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: 1048834
Sex: M
Age: 86
State: IL

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/23/2021
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: Lisinopril, Sulfa antibiotics

Symptom List: Dysphagia, Epiglottitis

Symptoms: No adverse reaction. Patient hospitalized in December for COVID. Given FFP while hospitalized. Patient given 1st Moderna vaccine 1-28-21 which was not 90 days after the FFP.

Other Meds: Ca-MG-ZN, Vit D 3 Januvia 50, Toprol XL 25

Current Illness: COVID diagnosed 12-2-2020, given FFP in the hospital

ID: 1048835
Sex: M
Age: 74
State: MD

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

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

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Multiple Seizures: no long term side effects

Other Meds:

Current Illness:

ID: 1048836
Sex: F
Age: 53
State: IN

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
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: na

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

Symptoms: At approximately 9:30 pm, my bpm increased dramatically. I normally have a 70 - 85 bpm and last my my heart rate ranged from 120 - 152 while lying in bed. It still is above 100 today.

Other Meds: Tylenol Metformin Montelukast Pravastatin Duloetine Vitamin C Vitamin B12 Vitamin B Complex Melatonin Apple Cider Vinegar

Current Illness: Insulin resistance

ID: 1048837
Sex: F
Age: 74
State: PA

Vax Date: 02/19/2020
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
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: The second day I got a fever of 101.9 and later 101. The fourth day my arm was hotter and more sore than previously and noticed it had a big red circle around the injection site. It is now the next day and after putting ice on it it still itches and is less sore.

Other Meds: Synthroid, Valsartan-HCTZ, Metoprolol Suc, Atorvastatin

Current Illness: None

ID: 1048838
Sex: F
Age: 81
State:

Vax Date: 02/06/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
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: Patient was administered the second dose 15 days after the first dose (administration error).

Other Meds:

Current Illness:

ID: 1048839
Sex: F
Age: 33
State: MA

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
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: Patient got unconscious. Patient was sent 911. After following up with facility, patient was stable and doing well. Patient was sent home that evening.

Other Meds:

Current Illness:

ID: 1048840
Sex: F
Age: 69
State: OH

Vax Date: 02/08/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Slight itch, red rash around injection site, skin warm for 3 days (so far)

Other Meds: Atorvastatin 10 mg, Hair, Skin & Nails

Current Illness: None

ID: 1048841
Sex: M
Age: 89
State: ME

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: DVT Right leg Femur

Other Meds:

Current Illness:

ID: 1048842
Sex: F
Age: 27
State: KY

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: dairy and beeswax

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: fever of 103, chills that lasted hours, nausea and a headache that would not go away.

Other Meds: none

Current Illness: none

ID: 1048843
Sex: F
Age: 27
State: MA

Vax Date: 02/15/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: severe cough, phlegm, severe asthma flare up, headaches

Other Meds:

Current Illness:

ID: 1048844
Sex: F
Age: 17
State: FL

Vax Date: 01/13/2021
Onset Date: 01/01/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient is less than 18 years of age when she received vaccine, however EUA is only for 18 years of age and older. No other adverse effects noted other than aches from vaccination.

Other Meds:

Current Illness:

ID: 1048845
Sex: F
Age: 51
State: PA

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: extreme upper body muscle pain, joint burning, involuntary shaking, headache, vomiting, stomach lightning; 14 hour duration; 1,000 mg Tylenol/ 6 hours and ice packs were used; after symptoms subsided slept 24 hours

Other Meds:

Current Illness:

ID: 1048846
Sex: F
Age: 26
State:

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/23/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Anaphylaxis - tachycardia, palpitations, shortness of breath, skin itching. Received epi pen and ER transport. Now undergoing allergy testing.

Other Meds:

Current Illness:

ID: 1048847
Sex: F
Age: 58
State: MA

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
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: NKA

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

Symptoms: Began feeling unwell around 1 am, with symptoms including uncontrolled chills, generalized body aches, low grade fever 100.1 (baseline always 98.6). Took 600 mg of Ibuprofen around 4 am, and this morning chills and fever have subsided, body aches are starting to minimize, and feeling generally better 9 am.

Other Meds: Lisinopril 5 mg, Magnesium 400 mg, Flaxseed Oil 1200 mg all daily

Current Illness: None - felt well.

ID: 1048848
Sex: F
Age: 60
State: UT

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 02/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Pt came to the counsel window last night and said she needed to get her second dose of the Shingrix vaccine but was concerned because she said after receiving the vaccine she developed a red, itchy, 2 inch raised rash at the injection site that lasted about 2 weeks. I told her I would report the adverse event and contact both the manufacturer and her primary care doctor to see clinically if she should get the second dose or to not complete the series.

Other Meds:

Current Illness:

ID: 1048849
Sex: F
Age: 60
State: WI

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
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: strawberry allergy, Erythromycin, Bactrim, Penicillin, Crestor

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

Symptoms: This occurred while EMS was on standby at the COVID vaccination clinic. The patient stated she started getting itchy skin after her COVID vaccination. Her scheduled appointment time was 12:40pm, but she arrived later for her vaccine. Patient asked for Benadryl. Patient did not have any other symptoms besides itching. At 1:38pm the patient assessment was done and vitals taken. Patient HR was 60 and RR was 20, BP was not taken. Patient was given 25 mg oral Benadryl at 1:45pm. Patient was asked to stay an additional 15 minutes for observation, and after that time she felt fine. Patient stated she was staying at work and in her office which was close to the vaccination area. Patient denied further care and transport to

Other Meds: Unknown

Current Illness: unknown

ID: 1048850
Sex: F
Age: 39
State: NM

Vax Date: 01/22/2021
Onset Date: 01/27/2021
Rec V Date: 02/23/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None

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

Symptoms: I?m not sure if this is from the vaccine but I have had bad panic and anxiety attacks with elevated heart rate I?ve even visited the ER they did a few tests said I was ok but I?m reporting this because I haven?t had this bad of panic and anxiety in years and want to make sure it?s not affecting me that way

Other Meds: Multi vitamin , B12, Iron with vitamin c

Current Illness: None

ID: 1048851
Sex: F
Age: 71
State: CT

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Zocor, Rizatriptan Benzoate, Prozac, Tylenol, Anti-depressants, statins, sulfur drugs, Primecrolimus Cream, Parmesan Cheese, nuts, yeast, ginger, Berberine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: About 15 hours after receiving the shot I started to experience nausea, headache, heavy sweating & freezing chills (at the same time), and then this morning about 36 hours after the shot, itching. Took Zomig nasal spray and oxycodone aspirin for the headache.

Other Meds: Pantoprazole Sodium EC 40mg/take 1 every 3rd day), Oxycodone 325mg (take as needed), Zomig Nasal Spray (take as needed), Ajovy (take 3 doses every 3 months), Baclofen 10mg (take as needed), Betamethasone Dipropionate Cream (use on exzema as

Current Illness:

ID: 1048852
Sex: F
Age: 52
State: NY

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

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: "10min after vaccine, experiencing chest tightness and feeling SOB, BP 124/82 HR 44-86 with abnormal heart rhythm on auscultation O2 sat 100% temp 36.8 . She expresses tingling to the tips of her fingers, left shoulder pain radiated to her neck. DR in urgent care immediately notified and arrived . EKG ordered "

Other Meds:

Current Illness:

ID: 1048853
Sex: F
Age: 55
State: AZ

Vax Date: 02/12/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: Hydrocortisone

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

Symptoms: Rash developed this morning on left arm. Doesn?t itch.

Other Meds: Pravastatin, magnesium,centrum silver, fish oil, calcium, Nature?s Bounty immune

Current Illness: None

ID: 1048854
Sex: M
Age: 81
State: NY

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/23/2021
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:

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

Symptoms: Shaking terrible for like 18 hrs about 24 hrs after shot, vomiting, diarrhea, disoriented. A week later he is very weak. Has decided not to do the 2nd shot

Other Meds:

Current Illness:

ID: 1048855
Sex: M
Age: 71
State: MD

Vax Date: 02/13/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
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: Unevaluable event

Symptoms: Delayed cutaneous hypersensitivity (Covid arm). Red rash, warm to the touch at injection site. No treatment required. Occurred 8 days after injection.

Other Meds: Xarelto 20mg, Atorvastatin 10mg, Clonazepam 0.5 mg, Flecainide 50mg x2, Metoprolol 12.5mg, Centrum Silver, Vitamin D 1000iu.

Current Illness: None

ID: 1048856
Sex: F
Age: 67
State: OH

Vax Date: 02/12/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
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, Penicillin, Macrodantin, Cipro

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

Symptoms: ?COVID arm? 2/20/21 I noticed a 2.5? (diameter) hard mass below injection site. Mass became deep red, painful and itchy. 2/20-2/22/21 I ran a low grade fever, burning eyes, malaise, and significant generalized muscle aches. On 2/21 the mass and redness had become larger 3.5?, remained tender and very red. 2/23, I was no longer febrile and had no extraneous symptoms other than my arm. The area became softer, still tender, redness was a lighter red but more diffuse. 2/24 much better but still noticeable.

Other Meds: Levothyroxine, multivitamin, tylenol

Current Illness: None

ID: 1048857
Sex: F
Age: 34
State: AZ

Vax Date: 01/31/2021
Onset Date: 01/31/2021
Rec V Date: 02/23/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: This patient is a 34 y.o. female presenting to the emergency department with a chief complaint of anxiety onset 1130. The patient reports that she had her second dose of the COVID vaccine, and 4 minutes after, had chest tightness with palpitations. She had associated nausea, vomiting and a mild headache. She states that her symptoms come in waves and are similar to a panic attack. She has had panic attacks in the past. She reports that she had similar symptoms after her fist dose, but states that they were much more mild.

Other Meds:

Current Illness:

ID: 1048858
Sex: F
Age: 22
State: TN

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: PCN; Zithromycin

Symptom List: Injection site pain, Menorrhagia

Symptoms: 9:40 am; person reported this person having problems after vaccination of the Moderna Covid-19 vaccine. Experiencing difficulty swallowing; "feels like a lump in my throat", headache. Proceeded to her vehicle and assessed, she reports having a little difficulty swallowing and felt a little funny, alert and oriented. BP 120/60, R 12 P62, continued to monitor - BP rechecked at 9:44 am 132/90, R 12 P 66. Pt. complained of itching around face and neck, 9:45 am EMS/911 contacted and Pt. given Benadryl 50 mg/ml 1cc IM to Rt. Deltoid. Pt. developed redness to face/chest and continued to complain of itching. 9:49 am EMS on scene and report given. PT. was able to walk to back of ambulance and enter for further evaluation and treatment as needed.

Other Meds: None

Current Illness: None

ID: 1048860
Sex: F
Age: 49
State: VA

Vax Date: 02/16/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
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: PCN

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

Symptoms: Pain, tenderness, and swelling near the left collar bone. (Lymph node?)

Other Meds: Vitamin D

Current Illness: none

ID: 1048861
Sex: M
Age: 52
State:

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 02/23/2021
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: Itchy, erythematous rash. Did not go to ER or get treatment immediately but then saw allergy, received allergy testing and later received 2nd dose.

Other Meds:

Current Illness:

ID: 1048862
Sex: F
Age: 87
State: NY

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient had trouble breathing after vaccination. Assessed by on-site EMT who determined she could return to home.

Other Meds:

Current Illness:

ID: 1048863
Sex: F
Age: 79
State: FL

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: First dose 4 weeks ago, second dose February 17th, 2021. Time 1000 Redness around injection site. She couldn't move her arm and it was sore when trying to move arm above mid chest. "Looks like someone sprayed red paint over her". These sx resolved today however she is still experiencing unbearable itchiness. Caller did mention that she has been having chronic itchiness for what she was taking daily Antihistamines (LORATADINE 5mg) but had d/c it prior to vaccine as she was told that taking antihistamines was not recommended. PCC Recommended to go ahead and take an antihistamine as it is not contraindicated. She usually takes Loratadine and was going to take a 10mg tablet. PCC will fu.

Other Meds: Synthroid 75mcg QD

Current Illness:

ID: 1048864
Sex: F
Age: 75
State: NJ

Vax Date: 02/13/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
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: SORENESS, ITCHINESS & MUCH SWELLING. THE TREATMENT I WENT TO THE DOCTOR ON 02/22/2019 AND WAS PRESCRIBE AMOX-CLAV 500-125 MG TWICE A DAY AND TRIAMCINOLONE ACETONIDE CREAM USP

Other Meds: CRESTOR, ASPIRIN, AND LUMIGAN

Current Illness: ASTHMATIC

ID: 1048865
Sex: F
Age: 70
State: IL

Vax Date: 02/10/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: Penicilin, Codeine, Erythromycin, Darvon, Clinoril, Clindamycin, Ace Inhibitors

Symptom List: Injection site pain

Symptoms: I developed a red, itchy rash at and below the vaccine site after 8 days on my upper right arm. It became itchier after 9 days, it disappeared after 10 and 11 days, and it reappeared after 12 days, spreading to the left upper arm and both thighs.

Other Meds: Anastrozole 1 mg, Atorvastatin 20 mg, Fluoxetine 20 mg, Hydrochlorotiaide 25 mg, Amlodipine 5 mg, Metoprolo Such Er 100 mg, Omeprazole 10 mg, Ca 600 mg + D3 500 IU, Women's One Daily Multivitamin - All Daily.

Current Illness: None

ID: 1048866
Sex: F
Age: 35
State: AL

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: NA

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

Symptoms: I started having minor body aches about six hours post vaccine. I woke up that night nauseous and dizzy. I passed out on the way to the kitchen to get water. My husband somehow heard me and helped me back to the bedroom where I passed out again. I was eventually able to get back in bed without passing out, though I couldn't get warm and had severe body aches for most of the night. It was like having a very high fever, only there was no fever. I was clammy, but no fever. Around 4:30 a.m. the 'non-fever' broke and the chills and body aches stopped. I was extremely fatigued for the next two days and felt myself again by the third. The arm in which I received the shot hurt pretty bad Friday too but that was the least of my concerns. I did not seek medical treatment for these symptoms.

Other Meds: Lexapro, Spironolactone

Current Illness: NA

ID: 1048867
Sex: F
Age: 51
State:

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 02/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Palpitations 18 hours after vaccine

Other Meds:

Current Illness:

ID: 1048868
Sex: F
Age: 57
State: SD

Vax Date: 02/18/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
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: Clarithromycin, Lurasidone, Cipro, Montelukast

Symptom List: Tremor

Symptoms: developed rash 56 hours after covid vaccine and it lasted 24 hours. Rash was on both legs. she also had fever, chills aches 10 hours after the vaccine and that lasted 24 hours.

Other Meds: Flonase, Acyclovir, probiotic, optivar

Current Illness:

ID: 1048869
Sex: F
Age: 71
State: FL

Vax Date: 02/12/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Initially, post vaccination on 2/12/21, patient experienced pain, and swelling at the injection site which then resolved. Yesterday on 2/20/21, patient started experiencing discomfort, redness and swelling at injection site (left deltoid). referred patient to primary provider if symptoms worsen

Other Meds: calcium, MVI

Current Illness:

ID: 1048871
Sex: F
Age: 60
State: AL

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
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: Cipro, Neosporin, Aleve

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

Symptoms: Moderna COVID-19 Vaccine EUA First 24 hours - headache, tiredness, nausea Second 24 hours - chills, headache and tiredness continued

Other Meds: Losartan Calcium Multivitamin plus iron-daily Azo cranberry supplement Cetirizine Estrace vagina cream Trimethoprim Zyrtec

Current Illness: None

ID: 1048872
Sex: F
Age: 45
State: NM

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
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: Zithromax, penicillin, sulfa, Trileptal, Haldol

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

Symptoms: Experiencing heightened psychosis with bouts of uncharacteristic anger with no other probable cause. Started calming down 5 days after onset. Peak psychosis at 4 days after vaccine. Still some residual effect today (6 days in), but psychotic symptoms are manageable, as before vaccine.

Other Meds: Abilify, Benztropine, Myrbetriq

Current Illness:

ID: 1048873
Sex: M
Age: 1
State:

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
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: Milk-containing products, peanuts

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient in distress after receiving immunizations D Tap, pneumonia, Hib, Flu. RN arrived to see patient laying on exam room table, and appeared to be having a seizure. 911 was called. Monitored for approximately 4 minutes. Breathing rapidly at first then transitioned to shallow breathing and dusky around mouth, body limp at this time. Ambu bag applied with oxygen. O2 sat 100%, patient started to become more responsive. Respirations improved, changed oxygen to blown by oxygen. EMS arrived. Patient more alert and transferred to ER.

Other Meds:

Current Illness:

ID: 1048874
Sex: M
Age: 86
State: IL

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/23/2021
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: Lamictal

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

Symptoms: Approximately 30 minutes after receiving the vaccination dad had a seizure, and he continued having seizures for 24 hours. He developed a low grade fever of 99.4 for 24 hours. He was very ill for 8 days and has been continuing to recover slowly.

Other Meds: Keppra, Vimpat, Lorazepam, Citralopram

Current Illness: None

ID: 1048875
Sex: F
Age: 50
State:

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
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: demerol

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

Symptoms: Shooting pain down the arm to the finger-tips and up to the neck, cannot lift arm over head. Headache.

Other Meds: Amlodipine

Current Illness:

ID: 1048876
Sex: F
Age: 61
State: NJ

Vax Date: 01/28/2021
Onset Date: 01/30/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: sulfa

Symptom List: Pain in extremity

Symptoms: nausea, vomiting, headache, tired, chills, pain in injection site

Other Meds: nausea, dizzy, tired

Current Illness: 2nd vaccine shot after 48 hrs I had a 5 hr event of nausea, vomiting, headache, tired which quickly went away

ID: 1048877
Sex: F
Age: 66
State: FL

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
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: patient claimed that she developed arm pain that radiate to the nick and ear aches after 1 hour from receiving the first dose and pain still occuring 3 days after her first dose. patient denies any allergies. patient is taking synthroid for low thyroid level, lipitor for high cholestrol, and effexor for depression. patient was instructed to take over the counter medication ibuprofen or acetaminophen and to perfom cold compression to help with the pain symptoms,

Other Meds: synthroid for low thyroid level, lipitor for high cholestrol, and effexor for depression.

Current Illness:

ID: 1048878
Sex: M
Age: 70
State: TX

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
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: NO

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

Symptoms: Fever of 101.6 had chills, headache, dizziness . Just like when i had covid.

Other Meds: NO

Current Illness: NO

ID: 1048879
Sex: F
Age: 42
State: NJ

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/23/2021
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 known allergies to medications, food or products. Seasonal allergies to pollen.

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

Symptoms: Client stated that her right side burned and was painful on the evening of 2/16/2021. The pain continued and she went to Hospital on 2/19/2021 , and had an ultrasound. She was not admitted. She stated that they said her spleen was inflamed. She will go for follow-up at Dr.

Other Meds: Multivitamins

Current Illness: None

ID: 1048880
Sex: F
Age: 74
State: FL

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
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: LATEX

Symptom List: Vomiting

Symptoms: PT RETURNED TO FACILITY ON 2/23/2021 TO REPORT SYMPTOMS OF REDNESS, WARM TO TOUCH, AND SWELLING AT INJECTION SITE - LEFT DELTOID NOTIFIED PTS PRIMARY PHYSICIAN, SET UP APPOINTMENT FOR 1130 TODAY TO BE SEEN

Other Meds:

Current Illness:

ID: 1048881
Sex: F
Age: 80
State: PA

Vax Date: 02/03/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
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: Patient received vaccine on 2/3/21. Developed headache, fever and red warm rash to injection site on 2/21/2021. Applied ice and took Tylenol. Symptoms starting to resolve today

Other Meds:

Current Illness:

Date Died: 02/12/2021

ID: 1048882
Sex: F
Age: 71
State: MA

Vax Date: 02/01/2021
Onset Date: 02/12/2021
Rec V Date: 02/23/2021
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: Augmentin (hives)

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

Symptoms: Vaccine was administered 2/1/2021 at approximately 9am. Due to self reporting of allergic reaction (hives) to Augmentin, patient was monitored on site for 30 minutes. After the monitoring period, she was cleared to go with no issues reported at the time. We were later informed that the patient passed away from a pulmonary embolism on 2/12/2021.

Other Meds:

Current Illness:

ID: 1048883
Sex: M
Age: 64
State: GA

Vax Date: 01/05/2021
Onset Date: 01/10/2021
Rec V Date: 02/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: rash on chest and back

Other Meds: losatain proastatain

Current Illness: none

ID: 1048884
Sex: F
Age: 24
State: VA

Vax Date: 02/14/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: Sulfa allergy

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

Symptoms: One week from the vaccine there is a large red welt at the vaccine site. My arm is also very sore and itchy. It?s not serious enough to see a provider but I wanted to document any adverse reactions as the vaccine is still being rolled out.

Other Meds: N/A

Current Illness: N/A

ID: 1048885
Sex: F
Age: 52
State: MD

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 02/23/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Morphine, Diltide, Vancomycin. Lisinopril, Turkey, Peanuts

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

Symptoms: I had light headedness,breaking out severe sweats, nausea and vomited (1). I was transported to ER with a 103.5 fever lasted for 10 days, Covid test, Epipen,swollen lymph nodes(right arm) painful,increased fatigue.During the 10 day period I had went to the ER again 5th day got tested for Covid and rechecked symptoms.

Other Meds: Coreg, Intresta, Trumesmeride?

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm