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
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 1077045
Sex: F
Age: 18
State: CA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: On Fri 3/5 one of the RPhs on duty administered the vaccine around 2:45 PM. RPh advised patient to wait in the waiting room for 15 minutes to make sure she felt fine. Around 3 PM patient told another patient sitting in the waiting room that she was feeling light headed and told her to call the pharmacy staff, which she did. One of the RPhs went out of the pharmacy into the waiting room to check up on her while the other pharmacist called 911. RPh who went to check up on her found her on the floor slouching. RPh tried to shake her awake and she appeared nodding off and on. Finally after a minute of two, she became more coherent and conscious. Team member grabbed orange juice to give to her. Other patient who grabbed our attention stated she was slowly sliding off her chair. RPh stayed by her side until paramedics arrived. Although she marked "No" on Section B #5 on the VAR form, she stated that she gets light headed and dizzy whenever she gets blood drawn or at the dentist. Paramedics checked on her vitals, was within normal range. Patient opted not to be taken to the hospital. RPh advised patient to call a family member to pick her up because although she felt ok to drive, she stated she felt a little nauseous and her head kind of hurts. Mother picked her up about an hour after the incident occurred.

Other Meds: Patient stated that she is currently on birth control when paramedics questioned her.

Current Illness: Unknown

ID: 1077046
Sex: F
Age: 44
State: NY

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: Itchy red rash covering my neck, both arms, full abdomen and back

Other Meds: Domperidone, Crestor

Current Illness:

ID: 1077047
Sex: F
Age: 29
State: IA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List:

Symptoms: Patient became very lightheaded and fell to the floor approximately 15 minutes after receiving the vaccine. She did not completely lose consciousness and did not hit her head but was very confused and disoriented. An ambulance was called and the patient was taken to the hospital.

Other Meds: NA

Current Illness: NA

ID: 1077048
Sex: F
Age: 63
State: UT

Vax Date: 02/23/2021
Onset Date: 02/28/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Pcn

Symptom List:

Symptoms: Developed shingles post vaccine day #5

Other Meds: Daily vitamin glucosamine collagen

Current Illness: None

ID: 1077049
Sex: F
Age: 24
State: IL

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Client notifed paramedics she didn't feel well. LOC-alert Lung sounds- clear Skin-pale Pain-no oxygen- non rebreather at 10 L 11:36AM- BP was 110/80;Pulse 60; O2 sat 99 11:39AM- pulse was 107 Benadryl 50mg was given at 11:36AM 11:42AM- O2 sat 95 Slow capillary refill numbness and tingling in extremities cold/shivering/goosebumps shaking rapid/thready pulse Did not eat prior to coming to appointment Blood sugar 91 Gave the client water during all of this, she stated she felt heavy. We laid her on the floor and elevated her feet. The ambulance came and took her to the local hospital.

Other Meds: birth control

Current Illness:

ID: 1077050
Sex: F
Age: 70
State: WA

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: 2nd dose at 1615 on March 4, HA started morning of the 5th, pt called and spoke with triage RN at 1400, triaged per protocol and pt directed to ED for "worst HA of life". Pt also endorsing fever, nausea, "sparkles" in vision of 1 eye. Pt took tylenol and advil w/o relief (doses unknown).

Other Meds:

Current Illness:

ID: 1077051
Sex: M
Age: 46
State: CA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List:

Symptoms: Approximately 3 minutes post-vaccination, the patient suffered a witnessed tonic-clonic seizure, which lasted less than a minute.

Other Meds: N/A

Current Illness: N/A

ID: 1077052
Sex: F
Age: 37
State: OR

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: MSG, NSAIDs, aspirin, ibuprofen (= anaphylaxis); Atarax (=itching)

Symptom List:

Symptoms: This is a 37 year old female. Within 10 minutes of her 1st dose Moderna, the patient developed a mild rash (location not specified). She took a dose of diphenhydramine with some relief. She went home. 2.5 hours later, she developed a facial twitching and reported to the ED. She reported involuntary facial muscle twitching, like spasms, that were painful. On ED presentation, BP=121/86, HR=93, RR=16, SpO2=98%. ED noted no swelling, itching, SOB, chest pain, N/V/D, or rash. The ED notes describe the symptoms as "Numerous and varying facial movements including contraction of the lower cheek muscles on the left and then the right along with movement of the tongue from side to side at which point she bites or gets the tongue in the way while trying to speak. Speech is therefore slurred however at times clear. Oropharynx is clear with mildly dry mucous membranes. No oral or pharyngeal swelling, difficulty swallowing, or stridor. Neck is supple and nontender without adenopathy. Differential diagnosis includes: allergic reaction, dystonic drug reaction (unusual to be varying from the left to the right), dyskinesia, anxiety, somatization or conversion disorder, among others. Her symptoms are not consistent with Bell's palsy, stroke, or clearly tardive dyskinesia. Subsequently given diazepam, fentanyl, and 500mL IV fluids." She was discharged home. Patient returned to the ED on 12/31 (within 24hrs) with ongoing symptoms. Patient was monitored and discharged home again. One month later, on 1/28/21, chart notes indicate that she has continued to have intermittent symptoms continue. A trial of steroids reportedly made symptoms worse. She reports that she also feels fatigued and with 'brain fog.' She currently has a neurology consult pending.

Other Meds: Albuterol, norco, lidoderm, pregabalin, sumatriptan

Current Illness:

Date Died:

ID: 1077053
Sex: M
Age: 77
State: CA

Vax Date: 02/17/2021
Onset Date: 02/21/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Metoprolol

Symptom List:

Symptoms: Patient received the first shot on 2/17/21. Nothing seemed unusual during the following days; no complaining of soreness or anything. He hadn't introduce any new medicine or food into his routine. On the morning of 2/21/21, he woke up around 5 AM as usual. He spoke with his wife for a bit. Around 7:00 AM, he started having trouble breathing. He asked for help from family members. 911 was called. EMT's preformed heart compressions for about 45 minutes before pronouncing patient deceased. During EMT's initial encounter, EMT's struggled getting a tube down patient's throat due to his tongue being swallon

Other Meds: Hydralazine, Ipratropium, Alvesco, Losartan, Clonidine Humulin

Current Illness:

ID: 1077054
Sex: M
Age: 17
State: OR

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

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: None - Pt. under the age of 18

Other Meds: None

Current Illness: None

ID: 1077055
Sex: M
Age: 27
State: MA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List:

Symptoms: Fever onset (100F) along with chills uncontrollable shivering and teeth chattering around 8 PM. Around 5 Am, fever had hit 103F and body temperature (measured by an Oura ring) recorded average body temperature increase of +5.6F while sleeping compared to baseline. Fever remained intermittently throughout the next day, as well as headache, sore throat, chills.

Other Meds: N/A

Current Illness: minor sore throat

ID: 1077056
Sex: M
Age: 30
State: NJ

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

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

Lab Data:

Allergies: No

Symptom List:

Symptoms: I am experiencing severe ringing in the ears (tinnitus) that occured within 24 hours post getting the vaccine. I am still experiencing ringing in the ears and have since made an appointment with my ENT to determine if there are any other possible issues. I never had ringing in the ears prior to the vaccine.

Other Meds: Adderall 20mg (1 per day)

Current Illness: No

ID: 1077057
Sex: F
Age: 29
State: CO

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Fever, body aches, chills, treated with fluids, rest, and Tylenol

Other Meds: Nexplanon implant

Current Illness: None

ID: 1077058
Sex: F
Age: 46
State: OK

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: PENICILLIN, CEPHALEXIN

Symptom List:

Symptoms: PT HUSBAND CALLED PHARMACY AROUND NOON ON 3/4/21. HE STATED THAT PT WAS 'DELIRIOUS' TALKING AND HAD A TEMP OF 103*. HISTORY HE GAVE WAS THAT AT 7:OOPM ON NIGHT OF VACCINATION (3/3/21) PT ARM BECAME SORE, THEN AT 10PM IT BECAME SORE WITH MUSCLE ACHES, BY 1:20AM SHE WAS HAVING SEVERE MUSCLE ACHES WITH FEVER. PT SAID ON 3/4/21 HE CAME HOME FOR LUNCH AND PT WAS CRYING, TALKING DELIRIOUS AND TEMP WAS AT THE 103*. PT HAD TAKEN TYLENOL BUT ONLY 10 MINUTES PRIOR TO THEIR CALL TO THE PHARMACY. PT'S HUSBAND HAD TRIED TO CALL THEIR DOCTOR BUT WAS TOLD THEY WOULD HAVE TO WAIT FOR A CALL BACK. AFTER CALLING PT LATER THAT DAY TO CHECK ON HER SHE SAID THAT SHE HAD GONE TO THE ER WHERE THEY ADMINISTERED FLUIDS TO HER.

Other Meds:

Current Illness:

ID: 1077059
Sex: M
Age: 63
State: NM

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: States two days prior to vaccine he first noticed a fever blister. Reports since receiving first vaccine dose last Friday (2/26/21) he has not been feeling well, notes swollen eyes (lid overlap eyelashes), eyes wet/watery constant, swollen throat, face swelling, and fatigue. Reports this has improved somewhat. Denies any pain/injection site reaction from vaccine.

Other Meds:

Current Illness: none

ID: 1077060
Sex: M
Age: 71
State: GA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List:

Symptoms: As the patient was walking out the door, after getting his vaccine, states, " It feels like my blood pressure is high".

Other Meds: he is taking a prescription medication.

Current Illness: Hypertension

ID: 1077061
Sex: F
Age: 75
State: MI

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List:

Symptoms: Patient said she experienced atrial flutter later that evening. She reported that it went back into normal rhythm in a day and a half. She stated she would contact her cardiologist to discuss.

Other Meds:

Current Illness:

ID: 1077062
Sex: F
Age: 36
State: OK

Vax Date: 02/24/2021
Onset Date: 02/01/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Severe dizziness, vertigo, fatigue, brain fog. Persistent since vaccination 9 days ago.

Other Meds: Advair 250/50, Xanax .5 mg

Current Illness:

ID: 1077063
Sex: F
Age: 64
State: WA

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: "Pfizer-BioNTech COVID-19 Vaccine EUA" I woke up the morning after my vaccine with diminished hearing in my left ear. I could feel pressure in my ear but hearing was distinctly muffled. I took 2 "DayQuil" cold capsules hoping an antihistamine might alleviate the situation. I had no relief until 8 hours later when I noticed the pressure in my ear was reduced and my hearing seems to be returning to normal.

Other Meds: Atorvastatin, Vitamin D, Vitamin C, CoQ-10 Supplement, Baby Aspirin, Assorted Herbal Supplements

Current Illness: None

ID: 1077064
Sex: F
Age: 45
State: WA

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

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

Lab Data:

Allergies: none reported

Symptom List:

Symptoms: Patient described significant flare-up of arthritis symptoms including joint pain and swelling. Likely due to typical post-vaccination immune response, but more severe considering this patient's underlying medical conditions and treatments. She returned for the 2nd dose, but wanted to report to increase available data regarding this vaccine in immunodiverse individuals.

Other Meds: full list unknown but includes methotrexate

Current Illness: none reported

ID: 1077065
Sex: F
Age: 58
State: IL

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Codeine

Symptom List:

Symptoms: After the client received the vaccine she was in the observation area and the client approached the nurse and stated that she felt like she was having trouble swallowing and the nurse directed her towards the paramedic. the paramedics checked her out and gave her some water. She wasn't feeling any better so they gave her 50mg of Benadryl at 10:00AM. Her BP was 135/84 at 10:02am, pulse 68, resp 16 and 02 sat 96. Another dose of Benadryl 50mg was given at 10:15 and vitals were BP 144/92, pulse 64, o2 98. At 10:30am the client was given the epi pen while an ambulance was called. Her vitals were at 10:30am BP 160/96, pulse 81, resp 16, o2sat 99. Lung sounds were clear with light wheezing when checked at 10:20 She was taken via ambulance to the local hospital. At 3:25PM- the health department staff called the client to check on her. She answered the phone and said that she was at home sleeping. That they didn't do anything for her at the hospital, that she got another epi pen in the ambulance and no diagnosis was given.

Other Meds:

Current Illness:

ID: 1077066
Sex: F
Age: 35
State:

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin- Hives Seasonal Allergies

Symptom List:

Symptoms: At Approximately 1040, patient (Age 35,) received her 2nd dose of Pfizer vaccine (Lot# 6200 Exp. 06/2021). At approximately 1055, EMT was alerted by patient that she felt her tongue somewhat swollen and itchiness in the back of tongue, patient was sitting in observation chair at this time, A&Ox4. At approximately 1100, pt was moved to zero gravity chair, water was given, pt remained A&Ox4 and pink in color. Pt reported allergy to Penicillin- reaction Hives and also has seasonal allergies, with no past history of anaphylaxis. At approximately 1112, RN Lead spoke with patient and EMT about how patient is feeling, patient declined to have EMS called, patient was offered Benadryl, patient agreed and took Benadryl 25mg in 10ml Oral Solution. Vital signs at 1117: HR 74, RR 14, BP 130/90, Vital Signs at 1123 HR 70, RR 14, BP 128/90. At 1125, Patient claims symptoms not worsening. At 1128, tongue did not swell up more than initial complaint. At 1128, Pt stated she ?felt better? and left the facility, Pt A&Ox4, pink in color, ambulating with steady gait, driving herself in her vehicle. Pt verbalized understanding to call her doctor or 911 if she felt anything worsening.

Other Meds:

Current Illness:

ID: 1077067
Sex: F
Age: 21
State: AZ

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Chills, fever, headache, muscle pain, and tiredness.

Other Meds: None

Current Illness: None

ID: 1077068
Sex: F
Age: 16
State: NM

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

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

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Itching and rash to neck

Other Meds: None

Current Illness:

ID: 1077069
Sex: F
Age: 75
State: NJ

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Kiwi

Symptom List:

Symptoms: Long term severe nausea

Other Meds: Renexa, vitamin multi, c,d,e, ubiquinol, calcium, bio flex, acid reducer

Current Illness: None

ID: 1077070
Sex: F
Age: 44
State: IN

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Levaquin causes joint pain.

Symptom List:

Symptoms: Aching arm < 30 minutes after shot. Swelling in neck (left side) 2-3 hrs after shot. Body aches within 6 hours. Fever, chills, and ringing in head within 10 hrs after shot. Fever up to 102.5F. Shot given 2/16 at 8:30 am. 2/18 at 1pm numbness to left side of face. Went to ED. Swelling in neck visible with movable gland. Discharged home. 2/19 numbness gone and swelling decreasing. 3/5 arm aches, swelling mild in neck, movable gland persists, ringing in head continues.

Other Meds: None

Current Illness: None

ID: 1077071
Sex: M
Age: 24
State: VA

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

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

Lab Data:

Allergies: No Known Allergies

Symptom List:

Symptoms: Following the vaccine the patient began experiencing flu-like symptoms including headache and fatigue the same day. They subsided the next day, however the injection site began to swell, turning warm and red. A large portion of patients deltoid around administration site continues to be swollen and red 3 days following administration. The patient hasn't noticed the area getting any larger and is going to continue to monitor for any worsening symptoms. Patient was advised to seek medical care if symptoms worsened.

Other Meds: Unknown

Current Illness: Uknown

ID: 1077072
Sex: M
Age:
State: CO

Vax Date:
Onset Date:
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient received first dose of vaccine on 2-12 (lot EN6201) in right deltoid. Patient was administered a vaccine for his second COVID shot instead of other COVID-19 vaccine.

Other Meds:

Current Illness:

ID: 1077073
Sex: F
Age: 65
State: CA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Syncope, roused after roughly 4 minutes. Patient seen by MD, had juice, observed for 30 minutes, experienced dizziness, see again by MD, eventually DC to home @1100 with significant other.

Other Meds: Gabapentin (NEURONTIN) 100 mg Oral Cap Famotidine (PEPCID) 20 mg Oral Tab Fluticasone-Salmeterol (Wixela Inhub) 500-50 mcg/dose Inhl Disk w/devi Montelukast (SINGULAIR) 10 mg Oral Tab traZODone (DESYREL) 100 mg Oral Tab Acyclovir

Current Illness: None

ID: 1077074
Sex: M
Age: 69
State:

Vax Date: 01/28/2021
Onset Date: 02/01/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: eczematous rash on torso

Other Meds: none

Current Illness: none

ID: 1077075
Sex: M
Age: 36
State: AK

Vax Date: 02/03/2021
Onset Date: 02/07/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Latex sensitivity

Symptom List:

Symptoms: Right side of face numbness, then migrating over to numbness to left side of face, then forehead.

Other Meds: Vitamin E, Vitamin D3, Psyllium Husk, Glucosamine HCl with MSM, Flaxseed Oil, Milk Thistle, Vitamin B-12, Fish Oil capsules

Current Illness: None

ID: 1077076
Sex: F
Age: 57
State: NV

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Swollen, red, tender/pain at injection site

Other Meds:

Current Illness: None

ID: 1077077
Sex: F
Age: 67
State: TN

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/05/2021
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Allergies: Levaquin

Symptom List:

Symptoms: Red spot size nickel. No pain in arm. Flu like aches. Woke up vomiting violently that night approximately 2:00am, headache

Other Meds: Gabapentin 60-mg 3x daily, Aprazolam .5 3xdaily, Lisinopril 20mg 2x daily, Telturna 300mg 1x daily, Celebrex 200mg 1x daily

Current Illness: None

ID: 1077078
Sex: F
Age: 42
State: CO

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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Symptoms: Swelling and discomfort in left underarm lymph node, fever, body aches

Other Meds: Citalopram, lisinopril

Current Illness:

Date Died: 03/05/2021

ID: 1077079
Sex: F
Age: 77
State: CA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
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Allergies: Iodine (Skin Reaction)

Symptom List:

Symptoms: Patient was alert and oriented with no signs or symptoms of sickness prior to immunization for 2nd dose of Pfizer COVID19 vaccine. Temperature 98.7. Patient under hospice care and DNR status for wound care (coccyx). Patient has no recollection of first dose, but no adverse reactions to first dose per her caregivers. Patient did not appear to have any adverse reactions to the vaccine after the 15 minute observation period. About 1 hr after vaccine administration, patient was reported deceased. No signs of swelling or allergic reaction at site of injection.

Other Meds: Aspirin, Tylenol, Sennakot, Amlodipine

Current Illness: Coccyx wound (hospice care)

ID: 1077080
Sex: F
Age: 58
State: WA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
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Allergies: None

Symptom List:

Symptoms: Patient here for 1st dose. At 3:15, patient complained of itching L upper arm and 5 minutes later itching to back and neck area. Patient self administered Benadryl at 2:40 and additional 50 mg of Benadryl at 3:53 PM. Patient is alert X3, speech at baseline, breath sounds clear to A&P no stridor, no wheeze noted. BP 130/80, HR 95, Temp 98.4, O2 Sat 99 %. Patient was refusing to have Epi Pen administered by RN X3 attempts. AIDE was called to assess. Patient alert, no visual swelling or difficulty breathing. 3:20 patient ambulated to the bathroom. 3:33 patient advised by medics to call a family member to drive her home. Patient agreed and called family. Reports her itching is improving and continues to be alert. VS are stable. 5 PM patient left with friend driving via private car. Patient was advised to consult with doctor prior to next vaccine.

Other Meds: Benadryl 25mg

Current Illness: None

ID: 1077081
Sex: F
Age: 24
State: WI

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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Allergies: Amoxicillin, penicillin

Symptom List:

Symptoms: Very tired, chills, rash near injection site. The tiredness and chills lasted about a day. The rash started the second day after my vaccination

Other Meds:

Current Illness:

ID: 1077082
Sex: F
Age: 63
State: MO

Vax Date: 02/25/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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Allergies: Sulfa

Symptom List:

Symptoms: redness and itching around the injection sight

Other Meds: Stialto inhaler for COPD

Current Illness: None

ID: 1077083
Sex: F
Age: 74
State: IL

Vax Date: 02/19/2021
Onset Date: 02/22/2021
Rec V Date: 03/05/2021
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Allergies: Sensitivity to anti-inflamatories

Symptom List:

Symptoms: A large welt appeared over the injection site about 3 1/2 inches square. The next day it traveled down the arm to the inside of elbow. It was hot to the touch and extremely itchy. It lasted until day 10. I consulted with my GP today who told me to fill out this form.

Other Meds: OMEPRAZOLE, HYDROCHOLORTHIAZIDE, CARTIA (DILTIAZEN) , ZETIA (EZETIMIBE), FLUTICASONE PROPIONATE & SALMETEROL INHALATION POWDER, glucosamine, CO Q10, CALCIUM WITH D, IODINE + POTASSIUM,, ONE-A-DAY VITAMINS

Current Illness: Emphysema, mitral value prolapse, PVD

ID: 1077084
Sex: F
Age: 50
State: OR

Vax Date: 12/27/2020
Onset Date: 12/27/2020
Rec V Date: 03/05/2021
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Lab Data:

Allergies: Grape (anaphylaxis), latex (rash), nitrile gloves (rash), thimerosol (rash)

Symptom List:

Symptoms: This is a 50 year old female. She received the 1st dose Moderna on 12/27/20 at 1535. Within 5 minutes of administration, the patient reported itching over the injection site, chest, and lips. The patient self-administered diphenhydramine at 1555 with some improvement, but not resolution. She presented to the ED with a BP=160/68, HR=64, RR=16, SpO2=100%. ED noted no swelling of the tongue/throat, no breathing difficulty, no abdominal pain/cramping. Labs normal. Patient was treated with famotidine and prednisone (patient refused additional diphenhydramine). Patient monitored and discharged home with symptom improvement. 24hr post-discharge follow-up consult confirmed resolution of symptoms.

Other Meds: Albuterol, fluticasone, gabapentin, losartan, montelukast

Current Illness:

ID: 1077085
Sex: F
Age: 76
State: MO

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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Symptom List:

Symptoms: left side numbness- arm, shoulder, face began evening of shot, were improving by morning.

Other Meds:

Current Illness:

ID: 1077086
Sex: F
Age: 65
State: CT

Vax Date: 02/25/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
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Allergies: None

Symptom List:

Symptoms: Arm goes numb, itches. Bump; slight redness.

Other Meds: None

Current Illness: None

ID: 1077087
Sex: M
Age: 36
State: AK

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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Allergies: Latex sensitivity

Symptom List:

Symptoms: Muscle aches, joint pain, and severe headache that lasted for 40 hours.

Other Meds: Vitamin E, Glucosamine HCl with MSM, Flaxseed Oil, Vitamin D3, Psyllium Husk capsules, and Milk Thistle

Current Illness:

ID: 1077088
Sex: F
Age: 43
State: IL

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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Allergies: Latex

Symptom List:

Symptoms: 2/2/21 1st Moderna shot was at 10 am, by 4 pm I was shaking uncontrollably with chills. I had on fleece pjs and three blankets laying in front of fireplace and could not get warm. Headache out of this world. Every joint in my body hurt. My ankles were so swollen I could barely walk. I missed three days of work. 3/4/21 2nd dose of Moderna. Same as above only joint pain was much worse. Chills and then breaking out in sweats. I?ve missed two days of work as of now with this shot. It?s really wiped me out. I haven?t been able to eat or sleep much because I hurt so bad. My knees, ankles, and neck seem to be the worst. I?ve never experienced joint pain as bad as these two times. I could barely walk to the bathroom.

Other Meds: Ozempic

Current Illness:

ID: 1077089
Sex: F
Age: 80
State: ME

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 03/05/2021
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Allergies: None

Symptom List:

Symptoms: Fever of 102 to 103, nausea, headache and fatigue for 24 hours

Other Meds: Lisinopril, hydrochlorothiazide, pravastatin

Current Illness: None

ID: 1077090
Sex: M
Age: 17
State:

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/05/2021
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Symptoms: Patient is under the age of 18

Other Meds:

Current Illness:

ID: 1077091
Sex: F
Age: 28
State: NV

Vax Date: 01/20/2021
Onset Date: 02/01/2020
Rec V Date: 03/05/2021
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Allergies: latex - rash

Symptom List:

Symptoms: Aside from flu-like symptoms following both vaccine doses lasting 24 hours. Following the second dose I have experienced intermittent/consistent dizziness since February. Some aural fullness in L ear, significant for 3 day Valentines weekend. The fullness comes and goes. Have not seen a doctor. Saw a PT - negative for BPPV. Dizziness worse with head movement.

Other Meds: Vitamin D, Omega-3, probiotics, pimecrolimus cream

Current Illness: none, aside from anxiety

ID: 1077092
Sex: M
Age: 76
State: CA

Vax Date: 02/19/2021
Onset Date: 02/26/2021
Rec V Date: 03/05/2021
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Allergies: MSG

Symptom List:

Symptoms: One week after the second shot I started to get bumps on my neck, that was on a Friday night. By Sunday it was much worse so I went to the emergency care facility and the Dr. told me I had shingles and prescribed Valacyclovir for 7 days. I reached out to people on an App and explained my side effect. There were over 9 people that also had the shingles after the second dose. They didn't necessarily get the shot from the same pharmacy. It is obvious that there is a direct correlation between the two.

Other Meds:

Current Illness: none

ID: 1077093
Sex: F
Age: 67
State: TN

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/05/2021
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Allergies: codeine, oxycodone, some antihistamines, diflucan, meloxicam, benadryl, all peppers ie,cayenne, and any red pepper, except black + white pepper, cilantro, and coriander,

Symptom List:

Symptoms: Friday around 5:30pm a headache began and then tongue swelling began around midnight Then the swelling of tongue went away around 3pm on Saturday afternoon. On Saturday The nausea and diarrhea started around 7:30am and subsided by 9am. The headache went away by Sunday afternoon.

Other Meds: synthroid 100mgc, ezetimide 10mg, olmesartan 40mg, montelucast 10mg, albuterol inh, symbicort 160/4.5, fish oil, move free glucosamin chondroitin, cholestoff, womens 50+ vitamin,

Current Illness: treated on Jan 22 for a viral infection tested negative twice for COVID.

ID: 1077094
Sex: F
Age: 59
State: WI

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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Lab Data:

Allergies: Having digestive problems. Unsure if food related or bad gut .

Symptom List:

Symptoms: Moderna

Other Meds: Losartan potassium 100mg 1xdi. Metoprolol succinate er 200mg 1xdi. Sertraline hydrochloride 100mg 1xdi. Loperamide hydrochloride oral 2 MG x2 di

Current Illness: None

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm