VAERS 2021 Database www.vaers.hhs.gov

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

Total Manufacturer

Incidents per State

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

ID: 1105783
Sex: M
Age: 60
State: MO

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: antihistamines and dramamine

Symptom List:

Symptoms: Pt began to feel lightheaded and dizzy. He did pass out while sitting in chair. Quickly came back, woke back up and was able to answer orientation questions. He did report that this always happens to him when he takes antihistamines. Observed for a period of 5-7 minutes and felt / looked better. Told him we would observe him for a period of 30 minutes. Within 5 minutes, he had the exact same reaction. Patient passed out, was pale and diaphoretic. Blood pressure was 65/39 with HR 45 (3/16 @ 1430). At that time, he was moved to a gurney and placed in Trendelenburg position. Patient observed. repeat blood pressure at 1435 was 104/64 with HR 68. Patient continued in Trendelenburg position. Patient observed until 1455. Repeat blood pressure at 1452 was 105/69 with HR 73. Patient looked and felt better. He refused to go to ED. Wife to stay with patient and observe this evening and afternoon.

Other Meds: UNKNOWN

Current Illness: unknown

ID: 1105784
Sex: F
Age: 54
State: MI

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Vax Name:
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Lab Data:

Allergies: cobalt, motrin, amoxicillin, cats

Symptom List:

Symptoms: My lips started to tingle (same reaction as cobalt allergy before my lips swell). I asked if I could take benadryl (which I brought with me). The person watching us texted someone and they came in and looked at me, asked me what was happening, took my blood pressure and said to take 2 benadryl. I told the nurse I only take one benedryl when this happens. She said take 2 benadryl. I did take 2 benadryl 12 minutes after my vaccine. My blood pressure went up. They called an ambulance and I went to the Hospital. My blood pressure was 176/105 at 11:50 am. While I was in the ER, I took a selfie and noticed that I had a rash. No one mentioned that earlier so I am guessing that is why they had me take 2 benadryl. At the ER I was put on an IV - NS .09% 1000ML at 12:27 pm. Then at 13:04 I was given Pepcid 40 MG/NS 250 ML IV at 500 ml/hr intravenous. At 1:12 pm my blood pressure was 138/96 and at 2:31 pm it was 135/70. My rash went away then. Up until last week I have been taking benadryl and/or pepcid everyday since the vaccine. I would still get a rash. I have not had the rash for about 5 days.

Other Meds: Equate allergy relief

Current Illness:

ID: 1105785
Sex: M
Age: 73
State: MD

Vax Date: 02/15/2021
Onset Date: 02/22/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Tininitud

Other Meds: Metropolol, Alendonate Sodium, Flomax,tamsulosin

Current Illness:

ID: 1105786
Sex: M
Age: 76
State: IA

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

Vax Type:
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Lab Data:

Allergies: none

Symptom List:

Symptoms: Blood sugar levels increased over 100 points. Averaged around 260.

Other Meds: Baby aspirin, Red Yeast Rice, Adult multivitamin, Metformin 2000mg

Current Illness: none

ID: 1105787
Sex: F
Age: 66
State: WI

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies: Bee sting: Allergy shellfish: Allergy latex: Allergy

Symptom List:

Symptoms: Pt received her 1st Moderna covid vaccine at Clinic on 3/11/21. She noted a history of bee stings and that she has an epi pen at home so was given the shot and monitored for 30 minutes. 20 minutes post vaccine, patient noted she felt dizzy and somewhat disoriented. She noted a dry throat and like her arms and legs felt funny "like jello". Her husband alerted staff at the vaccination site and EMS assessed her. She said she was told her blood pressure was high for her but otherwise vitals were fine. She denied itching, or shortness of breath or trouble breathing. She actually asked her husband to go home and get her epi pen and he returned with it and was given a dose of epi and sent to the local emergency room for evaluation. She said she felt better by the time she got their but was monitored for a number of hours. She felt completely fine by the time she was discharged. She noted for a few days following the vaccine she felt fatigued and a slightly itchy spot at injection site but that's it.

Other Meds: Vitamin D3 1000 UNIT Tablet 1 tablet Orally Once a day. Loratadine 10 MG Tablet 1 tablet Orally Once a day, Notes: otc. EpiPen 2-Pak 0.3 MG/0.3ML Solution Auto-injector inject 1 pen Injection as needed, Notes: on file.

Current Illness: none.

ID: 1105788
Sex: F
Age: 73
State: TX

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List:

Symptoms: I exp nausea and slight headache lasting 8 hours.

Other Meds: Blood pressure, Thyroid, Folic, Vit D3, Vit C, Cholesterol, Beta Blocker medications

Current Illness: Bronchitis taken Z Pack stop taking Monday prior to Dose 2 vaccine

ID: 1105789
Sex: F
Age: 48
State: CA

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

Vax Type:
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Lab Data:

Allergies: NO

Symptom List:

Symptoms: 2:17 pm, Suddenly client felt faint, Layed her in exam room table gave, water & crackers, 2L 02 via adult face mask sat 100%. vitals; 139/82 HR 98. 2:30 felt, cold & clammy, shakey and tingling body & nausea vitals 125/70 HR 95 O2 sat 100% . By 3:00 previous symptoms subside , new symptoms dry mouth, headache 7/10 and nausea vitals 145/85 HR 105, taken of 2L 02. Called 911, emergency transport to AV emergency room. Patient choose to be driven to AVH emergency room by daughter who was at her mothers bedside during observation.

Other Meds: NO

Current Illness: No

ID: 1105791
Sex: F
Age: 79
State: AZ

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

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

Lab Data:

Allergies: N/A

Symptom List:

Symptoms: Extreme weakness requiring short emergency room stay (3 hours)

Other Meds:

Current Illness: None

ID: 1105792
Sex: F
Age: 64
State: NY

Vax Date: 03/04/2021
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: Latex

Symptom List:

Symptoms: Developed hives three (3) hours after vaccine administration; Treatment--Benadryl (25mg) po

Other Meds:

Current Illness:

ID: 1105794
Sex: F
Age: 52
State: TN

Vax Date: 03/08/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Codiene While taking. Disulfiram I cannot have any alcohol while taking the medication. They did not use an alcohol swab before giving the vaccine

Symptom List:

Symptoms: The day of the injection my injection site was sore and tender to the touch. But no other side effects until yesterday. Seven days after the 1st vaccine I began feeling tired and had a headache that has lasted two days. Then the area around my injection site became swollen red and very painful to touch. The site is also very itchy.

Other Meds: Adderal. 30 mg 2x day Lexapro 20 mg 1Xday Clonazpam 1xday Disulfiram 250 mg 1xday Xytal daily allergies

Current Illness: Lyme and Babesia positive for past five years and Disulfiram is helping kill the disease in my body. I?m halfway through a 90 day treatment.

ID: 1105795
Sex: F
Age: 50
State: ID

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

Vax Type:
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Lot:
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Vax Site:

Lab Data:

Allergies: hx med rxns (tongue swelling) to: Sulfas BP med

Symptom List:

Symptoms: Pt felt slight headache coming on - was not sure if might progress to full-blown hemiplegic migraines - stated can be brought on by stress; requested check-up and VS, monitoring prior to departure.

Other Meds: Migraine meds: Topamirate 75mg po QD Lisinopril po QD Emgality inj Q month Mg++ po QD Fioricet PRN migraines Anti-nausea med PRN migraines

Current Illness: none

ID: 1105796
Sex: F
Age: 24
State: MA

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

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Arm swollen, +induration, unable to move freely. Denies fever, skin breakdown. Used Tylenol, Motrin with minimal relief

Other Meds:

Current Illness:

ID: 1105797
Sex: F
Age: 73
State: NY

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

Vax Type:
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Vax Route:
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Lab Data:

Allergies: raw pineapple, grass and tree allergies seasonally, lidocaine

Symptom List:

Symptoms: On 03/14, I had a slight headache all day, a sore left arm where the injection was given. The site was warm and a large red, itchy spot beneath the injection site appeared. My normal temp is 97. I felt flushed all day and my temp was 98.6 at its highest. I took 1 tylenol 500 tablet at 3pm and another 1 tablet at 9 pm. On Monday, 03/15, all symptoms were gone except for my slightly sore arm and the red spot which was lessening. On 03/16, my left arm is almost back to normal.

Other Meds: Early AM on 03/13 took a zyrtec allergy pill OTC type

Current Illness: None

ID: 1105798
Sex: M
Age: 63
State: NJ

Vax Date: 03/06/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type:
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Lot:
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Lab Data:

Allergies: NONE

Symptom List:

Symptoms: Moderna COVID?19 Vaccine: Left arm rash slightly below injection site, 9 days after 1st Dose. Raised circular rash, itching and warm. I am using Cortizone 10 Maximum Strength cream to relieve itching

Other Meds: DAILY MEDICATION ? 3/6/21 NAME TABLET FREQUENCY 1. ATORVASTATIN 10mg

Current Illness: NONE

ID: 1105799
Sex: F
Age: 72
State: CO

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

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

Lab Data:

Allergies: Penicillins, amoxicillin, aspirin, tylenol, ibuprofen, eliquis, iodine & seafood

Symptom List:

Symptoms: Within 15 minutes of injection, back if throat & back of tongue began to tingle & burn. I could feel my whole face & throat tightening up. Began to have swallowing difficulty. I was getting a woozie feeling within 30 minutes. I took 100mgm benedryl by mouth w about a pint of water. For the next 50-60 minutes, the tightness continued as far as below my collar bones face very tight swollen. Red raised itchy rash started all over my body. Had epipen in hand as well as stat dose of prednisone to take if necessary. (I have an allergic reaction protocol in hand from my doc for these cases. Transport to ER is always there if needed) . Took about an hour for the benedryl to start countering the adverse affect. Took another 100 mgm at the 4 hr post injection time mark. By bedtime about 10pm, I felt very fatigued, throat & back of tongue very sore & raw feeling.

Other Meds: Synthroid, diltizeim, metropolol, losartan, lasix, encruise inhaler, singular, B12 injectable, calcium, fergon, eye vitamins

Current Illness: None

ID: 1105800
Sex: F
Age: 37
State: VA

Vax Date: 02/08/2021
Onset Date: 03/10/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Hives on arms and chest

Other Meds: Humalog Insulin, Sertraline, iron gummies, Goli gummies, and Vitamin D

Current Illness: Diabetes

ID: 1105801
Sex: F
Age: 0
State: CA

Vax Date: 04/27/1984
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: Yes

Symptom List:

Symptoms: redness and itchiness in bilateral arms and neck. received benadryl iM. improved and dc'd t home with husband.

Other Meds:

Current Illness: None

ID: 1105804
Sex: F
Age: 62
State: WA

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: sulfa thomixine

Symptom List:

Symptoms: Whole body is sore like as if I just ran a mile and every muscle hurts. shoulder/injection site hurts. Legs especially hurt.

Other Meds: vimpat, topiramate, pravastatin, fenobarbital, sertraline hydrochloride, vitamin P5P, vitamin D3, magnesium

Current Illness: No

ID: 1105805
Sex: F
Age: 35
State: CO

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: None

Symptom List:

Symptoms: Facial numbness which began 17-18 minutes after the injection. Tingling/numbness in jaw area, from ears to chin on both sides. Lasted only a minute or two and went away. Face has continued to feel flushed for 2 hours since. No other reaction.

Other Meds: Propranolol Iron Supplement Vitamin C Supplement Magnesium Supplement Riboflavin Supplement

Current Illness: None

ID: 1105806
Sex: F
Age: 26
State: CA

Vax Date: 02/15/2021
Onset Date: 02/19/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: N/a

Symptom List:

Symptoms: Unexplained dizziness, feeling very disoriented, almost vertigo like symptoms but it has affected my entire body not just my head. I?ll be functioning normally and then a wave of dizziness runs through me. This has persisted for nearly 4 weeks with only minor improvement. It feels like I?m ?off?, not debilitating enough to cancel work/plans, but persistent enough to know something isn?t normal. Had no symptoms prior to receiving the shot.

Other Meds: N/a

Current Illness: N/a

ID: 1105807
Sex: F
Age: 21
State: MO

Vax Date: 03/10/2021
Onset Date: 03/11/2021
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: Patient received first dose of Moderna COVID-19 vaccine on 2/10/21 and had a large, red, inflamed area on her arm at the injection site for a few days, but otherwise tolerated vaccine well. She received the second dose of the Moderna COVID-19 vaccine on 3/10/21 and the next day (3/11/21) developed fatigue and lightheadedness while exercising, which continued for the next few days. She developed acute onset, sharp chest pain on 3/13/21 AM which did not resolve so she presented to an ED. Vitals were normal but labs notable for troponin I which peaked at 4.36, CK 758, d-dimer 640. CBC/CMP and EKG were unremarkable and initial TTE with EF ~45%. Repeat TTE obtained a few days later with normal LV and RV size/function without any wall motion abnormalities. Cardiac MRI obtained with normal LV function (EF 64%) but late gadolinium enhancement in a subepicardial distribution within the inferolateral wall of the left ventricle at the base most compatible with myocarditis. ESR and CRP were normal. Further workup to determine etiology of myocarditis was negative (ANA, ANCA, RF, hepatitis panel, HIV, full respiratory viral panel, COVID-19 PCR). She was placed on metoprolol succinate 12.5mg XL daily and will follow up with a cardiologist as an outpatient. Family concerned that COVID-19 vaccine was the trigger/underlying etiology of her myocarditis.

Other Meds: None

Current Illness: None

ID: 1105808
Sex: M
Age: 35
State: HI

Vax Date: 03/05/2021
Onset Date: 03/06/2021
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: Patient received his first dose of Pfizer covid19 vaccine on 3/5/21. Over the next few days he developed progressive right facial weakness and was evaluated in the emergency dept. It progressed over the next week to severe R sided facial nerve palsy and has remained in this condiiton at the time of this report. He was started on Valacyclovir and prednisone with minimal improvement

Other Meds: None.

Current Illness: None

ID: 1105809
Sex: F
Age: 88
State: IL

Vax Date: 02/18/2021
Onset Date: 03/11/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: nka

Symptom List:

Symptoms: 3/13/21 ER HPI -> transferred to hospital 88 y.o. female who presents to the Hospital Emergency Department by private auto with her daughter. Apparently, the patient has a 2 day history of intractable nausea and vomiting. She states she has vomited more than 5 times over the last 2 days. She has become more and more weak. She states she has been having coffee-ground emesis. No definite fever. The patient had a similar episode to this a few months ago. The patient does take nightly ibuprofen. She also take iron on a daily basis because of chronic anemia. She is not on any blood thinners. When the patient did get to the ER she had an episode of vomiting and it did appear coffee-ground. She is having a little bit of epigastric abdominal pain. No history of GI bleed in the past 3/16 note from Hospital Hospital Course: 88 y.o. female with a past history significant for hypertension, renal artery stenosis, arthritis, skin cancer presented to hospital with nausea/vomiting and transferred to another hospital on 3/13/2021 for GI evaluation. Patient developed coffee ground emesis and had NG tube placed, yielding 1800 cc of coffee-ground emesis. She was also noted to be hypertensive. A CT done at the outside hospital revealed a large hiatal hernia with a significantly distended herniated portion of the stomach and a portion in the left upper quadrant compatible with a gastric outlet obstruction. Transferred to another hospital and GI consulted. Underwent EGD on 3/14 with results as noted below. Recommended to continue PPI, avoid NSAIDs if possible and repeat EGD in 8 weeks as outpatient. NG-tube removed and tolerated diet. No further bleeding noted. Hgb remained stable. Medically stable for discharge. Counseled on medication use and diet. Patient or daughter had no further questions or concerns on discharge.

Other Meds: Current Outpatient Medications: ? amLODIPine (NORVASC) 5 MG tablet, Take 1 tablet (5 mg) by mouth daily, Disp: 90 tablet, Rfl: 1 ? Apoaequorin (PREVAGEN EXTRA STRENGTH) 20 MG CAPS, Take 1 capsule by mouth daily, Disp: , Rfl: ? cephALEX

Current Illness:

ID: 1105810
Sex: F
Age: 57
State: FL

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: Contrast Dye

Symptom List:

Symptoms: Muscle aches and pains and extreme fatigue the day after. Resolved by the day after that. Am 96 hours out from vaccine and still have red arm and some slight swelling at injection site and some pain, slight though. Still feels a tad warm.

Other Meds: Amlodipine-Valsartan, Crestor, Aspirin, Metformin

Current Illness: None

ID: 1105811
Sex: F
Age: 61
State: FL

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

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

Lab Data:

Allergies: no

Symptom List:

Symptoms: 61 yo female admitted with palpitations and flushing since getting the Covid 19 Vaccine on 3/8.. She was prescribed metoprolol and a short course of steroids by her pcp for symptomatic relief which patient took 1 dose of metoprolol and did not start steroids. She came to the ED due to her symptoms, Her main concern was why did she react to the Vaccine., and wanted answers.

Other Meds: unknown

Current Illness: no

ID: 1105812
Sex: F
Age: 14
State: OH

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:

Symptom List:

Symptoms: Child age 14 received vaccine.

Other Meds: Sythroid

Current Illness:

ID: 1105813
Sex: F
Age: 68
State:

Vax Date: 02/17/2021
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:

Symptom List:

Symptoms: Large red ring around injection site. Lasted a week. Itchy. Hot.

Other Meds:

Current Illness:

ID: 1105815
Sex: F
Age: 37
State: SC

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: none stated

Symptom List:

Symptoms: Scenario: Pharmacist administered immunization and patient had immediate reaction to imz. The patient has multiple health conditions such as lupus, cerebral palsy, and is currently on dialysis. She indicated on the PQCF that she had never had an adverse reaction after a vaccine but after the incident, her husband indicated this was normal and not uncommon. SIG: Pharmacist Administered Immunization What happened (Describe in detail, what occurred)? * The patient came in for a covid vaccine; this was the first of a 2 series of Pfizer. * The pharmacist injected the immunization and a few minutes afterwards the husband called for the pharmacist to come because his wife didn't feel well. She immediately became unresponsive and her eyes rolled back into her head but she came to. She was responding somewhat to questions but she was also slightly mentally impaired at baseline due to her co-morbidities. She never fell to the ground or wanted to lie down, so not a true faint. * The pharmacist offered to call 911 but they both declined. The patient was given water and a banana and taken to a private area to recover until she fell well enough to leave. How did it happen? * The Pharmacist administered an appropriate, routine vaccine per protocol. *Patient had an somewhat immediate reaction (~4 minutes) after the vaccine. *The pharmacist followed the adverse event protocol. CPR was not administered nor benadryl. Why did it happen (Root Causes)? * Unknown; patient has no known allergy to the vaccine but has had adverse reactions to different procedures in the past. Plan of Action * Make sure all pharmacists are refreshed and aware of the adverse reaction protocol. *Document reaction as a SCRT and with VAERS. What specific task will take place to prevent future recurrence? *N/A. Who: * Pharmacist Where: * clinic When: *All pharmacists at location must review by 3/20.

Other Meds: n/a

Current Illness: Lupus, Cerebral Palsy, and dialysis,

ID: 1105816
Sex: F
Age: 38
State: IL

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/16/2021
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Allergies: N/A

Symptom List:

Symptoms: Patient symptoms: chills and body aches (initiated 12 hours post injection. Lasting for 8 hours) pain at the injection site (lasting at least 5 days post injection). No interventions sought. Breastfeeding Infant: Infant (39 days old at the time the vaccination was administered to the breastfeeding mother) who exclusively breastfeeds experienced emesis of breastmilk and stomach contents starting 12 hours post injection lasting for approximately 6 hours. In addition, increased nasal secretions/mucous noted. Symptoms resolved naturally without interventions

Other Meds: prenatal vitamin

Current Illness: N/A

ID: 1105817
Sex: M
Age: 60
State: AZ

Vax Date: 03/09/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
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Allergies: Penicillin

Symptom List:

Symptoms: Bells Palsey symptoms have returned. Right side of my face twitching and drooping

Other Meds: None

Current Illness: None

ID: 1105818
Sex: F
Age: 34
State: IL

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
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Allergies: unknown

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Symptoms: The needle came off the syringe. The medic felt that .50-.75% of the dose was administered. Department of Public Health notified and dose will not be repeated.

Other Meds: unknown

Current Illness: unknown

ID: 1105819
Sex: F
Age: 75
State: AZ

Vax Date: 03/14/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
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Allergies: Penicillin

Symptom List:

Symptoms: 1st time no effect. 2nd time swollen and redness and pain at injection site. The shot stung bad going in. Excruciating pain in lower back. Drank lots of water, took Liquid Ibuprofen Children's liquid 2 tablespoons every 6 hours. Heating Pad on lower back. Still have effect two day later but not as bad. Swelling going down but still red. . and used heating pad.

Other Meds: None

Current Illness: None

Date Died: 02/14/2021

ID: 1105820
Sex: F
Age: 89
State: WI

Vax Date: 02/12/2021
Onset Date: 02/14/2021
Rec V Date: 03/16/2021
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Allergies: none

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Symptoms: Patient seen and evaluated by PA-C. with myself. We agreed on the clinical findings and implemented our plan together. Please see PA's note for details. All relevant procedures supervised. Patient arrived to the emergency department due to respiratory symptoms, hypoxic, reported that Wednesday he received his 2nd dose of COVID vaccine. His initial workup was concern for NSTEMI with elevated troponin and peaked T-waves, his chest x-ray concerning for COVID/pneumonia. Patient initially tolerated oxygen by nasal cannula and sepsis protocol was started including IV fluid resuscitation that was done cautiously due to the concern of COVID with respiratory failure. The biotics were given. PA-C readdressed code status with patient who confirmed that his DNR DNI, she so contacted his daughter. Patient had multiorgan failure including acute kidney injury, and pneumonia with respiratory failure +/- respiratory failure. Due to the concern of NSTEMI patient was initially going to be transfer to was hospital and transfer was started. Patient respiratory status started deteriorating and his blood pressure dropped slightly but improved after 500 cubic centimeters of IV fluid and he was also placed on a NIPPV. Around 6:00 p.m. patient has significantly desaturation and he discontinued himself NIPPV. Due to inability to intubate patient, he was ventilated with BVM, patient is slowly improved saturation levels and was opening his eyes, he was placed on a non-rebreather. At this point there is high concern of ARDS and due to inability to intubate or give for the respiratory support His daughter was at bedside and updated of current medical status and poor prognosis. Patient continued deteriorating and at this point he had agonal breathing. His daughter was at bedside and she was made aware of the futile prognosis of patient due to his respiratory failure. Patient rapidly became bradycardic and went into cardiac arrest. No CPR was done due to the DNI DNR status of the patient. Critical Care Procedure Note Authorized and Performed by: MD Total critical care time: Approximately 30 minutes Due to a high probability of clinically significant, life threatening deterioration, the patient required my highest level of preparedness to intervene emergently and I personally spent this critical care time directly and personally managing the patient. This critical care time included obtaining a history; examining the patient; pulse oximetry; ordering and review of studies; arranging urgent treatment with development of a management plan; evaluation of patient's response to treatment; frequent reassessment; and, discussions with other providers. This critical care time was performed to assess and manage the high probability of imminent, life-threatening deterioration that could result in multi-organ failure. It was exclusive of separately billable procedures and treating other patients and teaching time. Please see MDM section and the rest of the note for further information on patient assessment and treatment. PE: VITAL SIGNS: BP: 126/75 Pulse: (!) 122 Resp: (!) 40 SpO2: (!) 82 % Temp: 98.1 ?F (36.7 ?C) Height: 5' 8" (172.7 cm) Weight: 152 lb (68.9 kg) General: Alert, nontoxic, in no acute distress. Lungs: Clear to auscultation bilaterally. CLINICAL IMPRESSION: 1. Sepsis with acute hypoxic respiratory failure and septic shock, due to unspecified organism (HCC) 2. Suspected COVID-19 virus infection 3. NSTEMI (non-ST elevated myocardial infarction) (HCC) 4. Multifocal pneumonia 5. ARDS (adult respiratory distress syndrome) (HCC) 6. Acute kidney injury (HCC) Further care and disposition otherwise as outlined by PA. ED on 2/14/2021 Revision & Routing History Detailed Report Note filed date Mon Feb 15, 2021 8:46 AM

Other Meds: Rivaroxaban 15 and 20 MG, Tylenol, Meclizine 25 MG; Aspirin 18 MG daily, Pravastatin 20 MG daily, Multivitamins, BP formulation, Norvasc 5mg tablet daily . atenolol 25MG tablet daily

Current Illness: none

ID: 1105821
Sex: M
Age: 73
State: NV

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 03/16/2021
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Allergies: none

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Symptoms: Headache, among other symptoms, began the day after the 1st shot. After 6 weeks (second shot after 4 weeks) the headache has not stopped. Doctor has now placed me on 6-day regimen of Prednisone.

Other Meds: Tamsulosin HCL 0.4mg, Metformin HCL 1000mg, Atorvastatin Ca 40 mg, Oxybutynin Cl 10 mg, Losartan K 100 mg, Levothyroxine Na 100 mcg, Omega-3-acid ethyl esters 1gm cap, ASA 81 mg, Vitamin D3 125 mg, Vitamin B-12 500 mcg x 2

Current Illness: none

ID: 1105822
Sex: F
Age: 23
State: NC

Vax Date: 03/08/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
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Allergies: None

Symptom List:

Symptoms: Red, swollen, itxhy

Other Meds: Birth control, multivitamin, vitamin D supplement

Current Illness: None

ID: 1105823
Sex: M
Age: 72
State: CA

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 03/16/2021
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Allergies: no

Symptom List:

Symptoms: 24 Hours after the first vaccine shot a rash appeared on my left leg. Experienced severe itching and scratching and the rash became raw. Within 48 hours rash had spread covering a larger area on my leg and then I developed numerous random blisters on both arms , right leg and back, causing severe itching and mild burning pain. The rash on my leg became extremely red and caused pain and swelling. None of these symptoms have abated.

Other Meds: Lisinapril, Brupopion

Current Illness: no

ID: 1105824
Sex: F
Age: 69
State: AZ

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
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Symptoms: Severe arm pain, chills, severe fatigue, headache, stomach ache, rash over neck, chest, shoulders and upper back.

Other Meds: Sumatriptan for migraine morning of the shot

Current Illness:

ID: 1105825
Sex: F
Age: 71
State: CA

Vax Date: 02/05/2021
Onset Date: 02/14/2021
Rec V Date: 03/16/2021
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Allergies: Shellfish, bees, nickel, opioids, Indian food, Cipro

Symptom List:

Symptoms: Itchy, red , swollen & rash started 8 days after injection.

Other Meds: Lipitor, aspirin, omeperazole, singular, xyzal, Flonase, seroflo

Current Illness: Nf/A

ID: 1105826
Sex: M
Age: 33
State: UT

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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Allergies: Penicillin, Bactrim

Symptom List:

Symptoms: The first adverse effect started a couple minutes after the injection. I felt lightheaded and dizzy and then I broke out into a cold sweat followed by blurry vision. I felt as though I was going to pass out. These symptoms lasted for approximately 10-12 minutes after starting and then I started to feel better. I then experienced a headache in just above the base of my neck in the back of my head and that lasted for approximately 5 minutes.

Other Meds: CLA, Raspberry Keytones, Green Tea Extract, Melatonin

Current Illness: None

ID: 1105827
Sex: F
Age: 27
State: AZ

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
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Allergies: N/A

Symptom List:

Symptoms: Rash at injection site developed within 24 hours of receiving vaccination. Rash oval in shape. Rash remained for three days after shot.

Other Meds: Generic Adderall IR 20mg 1 1/2 tab TID Spironolactone 100mg 1 QD AM Alprazolam IR 0.5mg 1 1/2 tab BID Vitamin D 1 QD AM No Doz (Caffeine) 200mg 1 QD AM Claritin 1 QD AM Women's One-A-Day 1 QD PM Vitamin C 1 QD PM Glucosamine 1 QD PM Lov

Current Illness: N/A

ID: 1105828
Sex: F
Age: 74
State: LA

Vax Date: 01/11/2021
Onset Date: 02/17/2021
Rec V Date: 03/16/2021
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Allergies: n/a

Symptom List:

Symptoms: left thigh became painful, it seems its the muscle on top of the thigh. Most painful at hip site and at out side of left knee, sometimes directly in middle.

Other Meds: multi-vitamin

Current Illness: 00

ID: 1105829
Sex: F
Age: 26
State: CA

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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Allergies: kna

Symptom List:

Symptoms: Patient experienced a vasovagal response 5-10 minutes after receiving their first dose of the Moderna vaccine on their left arm. After receiving their dose, patient felt dizzy and lightheaded and passed out. During period of syncope, patient hit their head and reported to have woken up crying on the ground. Medics was informed, vitals taken, and neurological exam was performed. Everything WNL, no abnormal findings, and patient advised to stay another 15 minutes and to request a ride home from a family member. Patient expressed that this is a common occurrence after receiving vaccines, shots, and blood draws.

Other Meds: n/a

Current Illness: n/a

ID: 1105830
Sex: M
Age: 78
State: TX

Vax Date: 03/03/2021
Onset Date: 03/10/2021
Rec V Date: 03/16/2021
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Allergies: latex

Symptom List:

Symptoms: left arm deltoid swelling, tenderness measuring 2.5in x 3 in

Other Meds: levothyroxine, atorvastatin, vit b12, vit d3, probiotics, nystatin topical

Current Illness: none

ID: 1105831
Sex: F
Age: 36
State: AZ

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 03/16/2021
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Allergies: Sulfamethe, Amoxycilin, Almonds, legumes, Eggs

Symptom List:

Symptoms: Immediate fever, night sweats, extreme fatigue, shortness of breath, chills, stuffy nose and sore arm lasting 48 hours

Other Meds:

Current Illness:

ID: 1105832
Sex: F
Age: 63
State: AZ

Vax Date: 02/02/2021
Onset Date: 02/09/2021
Rec V Date: 03/16/2021
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Allergies: None

Symptom List:

Symptoms: Itchy, 5cm x 5cm wheal around injection site that began one week after injection Applied topical cortisone cream (OTC) and took one Benadryl for two nights in a row. Cleared up with no further issues.

Other Meds: Magnesium Thyroid Support Niacin Vitamin D3 Melatonin Omega3

Current Illness: None

ID: 1105833
Sex: M
Age: 46
State: SC

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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Allergies: N/A

Symptom List:

Symptoms: I had an appointment that was cancelled due to "no vaccine from the CDC". VAMS ID: VAMS-106446464 Suspect possible fraud, and requesting investigation, or for the CDC to take note of Pharmacy.

Other Meds: N/A

Current Illness: N/A

ID: 1105834
Sex: F
Age: 62
State: OH

Vax Date: 03/02/2021
Onset Date: 03/11/2021
Rec V Date: 03/16/2021
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Allergies: Demerol

Symptom List:

Symptoms: Redness, swelling, severe itching, hot to the touch, symptoms are ongoing 5 plus days

Other Meds: Vitamin D Calcium Hydrochlorothiazide 12.5 Protonix 40mg Premarin (vaginal cream)

Current Illness:

ID: 1105835
Sex: F
Age: 29
State: MO

Vax Date: 02/23/2021
Onset Date: 02/26/2021
Rec V Date: 03/16/2021
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Symptoms: **8 weeks pregnant, estimated due date 10/25/2021. 2nd pregnancy ** I had vaginal spotting. I went to see my Midwife, they had me do an ultrasound and drew some labs. I went back two weeks later and had blood drew again and everything came back normal. My Midwife told me she had a lot of people call and tell her they were spotting after there vaccine.

Other Meds: Prenatal

Current Illness:

ID: 1105837
Sex: F
Age: 78
State: MA

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
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Allergies: Fish without a shell

Symptom List:

Symptoms: Chills, headache, nausea, fatigue - 3 days. Aspirin 1x per day.

Other Meds: Enbrel. 50 mg injection each week Hydrochlorothiazide 12.5mg. 1x per week Vitamin D, 2000. 2000 u 1x per day Calcium 600 mg 2x per day Chlortrimeton 4 mg 1x per day Aspirin 325mg 1x per day

Current Illness: Rheumatoid Arthritis High Blood Pressure

ID: 1105838
Sex: F
Age: 74
State: CA

Vax Date: 03/05/2021
Onset Date: 03/07/2021
Rec V Date: 03/16/2021
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Allergies: Penicillan

Symptom List:

Symptoms: Dizziness - like vertigo (room seems to be spinning) when I move to a prone position and put my head down. Occurs during yoga practice and when I lie down in bed. Abates within minutes if I stay perfectly still.

Other Meds: L-Lysine, Vitamin B, C, D, Bone Up, Magnesium, Chondro Flx, Fish oil tablet, & My Community

Current Illness: none- although In late December and early January I had an illness that lasted 3 weeks which made me have a slight fever, a constant headache, some aches and pains and fatigue. During the illness I took 2 covid tests and both were negative.

Total 2021 VAERS Injuries: 704,237

Page last modified: 03 October 2021 5:28pm