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: 1055108
Sex: M
Age: 27
State: WY

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
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: Allergic Rhinitis

Symptom List: Dysphagia, Epiglottitis

Symptoms: Headache, nausea/vomiting, chills, anxiousness, symptom onset with in 60 minutes of injection Tx-50mg diphenhydramine PO in clinic Rx-40mg prednisone QD x 5 days

Other Meds: Albuterol Sulfate HFA inhaler

Current Illness:

ID: 1055109
Sex: F
Age: 52
State: MI

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
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: Morphine, dust mites, mold, trees, grass, cockaroaches,

Symptom List: Anxiety, Dyspnoea

Symptoms: Hard to breath, itching .. hot feeling from left arm area spread to neck face head. Itchying all over, pins and needles feeling in my hands, numbness in lips ear cheek , headache neck pain. Tiredness.

Other Meds: Zyrtec, metformin, inhaler, spironolactone, vitamin c, mito q, progesterone, rhodiola, benadryl

Current Illness: Diabetes, asthma,

ID: 1055110
Sex: F
Age: 36
State: CT

Vax Date: 02/02/2021
Onset Date: 02/10/2021
Rec V Date: 02/25/2021
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: NKDA

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

Symptoms: Developed a rash with hives, pruitus, burning on whole body (worst areas: head, neck, arms, back, and posterior thighs) Displaying signs of Dermatographia. Occurring all day worse at night and with hot temperatures/showers. Treated with prednisone 80mg taper, hydrocortisone cream, benadyrl initially, still taking allerga and singular.

Other Meds: allerga and singular are PRN for the seasonal allergies. I did not take them prior to either vaccination.

Current Illness: none

ID: 1055112
Sex: F
Age: 70
State: MD

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: none listed

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient possibly inadvertently received 1cc of Moderna COVID vaccine instead of 0.5cc. Patient was notified. State was notified

Other Meds: unknown

Current Illness: none at the time of vaccination

ID: 1055113
Sex: F
Age: 77
State: TN

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: denies

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

Symptoms: 1604 rt deltoid swelling raised area 2 in. in diameter no rendess/drainage ice pack applied new band aid applied 1620 swelling reduced pt left after visualizing and verbalizing no additional change or concern

Other Meds: Aspirin 81 mg po

Current Illness: denied

ID: 1055114
Sex: F
Age: 71
State: GA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
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: I am allergic to codeine.

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

Symptoms: 11 hours after shot chills and high temperature. I couldn't sleep...I took something for the fever. I was dizzy and nauseous. It was hard for me to leave my bed. My joint felt inflamed. Early this morning I fell asleep and when I work up at 11 am I was drenched in sweat. My fever has come down but I still have a low fever.

Other Meds: Turmeric golden paste,zinc +vit C,collegen, vit A,

Current Illness:

ID: 1055115
Sex: M
Age: 63
State: NY

Vax Date: 02/17/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
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: n/a

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: rash all over chest, stomach, arm pit, shoulder arms etc. Itchy sensation for the past more than 24 hours (2/24/2021 11am to now 2/25/2021 4pm)

Other Meds: hyzaar 100-12.5mg daily toprol-xl 50mg daily lipitor 20mg daily metformin 1000mg daily zinc 50mg every other day Vitamin D3 - 10000 iu once a week

Current Illness: n/a

ID: 1055116
Sex: F
Age: 38
State: TX

Vax Date: 02/21/2021
Onset Date: 02/23/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: Penicillin- vomiting

Symptom List: Pharyngeal swelling

Symptoms: Red flat rash on trunk, neck, back groin. I first noticed about 36 hours after second dose. It could have been there sooner, I was just so sick from fever/body aches, I would t have noticed. It progressively got worse by the end of the day so I finally took Benadryl before bed. The nurse told me to try not to take anything, but the night before my fever wouldn?t let up and I felt really bad so took Advil. The rash kept getting worse so I ended up taking Benadryl and it helped clear it up. It looked very drug allergy to me. Not raised, just red

Other Meds: Relpax for migraine Advil for fever

Current Illness:

ID: 1055117
Sex: F
Age: 67
State: WA

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Genera side effects: fatigue, headache, muscle pain, joint pain, chills, nausea & vomiting, ? fever. Plus: Dizziness & weakness, tinnitus. 4"x5" hard, hot, swelling at site of injection. These effects were noted the same on first injection but not nearly as extreme. After 4 days feeling better but dizziness & tinnitus remains along with arm tenderness.

Other Meds: Rx: Spironalactone 25mg 1QD Multivite, Calcium/Magnesium/Zinc, Biotin, Fish Oil. One each QD

Current Illness:

ID: 1055119
Sex: F
Age: 73
State: NC

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received vaccine and 5 minutes after vaccine admin., she started with mouth and throat tingling, dizziness and headache. Evaluated by EMS at the scene and the transported to UNC-Nash Hospital to be evaluated.

Other Meds: None

Current Illness: Hypertension/High blood pressure, Obesity

ID: 1055120
Sex: F
Age: 31
State: WA

Vax Date: 02/17/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: NA

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

Symptoms: Large red rash, skin slightly firmer to the touch where it's red. Only itched slightly the first day I noticed it. It spread the second day (today).

Other Meds: B-complex, 400mg folic acid, lactobacillus

Current Illness: NA

ID: 1055121
Sex: M
Age: 40
State: NJ

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/25/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: I had extreme chills, aches, muscle pain, vertigo, headache, and fatigue for 72 hours. At one point is was so bad i could just lay with my eyes closed and could not sleep but just lay there. I had to take off of work and was bed ridden.

Other Meds: Dulexus

Current Illness: None

Date Died: 02/21/2021

ID: 1055122
Sex: F
Age: 88
State: ID

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 02/25/2021
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 Known Allergies

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

Symptoms: Pale, Short of Breath, Hypoxic, Lethargic within minutes became unresponsive and died.

Other Meds: Loperamide , Tylenol 500mg, Acidophilus, Alka-Seltzer, Citalopram, D-Mannose, Docusate, Ensure, Losartan, MacuHealth, Naproxen, Omeprazole, Refresh tears, Gas X, Vagisil,

Current Illness: Nausea, Vomiting, Diarrhea on 2/19

ID: 1055123
Sex: M
Age: 57
State: TX

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
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: unknown

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

Symptoms: Patient received first does of COVID-19 vaccine on 02/04/2021. Pt presented to clinic for second dose of vaccine. Patient was asked several times by front desk staff and nurse about getting second dose of COVID-19 vaccine. Pt stated yes and was given vaccine. While reviewing the patients chart, the provider noticed patient should have received one vaccine not other, but patient had already had vaccine administered to him. The event was reported to Dr and patient was counseled by PA and monitored in clinic for 15min after vaccine. Patient was advised he did not need to receive the second dose of the Covid vaccine. Patient was advised of possible side effects and instructed to contact the clinic with any adverse effects that were not normal.

Other Meds: unknown

Current Illness: unknown

ID: 1055124
Sex: M
Age: 1
State: WI

Vax Date: 02/01/2021
Onset Date: 02/08/2021
Rec V Date: 02/25/2021
Hospital: Y

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

Lab Data:

Allergies: N/A

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

Symptoms: Patient developed fever, new onset erythematous rash on face and trunk, limping on L leg and toe walking, soft tissue swelling, and conjunctival injection. Patient admitted to hospital on 2/12/21 with diagnosis of Kawasaki disease and received treatment with IVIG and aspirin. Discharged on 2/15/21 with continued aspirin until follow-up. Re-admitted on 2/16/21 for overnight admission and received another dose of IVIG.

Other Meds: N/A

Current Illness: N/A

ID: 1055125
Sex: F
Age: 43
State: NC

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
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: tetracycline

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

Symptoms: General mild itchiness all over the body

Other Meds: levothyroxine

Current Illness: n/a

ID: 1055126
Sex: F
Age: 71
State: NY

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 02/25/2021
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: - erythema diffuse body, hot flashes, headache and ecchymotic areas

Other Meds:

Current Illness:

ID: 1055127
Sex: F
Age: 35
State: OH

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: Tylenol, aspirin, naproxen, ibuprofen

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Fatigue, nausea, fever, body aches, joint pain

Other Meds: Celexa, trazadone, QNSL

Current Illness: None

ID: 1055128
Sex: M
Age: 81
State:

Vax Date: 02/19/2021
Onset Date: 02/20/2021
Rec V Date: 02/25/2021
Hospital: Y

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

Lab Data:

Allergies: AMLODIPINE

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient presented to ED due to AMS, syncope. Wife reported that he became confused with generalized weakness and dropped his food on the floor and became unresponsive with his eyes and mouth open. Patient was febrile to 103 on admission w/o leukocytosis. He was admitted to hospital medicine for acute encephalopathy with associated loss of consciousness. Neurosurgery consulted but no neurosurgical intervention needed. Patient improved & discharged home 2/24/21.

Other Meds: AEDs

Current Illness:

ID: 1055129
Sex: F
Age: 46
State: AZ

Vax Date: 02/14/2021
Onset Date: 02/23/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: Premarin

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

Symptoms: 9 days after vaccination, arm became slightly itchy, red about 2? diameter, knot-like to touch

Other Meds: Armour thyroid, levothyroxine, multivitamin, divigel, flaxseed oil, vitamin D/EPA/DHA, estarylla, calcium, melatonin

Current Illness: None

ID: 1055130
Sex: M
Age: 54
State: NC

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/25/2021
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: Covid-19 like symptoms for 28 hours after injection. Chills, headache, muscle ache, fever of 101.7. I had COVID in October and this was as bad as the worst day when I was positive.

Other Meds: Benazepril

Current Illness: None

ID: 1055131
Sex: F
Age: 61
State: IN

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
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 known

Symptom List: Unevaluable event

Symptoms: numb face and tongue feeling different. no treatment yet. taking Benedryl.

Other Meds: vitamin D, multi vitamin, lispinidril,lipitor

Current Illness: none

ID: 1055132
Sex: F
Age: 52
State: GA

Vax Date: 02/20/2021
Onset Date: 02/23/2021
Rec V Date: 02/25/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: I have a 3 inch in diameter mass of swollen lymph nodes under my left arm (had both shots in left arm). I read online that this is a sign of my body fighting the vaccine and it is a good sign. I went to my doctor just to have it checked out and because both of my eyes look like I have pink eye. My doctor isn't sure if my eyes have anything to do with the vaccine but said probably not. She said that I needed to report my mass as it is not one of the most common side effects. I also went to the health department, where I had both shots, and had them look at the mass. They said the same thing about my body fighting the vaccine. My doctor and the health department said that while they have seen the swollen lymph nodes from the shot, they haven't seen such a large mass like mine. Both of them said I needed to report this.

Other Meds: Amitriptyline Metoporol Soma Tramadol Gabapentin

Current Illness:

ID: 1055133
Sex: F
Age: 67
State: OH

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
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: S/P Covid Vaccine 1st dose, pt alert/oriented, calm, answering Covid questions appropriately. Prior to vaccine. pt reports she doesn't really like vaccines. Vaccine administered at approx 2:34 pm. Pt reports she doesn't feel well, reports she did not eat or drink today. This nurse gave her water to drink. Pt unable to drink, briefly passed out in chair approx 2:36pm. Myself and RN lowered pt from chair to floor. Site Director called EMS. RN assisted by raising pt's legs above heart level. RN checked b/p 70 palp, pts airway maintained, rechecked b/p 80 palp. As pt returned to consciousness reports she is about to vomit, assisted pt to (R) side >vomited small amount clear liquid x2 into bag provided, pt reports she feels better. EMS arrived, transported pt to ED via stretcher @ 2/40 pm, pt's coat, eye glasses, and purse placed on stretcher with pt. Phamacist contacted pt's husband at 2:40 pm. Site Director notified.

Other Meds:

Current Illness:

ID: 1055134
Sex: F
Age: 29
State: NY

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: Seafood, almonds, cantaloupe

Symptom List: Injection site pain, Menorrhagia

Symptoms: Effects started 2/10/21. Very sore arm (pain level 8/10). Inability to use my left arm for two days. Used ibuprofen 600mg every 6 hours for 2 days. On 2/11/21, felt chills, fatigue, malaise, body aches. On 2/12/21, symptoms subsided except slightly sore arm. Arm became itchy and developed 3 large red lumps on my shoulder/upper arm (only one lump was at the injection site. Other lumps were distal). Benadryl used for itchiness. Lumps subsided by 2/13/21 in the evening with slight skin discoloration. As of today, 2/25/21, experienced stabbing pain through my upper arm that lasts seconds and subsided. Occurs 2-3 times a day

Other Meds: Zyrtec, spironolactone, turmeric, allicin

Current Illness:

ID: 1055135
Sex: M
Age: 72
State: MD

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
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: none listed

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

Symptoms: Patient possibly inadvertently received 1cc of Moderna COVID vaccine instead of 0.5cc. Patient was notified. State was notified

Other Meds: unknown

Current Illness: none at the time of vaccination

ID: 1055136
Sex: F
Age: 73
State: OK

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

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

Lab Data:

Allergies: No drug allergies Seasonal allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Approx 5 hours following Pfizer injection her heart beat was rapid and the right half of her tongue was swollen and red. No other symptoms, resolved without treatment 3 hours later. She notified her physician who recommended not taking the 2nd dose.

Other Meds: Metoprolol 50 mg daily Radeprazole Sodium 20 mg daily MPThyroid 90 mg daily Imdur 30 mg daily Ranexa 500 mg twice a day Nac 600 mg daily, Alpha lipoic acid (ALA)600 mg daily, D3 125 mg daily, CoQ10 100 mg daily, Vit B complex daily, Trace M

Current Illness: No illnesses

ID: 1055137
Sex: M
Age: 93
State: NC

Vax Date: 02/02/2021
Onset Date: 02/20/2021
Rec V Date: 02/25/2021
Hospital: Y

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: Pt admitted w/ severe COVID diagnosis on 2/20/2021.

Other Meds:

Current Illness:

ID: 1055138
Sex: F
Age: 52
State: FL

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
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: Latex, Egg Whites, Codine

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

Symptoms: Following morning after vaccine: Adverse events started at 6:00 AM -Fainting? 3 times. Hit my head on the tile. Fainting occurred until 12 Noon. -Excessive Sweating-6-noon. Clothing was drenched -Diarrhea-Morning -7:00 AM -Vomiting-7:00 AM -Headache-All Day -Pain at injection site-All Day

Other Meds: Tylenol, Zyrtec D, Fluoxetine 10mg, VItamin D 2500 mg

Current Illness: None

ID: 1055139
Sex: F
Age: 71
State: CA

Vax Date: 02/15/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
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

Symptom List: Nausea

Symptoms: Swelling, redness, and soreness at injection site for 3-4 days before subsiding. Woke up on the morning of the 9th day with major itching and redness. Using a cortisone cream for relief, yet symptoms are still apparent.

Other Meds: blood pressure, thyroid, Xyzal, Ibuprofin, Nasacort

Current Illness:

ID: 1055140
Sex: M
Age: 80
State: AL

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: No adverse events at this time - Patient was given 0.6mL of vaccine instead of 0.3mL

Other Meds:

Current Illness:

ID: 1055141
Sex: F
Age: 37
State: WI

Vax Date: 01/28/2021
Onset Date: 01/30/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: antibiotics

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

Symptoms: itching, hives, welting x 1 week

Other Meds:

Current Illness:

ID: 1055142
Sex: F
Age: 77
State: MO

Vax Date: 02/12/2021
Onset Date: 02/14/2021
Rec V Date: 02/25/2021
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: none known

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

Symptoms: Patient had swollen injection arm, red rash and chills for 7 days following administration. Also had pain in calves and ankles

Other Meds: none known

Current Illness: none known

ID: 1055143
Sex: F
Age: 67
State: IA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/25/2021
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: Moderna was given as First Dose on 12/23/2020 Pfizer was given as Second Dose on 01/15/2021

Other Meds:

Current Illness:

ID: 1055144
Sex: M
Age: 18
State: MO

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/25/2021
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: WITHIN 5 MINUTES OF VACCINE PATIENT FELT FAINT, LIKE HIS HEAD WAS SPINNING. BP WAS 80/40. PULSE WAS 42. BLOOD SUGAR WAS 125. VERY PALE, LIPS WERE PALE/BLUISH IN COLOR. HAD A DECREASED LEVEL OF CONSCIOUSNESS. SPO2 WAS 88%, OXYGEN WAS PLACED ON HIM. HE WAS TRANSPORTED TO HOSPITAL VIA EMS

Other Meds: FULFAMAF/TRIMETHOPRIM triamcinolone CREAM

Current Illness: NONE

ID: 1055145
Sex: F
Age: 75
State: CA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
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: Penicillin.

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

Symptoms: Moderna COVID?19 Vaccine EUA Extreme difficulty breathing. Started earlier in the day. Hospitalized within 3 hours of onset. Breathing difficulties relieved somewhat prior to hospitalization by administration of two puffs of ProAir HFA. Experienced extreme abdominal pain. Hospital administered Albuterol, contact hospital for dose.

Other Meds: 200mg Trazadone

Current Illness:

ID: 1055146
Sex: F
Age: 16
State: CO

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/25/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: No adverse even occurred. Reporting because patient was too young for Moderna vaccine

Other Meds: Albuterol

Current Illness: None

ID: 1055147
Sex: M
Age: 80
State: FL

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/25/2021
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 known

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: The day after the shot, my husband fell asleep on the couch for several hours. He was freezing and had a fever of 100.5 taken orally (under tongue). I gave him Tylenol and water He perked up that evening. People say the second dose is worse and I am concerned about him having a worse reaction. He was in the hospital with COVID 19 last August and September and was very ill. He came home in a wheel chair and oxygen 24/7. He is walking with a cane now and only uses oxygen at night. I am wondering what you think about him getting the second dose of Moderna. .?.? Please let me know what your expert opinion is. Thank you very much.

Other Meds: Clopidogrel 75 mg Furosemide 40 mg Warfarin 5mg Atorvastatin 10mg

Current Illness: None Had COVID 19 in August. Was hospitalized for 7 weeks.

ID: 1055148
Sex: M
Age: 73
State: LA

Vax Date: 02/09/2021
Onset Date: 02/11/2021
Rec V Date: 02/25/2021
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:

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

Symptoms: Patient reports having had a rash develop two days after the injection, self-treated with benadryl as directed by urgent care. Patient states a sore formed in his mouth the next day after the rash had started.

Other Meds:

Current Illness:

Date Died: 02/22/2021

ID: 1055149
Sex: M
Age: 95
State: MI

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/25/2021
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: ace inhibitors, codeine, lysynopril

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

Symptoms: This is a hospice patient under the care of Hospice at an affiliated nursing home. Pt received the vaccination around noon on 2-16-21 by a representative from Pharmacy. The following afternoon 2-17-21 at 14:45 the pt started to experience severe SOB resp rate 36, audible wheezing and use of respiratory accessory muscles. BP180/80, 113 pulse temp 98. Pt was given morphine and ativan. The respiratory distress was eased however pt never returned to baseline and died 2-22-21 around 4am.

Other Meds: Amlodipine, lasix, toprol XL, PRN: lorazipam and morphine

Current Illness: MEDICAL HISTORY; CHF (EF=20%), CAD, AAA (NO REPAIR) 5.3CM, ANEMIA (HISTORY TRANSFUSIONS ARANESP/PROCRIT), CKD STAGE 5 (BUN=110/CREATININE=6.09), HTN, ISCHEMIC CARDIOMYOPATHY, GLAUCOMA, HOH, COVID-19 PNEUMONIA 11-27-2020 THROUGH 12-12-2020, SEVERE NONRHEUMATIC MITRAL VALVE REGURGITATION, NSTEMI 03-27-2019, CAROTID ARTERY STENOSIS, CABG 2009, CARDIAC STENT PLACEMENT, FORMER SMOKER.

ID: 1055150
Sex: F
Age: 75
State:

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
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: Pain in extremity

Symptoms: Client stated she had a wave of lightheadedness. No other complaints. Evaluated by EMS. BP146/82. 2:34 pm client states symptoms resolved, kept for additional monitoring. 2:54 client stood and became lightheaded. Evaluated by EMS. BP 151/78, repeat 147/85, HR-82, O2-99% on room air. 2:59pm client took Xanax 0.25 mg po pres ribed by her PCP. 3:14pm. Sx resolved. 3:20pm discharged home.

Other Meds:

Current Illness:

ID: 1055151
Sex: F
Age: 79
State: FL

Vax Date: 02/20/2021
Onset Date: 02/22/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: injection site soreness, tired, chills, nausea, headache

Other Meds: raloxifene 60mg, omeprazole 20mg, acyclovir 200mg, atenolol 25mg, simvastatin 40mg, famotidine 20mg, multi vitamin, calcium citrate with vitamin d

Current Illness: n/a

ID: 1055152
Sex: M
Age: 68
State: CA

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/25/2021
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: erythromycin

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

Symptoms: Intense pain in upper left arm 15 hour after injection

Other Meds: alvesco, zyrtec, vit B12, vit D3, rosuvastatin

Current Illness: none

ID: 1055153
Sex: M
Age: 79
State: IL

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
Hospital: Y

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

Lab Data:

Allergies: Bee venom Sulfamethoxazole w/trimethoprim

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

Symptoms: Pt received COVID injection at doctors office. Approximately 1 hour later while sitting in recliner, wife noticed patient pale and unarousable. Paramedics were called and found patient with agonal respirations in asystole. Pt was intubated, received epinephrine, amiodarone and atropine per ALS care. Pt wife stated patient complained of dizziness and headache, but no chest pain or shortness of breath. Pt transported to ER. Following testing and treatment in ER, pt transferred to ICU.

Other Meds:

Current Illness:

ID: 1055154
Sex: F
Age: 23
State:

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: On 1/29/21 claims she got her menstrual cycle 2 weeks earlier than usual cycle. Total of 4 days of menstrual bleeding.

Other Meds:

Current Illness:

ID: 1055155
Sex: F
Age: 62
State: WI

Vax Date: 02/19/2021
Onset Date: 02/21/2021
Rec V Date: 02/25/2021
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: Marigolds

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pain in left back/rib cage radiating to front of chest. No blistering rash yet. Patient also reports itching and burning sensations in affected area. Patient went to urgent care (2/25/21) and was diagnosed with shingles. Patient was prescribed valtrex.

Other Meds: Glipizide Trazodone Citalopram Zetia

Current Illness: N/A

ID: 1055156
Sex: F
Age: 55
State: ME

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/25/2021
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: NKDA

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

Symptoms: same day of injection - large area of swelling 6 cm, vomiting, high fever, chills, hallucinations, severe joint pain , fatigue, discoloration and pain in hands.

Other Meds: aspirin and multi-vitamin

Current Illness: none

ID: 1055157
Sex: F
Age: 49
State: WV

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 02/25/2021
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: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 12/22 vaccination 4pm. 4:05 PM, my HR went way up. I broke out on neck, chest, face; fire engine red. Felt like burning from the inside, out. Lightheaded and dizzy. Got puffy. Was NOT anaphylactic. 2 Benadryl. I didn't feel good for a couple weeks. 14-20 days, same experience with redness/burning. I took pictures. That happened every day for 4-5 more days. I went to doctor after doctor; ER after ER. About 6-7 times I have been to the ER; SOB, dizzy all the time, panic attack/anxiety, Stomach is not emptying correctly (NOT diabetic), eye keeps twitching, hurting behind my eyes, all my muscles are shrunken now. Blood panel, stress test; gastroparesis; positive; ringing in my ears; SOB; *COVID; negative.

Other Meds: Thyroid meds, Lip injections 10/2020

Current Illness: N/A

ID: 1055158
Sex: F
Age: 41
State: HI

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 02/25/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Fever, chills, muscle aches, fatigue, soreness and lump at injection site.

Other Meds: None

Current Illness: None

ID: 1055159
Sex: F
Age: 79
State: AL

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/25/2021
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:

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

Symptoms: No adverse event at this time - patient was given 0.6ml of vaccine instead of the indicated 0.3ml

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm