VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer

Incidents per State

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

ID: 1090775
Sex: F
Age:
State: PA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Serious derm reaction to both shingrix and moderna vaccine; Raised red rash on arms and chest; Raised red rash on arms and chest; This case was reported by a pharmacist via call center representative and described the occurrence of skin reaction in a 67-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Co-suspect products included mrna 1273 vaccine (Moderna (Mrna Ribonucleic Acid Vaccine)) for prophylaxis. Concurrent medical conditions included asthma. On an unknown date, the patient received Shingrix and Moderna (Mrna Ribonucleic Acid Vaccine) at an unknown dose and frequency. On an unknown date, unknown after receiving Shingrix, the patient experienced skin reaction (serious criteria other: Serious as per reporter), red rash (serious criteria other: serious as per reporter) and raised rash (serious criteria other: serious as per reporter). On an unknown date, the outcome of the skin reaction, red rash and raised rash were unknown. It was unknown if the reporter considered the skin reaction, red rash and raised rash to be related to Shingrix. Additional details were reported as follows: The age at vaccination was not reported. The patient had a serious derm reaction to both shingrix and moderna vaccine. The reporter asked if there were any common properties. The patient experienced raised red rash on arms and chest. No other information was available regarding the timeline of the patient receiving both vaccines or duration of symptoms. The reporter did not consent to follow-up.

Other Meds:

Current Illness: Asthma

ID: 1090776
Sex: F
Age:
State: FL

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: beeps, noise in her ears; muscle and joint pain; muscle and joint pain; tongue was a little numb; face lips; felt paralyzed/Felt like I couldn't move it like paralyzed a little bit; whole left side of body started going numb/Left side was numb around 7 or 8 that night/all left side was numb; pains in all of her face; pain and soreness in arm/arm was painful; tachycard, high heart rate; very tired, sleepy; very tired, sleepy; headache, heavy in her head; pain in both ears; This is a spontaneous report from a contactable consumer (patient). This 71-years-Old female patient received the first dose of (Pfizer Biontech Covid 19 Vaccine, Lot No. EN6198) intramuscularly at single dose on 23Feb2021 for COVID-19 immunisation. Relevant history and concomitant drugs were unknown. Past dug included flu vaccine in Sep2020. The patient received her first dose of Covid 19 vaccine on 23Feb2021 at 3:30 in the afternoon. She came home and felt, not bad at any time but more or less towards 6:00 or 7:00 at night she started feeling bad. Her whole left side of body started going numb around 7 or 8 that night. Her arm was painful, face lips and all left side was numb. Felt like she couldn't move it like paralyzed a little bit. Clarified as whole left side, even her leg, her feet everything on that left side. She started feeling pains in bones of head, especially her face, clarified all of her face and her left side was numb even her lips on the left side were numb. Her tongue was a little numb. She had muscle and joint pain. The pain, of course, in the arm, but that was normal. Clarified pain in the arm as the injection site. She didn't feel any swell there. She did not take medication for anything. She used a lotion. The lotion was trividol aloe vera arnica caleudula and helped to relive the pain. The arm was still a little painful but it's not bad but that feeling made her tachycard, clarified as high heart rate, feeling like boom boom boom, but she did not have any shortness of breath. The high heart rate was gone the same day. She had no fever or chills. She felt very tired and slept for about 10 hours but during the sleepy she started feeling a headache she couldn't get up because she was so tired and she felt pain in both ears. She had not been to the doctor in a while. She was still old fashioned so she carries everything in a little telephone book. While trying to read information caller states she had to change her eyes. She still felt numbness in left side of left leg but she thought it might be because she had not been exercising. When she was waking up around 9am in the morning, it was yesterday that she felt better in regards to the paralyzed feeling. When pains in her face came she felt and she thought what is this? It only lasted for a little while. It was during the night. The pain and soreness in arm at injection site is still there, she did not feel any swelling, or hot at that site. She confirmed she still felt a little tired, sleepy. It's getting better. She may feel a little heavy in her head and would like to go to sleep, but she was not sleeping. She had many things to do and knew she had to be up. The headache went away and was gone on 24Feb2021. It was persisting for a while, not too hard or heavy, but it resolved by 2 or 3 in the afternoon on the 24th. In regarding to pain in ears she mentioned she no longer had. She had beeps, noise in her ears even at the time she went to bed it was better. The outcome of events paralyzed, pain in arm, tired, sleepy, was recovering, the outcome of events tachycard, pains in all of her face, pain in both ears was resovled, the outcome of other events was unknown.

Other Meds:

Current Illness:

ID: 1090777
Sex: F
Age: 65
State: IL

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Chills, sweats, massive headache, body aches, nausea

Other Meds: Turmeric otc

Current Illness: None

ID: 1090778
Sex: F
Age: 31
State: OK

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

Vax Type:
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Lab Data:

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Symptom List:

Symptoms: Had severe vomiting every half our from 3pm until midnight the day I received the vaccine. I was vaccinated at 10:30am. I couldn?t hold down any fluids and had severe lower back pain, fever and chills.

Other Meds:

Current Illness:

ID: 1090779
Sex: M
Age: 76
State: KS

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

Vax Type:
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Lot:
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Lab Data:

Allergies: penicllin

Symptom List:

Symptoms: Moderna COVID-19 Vaccine EUA 0300 on the 10th, flu-like symptoms, headache, 100.8 fever, complete body ache, dizzy spells complete bed rest, hydrate, soup, TYLENOL 0900 on the 11th, fever has returned to normal, some body ache remains, dizzyness has subsided

Other Meds: Tamsulosin 0.4 MG Pantoprazole 40 MG Metoprolol 50 MG Valacyclovir 500 MG Symbicort 160\4.5 Vitamin C 1000 MG Ferrous Gluconate 324 MG Super Beta Prostate 2tab

Current Illness: none

ID: 1090780
Sex: F
Age: 55
State: IN

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: PCN, loran, morphine

Symptom List:

Symptoms: Headache lasting for 48 hours. Low grade temp of 99.8,36 hours later.

Other Meds: Omeprazole, vitamin b12, fluoxatine, metoprolol

Current Illness: None

ID: 1090781
Sex: F
Age: 56
State: MS

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: none known

Symptom List:

Symptoms: Fever, chills, and headache

Other Meds: vitamin e, amlodipine, risperidone, lovastatin

Current Illness:

ID: 1090782
Sex: F
Age: 44
State: VA

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Site:

Lab Data:

Allergies: n/a

Symptom List:

Symptoms: Within 4 hours on date of second dose (3/8/21) only felt tired and site injection soreness. 27 hours after vaccine (3/9/21) I felt "unwell", out of sorts, very tired. at 31 hours I had body aches throughout my body, no energy, light headed, could not be up and about for more than a few seconds, no appetite. Slept for about 3 hours then went to bed officially from 8pm to 6am and felt 100% normal.

Other Meds: n/a

Current Illness: n/a

ID: 1090783
Sex: F
Age: 54
State: IL

Vax Date: 03/09/2021
Onset Date: 03/11/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Left supraclavicular lymphadenopathy in the ipsilateral arm as the vaccine. The patient reports a similar reaction to previous influenza vaccination, which spontaneously resolved.

Other Meds:

Current Illness:

ID: 1090784
Sex: F
Age: 74
State: OR

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: Codine

Symptom List:

Symptoms: Onset of Chills a couple of hours after vaccinated. Temperature 99-100. Fatigue. Lasted most of the day through the evening. Took Tylenol and it helped with the temperature. Better next day

Other Meds: 25mg Levothyrox 50mg Losartan 25mg HydroChlorothiaz

Current Illness: none

ID: 1090785
Sex: F
Age: 34
State: AL

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

Vax Type:
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Lot:
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Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: About 20 minutes after injection (2nd injection in series), her mouth, tongue, and throat began to tingle. She broke out in a red rash from the injection site up to chest, neck and face.

Other Meds: None

Current Illness: No

ID: 1090786
Sex: F
Age: 51
State: NM

Vax Date: 02/26/2021
Onset Date: 03/07/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: Developed skin rash on arm below injection site on arm. Red, itchy, warm to touch. About 4 inches in diameter, oval shaped. Symptoms not severe, and did not require medical attention. Cleared up after 5 days.

Other Meds: none

Current Illness: none

ID: 1090787
Sex: F
Age: 74
State: IN

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 03/11/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: discomfort in arm for two days, minor headache one day, felt tired for approximately six days.

Other Meds: Metformin, Metoprolol ER, low dose aspirin, Losartan, Amlodipine, Atorvastatin, Gabapentin, Centrum vitamin, Calcium

Current Illness: None

ID: 1090788
Sex: M
Age: 39
State:

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Chills, body aches, and no energy

Other Meds: Claritin and omeprazole

Current Illness: None

ID: 1090789
Sex: M
Age: 47
State: AL

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Soreness at point of injection, beginning a few hours after shot. Greater swelling/discomfort at approximately 4AM the next morning. Mild fatigue, slight headache, mild swelling at lymph nodes approximately 20 hours after dose.

Other Meds: Atenolol, Lexapro, zyrtec, multi-vitamin, vitamin d3

Current Illness: None

ID: 1090790
Sex: M
Age: 77
State: MO

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

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

Lab Data:

Allergies: Sulfa, Codeine, Actos

Symptom List:

Symptoms: Burning and pain at site, Burning of face, nausea, extreme fatigue resulved after 4 days

Other Meds: Hydrocodone/acet 10/325 1 tab every 6 hrs as needed ? pain Tizanidine 2mg BID/PRN ? leg spasms Miralax 1 capful dailyPRN ? constipation-receives dly Glipizide ER 5mg BID ? Type 2 diabetes Latanoprost 0.0005% 1 drop both eyes every evening

Current Illness: General pain, Type 2 diabetes, Stage 4 kidney disease,

ID: 1090791
Sex: F
Age: 39
State: CT

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: At 2am, I woke up with severe chills and uncontrollable shaking. No fever. Around 6am woke up with severe aches, and flu like fatigue. Severe nausea.

Other Meds:

Current Illness: Covid 19

ID: 1090792
Sex: M
Age: 29
State: DC

Vax Date: 02/11/2021
Onset Date: 02/15/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Tinnitus starting 4 days after first dose of Pfizer Covid vaccine. Tinnitus is single toned, bilateral. Mild HA. Was Covid positive in December.

Other Meds: none

Current Illness: Covid positive in December

ID: 1090793
Sex: M
Age: 49
State: CA

Vax Date: 03/09/2021
Onset Date: 03/11/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: Preservative Methylisothiazolinone and all variants

Symptom List:

Symptoms: Uncontrollable intermittent twitching of muscles in only left side of face that shortly after waking 2 days after the second dose

Other Meds: None

Current Illness: None

ID: 1090794
Sex: F
Age: 20
State: CA

Vax Date: 02/09/2021
Onset Date: 02/21/2021
Rec V Date: 03/11/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: 20 yo female with recent hospitalization for myocarditis. Pt initially Dx with Covid 19 on 31 Dec 2020 and received Pfizer COVID Vaccines on 19 and 09 Feb. Pt reports on 21 Feb developing fevers of 107 and stomach upset, by 25 Feb she developed chest pain, SOB, weakness, continued fevers and diarrhea. She was seen at ER on 25 Feb where she was tachycardic, hypotensive, and hyponatremic with an elevate lactate. She was transferred to another hospital and found to have a Troponin of 0.629. she was admitted from 25 Feb to 04 March. During that time she had an ECHO with an EF of 35-45% with global hypokinesis and peak BNP of 1389. Pt is currently felling well with no chest pain or shortness of breath.

Other Meds: Nexplanon, Iron, Elderberry Vitamin C + Zinc, Immuneti Advance

Current Illness: Covid 19 infection 31 Dec 2020 (2 months prior)

ID: 1090795
Sex: F
Age: 55
State: TX

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: Macrobid, Sulfa

Symptom List:

Symptoms: Slight Nasal Congestion similar to COVID Body Aches Fever (100) Fatigue COVID Arm 6 days after injection

Other Meds:

Current Illness:

ID: 1090796
Sex: M
Age: 79
State: MD

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: none listed

Symptom List:

Symptoms: Patient may have inadvertently given1cc of Moderna COVID vaccine instead of 0.5cc. Patient was notified. State was notified.

Other Meds: none listed except a blood thinner

Current Illness: none at time of vaccination

ID: 1090797
Sex: F
Age: 51
State: TX

Vax Date: 03/02/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: Penicilin

Symptom List:

Symptoms: Pain, 3 large red circles on upper left arm warm to the touch and swollen.

Other Meds: Levothronine, levotyhroxine, vitamin D, omega 3

Current Illness: None

ID: 1090798
Sex: M
Age: 54
State: IN

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

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Severe chills for several hours, then high temps for several hours, then racing heart rate for 3-4 hours, tightening of chest, inability to sleep . Onset took 6 hours from shot. Conditions lasted about 18 hours.

Other Meds: Normal daily vitamins including vitamin d3

Current Illness: None

ID: 1090799
Sex: F
Age: 60
State:

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: c/o headache- IDDM- ate breakfast 0930 other and nothing since. Denies any of adverse symptoms. does self report. high anxiety R/T being here, getting vaccine & "emtional" as has not seen spouse who underwent liver transplant 2 months ago & contracted meningitis. 173/94- 72 given water & banana. Rested & relaxed w/ fresh air flow x 15 additional mins. w/ resolution of symptoms.

Other Meds:

Current Illness:

ID: 1090800
Sex: F
Age: 30
State: TX

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: LATEX AND INGESTIBLE ITEMS WITH SIMILAR LATEX INGREDIENTS

Symptom List:

Symptoms: PT C/O DIZZINESS, SOB, TIREDNESS, AND FACIAL FLUSHING. SHE STATES THAT THESE SYMPTOMS STARTED ABOUT FIVE MIN AFTER RECEIVING HER VACCINE. AFTER 10-15 MINUTES HER EYES STARTED TO FEEL HEAVY AND SHE NOTICED SHE WAS SQUINTING MORE. SHE HAS A Hx OF ANAPHYLAXIS AND BROUGHT HER EPI PENS IN CASE SHE NEEDED THEM, BUT THIS REACTION WAS NOT AN EARLY SIGN OF HER NORMAL ANAPHYLAXIS. SHE MENTIONED THAT SHE CONSUMED A MONSTER ENERGY DRINK THIS AM AND A PIECE OF TOAST. PT DENIED CP OR CHEST PRESSURE. BP 134/92 AND 138/93 SpO2 100% HR 71 AND 67 PT APPEARED IN MILD DISTRESS DUE TO A SENSE OF TIGHTENING WITHIN HER CHEST AND FATIGUE. AFTER ALLOWING PATIENT TO SIT IN HER CAR FOR AN ADDITIONAL 15 MIN , GIVING HER COOL WATER, AND A SNACK , THE PATIENTS BREATHING IMPROVED 100% AND HER DIZZINESS/FATIGUE IMPROVED 70%. AT THIS TIME PT WAS STABLE TO TRAVEL HOME (15 MIN) AND INSTRUCTED TO EAT AND REST FOR THE DAY. PT WAS NOT GIVEN MEDICATION.

Other Meds: TRAMADOL ALIEVE

Current Illness: NONE

Date Died: 03/05/2021

ID: 1090801
Sex: M
Age: 97
State: FL

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: no known allergies

Symptom List:

Symptoms: Rapid decline. Patient was reportedly vaccinated (unknown location / brand of vaccine) on 3/4/2021. On 3/5/2021, patient suffered fever of 104, nausea/vomiting, lethargy, loss of appetite, and patient expired unexpectedly.

Other Meds: Mirtazapine, seroquel, senna syrup, flomax, bicalutamide

Current Illness: Senile degeneration of brain

ID: 1090802
Sex: F
Age: 51
State:

Vax Date: 02/04/2021
Onset Date: 02/07/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: "I had to go to the doctor office due to sensitivity, soreness in the right armpit and tenderness in both breasts after receiving the first shot. This occurred approximately 3 days after the first inoculation and continued for 10+ days with the breast tenderness continuing to be an issue. The second shot was extreme fatigue for 2 days, and the continuing breast soreness."

Other Meds:

Current Illness: None

ID: 1090803
Sex: F
Age: 33
State: GA

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: Celery

Symptom List:

Symptoms: I am 12 weeks pregnant, due September 19, 2021. This is my first pregnancy and I had my doctor?s approval to get the vaccine. I have had no complications so far in my pregnancy. On the day after receiving the vaccine, I developed a severe headache, congestion, dehydration, and fatigue. I felt feverish and had chills, but I did not have a fever. I was unable to go about my daily activities (I was not working on this day). These symptoms went away about 36 hours after being vaccinated. I also had pain at the injection site.

Other Meds: Metorpolol, Procardia, prenatal vitamin, Culturelle probiotic

Current Illness: None

ID: 1090804
Sex: F
Age: 35
State: MT

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: PCN, Sulfa drugs, Keflex.

Symptom List:

Symptoms: Migraine, neck pain, muscle aches, fever of 100.8, fatigue. I noticed that the combination of Gabapentin and tylenol relieved most of the discomfort.

Other Meds: Gabapentin 600mg 2x/day, Adderall 20mg 2x/day, Effexor 225mg 1x/day.

Current Illness: None

ID: 1090805
Sex: M
Age: 65
State: IN

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

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

Lab Data:

Allergies: sulfa

Symptom List:

Symptoms: Mild fever, joint ache, fatigue, muscle ache at injection site

Other Meds: Armodafinil Atorvastatin Clopidogrel Bisulfate Dicyclomine HCL Fenofibrate Losartin Metoprolol Tartrate Pentasa Aspirin D3 Fish Oil Multivitamin/mineral

Current Illness: none

ID: 1090806
Sex: F
Age: 34
State: NC

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

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Allergies:

Symptom List:

Symptoms: patient became dizzy and lightheadedness.

Other Meds:

Current Illness: DM, PE, Anemia, Pnuemonia,

ID: 1090807
Sex: M
Age: 57
State:

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
Hospital:

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Symptom List:

Symptoms: pt. experiencing pin and needle on the L arm the vaccine was administered. pt. not in any distress and states that the pins and needles are fading.

Other Meds:

Current Illness:

ID: 1090808
Sex: F
Age: 33
State: NY

Vax Date: 03/08/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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Lab Data:

Allergies:

Symptom List:

Symptoms: Symptoms I experienced that were not listed on the CDC website were: sore throat, heavy cough.

Other Meds: Omeprazole, losartan, daily much-vitamin, medroxyprogesterone

Current Illness:

ID: 1090809
Sex: M
Age: 66
State: VA

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

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Symptom List:

Symptoms: Client "fell" outside after receiving dose. Stated chest felt tight. EMS on site

Other Meds:

Current Illness:

ID: 1090810
Sex: M
Age: 49
State: MD

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

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Lab Data:

Allergies: Shellfish (anaphylaxis), Pollen

Symptom List:

Symptoms: Brief episode of lightheaded dizziness and nausea, drank some juice, and wife drove patient home

Other Meds: none

Current Illness: none

ID: 1090811
Sex: F
Age: 20
State:

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 03/11/2021
Hospital:

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Lab Data:

Allergies: None

Symptom List:

Symptoms: Patient received the vaccine around 1600 on 05 March , then around 0330 on 06 March, she was awakened by a Migraine, she went to her kitchen to take Imitrex right after taking the medication she lost consciousness for about 60 minutes. she awakened on the floor at 0430. she was assessed int the ER abut 7 hours later .

Other Meds: Ferrous Sulfate 65 mg Summatriptan 50 mg Topomax 50 mg

Current Illness: Migraine with Aura

ID: 1090812
Sex: F
Age: 66
State: VA

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/11/2021
Hospital:

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Lab Data:

Allergies: Diovan-Tongue swelled Sulpha - headache Minocycline - dizzy, unbalanced, headache, pvc?s, GI issues Hypersensitivity to Sudafed Cipro and Levaquin- side effects Rifampin - Severe Gastro symptoms, Major Lyme Herx

Symptom List:

Symptoms: Monday day 1 Very slight headache Felt a little neuro within in 20 minutes Slight headache comes and goes Pain set in bones l. 2nd toe, back, hips, neck, elbow, ankle Some leg muscle pain Lymph nodes little pain and swollen Ears blocked Tired-slept 3 hrs in the afternoon Bedtime falling asleep-heart pounded 3 times Very cold Got very hot during night Day 2 Heart hurt upon waking, but then burped a lot -heartburn? Tired Air hunger Pain to include where ankle injury was Heart palpitations at rest in a.m. Felt 75% better during day Did chores Got very tired after having a snack-went for a nap at 2:30-4 Wed. Day 3 Heartburn Air hunger Lymph noes still swollen Ok during day-went out Pain set in by evening Neck, back, shoulders Day 4 Thurs. - still have back pain-took ibuprofen Tired

Other Meds: This is all I took the morning of the vaccine Neurontin - 500 mg a.m. / 500 mg p.m. bid- Lyme Disease/co-infections, Ativan 1mg -bid - Lyme Disease/co-infections, Combivent Respimat 20mcg - morning

Current Illness: Lyme Disease and Co-infections Asthma Fibromyalgia

ID: 1090813
Sex: F
Age: 71
State: MD

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

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Lab Data:

Allergies: None

Symptom List:

Symptoms: Convulsion like shaking but no chills, sweating, throat constriction, no tongue swelling

Other Meds: Nifedipine ER ,Pravasatin Sodium, Simbrinza, Limigan, Timolol, Metformin, Premarin, Multi Vitamin, Cod Liver Oil Tablet, Ocuvite.

Current Illness: High Blood Pressure, High Cholesterol, Glucoma, Diabetes,

ID: 1090814
Sex: F
Age: 42
State: NC

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
Hospital:

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Lab Data:

Allergies: No known allergies

Symptom List:

Symptoms: Itchiness dizziness fatigue headache

Other Meds: One a day women's multivitamin

Current Illness: No illness

ID: 1090815
Sex: M
Age: 62
State: TX

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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Lab Data:

Allergies: Allergic to Morphine

Symptom List:

Symptoms: Extreme pain right knee starting 12 hours after vaccine. Must use cane to walk.

Other Meds: Omeprazole 20 mg daily Albuterol 90 mcg as needed Symbicort 160/45 2 puffs daily Spriva respimat 2 puffs daily Tamsulosin 4 mg daily Docusate sodium 100 mg every other day Multivitamin no k daily Citrizine 10 mg daily Calcium 600 mg daily I

Current Illness:

ID: 1090816
Sex: F
Age: 54
State: NJ

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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Lab Data:

Allergies: Codeine, no other food or drug allergies

Symptom List:

Symptoms: Left facial numbness and pain

Other Meds: Oscal (calcium/vitamin D), Vitamin C, Levothyroxine sodium 112mcg, Vitamin B6

Current Illness: none

ID: 1090817
Sex: F
Age: 68
State: CO

Vax Date: 02/27/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Latex - rash (tingling in hands if wearing latex)

Symptom List:

Symptoms: Patient called reporting redness around the injection site from her first COVID-19 Moderna vaccine on 2/27 (lot # 029L20A). She says this symptom developed today (3/9/21) and is approximately 2 inches in diameter. She denies any discomfort to this area.

Other Meds:

Current Illness:

ID: 1090818
Sex: F
Age: 33
State: CO

Vax Date: 01/25/2021
Onset Date: 02/18/2021
Rec V Date: 03/11/2021
Hospital:

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Lab Data:

Allergies:

Symptom List:

Symptoms: My last period was Jan 7, 2021. Received Vaccine, dose 2 on 1/25/21 (I did not know I was pregnant at that time). Had a miscarriage and lost baby Feb 18-21

Other Meds:

Current Illness:

ID: 1090819
Sex: M
Age: 43
State: VA

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/11/2021
Hospital:

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Lab Data:

Allergies: none

Symptom List:

Symptoms: Vaccine was not administered on 3/8/21. Provider realized error and patient was contacted on 3/9/21 to come in for vaccine. He returned to clinic and received correct dose of vaccine. No harm to patient

Other Meds: none

Current Illness: none

ID: 1090820
Sex: F
Age: 72
State: TN

Vax Date: 03/04/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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Lab Data:

Allergies:

Symptom List:

Symptoms: erythematous rash around injection site

Other Meds:

Current Illness:

ID: 1090821
Sex: F
Age: 48
State: AZ

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 03/11/2021
Hospital:

Vax Type:
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Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Fever, chills, body aches, dizziness

Other Meds: Levothyroxine, Losartan, Propranolol, Escitalopram, 81 mg aspirin

Current Illness:

ID: 1090822
Sex: M
Age: 56
State: UT

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: none

Symptom List:

Symptoms: Body aches starting 2pm day of shot along with a headache. Around 11pm extreme chills and aches continuing

Other Meds: Losartan HCTZ 100-25 MG tab Centrum Mens 50+ one a day vitamin

Current Illness: none

ID: 1090823
Sex: M
Age: 70
State: IN

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

Vax Type:
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Lot:
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Lab Data:

Allergies: none known

Symptom List:

Symptoms: Overall achiness, typical of fever. Fatigue. Slight disorientation. Temperature, however was 98.6 Typically, my temperature is about 97.8

Other Meds: tamsulosin, saw palmetto, turmeric, garlic, fish oil, multi-vitamin, D3, E, K2, loratidine, magnesium citrate

Current Illness: none known

ID: 1090824
Sex: M
Age: 34
State:

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Vasovagal response, HR 91 BP 108/71, f/u vitals: 115/82, 81 HR

Other Meds: xanazx PRN

Current Illness:

Total 2021 VAERS Injuries: 704,237

Page last modified: 03 October 2021 5:28pm