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

Date Died: 02/25/2021

ID: 1055267
Sex: M
Age: 91
State: VA

Vax Date: 02/24/2021
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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Death

Other Meds:

Current Illness:

ID: 1055268
Sex: M
Age: 74
State: NY

Vax Date: 02/19/2021
Onset Date: 02/23/2021
Rec V Date: 02/25/2021
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: shell fish

Symptom List: Anxiety, Dyspnoea

Symptoms: Chill, headache, spike in blood pressure, hospitalized overnight

Other Meds: fosinopril 40 mg 5 mg amolipine

Current Illness: none

ID: 1055269
Sex: F
Age: 82
State: IN

Vax Date: 02/08/2021
Onset Date: 02/08/2021
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: Lipitor Zocor, Iodine (shrimp), Tape

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

Symptoms: headache, tiredness, muscle pain, chills, joint pain, fever

Other Meds: Plavix 75 mg., Aspirin 325 mg, Crestor 10 Mg., Zetia 10 mg., Potassium CL 20 MEQ Tab, Metoprolol Tartrate 100 mg. (2X day), Furosemide 10 mg., Amlodipine Besylate 2.5 mg.,Famotidine 20 mg (2X day), Primidone 50 mg. (2X day) Isosorbide MN ER

Current Illness:

ID: 1055270
Sex: F
Age: 31
State: CA

Vax Date: 12/29/2020
Onset Date: 01/05/2021
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: no

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Week after the vaccine, my left arm became painful. It got progressively more swollen throughout the day. It wasn't red that first day I noticed it but the next day it was a big splotch of bright red about the size of my hand - right on the injection site and underneath it. Hot to touch, painful and swollen. All day Tuesday, Wednesday. I had a Dr's appt on Wednesday. It eased off on Thursday and Friday and it was gone by Saturday. Dr prescribed antibiotics for it and also a creme - Triamcinolone. I still have the photos I took if that would help to see them. Doctor diagnosed as Cellulitis Dermatitis. I did get the same the same reaction the day after (Jan 27) my second dose of vaccine (Jan. 26).

Other Meds: Bupropion; Vit C; Vit D

Current Illness: no

ID: 1055271
Sex: F
Age: 77
State: FL

Vax Date: 02/15/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: pt has redness/itchiness in area around injection site (about 2 inch square)

Other Meds:

Current Illness:

ID: 1055272
Sex: M
Age: 75
State: MD

Vax Date: 02/01/2021
Onset Date: 02/20/2021
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: Only. Allergies are dust, tree. Pollen, cats

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

Symptoms: 10 days after2nd shot total body rash began -still thickly over chest,back, stomach,legs?still there after 3. Days-began prednisone, Allegra, Benadryl - day 2 rash still. Growing. ordered epipen. Will see dermatologist tomorrow

Other Meds: Hydroxzine, gabapentin areds2

Current Illness: Sinusitus

ID: 1055273
Sex: F
Age: 70
State: CA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Bromelain, Erythromycin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 2/25/2021 Vision changes, 2/24/2021joint pain, fever, fatigue

Other Meds: Tirosint, Cytomel, Estrogen Replacement Therapy-Prescribed Meds Supplements-Arthromax, Magnesium, VitaminD, Multiple Vitamin, Zinc, CoQ10, Macugard, Curcumin(Tumeric), VitaminC,VitaminB

Current Illness: None

ID: 1055274
Sex: F
Age: 55
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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient complained of "Hot everywhere, chest and heart racing" Denies SOB Bp 139/78, hr 64, oxygen level 99% on room air. EMS at patient's side at clinic, evaluated and discussed symptoms with patient. No interventions needed at this time and patient monitored for an additional 15 mins. VS remain stable and at 1045a, BP was 142/76, oxygen level 100%, HR 58 with patient states feeling better and feels she can drive home. EMS released patient.

Other Meds:

Current Illness:

ID: 1055275
Sex: F
Age: 51
State: TX

Vax Date: 02/24/2021
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: Latex tape

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Chills; 102 fever; uncontrollable shaking; severe headache; aching body; lethargy.

Other Meds: Azelastine; Montelukast (Singulair); Triamcinolone cream; daily vitamin

Current Illness: None

ID: 1055276
Sex: F
Age: 25
State:

Vax Date: 02/13/2021
Onset Date: 02/13/2021
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: Gelatine.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Extremely swollen lymph nodes in left axilla. Unable to press arm down against side due to the swelling. Very painful.

Other Meds: Concerta 54mg, Cipralex 30mg, Buspirone 20mg qid. Multivitamin. Naproxen 500mg prn, T3 prn.

Current Illness: No.

ID: 1055279
Sex: F
Age: 63
State: IN

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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Chills, 102?, headache, body aches, extreme fatigue and injection site pain Symptoms began within 45 minutes lasted 48 hrs , treated with Tylenol. Unable to get out of bed.

Other Meds: Synthroid, estrogen, vitamin D3, Multi vitamin, fiber supplement

Current Illness: None

ID: 1055280
Sex: M
Age: 75
State: NY

Vax Date: 02/11/2021
Onset Date: 02/19/2021
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: Swelling of hands where arthritis present, previously reported rash continuing - now both arms

Other Meds: see previous VAERS E-Report Number 314833

Current Illness: none

ID: 1055281
Sex: F
Age: 72
State: MA

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:
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: Sore Arm , lasting 2 days

Other Meds: Evista, Lisinopril, calcium, vitamin D

Current Illness:

ID: 1055282
Sex: M
Age: 75
State: CT

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: Unable to view in VAMS

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

Symptoms: Triaged pt c/o tingling in his inner left arm which was the arm he received the vaccine in. No other symptoms noted. BP 168\76 HR 66 O2 sat 96% EMS evaluated pt, pt refused transport. EMS went to get the refusal form for pt to sign on the computer however they did not come back inside after 45 minutes. The pt did not want to wait any longer and reported he was feeling better. ED precautions were given. Pt left clinic despite advice to wait for EMS.

Other Meds: Unable to view in VAMS

Current Illness: Unknown

ID: 1055283
Sex: M
Age: 24
State: NM

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: 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: SOB, vomiting mucous, tachypneic, unable to speak.

Other Meds:

Current Illness:

ID: 1055284
Sex: M
Age: 64
State: PA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: About 24 hours after I received the first dose of the Moderna vaccine, I broke out in itchy hives all over my body. I too two Benadryl and the hives went away.

Other Meds: Atenolol, losartan, Novolog Insulin, Lantus Insulin, Trulicity, Metformin, baby aspirin, protonix, simvastatin, imdur, a calcium channel blocker, plavix

Current Illness: None

ID: 1055285
Sex: F
Age: 24
State: CA

Vax Date: 02/24/2021
Onset Date:
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: Pt reported on 02/25/2021 at 12:45 pm stating her left hand was swollen. The shot was administered on her left arm. She stated she has a rash of goose bumps are red on both arms that are itchy off and on. Her entire arm is sore. We advised pt to contact her primary care physician and to keep us updated. We also told her it may subside with time.

Other Meds:

Current Illness:

ID: 1055286
Sex: F
Age: 50
State: IL

Vax Date: 02/10/2021
Onset Date: 02/11/2021
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: Darvocet N-100, Demerol, Inapsine, Erythromycin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: aches, chills, fever developed approximately 24 hours post vaccine. Unable to work 48hours post vaccine. Symptoms resolved

Other Meds:

Current Illness:

ID: 1055288
Sex: F
Age: 78
State:

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/25/2021
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: Chills, headache, shortness of breath the day after vaccine; shortness of breath has persisted.

Other Meds:

Current Illness:

ID: 1055289
Sex: F
Age: 38
State: IN

Vax Date: 01/17/2021
Onset Date:
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:

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

Symptoms: Shingles-rash/low grade fever. Started 2/21/2021

Other Meds: Allegra Probiotics

Current Illness: None

Date Died: 02/14/2021

ID: 1055290
Sex: F
Age: 94
State: MI

Vax Date: 02/08/2021
Onset Date: 02/11/2021
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: unknown

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

Symptoms: Death occurred 02/14/2021

Other Meds: not known at this time. I can research if needed

Current Illness: unknown

ID: 1055291
Sex: F
Age: 62
State: NJ

Vax Date: 02/22/2021
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: erythromycin - stomach cramping and diarrhea

Symptom List: Unevaluable event

Symptoms: Moderna COVID-19 Vaccine EUA Ist vaccine - 24 hrs after dose I developed chills, headache and a fever of 102. Symptoms subsided after 12-14 hrs. 2nd vaccine -12 hrs after dose I developed chills, headache, fever of 104.1, nausea, and extreme fatigue. Between the fever and nausea I became dehydrated as I couldn't keep anything down. Fever broke about 16 hrs and symptoms subsided once I was able to rehydrate.

Other Meds: levothyroxine, singulair, letrozole, xyzal, amitriptyline, calcium w/ D3, Terbinafine

Current Illness: fungal infection on my foot

ID: 1055292
Sex: F
Age: 92
State: TX

Vax Date: 02/25/2021
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: LA

Lab Data:

Allergies: NKA

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

Symptoms: Experienced generalized mid weakness 20 minutes after receiving the vaccine. BP 112/51, HR 71 O2 sat 97%

Other Meds: A 92 year old female developed mild generalized weakness 20 minutes after receiving the vaccine which lasted for 10 minutes. No other symptoms reported

Current Illness: None

ID: 1055293
Sex: M
Age: 41
State: MA

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Amoxicillin, penicillin

Symptom List: Injection site pain, Pain

Symptoms: Fever, chills, body aches. Started 24 hours after first dose. It lasted for about 20 hours.

Other Meds: Pro Air, Lisinopril

Current Illness:

ID: 1055294
Sex: F
Age: 49
State: NC

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

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

Lab Data:

Allergies: tetracyclines, wellbutrin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient developed chest pain 5-10 minutes after the first dose requiring hospitalization. I am a hospitalist physician admitting the patient to hospital from the ER.

Other Meds: Trazodone, lamotrigine, CELEBREX; buspar, levothyroxine, vraylar

Current Illness:

ID: 1055295
Sex: F
Age: 47
State: FL

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: SYR
Vax Site: LA

Lab Data:

Allergies: Amoxicillin, corn

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

Symptoms: low grade fever -hot flashes- began about 4 hours after vaccine remained about 14 hours sore throat - lasted 2 hours began 5 hours after vaccine feeling of muscle heaviness- began with low grade fever left with fever injection site soreness- 1 hour after remained 24 hours after runny nose- lasted only 2 hours began after sore throat started Headache- began 28 hours after vaccine....still present...getting worse

Other Meds: Levothyroxin, Vitamin D3 and Calcium

Current Illness: None

ID: 1055296
Sex: F
Age: 75
State: IL

Vax Date: 02/05/2021
Onset Date: 02/07/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Swelling of tongue as of 2/7 - admission to emergency on 2/8 hospital, swelling of lower lip on 2/23 to 2/24 - visit to Allergy Doctor on 2/25 - advised NOT to have second shot

Other Meds: Levothyroxine 75 mc

Current Illness: None

ID: 1055297
Sex: F
Age: 72
State: FL

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: pt had redness/itching in a patch around injection site, starting about a week after vaccination

Other Meds:

Current Illness:

Date Died: 02/15/2021

ID: 1055298
Sex: F
Age: 71
State: IL

Vax Date: 01/20/2021
Onset Date: 02/06/2021
Rec V Date: 02/25/2021
Hospital: Y

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: Emergency Room HPI: The patient is a 71 y.o. female with a PMH notable for COPD, hypertension and anxiety and depression who presented on 2/6/2021 for evaluation of shortness of breath. Patient presented to our emergency room yesterday morning from local nursing facility rehab nursing staff reported that she had had a increased shortness of breath for the last 3 days she has been diagnosed with COVID-19 on 2-2-2021. Patient has also received both COVID-19 vaccines. Patient presented to the emergency room with labored respirations conscious awake and was on a non-rebreather at 15 L. upon arrival to our emergency room patient's temperature 101.6?, pulse 169, respirations 40 to blood pressure 142/91 and oxygen saturation 100% on 15 L non-rebreather. Patient received a chest x-ray that showed chronic emphysema and fibrotic changes in the lung no acute processes identified. Patient's white count 12.8, glucose 197, creatinine 1.2, lactic acid 4.6, cardiac enzymes negative, D-dimer 1180, patient has urine culture pending. Patient has received about 3 L normal saline boluses patient was having hypotension 86/52. Patient also received IV acetaminophen a 1000 mg IV in the emergency room along with Decadron 10 mg IV piggyback. Patient was admitted acute care for the need of IV fluids and IV antibiotics for COVID-19 and sepsis 2/12 admit Brief history and initial physical exam: Patient is a 71 year old long-term resident of Rehab and Healthcare. Unfortunately, she contracted coronavirus (COVID-19) at the nursing home. Her respiratory status started to decompensate and so she was brought into the hospital. Initial workup showed significant bilateral pleural effusions and ground-glass opacity of both lungs. She had a significant supplemental oxygen requirement. She was admitted for further evaluation and treatment. Hospital course: The patient was admitted and started on IV Remdesivir. She was given IV Decadron. She was given immune support vitamins. Despite this, her sepsis worsened. When it became apparent that the patient was not going to recover, her daughter did make her comfort care only and hospice was consulted. The patient was found to be appropriate for general inpatient hospice and was made comfort care. Her requirement for morphine and Ativan did slowly rise. Eventually, the patient did succumb to her respiratory failure. Time of death was called at 10:00 p.m. on February 15, 2021 Discharge Condition: expired. Presume cause of death with cardiopulmonary arrest secondary to acute respiratory failure secondary to coronavirus (COVID-19) pneumonia Disposition: Deceased

Other Meds:

Current Illness:

ID: 1055299
Sex: F
Age: 31
State: CA

Vax Date: 01/26/2021
Onset Date: 01/26/2021
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: no

Symptom List: Nausea

Symptoms: Around 4 PM I started getting chills. I took Ibuprofen and it was much easier. It started coming back around 7:00 pm. I had super sensitive skin and chills that night and didn't sleep very much, if at all. I didn't go to work that day because I still had a fever in the morning. It broke mid-morning but I was nauseous all day and had a headache. I still had a headache the following day and I didn't want to eat the next day although I wasn't nauseous. Also on that third day- the redness and swelling started in my arm where the injection site was on the right arm. It was swollen, hot to touch. I called the Dr. again. I got a different doctor than the first dose. She thought it was an allergic reaction. She said to try antihistamines that day but if it didn't get better she did prescribe a different kind of antibiotic I took the antihistamines that day and it didn't get any better. So than I took the antibiotic and it got better. It was better by Friday evening.

Other Meds: Bupropion; Vit C; Vit D

Current Illness: Adverse reaction from Dose 1 of Moderna vaccine - a week after the vaccine

ID: 1055300
Sex: F
Age: 50
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: pt started feeling a little dizzy, stated that she hadn't eaten any thing for breakfast. Juice given and she ate a banana. Still feeling a little dizzy after, and taken to the first aid room. Vital signs 185/99 p127, respirations 22. denies chest tightness ore difficulty breathing. Md called to assess patient.

Other Meds: none

Current Illness: elevated blood pressure

ID: 1055301
Sex: M
Age: 88
State: AZ

Vax Date: 01/28/2021
Onset Date: 01/28/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Care giver reports patient experienced hallucinations the night/the next morning of the COVID-19 vaccine. The care giver states the patient is seeing his deceased wife. At the time the second dose was due, the symptoms have not gone away per the caregiver. The faculty contacted the doctor in regards to the reported side effect, however the doctor did not have a clear diagnoses or assessment regarding the patients condition. The Rph did not administer the second dose due the reported side effects. The daughter of the patient (who has power of attorney) was contacted by the faculty manager and she was okay with not giving the second dose.

Other Meds: unknown

Current Illness: DM T ll, glaucoma, Hyperlipidemia, HTN, influenza, Uveitis

ID: 1055302
Sex: M
Age: 43
State: FL

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Pt reported before shot that has had history in past of fainting after vaccinations. After receiving the shot, had him sit in a chair next to the table for a few minutes to see if would occur again. After about 2 minutes, pt began reporting that he felt that he was about to faint again. He began to dry heave and passed out momentarily for 2 seconds before coming back to. Pharmacist caught him before he fell. Gave pt water and took blood pressure. Patient began to feel better. Sat for 30 minutes and then he felt fine to leave.

Other Meds:

Current Illness:

ID: 1055304
Sex: M
Age: 71
State: LA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Tremor

Symptoms: Patient came a week early for second dose of COVID19 vaccine. Patient had similar name to another patient when verifying information. 2nd dose was administered 14 days after 1st dose.

Other Meds: unknown

Current Illness: unknown

ID: 1055305
Sex: F
Age: 22
State: MO

Vax Date: 02/12/2021
Onset Date: 02/13/2021
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: No known allergies

Symptom List: Erythema, Pruritus

Symptoms: Patient is a 22 y.o. female , critically ill , admitted to ICU through emergency department of this hospital. This lady is known to have diabetes mellitus. She has insulin pump and is very compliant with management of diabetes. For last 3 days her insulin requirement has gone up because of hyperglycemia and her endocrinologist has increased her basal nightly dose 3 days ago. Yesterday she received her second dose of corona virus 19 vaccine at health center and she has been been vomiting since then. Upon arrival in the emergency department her blood glucose level is 460 with anion gap of 28 and she is in ketoacidosis.

Other Meds: PTA med list in Epic: Novolog via insulin pump, Cyclafem 1/35, 28,) 1-35 mg-mcg 1 tab po qday, Zofran ODT PRN, Promethazine suppository PRN.

Current Illness: admitted for DKA and non-intractable vomiting with nausea after the second COVID vaccine

ID: 1055306
Sex: M
Age: 61
State: IL

Vax Date: 02/17/2021
Onset Date: 02/17/2021
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: None

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

Symptoms: Extreme exhaustion for more than 1 week; irritability; sleep interruption

Other Meds: Vegetarian, gluten free vanilla protein powder, Trazadone 300 mg, Folic Acid 1mg Apple Cider Gummies, Multi-vitamen for men; Green Food extract., Sea Moss with burdock root and bladderwrack

Current Illness: None

ID: 1055307
Sex: F
Age: 72
State: WA

Vax Date: 02/11/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin, amoxicillin, naproxen, tetracycline, Bactrim

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

Symptoms: Face pain within 10 minutes of injection, pain at back of head with in 20 minutes of injections, acute epigastric pain with in 3 hours, back pain with spasms over several days.

Other Meds: Calcium supplement, vitamin C, Aller DX, Osteo Move Joint Care, Tumeric, Shou Wu Wan herbal supplement

Current Illness: None

ID: 1055308
Sex: F
Age: 72
State:

Vax Date: 02/16/2021
Onset Date: 02/16/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient stated immediate itching, redness and soreness at injection site. She wasn't concerned with that but then the next day she started developing a rash around the injection site which lasted over a week. She read it was nothing to be concerned with as it is clearing up now.

Other Meds:

Current Illness:

ID: 1055309
Sex: F
Age: 74
State: NH

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: 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: 0843a patient c/o chest flutter, no SOB or any other symptoms. BP 130/78 oxygen 97% HR 100, seen by EMS and at pt's side. No new interventions provided. Monitored patient an additional 15 minutes . At 0905, patient feeling slightly better BP 134/74, HR 101 and down to 94, oxygen level 93 to 94%, . Patient feels ok to go home, released by EMS and assisted to son's car.

Other Meds:

Current Illness:

ID: 1055310
Sex: F
Age: 42
State: MI

Vax Date: 01/11/2021
Onset Date: 01/11/2021
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: Penicillin, watermelon

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

Symptoms: A few hours after the vaccine I developed a fever, chills, a headache, muscle pain mainly in the hip and thigh area all which lasted about 20 hours. The 2nd day I was a little dizzy with the headache lingering for about 2 days longer

Other Meds: Gabapentin, zoloft, Motrin, Tylenol, Vit B12

Current Illness: no

ID: 1055311
Sex: F
Age: 61
State: RI

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Bees

Symptom List: Pain in extremity

Symptoms: Felt throat get numb and tight

Other Meds:

Current Illness:

ID: 1055312
Sex: M
Age: 76
State: FL

Vax Date: 02/14/2021
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:

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

Symptoms: pt had redness, warmth, swelling around injection site starting 8-9 days after vaccine given

Other Meds:

Current Illness:

ID: 1055313
Sex: F
Age: 56
State: NJ

Vax Date: 02/20/2021
Onset Date: 02/24/2021
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: No allergies

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

Symptoms: Covid fingers - left ring finger swollen and black and blue (with a bump) - from base of the finger to the joint as of 4pm on 2/24. On 2/25 in the morning the black and blue has extended beyond the knuckle toward the end of the finger but only about 1/4" beyond the knuckle. Right hand, middle finger, black and blue between the knuckle nearest the hand and the knuckle nearest the finger tip. No swelling. This was noticed about 9pm on 2/24. Covid Toes - possibly - red bumps on toes same toe, both feet, red. Toes next to pinky toe.

Other Meds: Levothyroxin 150 mcg; Losartan 50mg; Calcium supplements + Vitamin D; Aspirin 81mg

Current Illness: No illnesses other than chronic

ID: 1055314
Sex: F
Age: 26
State: NY

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: No

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

Symptoms: Received vaccine at 9:15am and observed symptoms of severe rash on chest and neck with swelling in throat at 10:00am.

Other Meds: Birth control pills- Daysee

Current Illness: No

ID: 1055315
Sex: F
Age: 71
State: WA

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: PT GOT A HIGHER DOSE OF VACCINE INSTEAD (1.8ML)

Other Meds:

Current Illness:

ID: 1055316
Sex: F
Age: 68
State: OK

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Fragrance, Levaquin, Bactrim

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Feb. 23 eve. I had pains in the nerves in my left hip going down my leg and the left side of my tongue was sore. Feb. 24. I was very tired and achy all day with a bad headache. I had some nausea. I took Aleve but it didn't help much. I noticed when I went to bed that I had an open, bleeding sore on my right wrist. I knew that I had not done anything to hurt my wrist. Feb. 25. When I took a shower, I saw that I had an open, bleeding sore on my right shin. The right side of my tongue was hurting and sore. When I looked in the mirror at my tongue it had little red blotches all over the right side. I have a bad headache but not as bad as yesterday. I am also somewhat tired, but not achy.

Other Meds: Levothyroxine, Vitamin C, CoQ-10, Multivitamin

Current Illness:

ID: 1055317
Sex: F
Age: 36
State: NJ

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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Rice, squash

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

Symptoms: Anaphalaxis: hives, flushing/redness, itchiness, tongue swelling/tightness in chest. Self-administered Auvi-q epinephrine, went to the Hospital, received prednisone, pepcid, benedryl. Prednisone taper for 4 days after

Other Meds: Famotidine Xhance

Current Illness:

ID: 1055318
Sex: F
Age: 73
State: IL

Vax Date: 01/28/2021
Onset Date: 02/01/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: codeine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Emergency room HPI a 73 y.o. female who presents with NURSING HOME REPORTED TO EMS THAT PT WAS SHORT OF BREATH FOR 1 WEEK AND GETTING WORSE. NURSING HOME REPORTED TO NURSE HERE THAT PT HAD ALTERED MENTAL STATUS IN THAT SHE WAS NO LONGER SCREAMING. PT IS UNABLE TO GIVE ANY HISTORY SECONDARY TO DEMENTIA

Other Meds: Current Outpatient Medications: ? acetaminophen (TYLENOL) 325 MG tablet, Take 650 mg by mouth every 6 hours as needed for Pain, Disp: , Rfl: ? albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulizer solution, Take 2.5 mg by nebulization 4 t

Current Illness:

ID: 1055319
Sex: F
Age: 28
State: MN

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: IM
Vax Site: RA

Lab Data:

Allergies: N/A

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

Symptoms: Raised rash developed near injection site slightly larger than fist sized

Other Meds: N/A

Current Illness: N/A

ID: 1055320
Sex: M
Age: 52
State: WV

Vax Date: 12/28/2020
Onset Date: 01/26/2021
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: none

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

Symptoms: heart palpitations, tired, chest pain, anger outbursts, diarrhea , head ache.

Other Meds: Xanax sotalol blood pressure meds fish oil pepcid

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm