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: 1028168
Sex: F
Age: 44
State: NE

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Tetracycline, erithromyacin

Symptom List: Dysphagia, Epiglottitis

Symptoms: ?Covid arm? red, swollen, sore rash at injection site.

Other Meds: Prilosec, trazadone, coreg, hydrochloithiazide, Claritin, sprintec, amitriptaline, sertraline

Current Illness: None

ID: 1028169
Sex: F
Age: 48
State: CA

Vax Date: 02/12/2012
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Sulfa

Symptom List: Anxiety, Dyspnoea

Symptoms: Severe arm pain, chills, fever, body aches, headache, tired

Other Meds: Alleve after injection

Current Illness: Had a mild cold a few days prior

ID: 1028170
Sex: M
Age: 66
State: NJ

Vax Date: 02/01/2021
Onset Date: 02/10/2021
Rec V Date: 02/13/2021
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: penicillin

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

Symptoms: fatigue, muscle aches, chills for about 30 hours and sore arm where the injection occurred

Other Meds: none

Current Illness: none

ID: 1028171
Sex: F
Age: 27
State: MI

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 02/13/2021
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: 14-24hours of muscle aches. 20-48 hours fatigue. All symptoms resolved within 48hours of vaccine

Other Meds: None

Current Illness: None

ID: 1028172
Sex: M
Age: 40
State:

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Widespread tingling hours after getting vaccine, with anxiety

Other Meds:

Current Illness:

ID: 1028173
Sex: F
Age: 72
State: TX

Vax Date: 02/02/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Sulfa drugs.

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

Symptoms: Redness - Rash, swelling and very light pain. Not a problem, did not call doctor.

Other Meds: Multi-vita, Sertraline 150 mg, Livalo 4 mg, Vita. D and E, Magn., Calcuim Only, 2 medications from doctor.

Current Illness: No

ID: 1028174
Sex: F
Age: 23
State: IN

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Chills, body aches, burning up

Other Meds: Birth control

Current Illness: N/a

ID: 1028175
Sex: F
Age: 68
State: TX

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Pharyngeal swelling

Symptoms: Low grade fever, fatigue, chills, body aches

Other Meds: Triamterene hctz 37.2-25 mg Metoprolol ER 50 mg Rosuvastatin calcium 10 mg Ezetimibe 10 mg Cyclobenzaprine 10 mg Tramadol HCL 50mg

Current Illness: None

ID: 1028176
Sex: F
Age: 37
State:

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 02/13/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received Pfizer vaccine per EUA Emesis x1 with epigastric area "nausea" Vital signs and oximeter normal Symptoms spontaneously resolved. Routine post immunization instructions

Other Meds:

Current Illness:

ID: 1028177
Sex: F
Age: 52
State: IN

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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: Bees

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Heart racing, cold chills with uncontrollable shaking, nausea, headache, body aches, joint pain, fatigue and fever

Other Meds: Buspirone 10 mg, lexapro 10 mg, mimvey

Current Illness: Allergies

ID: 1028178
Sex: F
Age: 34
State: CA

Vax Date: 02/05/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Eucalyptus oil and leaves

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

Symptoms: 7 days after vaccine I got a big red spot on my arm at the site of the vaccine. It itches and felt like I had a bump under my skin. The next day still itchy , bigger red spot. Less of a bump under my skin.

Other Meds: No

Current Illness: None

ID: 1028179
Sex: F
Age: 41
State:

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 02/13/2021
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: Information reported by individual involved as follows. AFTER 2ND VACCINE OF PFIZER I HAD SEVERE MUSCLE ACHES AND FEVER ABOUT 12 HOURS POST VACCINE WHICH IS EXPECTED DIAGNOSED MILD CASE OF BELLS PALSY. LEFT SIDED FACIAL NUMBNESS TO CHEEK, TONGUE, MOUTH GUMS, INCREASED SNORING, THESE SYMPTOMS WERE NOTED SHORTLY AFTER VACCINE #2. I DID NOT PUT IT TOGETHER AT THE TIME THAT I WAS HAVING REACTION TO THE VACCINE ONLY AFTER DOING SOME RESEARCH ON WHAT COULD BE LEADING TO LEFT SIDED TONGUE NUMBNESS DID I REALIZE I COULD BE HAVING BELLS PALSY A REACTION TO THE VACCINE. WENT TO EMPLOYEE HEALTH ON 2/1/21 AND THEY NOTED POSTIVE MILD CASE OF BELLS PALSY. AFFECTED IS LEFT SIDE OF FACE, GUMS CHEEK TONGUE AND SLIGHT DROOP

Other Meds:

Current Illness:

ID: 1028180
Sex: M
Age: 80
State: IN

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Headache, chills, vomiting started on the morning of February 12, 2021. The vomiting happened twice but the chills and headache lasted almost 24 hours. He felt much better on February 13, 2021.

Other Meds: None

Current Illness: None

ID: 1028181
Sex: F
Age: 44
State: IN

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/13/2021
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: allergic to penicillin

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

Symptoms: sore, red and hot arm at injection site (lasted 5 days), chills, sweats, low grade fever, fatigue.

Other Meds: prozac, norvasc, vit d, turmeric, multi vitamin, baby aspirin

Current Illness: no

ID: 1028183
Sex: F
Age: 44
State: MA

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Headache, bod ache like flu. Fatigue. Swollen and painful injection site. Overall malaise. Next morning after 24 hrs since injection, rash developed around injection site. Slowly getting bigger.

Other Meds:

Current Illness:

ID: 1028184
Sex: M
Age: 66
State: AZ

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/13/2021
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: N/A

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

Symptoms: 2-4, 11:00AM - Achy and blah. Very light 'flu-like' feelings. Some nausea, slight sinus pain / headache. Lasted throughout day and evening. Temp. 99. Some small shots of pain up neck and in right shoulder. Possibly not related. 2-5, 09:00AM - Temp. 96.3. Still some light nausea, etc. 10:30AM - Feeling basically OK. Shot site was sore with some slight under arm lymph tenderness. (2nd shot was very painful and burned, unlike 1st dose which was amazingly painless with very little shot site soreness, if any.) 04:00PM - Discovered rash around shot site. Rash was blotchy, somewhat and about 4-5 inches in circumference. Slightly itchy. Rash continued through 2-10-21 with a bit of remanent through 2-12-21.

Other Meds: Lisinopril, aspirin, fish oil, turmeric

Current Illness: N/A

ID: 1028185
Sex: F
Age: 69
State: CT

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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

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

Symptoms: Severe BPPV Treated by Semont Liberatory Maneuver X 2 Still symptomatic

Other Meds: atorvastatin gabapentin tylenol

Current Illness: none

ID: 1028186
Sex: F
Age: 76
State: CA

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Latex and ambusol

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Immediately, within 2 hours of the vaccination, I developed a severe headache, join pain (knees, elbows, mostly legs and lower extremities) which evolved into intense, burning abdominal pain. My blood pressure rose to 160; however, there was no fever, cough or shortness of breath. This condition lasted until the 7am on the morning of February 8th, but pains returned that evening (Monday 2/8) through Tuesday morning. Symptoms subsided during the day on Tuesday, yet on Tuesday evening (2/9, approximately 48 hours after the injection), severe symptoms returned, similar to the initial evening. I visited my Primary Physician on Wednesday afternoon (2/10) for a consult.

Other Meds: Prednizone, Avastin, Amlodipine, Pantoprazole

Current Illness: IBS, Polymyalgia, Fibromyalgia

ID: 1028187
Sex: F
Age: 32
State: PA

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Cipro and latex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Rash on arm of injection site, across chest and face. Diarrhea.

Other Meds: No

Current Illness: Vomiting after first vaccine

ID: 1028188
Sex: F
Age:
State: OH

Vax Date: 01/17/2021
Onset Date: 01/17/2021
Rec V Date: 02/13/2021
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: I was 38 weeks at the time of my second vaccine. I experienced headaches, nausea, fever, chills and diarrhea. these symptoms lasted one day. I started also to have contractions due to the diarrhea and the following day I went to the maternity ward.

Other Meds: pre-natal vitamins, eye drops

Current Illness:

ID: 1028189
Sex: F
Age: 66
State: IL

Vax Date: 02/03/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: N/A

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

Symptoms: Red rash on left arm at the vaccine site.

Other Meds: Nature Made Multi Vitamin for her +50 Nature Made D3 2000IU Tum?s Ultra 1000

Current Illness: N/A

ID: 1028190
Sex: F
Age: 54
State:

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 02/13/2021
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: COVID PSYSR Vaccine observation area 1622 - 20 min after injection c/o itching inside of left ear / left face and left eye VS 150/102 HR 79 O2sat 97% Doctor notified 1628 sx increasing - Benadryl 25mg PO given 1640 sx decreasing VS 157/91 HR 65 1650 face and ear itching resolved.... eye still feel heavy 1700 - feeling well. Left observation area

Other Meds:

Current Illness:

ID: 1028191
Sex: F
Age: 37
State: WA

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/13/2021
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: No known Food or medication allergies

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

Symptoms: 2/5: Headache a few hours post injection. Pain at site 2/6: Exhaustion, extrem tiredness. Headache in morning. Pain at site. 2/7: approximately 1.5 inch radius firmness area from injection site (3 inch) diameter. Tiredness continues. Pain at firmness site. 2/8: rash over firmness area unchanged in size, area was also hot and itchy. Chills on and off throughout day. Tiredness continues. Pain at firmness site. 2/9: rash slightly still present, itchiness continued on-off through out the day. Chills thought day and more present in the evening. Pain still at firmness site. 2/10: Firmness goes away. Chills continue and tiredness continues. Itchiness continues on and off. 2/11: Itchiness continues on and off. Tiredness continues. Chills continue on and off, more present in the evening. site now sore (no longer pain) to pressure. 2/12: Itchiness continues on and off. Tiredness continues. Chills continue on and off, more in the evening. Site still sore to pressure 2/13: Itchiness continues on and off. Site still sore to pressure. 2/12:

Other Meds: Calcium & Magneium QD; Omega 3-6-9 (1000Mg) BID; Boron 3 mg BID; Folic Acid (800 mcg with vitamin B-12) QD; EVE (Superior Womane's Multi); Biotin (10 mg) BID; VitaminD (5,000 IU) QD; NAC (600 mg)

Current Illness: None

ID: 1028192
Sex: F
Age: 75
State: IN

Vax Date: 02/09/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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: remicade, sulfa ointments

Symptom List: Injection site pain, Pain

Symptoms: on 2/11/21 had a ocular miraine which lasted 30 minutes, drank coffee for caffine, took tylenol, still having minor headaches, do not know if attributed to taking the vaccine

Other Meds: pravaastatin 40mg, benicar 20mg, leflunomide 20mg, metoprolol 25 mg-twice a day, hydrochlorothiazide 12.5 mg.

Current Illness: none

ID: 1028193
Sex: F
Age: 66
State: PA

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Alphagen P, aromatic inhalants, chemical sensitivity, hydrocar

Symptom List: Injection site pain, Menorrhagia

Symptoms: About 2 hours after injection 1/29/21 lymph nodes swelling in neck, face, both arm pits; with tenderness and pain; slight headache; fatigue; dry eyes. 1/29/21 some 8 hours after injection worsening headache, onset of runny nose, body aches, sweating with chills, and lymph node pain, swelling face, neck and arm pits; very dry eyes. Low fever, extreme fatigue and flu symptoms persisted for 7-8 days; little appetite; lymph nodes in neck, both arm pits and breasts persistently swollen through and including 2/13/2021 with fatigue persisting. Am scheduled for vaccine second dose 2/26/21, but am hesitant to receive since my adverse reactions remain strong.

Other Meds: Zolpidem 6.25 ER/night; Magnesium 400mg/d; Riboflavin 200mg/d

Current Illness: hyperosmia: allergic to aromatics, chemicals, hydrocarbons;

ID: 1028194
Sex: F
Age: 37
State: MA

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: This nurse was administering Covid-19 vaccine in right deltoid to resident in ALF. As the plunger of the syringe was being depressed, the patient suddenly jerked hard to the left, exposing the needle, and then immediately back to the right, which caused the needle to pierce nurses gloves and pass into skin of left index finger (the hand that was on the patient's arm, bunching deltoid muscle was pierced. Needle stick immediately washed out with soap and water for 3-5 minutes, disinfected with first aid disinfection towel and covered with bandage.

Other Meds: N/A

Current Illness: N/A

ID: 1028195
Sex: M
Age: 80
State: FL

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: Ipsilateral axillary node swelling and tenderness beginning day 2; treatment - watchful waiting,; outcome - slowly improving tenderness, size unchanged on day 3 No reaction to first shot inseries.

Other Meds: Metropolol, diazide, fenasteride, tamsulosin, atorvastatin , occasional flovent 100, occasional diazepam

Current Illness: None

ID: 1028196
Sex: F
Age: 86
State: CA

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

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

Lab Data:

Allergies: Fresh pineapple

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: C/o muscle aches pain to both legs on 2/12/21. Medicated with Motrin 200mg PO x1 dose. Still c/o of achiness but has improved. 2/13/21 C/o general muscle pain up to ears. Medicated with Motrin 200mg PO x1 dose, so far today.

Other Meds: Vitamin D3, 50mcg; atorvastatin, 40mg; amloddipine besylate 5mg; vitamin B-12, 1000mcg; metoprolol tartrate 50mg; sertraline hcl 25mg

Current Illness: None

ID: 1028197
Sex: F
Age: 41
State: CT

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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:

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

Symptoms: Localized enlarge lymph nodes/hypertension

Other Meds: Lisinopril 5 mg

Current Illness:

ID: 1028198
Sex: F
Age: 82
State: WI

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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 stated on VAR

Symptom List: Nausea

Symptoms: pt received 2 2nd doses of the moderna covid19 vaccine in the same right deltoid

Other Meds: unknown

Current Illness: unknown/not noted

ID: 1028199
Sex: F
Age: 38
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 02/13/2021
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: 0855 - approximately 10 min after pfizer covid vaccine, patient had itching on her bell and face (Dr notified) VS 144/88 HR74 O2sat 100% 0902 - now nose is starting to itch 0907 - Benadryl 25mg PO per Dr 0918 - Decrease nose itching... continued face itching VS 132/86 HR71 0929 - chest/ back and eye now itching Benadryl 25mg PO per Dr 1006 VS 137/87 HR65 1026 - red welts on chest 1103 - Cetririzine 10m PO 1200 - slight decrease in itching / now feeling tingling 1230 - sleepy / decrease itching and tingling 1310 - home with husband driving

Other Meds:

Current Illness:

ID: 1028200
Sex: F
Age: 78
State: CA

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

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

Symptoms: Upper left arm, at site of injection: red, swollen, itching. Size = 3.5 inches x 2.5 inches.

Other Meds: omeprazone 20 mg po qd allerclear (loratadine) 10 mg po qd

Current Illness: none

ID: 1028201
Sex: F
Age: 69
State: NM

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/13/2021
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: Keflex,percodan, talwim, malerion,maderna vac

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

Symptoms: Swollen stiff painful arm, stiff neck side of face inflammation, lower eyelid lg inflammation migraine complex eye very red, migraine really bad,

Other Meds: No

Current Illness: Migraines

ID: 1028202
Sex: F
Age: 77
State: OR

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/13/2021
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. Blood thinners

Symptom List: Tremor

Symptoms: Bleeding on the toe of foot. Complete sock from ball of foot to end of ties was soaked with blood. This was a spot that Would bleed when I had IV chemo therapy in 2012. Called Dr. And HHT. Clinic at Hospital

Other Meds: Thyroid. Calcium

Current Illness: None

ID: 1028203
Sex: M
Age: 56
State: AZ

Vax Date: 02/03/2021
Onset Date: 02/06/2021
Rec V Date: 02/13/2021
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: nka

Symptom List: Erythema, Pruritus

Symptoms: rash, hot, tingling, swollen face, given 50mg benedryl... this happen again on the 9 Febuary 2021 and again on 13 Febuary 2021 treated with 50 mg benedryl po.... symptoms relived within 90 minutes... there was no difficulty breathing, swallowing or talking at anytime rash, face swelling, itching, tingling, hot,

Other Meds:

Current Illness: slight hypothyroidism

ID: 1028204
Sex: F
Age: 48
State:

Vax Date: 02/01/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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: Headache, fever (102), nausea, rash all over the body, swelling in the arm of the injection

Other Meds: vitamin D

Current Illness:

ID: 1028205
Sex: F
Age: 45
State: RI

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: Seafood,pcn, fruit

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

Symptoms: Anxiety

Other Meds: None

Current Illness: Hypertension, amxiety

ID: 1028206
Sex: F
Age: 29
State: MO

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: N/a

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Swollen L arm where it was injected, warm to the touch, red golfball sized mark where injected, very swollen lymph node under left armpit, low grade fever (99.3), migraine (started last night around 8 and ongoing) with no relief from my medication), mental fog (trouble processing/comprehending information or my thoughts to express), no sleep last night,. I can not touch my left arm from my shoulder to elbow without pain and I can?t lay on it/provide pressure at all.

Other Meds: Tretinoin topical gel, adderall 30 mg daily, Zyrtec & Benadryl daily

Current Illness: None

ID: 1028207
Sex: M
Age: 78
State: UT

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/13/2021
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: None

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

Symptoms: Itching, rash all over body, large blisters on chest and face. Started exactly 24 hours after 2nd shot. came very fast , within five minutes of no problems.

Other Meds: Jardiance, Januvia, baby asprin, vitamins, one shot a week of Bydureon BCise

Current Illness: None

ID: 1028208
Sex: F
Age: 77
State: CA

Vax Date: 02/01/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: sulfur drugs

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

Symptoms: red rash on/near area of injection, hot to touch, itchy, some swelling

Other Meds: Losartan potassium furosemide carvedilol methotrexate folic acid Omeprazole

Current Illness: none

ID: 1028209
Sex: F
Age: 35
State: MD

Vax Date: 02/05/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: Intolerance to stone fruits, wheat, banana, avocado, possible latex intolerance.

Symptom List: Pain in extremity

Symptoms: I noticed my arm was feeling sore again at the injection site the night before. When I woke up on February 13, 2021, I noticed a red raised bump at the site of injection. Within an hour the redness spread and was getting warmer and sore. Within a couple hours the bump was gone but the redness spread to a couple of inches in a blotchy pattern. It did not itch at all and was sore only when I moved my arm or pressed on it. The bump has not returned yet and the redness and warmth are still there. The redness has also not spread anymore so far. This is approximately 8 hours after I noticed the red bump. Otherwise I feel normal. I did not seek medical attention because at the time, I do not feel it is concerning, but I just wanted to report it for data purposes.

Other Meds: Omepetozole Oral contraceptive Prozac 20mg Zyrtec

Current Illness: None

ID: 1028210
Sex: F
Age: 44
State: SC

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
Hospital:

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

Lab Data:

Allergies: ciprofloxacin, levaquin

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

Symptoms: Pt developed left sided chest pain at 2:50 immediately after being given first dose of covid vaccine . No radiation to neck or jaw. Pt denies any cardiac hx. Pt denied nausea or prb breathing, HR=90, BP180/110, pulse ox =96%, unlabored resp. Pts neck and upper chest became red but no edema or facial redness. Ambulance was called. 2:55 PM -pt improved immed after 0.3 mg epi IM and 50 Mg benadryl injected with resolution of chest pain and rash. Repeat HR=79 and BP =120/72. Ambulance arrived at 3:00 and pt transported for evaluation of chest pain. Pt gave hx of allergies to cipro and levaquin with hx of hives

Other Meds: adderall XR, synthroid, zyrtec

Current Illness: none known

ID: 1028211
Sex: F
Age: 63
State: CA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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: shellfish, acetaminophen, penicillin

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

Symptoms: minor fever and sore arm until bedtime. I awoke about 10:30 PM with nausea and abdominal pain, even to the touch, higher fever, mild headache and significant thirst. When I awoke a few hours later and tried to get out of bed my feet were cramping so I couldn't stand comfortably, also achiness in ankles, hands and wrists. I was very thirsty and cold, so cold that I could not get a thermometer in my mouth as my teeth were chattering. I tried to drink some water and went back to bed. A few hours later I woke up, thirsty, kind of crawled into the bathroom. I had a 101 temperature, still nauseous and achy joints. I tossed and turned all night. When I got up at 6:15 AM I went into the bathroom, tried to drink water but was feeling very nauseous and felt like I was going to pass out. I woke up on the floor when my husband came in - he heard my head hit the floor from another room. My first instinct was for water, which he squirted into my mouth. Both of my arms and hand were tingling. He managed to help me up, and I crawled back to the bed. My temp was about 100.5 where it stayed for most of the day. I called a friend, she told me to take some ibuprofen -I can't take acetaminophen- I took one, drank lots of fluids, and spent the rest of the day sleeping on and off. I did cut my head but not significantly enough to go to a facility. I was literally unable to do anything for the entire day. When I woke up today my temperature was down to 98.1 - its normally in the 97's - and feel much better except my sore arm and aching head

Other Meds: none

Current Illness: none

ID: 1028212
Sex: F
Age: 38
State: OH

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/13/2021
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: PCN

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

Symptoms: Arm got very sore the evening after injection. Developed a headache about 3 hours after the injection. On 01/16/2021 woke up with cold like symptoms such as stuffed up nose, slight cough that lasted about 2 days. Body very tired and sluggish for about 2 days as well.

Other Meds: Multivitamin, Motrin

Current Illness: N/A

ID: 1028213
Sex: F
Age: 16
State: MI

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/13/2021
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:

Symptom List: Vomiting

Symptoms: The patient is 16 years old and was given the incorrect vaccine for her age.

Other Meds:

Current Illness:

ID: 1028214
Sex: M
Age: 61
State: MN

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/13/2021
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: sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After Covid vaccination #1, patient was instructed to be monitored for 30 minutes due to history of sulfa allergy. After about 5 minutes of observation, she approached me (pharmacist) saying she had tingling and a little numbness in right side of lower face. She reported no difficulty breathing and no other symptoms. I consulted the two other pharmacists I was with and we decided to not take any immediate action but continue monitoring. I checked in with patient every few minutes to ask if symptoms were getting better/worse. For first 30 minutes, pt said symptoms were the same. After about 30 minutes, she said she had a little itching down her throat, but still no difficulty breathing. We gave her 50 mg diphenhydramine and monitored for 30 more minutes. After 1 full hour of observation, she never reported difficulty breathing. She did get tired from the Benadryl and was up on moving around and said feeling slightly better. After 1 hour, she went back to her room.

Other Meds:

Current Illness:

ID: 1028215
Sex: F
Age: 29
State:

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 02/13/2021
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:

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

Symptoms: Covid-19 Vaccine Clinic: @0857, after receiving Pfizer Covid-19 vaccine, patient c/o "jittering" and anxiety. Patient denies any other PMH except for preeclampsia with last pregnancy. MD aware. Initial VS at 0857: BP 139/99 HR 86 SpO2 100% RR 20. @0903 Patient continues to report "jitterness" and anxiety at this time. Subsequent VS: BP 122/90 HR 84 SpO2 100% RR 18. @0915 patients blood sugar checked. Patient did report eating breakfast this morning. BS 135 @0927 patient reports "i'm not feeling right" BP 119/82 HR 80 RR 18 SpO2 96% RA. Symptoms reported: weakness and patient states "I feel like if I get up i'm gonna fall". Denies "jitterness". @0929 MD notified via phone regarding patients new symptoms. MD to come assess patient @0938 MD at patients side. Pt reports feeling like "i'm gonna pass out". RN STAT called. Patient placed on bed cot initially and wheel chaired over to reclining chair. @0954 BP 123/87 HR 78 SpO2 96% RA RR 18. Patient states "head foggy" and "I can't get up" @1015 #20 G PIV started on right forearm. Patient reports "I don't feel right" BP 118/83 HR 66 RR 18 SpO2 99% RA. @1045 BP 121/83 HR 57 RR 19 SpO2 96% RA. Patient still reports "I feel like passing out" MD called back for re-assessment of patient @1105 MD at patients side for assessment. Per MD, patient is physiologically stable for mother to pick up and take her to urgent care (patient refusing to be sent to ER)(Urgent care as requested by patient as she states she is a per diem worker and does not have Kaiser insurance). BP 118/89 HR 69 RR18 SpO2 98%. @1145 Patient picked up by mother to go to urgent care. Okay to leave PIV in place by MD d/t patient a hard stick and may require intervention at urgent care

Other Meds:

Current Illness:

ID: 1028216
Sex: F
Age: 66
State: IN

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/13/2021
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: Lethargy, sleepy. painful left armpit and breast, headache

Other Meds: Metformin, Simvastatin, Clopidogrel, Estradiol, Progesterone, Omeprazole, Losartsn, Mobic

Current Illness: None

Date Died: 02/01/2021

ID: 1028217
Sex: M
Age: 72
State: MI

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

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

Lab Data:

Allergies: no

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

Symptoms: DEATH

Other Meds: Type 2 diabetes medication, Blood pressure Medication, arthritis medication. blood thinner medications

Current Illness: no

ID: 1028218
Sex: F
Age: 54
State: ID

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/13/2021
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: No medicine or food allergies

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

Symptoms: Approximately 2 hrs after vaccination, I felt extremely tired. Tired feeling continued for 3 days. Arm developed sore lump at vaccination site, again about 2 hrs after vaccination, which dissipated over the course of a week. Day after vaccination, I felt aching all over my body. This feeling only lasted the day. I do not consider myself to have had an adverse reaction. I am only reporting for research purposes.

Other Meds: Dorzolamide timolol, Rocklatan, loratadine, multivitamin, calcium supplement

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm