VAERS 2021 Database www.vaers.hhs.gov

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

Total Manufacturer

Incidents per State

State Total
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 1105163
Sex: F
Age: 26
State: CA

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Lot:
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Vax Route:
Vax Site:

Lab Data:

Allergies: macrobid: hives

Symptom List:

Symptoms: Staff member called a Health Office 3-16-2021 10:40am and reported since COVID-19 vaccine #2 on 1-29-2021 IM to left deltoid, she's had constant dull, aching pain level 3/10 to her left upper arm deltoid area. States pain occasionally radiates to left axilla, but never below her elbow. Denies redness or swelling. States pain relieved with over the counter Tylenol as needed. Has appointment with her doctor 3-16-2021 for evaluation of pain.

Other Meds:

Current Illness:

ID: 1105164
Sex: F
Age: 19
State: GA

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Approximately 5 mins after vaccine administration, patient became lightheaded and fainted. Patient regained consciousness and recovered quickly.

Other Meds:

Current Illness:

ID: 1105165
Sex: F
Age: 48
State: TX

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: dizzy, nauseous, rapid heartrate, elevated blood pressure

Other Meds: promethazine, hydrocodone, hydroxyzine

Current Illness:

ID: 1105166
Sex: M
Age: 70
State: MI

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Vax Site:

Lab Data:

Allergies: NONE

Symptom List:

Symptoms: Chills Slight Headache 100.5 Fever I took 2 (325mg ea.) tablets of Tylenol 1 time. This is the only treatment I took.

Other Meds: Olmesartan HcTz 20/12.5 Daily Simvastatin 20mg Daily Metoprolol 100mg Daily Eliquis 5mg Twice Daily Vitamin D 4000 IU Multiple Vitamin Daily Niacin 500 mg Daily

Current Illness: NONE

ID: 1105167
Sex: M
Age: 73
State: AL

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Only wheat (very likely) as I get rash after eating it. NKDA

Symptom List:

Symptoms: Simply that I felt very very tired/weak 2nd day after injection. Didn't go to work that day. No other symptoms. Felt fine with no side effects on the 3rd day or any other

Other Meds: Routinely ; Lisinopril, HCTZ, metoprolol, losartan, atorvastatin, duloxetine, clopidogril, 2 ibuprofen taken immediately after injection and 2 more 4 hours later

Current Illness: No illness within the previous month

ID: 1105168
Sex: F
Age: 15
State: IL

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Vax Site:

Lab Data:

Allergies: unknown

Symptom List:

Symptoms: Found through quality improvement work that this person is under age 16. No adverse event occurred.

Other Meds: unknown

Current Illness: unknown

ID: 1105169
Sex: F
Age: 30
State: KS

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

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Progress Notes APRN (Nurse Practitioner) ? ? Family Medicine Cosigned by:, MD at 3/16/2021 9:55 AM Expand AllCollapse All VACCINE CLINIXC 3/15/2021 Subjective Pateint is a 30 y.o. male who was seen at Vaccine Clinic today for his first dose of the COVID 19 vaccination. He was given the Pfizer vaccination in the left deltoid muscle. During his 15 minute waiting period after the injection, the patient began to experience lightheadedness and nausea, hot, dry mouth. He denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, facial swelling, lip swelling and tongue swelling. This provider was notified of patient reaction and he was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to blood pressure abnormality , rapid progression of symptoms and vomiting. Past Medical History: Diagnosis Date ? Hernia ? Past Hospitalization Admit on: 20130219; Diagnosis: Aseptic meningitis, dehydration; at: HealthCare; MD; Hx of + covid infection in November 2020. ALLERGY REVIEW OF SYSTEMS: Patient complains of chills and vomiting (scantly, x 3 times) Patient denies fever, malaise/fatigue, facial swelling, sore throat, frequent throat clearing, rash, hives, itching of skin, abdominal pain, dizziness and headaches + nausea: + lightheaded: Previous Reactions: none with vaccines. Objective Vitals Vitals: 03/15/21 0956 03/15/21 1009 03/15/21 1032 BP: (!) 142/95 127/79 129/83 Pulse: 84 SpO2: 99% Blood Sugar 112 collected at 1045 Physical Exam Vitals reviewed. Constitutional: General: He is not in acute distress. Appearance: He is ill-appearing. He is not diaphoretic. Comments: Slightly flushed HENT: Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: Oropharynx is clear. Eyes: Extraocular Movements: Extraocular movements intact. Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds and air entry. Abdominal: Tenderness: There is no abdominal tenderness. Skin: General: Skin is warm. Coloration: Skin is pale (improved with rest). Findings: No rash. Neurological: General: No focal deficit present. Mental Status: He is alert and oriented to person, place, and time. Psychiatric: Mood and Affect: Mood normal. Thought Content: Thought content normal. Judgment: Judgment normal. Patient with several brief episodes of dry heaving/burping throughout his observation here. He's managed to have scant amount of emesis. Pepcid 20 mg given, then zofran odt 4mg given, He was feeling better with ice pack and laying down. Upon sitting up he started to feel lightheaded and dizzy again. Restarted to burp with scant periods of nausea with dry heaves. Pepcid 20 mg given again. Pt able to sit up but still feeling nauseated. New ice pack given to neck. Pt asked to call for a ride. Security had to go out to his car to get his phone. Pt called his mom. Mom will come to pick pt up. Pt reports dizziness/lightheaded with position changes with increased nausea upon transfer to wheelchair. Assessment/Plan Treatment included: water, snacks and pecid and zofran. Follow up response to treatment: no change. Patient discharge: Transported to ED . Differential Diagnosis: Red flag symptoms (CP, SOB, NVD, Visual/Neuro concerns) Nausea and lightheaded/dizziness primarily. Pt monitored in bay for over an hour. Stable vs. Mom here to pick up patient and will transport to ED at for further evaluation/treatment due to failing PO challenge. Pt wheeled out in wheel chair. ED notified of patient coming. , APRN Electronically Signed 3/15/2021 10:12 AM

Other Meds:

Current Illness:

ID: 1105171
Sex: F
Age: 70
State: CT

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

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Healthcare professional administering vaccine did not draw it up correctly and administered less than 0.3 mL. The error was found when she brought back the vial, used all 6 syringes but there was still enough liquid in the vial for 3-4 doses. It is unclear how much of the vaccine was injected into each person who received a dose from this particular vial.

Other Meds:

Current Illness:

ID: 1105172
Sex: F
Age: 46
State: VA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
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Lab Data:

Allergies: Latex (skin allergy) Keflex Silvadene Butoconazole

Symptom List:

Symptoms: During injection, left deltoid muscle pain and spasm. No anaphylactic allergic response. Within 1 hour of vaccine, tingling in hands and feet. Started with left then all four extremeties. Tingling lasted until March 3. Second dose scheduled for March 5. Other symptoms that arose within 8 hours of vaccine and lasted approximately 3 days: Headache, Severe Nausea, Fatigue, Body aches, Chills (No Fever)

Other Meds: carvedilol, furosemide, valacyclovir, elmiron, elestrin, buproprion XL, zinc, magnesium, vitamin D3, vitamin E, Kelp, Selenium

Current Illness: None

ID: 1105173
Sex: F
Age: 20
State: WA

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

Vax Type:
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Vax Site:

Lab Data:

Allergies: Gluten

Symptom List:

Symptoms: Severe body aches Headache Fatigue Loss of appetite

Other Meds:

Current Illness:

ID: 1105174
Sex: F
Age: 59
State: MI

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

Vax Type:
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Lab Data:

Allergies: Penicillins, macrolide/ketolide antibiotics.

Symptom List:

Symptoms: Patient received the first dose of the Pfizer COVID-19 vaccine and was waiting in the observation area when she started to experience a racing heart-rate and warmth. The patient was brought water, juice, and tried to relax. Patient was stable but after drinking juice started to feel swelling of the tongue and itching around the neck. Patient was given more water and a diphenhydramine capsule. Tongue swelling and itchiness decreased and the patient went home with her husband after improving. Total course of observed reaction was around 1 hour.

Other Meds: Not known.

Current Illness: Not known.

ID: 1105175
Sex: F
Age: 61
State: IN

Vax Date: 03/03/2021
Onset Date: 03/08/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Vax Route:
Vax Site:

Lab Data:

Allergies: Penisilin, Vancomycin, Sulfa, Codeine

Symptom List:

Symptoms: 10 days later have a swollen arm, severe headaches for 2 days and started having intense ringing in my ears (which I have never had before)

Other Meds: Lisiniprol

Current Illness: None

ID: 1105176
Sex: F
Age: 33
State: IL

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Seasonal

Symptom List:

Symptoms: Weakness

Other Meds: NA

Current Illness:

ID: 1105178
Sex: F
Age: 81
State: IN

Vax Date: 01/30/2021
Onset Date: 02/10/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
Manufacturer:
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Dose Series:
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Lab Data:

Allergies: Sulfa, Norco, and Tramado

Symptom List:

Symptoms: Left arm was sore for 24 hours after injection. Ten days later the left arm became sore again. There was tingling in my lower face. Each day since February 10, there has been some degree of numb/tingling feeling in my lower face. There have been numb/tingling feelings in my left arm and hand, but also at times in both legs, and occasionally in my right arm. This has been going on for several weeks now.

Other Meds: Pantoprazole (20mg) once daily

Current Illness: None

ID: 1105179
Sex: F
Age: 41
State: DE

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Vax Site:

Lab Data:

Allergies: penicillin (unsure)

Symptom List:

Symptoms: 1/10 vaccination I was in the 15 min observation, my throat tightened up. I thought anxiety. I left and feeling never went away. Wheezing, coughing. Dr. informed me I had exercise induced asthma. called pcp 10 days later when symptoms not going away 02/2021 ENT; allergic reaction. Inhalers, antihistamines. No skin reaction tests. Suggested to get 2nd vaccine. *still having tightness in throat

Other Meds: Synthroid, Wellbutrin, omeprazole, magnesium, probiotic

Current Illness: n/a

ID: 1105181
Sex: F
Age: 69
State: NY

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Codeine

Symptom List:

Symptoms: Chills, Nausea, Fever, Aches, Diarrhea, Headache - unable to work for 2 days - symptoms milder but still linger 5 days later

Other Meds: Amlodipine, Hydrohlorthiazide, letrozole, Losartan, Carvedilol, Omeprazole, Mutli-Vitamin, Align, Metamucil, Vitamin D, Glucosamine Chondroitin

Current Illness:

ID: 1105182
Sex: F
Age: 53
State: MO

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

Symptom List:

Symptoms: 6 hours after vaccination in left arm deltoid muscle: Nausea/vomiting, 100 degrees temp (norm body temp is 97.5), severe all over body aches, chills, headache, fatigue, stomach cramps, loose stools. All reactions lasted 3-4 days

Other Meds: Multi-vitamin; probiotic, kidney cleanse

Current Illness: None

ID: 1105183
Sex: M
Age: 57
State: NJ

Vax Date: 03/11/2011
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Iodine

Symptom List:

Symptoms: Severe gout attack

Other Meds: Alupurunal

Current Illness: Diabetes kidney disease and aneurism

ID: 1105184
Sex: M
Age: 38
State: NJ

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Shellfish, iodine, tree nuts

Symptom List:

Symptoms: Chills, cold sweats, nausea, headache, body ache, fever, sore arm, for one week

Other Meds: Vit d3, calcium, magnesium

Current Illness:

ID: 1105185
Sex: F
Age: 71
State: CO

Vax Date: 02/27/2021
Onset Date: 03/03/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: morphine, codeine, all statins meds, latex

Symptom List:

Symptoms: pt states that her right arm got red around the injection site and had a spot in the center that looked like a blister. She then noticed she had another spot that turned red in the bend of her right arm that formed into a blister. Both of these spots got infected and formed puss. She had to clean them, put Neosporin on them and then cover them. When she took the bandages off she would have to drain them. They have knots under the skin. She has 2 blisters on her left side of the her belly that are infected and painful. They drain and have knots under the skin. She also has some very red blisters on her upper stomach but they did not get infected. She is cleaning all of them with wound cleaner. Pt has an appt w/her PCP on 3/17/2021.

Other Meds: cinnamon 1000mg x 4 daily, vitamin C 500mg 4-6 per day, Cinnamon 1000 plus chromium bds, osteo bi-flex bds, calcium 1200mg (600mg am/600mg pm), vitamin D3 4000 IU qd am, aspirin 81 mg qhs, gabapentin 300mg (900mg at 12:00 PM and 1500mg at

Current Illness: no

ID: 1105186
Sex: F
Age: 48
State: GA

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: fever of 101.7, body aches and painful joints, nausea I took ibuprofen and rested it lasted for about a 12 hour time period pain in the left arm and a large red painful bump at the injection site is ongoing as 72 hours from the shot

Other Meds:

Current Illness:

ID: 1105188
Sex: M
Age: 17
State: IA

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

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

Lab Data:

Allergies: None reported by client's mother.

Symptom List:

Symptoms: Client arrives with mother to receive vaccines for school. He sits in chair and answers questions. He is administered 5 vaccines, listed above. He verbalizes his left arm is stiff, so his mom rubs it. He then rolls his eyes back, head tilts back, legs out stiff, and body shakes. Client is lowered to floor then opens eyes and able to report his name. Vitals taken by PHNs and 911 called. Client pale. Mom denies any history of seizures or any other medical conditions. EMS arrives at 1505. Client able to walk to stretcher and taken to hospital.

Other Meds: None reported by client's mother.

Current Illness: Client's mom reports he was not feeling well last week.

ID: 1105189
Sex: F
Age: 40
State: MN

Vax Date: 02/23/2021
Onset Date: 02/28/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: On March 3rd, 2021, patient reported via email that she had developed Shingles. She had the vaccine 2/23 (dose #2). She wrote that she was out ill 2/24 with every symptom typical of vaccine side effects. Sunday (2/28 evening she noticed blisters. She only missed one day of work per her email 2/24 but was started on a course of acyclovir and under MD Care. She wrote that she thought the vaccine plus extra stress was possibly an cause. On a checkin today 3/16, she reports 5 days of pain and burning at lesions areas and feeling overall "awful but has returned to work. She did complete her own VAERS and PHN had encouraged report to ER and witness report for Risk Mgmt. PHN will also submit. Supervisor was alerted 3/3/2021 RN PHN.

Other Meds: unknown

Current Illness: none reported

ID: 1105190
Sex: M
Age: 66
State: IL

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: cephlexin, latex, amoxicillian , all produce rash.

Symptom List:

Symptoms: raised bumpy rash on right arm

Other Meds: glipizide 10mg, jardience 10mg, lantus insulin 60u, lisinipril 20mg, metformin ER 1500mg, simvastatin 40mg, eliquis 5mg.

Current Illness:

ID: 1105191
Sex: M
Age: 69
State: IL

Vax Date: 02/14/2021
Onset Date: 02/15/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List:

Symptoms: Vomiting-resolved Double vision in am for 7 days-resolved Balance issues-ongoing

Other Meds: Buprpion Trazedone Prostata aspirin vitamin D Multivitamin

Current Illness: N?A

ID: 1105192
Sex: F
Age: 46
State: VA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Latex (skin allergy) Keflex Silvadine Butoconazole

Symptom List:

Symptoms: Within 1 hour of vaccine tingling in left hand and left foot. Is much better, however, still not entirely resolved. Within 8 hours of vaccine and lasting 2 days: headache, nausea, chills (no fever), fatigue, body aches

Other Meds: carvedilol, furosemide, valacyclovir, elestrin, buproprion XL, elmiron, vitamin D3, vitamin E, zinc, magnesium, kelp, selenium

Current Illness: None

Date Died: 03/14/2021

ID: 1105193
Sex: M
Age: 83
State: IA

Vax Date: 03/12/2021
Onset Date: 03/14/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: celebrex, penicillin, sulfa drugs, tramadol

Symptom List:

Symptoms: Death due to pulmonary fibrosis

Other Meds: acetaminophen, benzonatate, clopidogrel, cyclobenzaprine, docusate-senna prn, doxylamine, escitalopram, fluticasone topical, furosemide, hydrocortisone topical, latanoprost ophthalmic, levothyroxine, metformin, midodrine, nitroglycerin prn,

Current Illness: Patient was hospitalized from 1/31- 2/4 with SARS- COVID-19 pneumonia.

ID: 1105194
Sex: F
Age: 45
State: TX

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

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

Lab Data:

Allergies: Codeine Naproxen Latex

Symptom List:

Symptoms: Swollen lips evening of 3/15/21. Swollen left side of face including pressure in ear and eye morning of 3/16/21. Treated with Benadryl

Other Meds: methimazole B12 D3 Gabapentin

Current Illness: Being treated for frozen shoulder

ID: 1105195
Sex: M
Age: 74
State: MI

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Pain in upper right thigh on day after vaccine and next day. Badly swollen calf on third day after vaccine. Hospitalized with "Right femoral acute thrombosis; no compression; no flow detected."

Other Meds: Atorvastatin, Finasteride, Rainbow Light Men's One Vitamin

Current Illness: None

ID: 1105196
Sex: F
Age: 85
State: NJ

Vax Date: 03/14/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: Adhesive tape

Symptom List:

Symptoms: 3/15 9AM started to have expressive aphasia noticed by family, shaking chills and headache. Brought to ER. CTH completed and negative. Admitted for monitoring. 3/16 early AM (5am) -seizure like activity and right sided facial droop. CTH negative MRI, EEG pending Fever 102 3/16 7AM.

Other Meds: axitinib pembrolizumab Xgeva anastrozole aspirin benazepril biotin fluticasone omeprazole ondansetron oxycodone

Current Illness: N/A

ID: 1105197
Sex: F
Age: 49
State: MN

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List:

Symptoms: Client received vaccine at 9:40 am lying down because of vasovagal and lightheadedness with previous dose of COVID-19. At 9:43 am, client reported feeling nauseous and lightheaded, so we elevated her legs. At 9:49 am she reported feeling better so she sat up and drank some water. Client felt better at 9:47 am and left.

Other Meds:

Current Illness:

ID: 1105198
Sex: M
Age: 60
State: AZ

Vax Date: 02/01/2021
Onset Date: 03/04/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: 3/4/21 out of breath , peaked 3/08/21. 3/09 pain in right lower leg Hospitalized 4 days - 5 hour procedure for Acute DVT and Acute Saddle pulmonary Embolus

Other Meds: Modafinil, Tramadol, Fenofibrate

Current Illness:

ID: 1105199
Sex: F
Age: 49
State: NY

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: I am allergic to : NSAID

Symptom List:

Symptoms: I went to get vaccinated at clinic on March 4, and I wait my 20 minutes at the time of leaving I got itchy all over my body, my face turned red and with many outbreaks, I went back to clinic and the doctor gave me an injection, I got better a little but it gave me a lot of hyperactivity, when I arrived at home I couldn't handle the itch in the body and I felt my throat closing my husband took me to emergency, I couldn't breathe well, and I was itchy from head to toe. I stayed in emergency and I got some green discoloration very big on my legs, I have to go to the allergist because I still had itchy in the body

Other Meds: I am not taking any medication

Current Illness: none

ID: 1105201
Sex: F
Age: 45
State: NC

Vax Date: 03/14/2021
Onset Date: 03/14/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Na

Symptom List:

Symptoms: Headache Fever Body aches Started within 12 hours of injection, have lasted 48 hours

Other Meds: Lisinopril Meloxicam Escitalopram Hydrochlorothiazide

Current Illness: None

ID: 1105202
Sex: F
Age: 77
State: TN

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
Dose Series:
Vax Route:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Painful, burning nodules on legs

Other Meds:

Current Illness: N/A

ID: 1105203
Sex: F
Age: 28
State: MA

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
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Lab Data:

Allergies: none

Symptom List:

Symptoms: day after vaccine, expereinced severe cramping and menstrual bleeding very heavily. I was two weeks before my period which is VERY abnormal. lasted for five days

Other Meds: none

Current Illness: none

ID: 1105204
Sex: M
Age: 71
State: FL

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: IV contrast

Symptom List:

Symptoms: Per patient report, symptoms began approximately one week after administration of first Moderna vaccine. Patient noticed a small grouping of pruritic papular lesions measuring 0.5cm or less over the ventral right wrist. Symptoms acutely worsened following the second vaccine on March 4, extending up the forearm, and growing to involve the bilateral forearms and posterior thighs. He used calamine lotion topically for symptomatic relief of itching. Symptoms were not reported to physician until a routine follow up appointment on 3/16/2021.

Other Meds: lisinopril 20mg one tab daily prasugrel 10mg one tab daily rosuvastatin 20mg one tab nightly aspirin 81mg one tab daily

Current Illness: None

ID: 1105205
Sex: M
Age: 85
State:

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Patient is experiencing numbness of the left side of his lower lip/chin since COVID19 vaccine. On exam, he has no cranial nerve deficits but has a patch of subjective numbness involving the above area. Tongue is not involved. Entire dermatome of the Mandibular branch of the L Trigeminal nerve does NOT appear to be involved. There is no swelling. There is no pain currently. Need to assume that this is a vaccine reaction.

Other Meds:

Current Illness:

ID: 1105206
Sex: F
Age: 67
State: NY

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Arm red rash from injection site to nearly elbow. Warm to touch.

Other Meds: Vitamin D, Glucosamine & Chondroitin, PreserVision, Benedryl.

Current Illness: None

ID: 1105207
Sex: F
Age: 49
State: NY

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Buspar

Symptom List:

Symptoms: Fever, left side face swelling and drooping

Other Meds: Valacyclovir HCL 1gm Hydroxyzine HCL 10mg Fluticasone 50mcg/Act Gabapentin 300mg Butalbital/Ace/Caffeine 50-325 Ibuprofen 800mg Esomeprazole Magnesium 40mg cyclobenzaprine HCL 10mg Triamterene/Hydrochloride 37.5-25mg

Current Illness:

ID: 1105208
Sex: M
Age: 46
State: FL

Vax Date: 03/03/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Swollen and painful lymph node in left armpit (same side of injection)

Other Meds: 50,000 IU Vitamin D, Prilosec

Current Illness: None

ID: 1105209
Sex: F
Age: 70
State: GA

Vax Date: 03/08/2021
Onset Date: 03/10/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: NSAIDS, PERCOCET, CORTICOSTERIODS, MORPHINE, ULTRAM, LEVAQUIN, FLAGYL, KEFLEX, SULFA DRUGS, FENTANYL DRIP, LEVONOX

Symptom List:

Symptoms: VACCINE ON 3/8 ARM SORE THAT EVENING. NEXT DAY 3/9 COULD BARELY RAISE ARM. 3/10 ARM STILL VERY SORE AND BY AFTERNOON SHORT OF BREATH. ON 3/11 SHE WAS STILL SOB AND WHEEZING, NO ENERGY AND PHONED HER PCP WHO TOLD HER TO CALL HEATLH DEPT AND GO TO ER. SON TOOK HER TO ER IN THE EVENING AROUND 4 PM. THIS DATE ER STARTED HER ON BREATHING TREATMENTS, DID CT OF CHEST THAT WAS NORMAL, COVID TEST NEGATIVE, CBC BLOOD WORK THAT WAS NORMAN. 3/12 THYROID TEST NORMAL AND SHE WAS RELEASED.

Other Meds: GUMMY VITAMINS FOR WOMEN OVER 50 DRINKS GREEN TEA DAILY IN THE A.M.

Current Illness: NONE

ID: 1105210
Sex: M
Age: 36
State:

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient appeared to experience vasovagal syncope within 30-60 seconds of injection. Patient briefly lost consciousness for approximately 30 seconds and complained of severe nausea following the incident. After recovering, he stated that he has a history of vasovagal syncope and usually receives injections lying down. He described tingling sensation of hands and feet, nausea, and was perspiring. Patient had gatorade and water and tried to eat crackers before complaining again of nausea. Observed him for about 20 minutes at which point he was still complaining of nausea but was able to ambulate unassisted and left with his nurse wife. Checked in with him three hours later and he stated that he was feeling better.

Other Meds:

Current Illness:

ID: 1105211
Sex: F
Age: 77
State: CA

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

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

Lab Data:

Allergies: unk

Symptom List:

Symptoms: sore at vaccination point; tightness and heaviness in chest about two hours following injection, lasted about two minutes.

Other Meds: lisinopril, levothyroxin, atorvastatin, carvidelol, hydralazine, zinc, vit D3, calcium

Current Illness:

ID: 1105214
Sex: F
Age: 40
State: KS

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Notes APRN (Nurse Practitioner) ? ? Family Medicine Cosigned by: MD at 3/16/2021 9:52 AM Expand AllCollapse All VACCINE CLINIC 3/15/2021 Patient: DOB: Date: 3/15/2021 MRN: Subjective Patient is a 40 y.o. female who was seen at COVID Vaccine Clinic today for her second dose of the COVID 19 vaccination. She was given the Pfizer vaccination in the right deltoid muscle. During her 30 minute waiting period after the injection, the patient began to experience chills. She denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, lightheadedness, dizziness, facial swelling, lip swelling and tongue swelling. This provider was notified of patient reaction and she was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to blood pressure abnormality , collapse, hypotension, rapid progression of symptoms and respiratory distress. Hx of htn, currently changing out medication to new one as she is 9 weeks pregnant. She is experiencing vaginal spotting in the last 2 weeks. Her obgyn is aware and monitoring. Recent u/s done and is okay. ALLERGY REVIEW OF SYSTEMS: Patient complains of chills Patient denies fever, malaise/fatigue, facial swelling, sore throat, frequent throat clearing, cough, chest tightness, shortness of breath, wheezing, rash, hives, itching of skin, vomiting, abdominal pain, muscle aches, dizziness and headaches Previous Reactions: none Objective Vitals There were no vitals filed for this visit. Physical Exam Constitutional: General: She is not in acute distress. Appearance: Normal appearance. She is well-developed. She is morbidly obese. She is not diaphoretic. HENT: Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: Oropharynx is clear. Eyes: Extraocular Movements: Extraocular movements intact. Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulses: Normal pulses. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. No wheezing. Skin: General: Skin is warm and dry. Neurological: General: No focal deficit present. Mental Status: She is alert and oriented to person, place, and time. Gait: Gait normal. Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. Assessment/Plan Treatment included: water, snacks and laying down and covered with blanket. Follow up response to treatment: good. Patient discharge: Stable to go home and follow up with PCP. Differential Diagnosis: Red flag symptoms (CP, SOB, NVD, Visual/Neuro concerns) Chills. She reports improvement of feeling chilled here in medical bay. She was able to sit up in bed w/o dizziness/lightheaded. Ambulates w/o assistance. She feels ready to go home. Continue care with obgyn and follow up with pcp as needed. Pt voiced appreciation of her care today. APRN Electronically Signed 3/15/2021 4:15 PM

Other Meds:

Current Illness:

ID: 1105215
Sex: F
Age: 66
State: GA

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: chills, fever, nausea, dull headache, exhaustion, : advil

Other Meds: multivitamin, biotin 10,000, vitamin d 1000,phosteum plus, levothyroxine, simvastatin

Current Illness:

ID: 1105216
Sex: F
Age: 32
State: OH

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Ephedrine Mucinex Pain meds

Symptom List:

Symptoms: The first day about 10 hours later I got flu like symptoms. I had nausea, chills, stiff muscles- it lasted 14-15 hours. I woke up Sunday morning and had shortness of breathe and have been ever since. I seen my PCP and he sent me for testing to rule out Blood clots and that came back ok, but I'm still having the shortness of breathe. If I get worse he advised me to go to the ER and if im not feeling better to call him in three days.

Other Meds: Nexium Prenatal Buspurin

Current Illness:

ID: 1105217
Sex: F
Age: 60
State: FL

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Doxycycline; Zephryx; Bextra; and Flagyl

Symptom List:

Symptoms: March 13, 2021 - Upset stomach; headache; fever & body aches March 14, 2021 - Fever; headache and tired March 15, 2021 - Tired & slight cough March 16, 2021 - Slight cough & minor rise in body temperature

Other Meds: Synthroid; Claritin; and Flonase

Current Illness:

ID: 1105218
Sex: M
Age: 80
State: PA

Vax Date: 02/16/2021
Onset Date: 02/27/2021
Rec V Date: 03/16/2021
Hospital: Y

Vax Type:
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Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Stroke 11 days (2-27) after first dose (2-16), discharged the following day (2-28). Spoke to PCP's office (nurse) who states stroke was likely due to patient's own decision to discontinue his blood pressure medications without doctor's approval. Stroke unlikely related to vaccination and determined patient should receive second dose on 3-16.

Other Meds:

Current Illness:

ID: 1105219
Sex: F
Age: 64
State: VA

Vax Date: 03/02/2021
Onset Date: 03/04/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Rash at injection(3/02) site 2days after lasted about 3 days cleared up & reappeared on 3/12 twice as bad & larger. Very warm to touch. Began using Benadryl ointment on 3/13 which helped somewhat. Inner areas of redness have turned kind of brown but outer edge is still red & spreading further down my arm. Feels burning/itchy

Other Meds: Warfarin, Lipitor, Fosamax, Vitamin D, Gabapentin

Current Illness:

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm