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: 1036080
Sex: M
Age: 70
State: FL

Vax Date: 01/31/2021
Onset Date: 02/01/2021
Rec V Date: 02/17/2021
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: Penicillin as a child

Symptom List: Dysphagia, Epiglottitis

Symptoms: Numbness in fingers and wrists; painns in shoulder, pectoral and scapula areas.

Other Meds: Vitamins D, C, Zinc, B12

Current Illness: None

ID: 1036081
Sex: F
Age: 30
State: IL

Vax Date: 02/14/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
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: NKA

Symptom List: Anxiety, Dyspnoea

Symptoms: Chills, fever 103.0 , muscle and joint ache, headache, nausea, vomiting, sore left arm at injection site and lump in under left armpit

Other Meds: Tylenol 500 mg

Current Illness: N/A

ID: 1036082
Sex: F
Age: 62
State: RI

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
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: food unknown

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

Symptoms: c/o of hands itching at 1125am Benadryl 25mg given at 1125am bp 169/95 p 69 99% r 18 1133am itching decreased bp 159/92 p 73 r 18 1150am vitals at 135/83 70 16 98% itching resolved and sent home.

Other Meds: metform

Current Illness:

ID: 1036083
Sex: F
Age: 49
State: CA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: Had the shot in my left arm. Felt normal "after vaccination soreness" but as the night progressed I had a lot of pain radiating from my left elbow to my left thumb. Felt like a broken bone. Pain was definitely radiating from the bone that extends from my thumb to elbow. Finally took 2 tylenol and that worked wonders. Just haven't heard anything about bone pain and wanted to make sure to report it. I also felt a small amount of pain in my left breast but that didn't last long.

Other Meds: Losartan and Cozar

Current Illness: none

ID: 1036084
Sex: F
Age: 42
State: NY

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/17/2021
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: Dizziness, Hard to Focus eyes, extreme fatigue, severe arm pain (unable to life arm without pain) (began that evening-lasted two full days)

Other Meds:

Current Illness:

ID: 1036085
Sex: F
Age: 66
State: AZ

Vax Date: 01/20/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
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:

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

Symptoms: No symptoms as of now. Just took the second dose today.

Other Meds:

Current Illness:

ID: 1036086
Sex: M
Age: 34
State: WA

Vax Date: 01/13/2021
Onset Date: 02/05/2021
Rec V Date: 02/17/2021
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 known

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Onset of dizziness and left Bell's palsy 23 days after 1st dose of series.

Other Meds: Multivitamin

Current Illness: None

ID: 1036087
Sex: F
Age: 29
State: NJ

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital: Y

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

Lab Data:

Allergies: Aspirin, Ibuprofen, Latex, Penicillins, Sulfa

Symptom List: Pharyngeal swelling

Symptoms: Difficulty breathing- received EpiPen dose, patient was able to breath normally again Shortly thereafter patient was witnessed to have seizure like activity, EMS was called and administered Ativan and Benadryl in route to ED

Other Meds:

Current Illness:

ID: 1036088
Sex: F
Age: 64
State:

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
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 was vaccinated at 0801. After 15 minutes patient started feeling light headed and weak. Vital taken. patient was monitored until 0842 with little improvement in symptoms and pulse was low. Patient was transferred to urgent care , and checked in for further evaluation,

Other Meds:

Current Illness:

ID: 1036089
Sex: M
Age: 71
State: IN

Vax Date: 02/01/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Dizziness after 2nd vaccine

Other Meds: Losartan 50 mg., Finasteride 5 mg, vitamin C 500 mg, Magnesium 400 mg, Vitamin D 1000 IU, Vit B 12 1000 mcg

Current Illness: None

ID: 1036091
Sex: M
Age: 61
State: CA

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Onions

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

Symptoms: Fever, chills, & dizziness. Blurry vision, aches/pains and shortness of breath.

Other Meds: None

Current Illness: None

ID: 1036092
Sex: M
Age: 54
State: AZ

Vax Date: 01/30/2021
Onset Date: 02/01/2021
Rec V Date: 02/17/2021
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: no

Symptom List: Rash, Urticaria

Symptoms: I started feeling sinus pressure behind my eyes. a few days later I started experiencing vision loss in my left eye. Ophthalmologist diagnosed me with optic neuritis. auto immune disease which causes pain and vision loss in the eye. it is inflammation of the optic nerve.

Other Meds: Allergy meds generic brand vitamins: D3 MK7

Current Illness: no

ID: 1036093
Sex: M
Age: 69
State: AL

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: Muscle weakness in legs and arms after fall on night of 02/14/2021 @11.00pm following the vaccination @ 9.00am on 02/13/2021 . Contacted PCP the next day she told me to rest and drink plenty of fluids take 2 Tylenol. I regain strength in your legs and arms so I could life myself up.

Other Meds: No

Current Illness: Schoeffective

ID: 1036094
Sex: M
Age: 58
State: IL

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/17/2021
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: Sulfa drugs

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

Symptoms: I felt tired the next day. My left arm was sore for two days.

Other Meds: Multi-vitamin

Current Illness: None

ID: 1036095
Sex: M
Age: 33
State: CA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Patient complained of chest pain/pressure after receiving the Modern Covid-19 vaccine.

Other Meds: None

Current Illness: None

ID: 1036096
Sex: F
Age: 57
State: MD

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: Felt light headed and dizzy for a few minutes

Other Meds:

Current Illness:

ID: 1036097
Sex: F
Age: 45
State: RI

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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:

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

Symptoms: Anxiety

Other Meds:

Current Illness:

Date Died: 02/12/2021

ID: 1036098
Sex: M
Age: 77
State: AR

Vax Date: 01/31/2021
Onset Date: 02/07/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received the vaccine on 1/31/2021. Patient complained of bleeding 2/7/2021. Went to clinic where labs were conducted. Patient had an INR of 12. Previous INR results were normal prior to vaccination. Patient was also diagnosed with UTI and given antibiotics. Patient was encouraged to go to ER. Patient died on 2/12/2021.

Other Meds: coumadin 5 mg, clopidogrel 75 mg, atorvastatin 20 mg, citalopram 10 mg, levothyroxine 75 mcg, lisinopril-hctz 20-12.5 mg, melatonin 5 mg

Current Illness:

ID: 1036099
Sex: F
Age: 60
State: WI

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/17/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Had the vaccine on Wed and then Thursday and Friday had 101.0 temp. By Saturday feeling better. Saturday evening began feeling itchy and painful nerve pain throughout my body. Finally went to ER on Sunday evening and kept as inpatient until Tuesday 2/16. I was also on an antibiotic for an infection and Dr. feels that this was the primary source of my reaction, but not sure if it was compounded by the vaccination. It?s been a rough couple of days, but feeling better now.

Other Meds:

Current Illness:

ID: 1036100
Sex: F
Age: 67
State: NC

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Benadryl, Codeine, Phenergan, Potassium,

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

Symptoms: Light headedness, 15 to 30 minutes post vaccination, EMS called and took her to the ED. Time spent in ED: 2.5 hours.

Other Meds: acetaminophen, Zyloprim, Arimedex, Coreg, Vit D3, Vasotec, Ativan, Compazine, Bicitra

Current Illness:

ID: 1036102
Sex: F
Age: 34
State: VA

Vax Date: 02/01/2021
Onset Date: 02/09/2021
Rec V Date: 02/17/2021
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: None

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

Symptoms: Itchy redness around shot site

Other Meds: N/A

Current Illness: None

ID: 1036103
Sex: F
Age: 27
State:

Vax Date: 01/03/2021
Onset Date: 01/04/2021
Rec V Date: 02/17/2021
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: Right hand and arm painful and swollen, hives on torso, both legs, and left side of neck

Other Meds:

Current Illness:

ID: 1036104
Sex: F
Age: 35
State: WA

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: Chills x 2-3 hrs with whole body shakes, severe weakness (unable to lift 10 lbs). Low fever. No treatment. Resolved within 24 hrs.

Other Meds: Prenatal vitamin, Miralax

Current Illness: Post partum 1.5 months.

ID: 1036105
Sex: F
Age: 59
State: MI

Vax Date: 02/09/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: sulfamthx/trimeth shell fish

Symptom List: Injection site pain, Pain

Symptoms: swollen arm, hot and itchy and hard, just stared yesterday, still persisitent today. also the same after the day of the injection but went away.

Other Meds: levothryoxin

Current Illness: thumb nail infection

ID: 1036106
Sex: M
Age: 50
State: MO

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: Tree nuts

Symptom List: Injection site pain, Menorrhagia

Symptoms: anaphylaxis, epi pen, resolution

Other Meds: Meloxicam, Singulair, Olmesartan, Hydralazine, Metformin, Humalog, Lantus, Sildenafil, Amlodipine, Atorvastatin, Flonase

Current Illness: idiopathic anaphylaxis, DM, allergies, HLP,

ID: 1036107
Sex: F
Age: 44
State: MI

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: Sulfa

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

Symptoms: Severe debilitating headache and full body aches. Insides felt like they were on fire. Severe sweating and nausea. Arm continued to swell and redness spread at injection site.

Other Meds: Norinthendrone 5mg

Current Illness: None

ID: 1036108
Sex: F
Age: 36
State: PA

Vax Date: 01/18/2021
Onset Date: 01/24/2021
Rec V Date: 02/17/2021
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: Employee was working with patient on 1/14/2021 who seroconverted to covid positive on 1/15/2021. She was not aware and proceeded with covid vaccine #2 on 1/18/2021. She developed typical low grade temp and flu like symptoms that resolved by 2/20/22. She felt fine until the evening of 2/22 when she had low grade temps, worsening myalgais and chills as well as chest heaviness. She tested positive by antigen test 0n 2/23. She then tested negative by PCR on 1/26. She was managed as covid positive. Reporting given she had completed her second covid 19 vaccine.

Other Meds:

Current Illness:

ID: 1036109
Sex: F
Age: 39
State: ME

Vax Date: 02/11/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I am a breastfeeding mom, I did have a strong immune response but that is not what I am reporting. My breast milk while I was sick with flu like symptoms from the vaccine changed to a chemical taste and it burnt my throat. I tasted it only because my baby was crying every time I was trying to feed her. The vile taste was in all of my breast milk while I was sick until my symptoms resolved 24 hours later. As I got better the taste was less noticeable. I wish I had kept the milk to be tested but ended up discarding all of it.

Other Meds: Prenatal vitamin, 81mg aspirin, calcium supplement, B12 1000mg iron 325mg

Current Illness: None

ID: 1036110
Sex: F
Age: 63
State: IL

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

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

Lab Data:

Allergies: none

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

Symptoms: Mild body aches and fatigue started at 10:00 pm, approximately 11 hours after injection. Next morning body aches and fatigue increased, generalized ill-feeling, also with joint achiness. Surface swelling, redness and warmth with approx 4 inch circumference at site of injection. Painful to move arm that had injection; raising arm above shoulder level (over head) extremely painful, almost impossible. All symptoms fading after 48 hours. All symptoms resolved within 72 hours except warmth and tenderness at injection site. Injection site back to normal without symptoms 7 days after injection.

Other Meds: Hydrochlorthiazide 1.25 mg Levothyroxine 112mcg Centrum Silver for Women multivitamin magnesium 200mg vitamin D 1000IU aspirin 81 mg Theracurmin (curcumin) 60mg Align probiotic

Current Illness: none

ID: 1036111
Sex: M
Age: 24
State: RI

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: syncope/vomit/vaso vagal

Other Meds:

Current Illness:

ID: 1036112
Sex: F
Age: 21
State: CA

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 02/17/2021
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: WELTS, RASH HEAD TO TOE, C/O BEING VERY HOT, BUT COOL AND CLAMMY TO TOUCH. LOW GRADE FEVE 99.4. TINGLING IN HANDS AND FEET. GENERALIZED C/O OF NOT FEELING WELL . HEADACHE WITH INCREASING PAIN. GAVE 50 MG BENADRYL AND 1000 MG ACETAMINOPHEN

Other Meds: NONE

Current Illness: NONE

ID: 1036113
Sex: F
Age: 41
State: CT

Vax Date: 01/08/2021
Onset Date: 01/11/2021
Rec V Date: 02/17/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Hives all over body. Did not go away. Still having hives everyday. Became even worse after second dose of moderna vaccine.

Other Meds: None

Current Illness: None

ID: 1036114
Sex: F
Age: 65
State: VA

Vax Date: 02/03/2021
Onset Date: 02/05/2021
Rec V Date: 02/17/2021
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: n/a

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

Symptoms: redness at site, itching, hydrocortisone cream to area, after2 days redness is increasing

Other Meds: n/a

Current Illness: n/a

ID: 1036115
Sex: F
Age: 35
State:

Vax Date: 01/08/2021
Onset Date: 01/16/2021
Rec V Date: 02/17/2021
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: Tremor

Symptoms: ipsilateral to the side the vaccine was given axillary lymphadenopathy

Other Meds:

Current Illness:

ID: 1036116
Sex: M
Age: 62
State: IN

Vax Date: 02/11/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
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: Erythema, Pruritus

Symptoms: He received the vaccine on Thursday. The left nostril started running, then his eye started getting vision issues on Saturday. He went to sleep and thought it would be better. On Sunday morning he could not stand the sunlight at all, and pain on top of the eye. He went to the ER and they called the eye doctor in. He didn't know what was going on, had blood work done. He told him to FU with his doctor. Gave him eye drops, Ibuprofen and eye cream to go into the eye. He is feeling better today, but when the light hits it a certain way the pain is bad, but it clears. In the morning he has to get used to the sunlight. His eye is red. He is to FU with his PCP.

Other Meds: Fish oil, Amlodipine.

Current Illness: None.

ID: 1036117
Sex: F
Age: 38
State: MD

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
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: None known.

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

Symptoms: Chills, full body aches, fatigue and rash around injection area. Lasted about 24 hrs.

Other Meds: Epiduo Forte, nutrafol vitamins and supplements, NAC 1000mg tablet, green tea, mushroom tea.

Current Illness: None.

ID: 1036118
Sex: F
Age: 62
State: NJ

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: NA

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

Symptoms: Malaise, sluggishness, body aches, temp 100.6, headache, lack of appetite and localized non-pruritic redness about the size of an uneven dollar bill about 1-2 inches below vaccine site.

Other Meds: Synthroid; Airborne

Current Illness: None

ID: 1036119
Sex: M
Age: 74
State: MI

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient felt funny reaction after the vaccine . Onsite EMS was called vitals were taken BP 132/74 99% O2 room air HR 64. General Malaise unknown cause . Patient refused evaluation/care. Left aginst medical advice.

Other Meds:

Current Illness:

ID: 1036120
Sex: M
Age: 52
State: OH

Vax Date: 02/09/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
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 known

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

Symptoms: Sever headache with Nausea and vomiting. Seen in the ED. improved with fluids, raglan, and benadryl

Other Meds: MVI

Current Illness: None

ID: 1036122
Sex: M
Age: 74
State: IN

Vax Date: 01/19/2021
Onset Date: 01/28/2021
Rec V Date: 02/17/2021
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: none

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

Symptoms: Diagnosed with Bell's Palsey. Dr prescribed Prednisone 20MG Tablets, Valacyclovir 1GM Tablets on February 1. 2021. Facial muscles on Left side of face would not move. Currently some of the movement is coming back. Some of the symptoms were: Left ekye would not close completly, mouth drooped on the Left side, had a bad taste in my mouth that felt like I had drank some very hot fluid, my lips felt like they were swollen.

Other Meds: gemfibrozil 600 MG tablet, valsartan 80 MG tablet, Fish Oil 30

Current Illness:

ID: 1036123
Sex: M
Age: 75
State: AZ

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
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: Pain in extremity

Symptoms: Total exhaustion. Achy joints, muscles. No fever but constant chills. Everything hurt

Other Meds:

Current Illness: None

ID: 1036124
Sex: F
Age: 57
State: RI

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: dizzy/lightheaded

Other Meds:

Current Illness:

ID: 1036125
Sex: F
Age: 91
State: AZ

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/17/2021
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: none

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

Symptoms: rectal bleeding on and off for 2 days

Other Meds: metformin lisinopril donepizil hydrochlorothiazide eloquis pioglitizone multi vitamin acetaminophin ferrus sulphate

Current Illness: diabetic atrial fibrillation'

ID: 1036126
Sex: F
Age: 63
State: IL

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/17/2021
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: No

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

Symptoms: Fever - 100.2 Chills Headache

Other Meds: Tegretol

Current Illness: None

ID: 1036127
Sex: F
Age: 66
State:

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
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: Bactrim, Tetanus

Symptom List: Vomiting

Symptoms: Patient received vaccine on 2/17/21 at approx. 1105, began noticing adverse symptoms at approx. 1115. Patient reports symptoms are similar but slightly worse than what she experienced with 1st dose. Patient reports throat tightness, lip and tongue tingling, and having slight trouble swallowing. Patient reports she did see her physician prior to receiving 2nd dose and was recommended to take PO Benadryl prior to 2nd dose, which patient did. Patient was closely monitored for an additional 15 minutes (approx. 45 mins. in total). While patient was waiting she also took another PO Benadryl which was her own medication. Paramedic was also on site and monitoring patient. Patient reported her symptoms were beginning to resolve and she felt well enough to go home. Patient refused to be assessed fully in the ER and went home on her own. Advised if she notices any worsening to symptoms to seek emergency care, patient verbalized understanding.

Other Meds:

Current Illness:

ID: 1036128
Sex: F
Age: 56
State: MA

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/17/2021
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: Fever, chills, sore throat, joint aches, Covid arm. Injection site hot red and HARD. Traveled to inner arm. Hives on neck and

Other Meds: Losartan

Current Illness: None

ID: 1036129
Sex: F
Age: 27
State: RI

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
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: anxiety

Other Meds:

Current Illness:

ID: 1036130
Sex: F
Age: 40
State: CA

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/17/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: muscle aches x 3 days, fatigue x 4 days, headaches x 4 days; did not seek medical treatment; 2/17/21 stated that the symptoms went away on 2/13/21 and have since been feeling fine.

Other Meds:

Current Illness:

ID: 1036131
Sex: F
Age: 36
State: RI

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Chest pain.

Other Meds:

Current Illness:

ID: 1036132
Sex: F
Age: 39
State: DC

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
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: nkda

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

Symptoms: Left shoulder pain, supraclavicular lymphadenopathy, started two days after second dose. One fever day 3, 103 F. Lymphadenopathy remains unresolved on 2/17/2021

Other Meds: none

Current Illness: none known

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm