the back of my right thigh, buttock and downward just below the back of my knee. I was prescribed Acyclovir, Hydrocode with Tylenol and suggested topical creams. I was unable to find the Zostrix suggested so began with Caladryl and Terrasil cream as well as baking soda/water soaks a couple times a day. As of today, February 12, I still have leg pain, markings from the lesions and am unable to sleep more than a couple of hours a night without throbbing, burning pain especially at 2 lesion sites. Now taking Tylenol alternating with Tramadol for the pain.

Other Meds: Z-pak, Tobrymycin/Dexamethasone drops) Losartin Rosuvastatin Calcium/magnesium, Vitamine D3 Acidophilus

Current Illness: Stye in left upper eye lid (Z-pak and Tobrymycin/Dexamethasone drops) Sciatica, right leg

ID: 1025636
Sex: F
Age: 63
State: WI

Vax Date: 02/09/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: FEVER, NAUSEA BODY ACHES

Other Meds:

Current Illness:

ID: 1025637
Sex: F
Age: 41
State: KY

Vax Date: 02/09/2021
Onset Date: 02/09/2021
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:

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

Symptoms: PER PATIENT STATEMENT: I noticed the itching around 3pm and redness associated, very inflamed feel. I had some upper back burning and prickly sensation last night and my arm is still itching today with a tight rubber band feeling around the area. Occasionally get a cool sensation down the arm with light tingling. I took Benadryl last night with hydrocortisone on the site. It seems less itchy today but still there.

Other Meds:

Current Illness:

ID: 1025639
Sex: F
Age: 42
State: CO

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: LA

Lab Data:

Allergies: None

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

Symptoms: Chills, Extreme back, hip, neck aches, Dizziness, Extreme fatigue to the point of barely being able to move or get out of bed. Arm pain at injection site.

Other Meds: None

Current Illness: None

ID: 1025640
Sex: F
Age: 17
State: AL

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: Allergic to environmental things

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt developed itching and burning on her neck and chest. Mom gave patient Benadryl and Motrin. This helped the itching but then it came back at noon the next day. Mom gave her more Benadryl. It then came back the following day and Mom gave Benadryl again and then it never came back.

Other Meds: None

Current Illness: Pt did test positive for Covid on Dec 2,2020.

Date Died: 01/22/2021

ID: 1025641
Sex: M
Age: 85
State: NE

Vax Date: 01/11/2021
Onset Date: 01/18/2021
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: Aspirin, Simvistatin, Tamsulosin

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

Symptoms: Complained of dizziness on January 18,th seen by MD this date. Passed away on 22nd.

Other Meds: Levothyroxine, Metformin, Tamsulosin

Current Illness: No other vaccinations no other illnesses

ID: 1025642
Sex: M
Age: 66
State: CA

Vax Date: 01/23/2021
Onset Date: 01/23/2021
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: NKDA

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

Symptoms: chills, fatigue, muscle and body aches, headaches, congestion, runny nose and nausea with vomiting

Other Meds: losartan, Zyrtec, Qnasl and ASA

Current Illness: NONE

ID: 1025643
Sex: F
Age: 29
State:

Vax Date: 01/22/2021
Onset Date: 01/27/2021
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: Hives 4 days after first dose that was self-limiting and resolved with Benadryl, reported at time of 2nd dose

Other Meds:

Current Illness:

ID: 1025644
Sex: M
Age: 39
State:

Vax Date: 01/27/2021
Onset Date: 02/07/2021
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: none

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

Symptoms: I am nursing and my son (10 months old) had a fever 10 days after my second vaccine. He also developed a rash, quarter size on his belly under his belly button about 14 days after the vaccine. He developed this rash after the first dose as well, 10 days after I received the vaccine.

Other Meds: none

Current Illness: none

ID: 1025645
Sex: F
Age: 48
State: WI

Vax Date: 02/09/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: FEVER HEADACHE

Other Meds:

Current Illness:

ID: 1025646
Sex: F
Age: 35
State: OH

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Symptoms started day after vaccine and continued a whole week ended up in the Ed was diagnosed with adverse reaction to canid 19 vaccine. Symptoms were vomiting, nausea, diarrhea, headache, severe swelling in lower back, legs and arms, low oxygen levels, low grade fevers intermittent with shakes and hot and cold sweats.

Other Meds: None

Current Illness: None

ID: 1025647
Sex: F
Age: 52
State: TX

Vax Date: 01/25/2021
Onset Date: 02/01/2021
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: Morphine codeine turmeric

Symptom List: Vomiting

Symptoms: Hives on back eye twitching throat closing eye secretion/dryness

Other Meds: Glucosamine testosterone progesterone estrogen tizanidine St. John?s wort magnesium theanine dextroamphetamine CBD trazadone

Current Illness:

ID: 1025648
Sex: F
Age: 53
State: MI

Vax Date: 01/28/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Luer lock needle was not firmly attached to the syringe containing the vaccine at time of administration. When the plunger was pressed, vaccine leaked out between the needle and the syringe. CDC guidance recommended repeating the 1st dose of vaccine due to less than half of the vaccine being administered to the client.

Other Meds:

Current Illness:

ID: 1025649
Sex: F
Age: 68
State: NY

Vax Date: 01/29/2021
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: RA

Lab Data:

Allergies: none

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

Symptoms: Round, red lesion about 3 inches in diameter at injection site. Warm to the touch, tender, itchy. Treated with ice, Clobetasol propionate cream. Doctor just prescribed Cephalexin 500 mg Capsule but have not taken first one yet.

Other Meds: atorvastatin, vitamin D2, vitamin d3, Vitamin B12, fish oil caps, Mag07

Current Illness: none

ID: 1025650
Sex: F
Age: 69
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: CHILLS FEVER 101 HEADACHE BLD PRESSURE 90/40 PULSE 95 lasted all day starting 15 hours after shot. Feel better today with mild headache and pulse 95

Other Meds: Chlord/Clidi ,Lipitor,Lisinopril

Current Illness: None

ID: 1025651
Sex: M
Age: 43
State: IN

Vax Date: 02/01/2021
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: None

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

Symptoms: Fever, fatigue, cold chills and body aches, migraine

Other Meds: Multi vitamin

Current Illness: None

ID: 1025652
Sex: F
Age: 61
State: GA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
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, SULFA

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

Symptoms: AT 3:41PM PATIENT TONGUE FEELS "OFF", HAS HAD FEELING FOR 10 MINUTES BEFORE REPORTING. PATIENT REPORTS FEELING SMALL AMOUNT OF DRAINAGE IN THROAT. ADMINISTERED 50MG OF DYPHENHYDRAMINE, IM, RO AT 3:43PM. PATIENT MONITERED VITALS EVERY 5 MINUTES. AFTER MEDICATION PATIENT REPORTS FEELING DIZZY AND "LOOPY" AT 5:17PM PATIENT COMPLAINS OF TONGUE SWELLING AND BLOOD PRESSURE ELEVATED. EMS CALLED, ARRIVED AT 5:34PM, PT TRANSPORTED TO NORTHSIDE HOSPITAL. FOLLOW UP CALL, NEXT DAY PATIENT STATES SHE WAS GIVEN STEROIDS IN THE ER AND PRESCRIBED AN EPI PEN FOR FUTURE USE.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm