VAERS 2021 Database www.vaers.hhs.gov

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

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1066760
Sex: M
Age: 54
State: CA

Vax Date: 01/07/2021
Onset Date: 01/11/2021
Rec V Date: 03/02/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Tinnitus increased dramatically approximately 4 days after first Pfizer vaccine. It slowly subsided and then again spiked a few days after my second Pfizer vaccine shot. It has ever so slowly subsided since the spike after the second shot, but is still much louder than prior to shot one.

Other Meds: None

Current Illness: None

ID: 1066761
Sex: M
Age: 70
State: PA

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Anxiety, Dyspnoea

Symptoms: Chills - lasted only one day Purchased Analgesic & Astringent Rinse for these symptoms (recommended by Pharmacist): Symptoms still persist: * Ulcers in mouth * Soreness of tongue

Other Meds: Advil, PreserVision Areds 2, Fluvastatin, Joint health dietary supplement, Low dose aspirin, multi vitamin.

Current Illness: none

ID: 1066762
Sex: F
Age: 23
State: MD

Vax Date: 01/08/2021
Onset Date: 02/26/2021
Rec V Date: 03/02/2021
Hospital: Y

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: none

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

Symptoms: 24 y.o. female with no significant past medical history who was diagnosed with COVID-19 (NP PCR on 1/27/2021) with mild symptoms (3-4 days of rhinorrhea and myalgia) and complete recovery with return to work who recently completed COVID-19 vaccine series (Pfizer 1/8/2021, 2/5/2021) now presenting for hospitalization (2/26/2021) with fever, rapidly progressive hypoxia, and hyperinflammatory state including elevated ESR, CRP, ferritin, D-dimer, and troponin (20) in the setting of positive COVID-19 NP PCR (2/26/2021) and positive S.pneumoniae urine ag with clinical diagnosis of MIS-A s/p high dose methylprednisolone and IVIG.

Other Meds: none

Current Illness: none

ID: 1066763
Sex: F
Age: 72
State: NJ

Vax Date: 02/22/2021
Onset Date: 02/26/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: ampicillin; latex;

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: extreme pain in both feet, , lumbar spine region; servere icy cold feeling, burning and tingling sensations in all body parts described above.

Other Meds: D3, 50 mcg; magnesium glycinate,450mg;

Current Illness: no

ID: 1066764
Sex: F
Age: 38
State: CA

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

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

Lab Data:

Allergies: Seaweed

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

Symptoms: Pt developed itching to face,scalp and chest as well as tingling and numbness in her tongue withinn the first five minutes of receiving the vaccine.Pt denied difficulty breathing,.pt started to develop hives to the chin while taking history. Pt was given epinephrine .3mg per epi autoinjector. Pt also used her albuterol inhaler 2 puffs. Paramedics were called and pt taken to hospital.

Other Meds: Albuterol inhaler

Current Illness: not/known

ID: 1066765
Sex: F
Age: 71
State: NC

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 03/02/2021
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: macrodinton, msg, dust mites, strong odors

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

Symptoms: difficulty breathing; lymphedema - R & L axillary & arm; numbing - right hand; weakness; loss of appetite; dizzy; nausea; headaches Symptons started on 02/02/21 & continues Predinsone 40 mg

Other Meds: Qvar 40mg; azelastine HCL & Fluticasone 137/50; lorazepam 10 mg; lexapro 5 mg; gabapentin 200 mg; zolpidem 5 mg; vitamin D 2,000; calicum citrate 1,000; magnesium 435; turmeric

Current Illness:

ID: 1066766
Sex: F
Age: 34
State: GA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/02/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Vomiting and fever. Vomited 4-5 times over 18 hours. Fever 99.6. Able to keep fever down with tylenol

Other Meds:

Current Illness:

ID: 1066767
Sex: M
Age: 54
State: NV

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 03/02/2021
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 presented for 1st dose Moderna, when entering information into EMR an alert came up that the patient had a Pfizer COVID 19 vaccine on 12/15/2020 at another Medical Center. We share an EMR with them. Patient contacted on 3/2/2021. He stated he did not have a vaccine on 12/15/2020 and had never been to another hospital. He was advised to contact other hospitals HIM department. He will continue to receive his second dose at the due time.

Other Meds:

Current Illness:

ID: 1066768
Sex: M
Age: 96
State: TN

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

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

Lab Data:

Allergies: PCN Dorzolamide

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient states that he woke at 01:00AM on 03/02/2021 to go to the bathroom. He reports that he was unable to move his arms or legs and had to call out to his daughter to assist him. His daughter had to physically assist him with sitting up on the edge of his bed. Symptoms lasted approximately 15 minutes. When he regained use of his arms and legs he was unable to void or have a bowel movement. Patient states that his symptoms have resolved and that he currently reports feeling fatigued.

Other Meds: Multivitamin

Current Illness: Denies

ID: 1066769
Sex: F
Age: 92
State: MT

Vax Date: 02/26/2021
Onset Date: 02/28/2021
Rec V Date: 03/02/2021
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: peanuts

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I HAD WHAT PEOPLE ARE CALLING "COVID ARM". BLOTCHY RED ITCHY

Other Meds: none

Current Illness:

Date Died: 02/09/2021

ID: 1066770
Sex: M
Age: 97
State: IL

Vax Date: 01/25/2021
Onset Date: 02/09/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: died

Other Meds: lasix, seroquel, kcl, coreg, eliquis, vasotec,omeprazole, tylenol, rocephin

Current Illness:

ID: 1066773
Sex: F
Age: 28
State: NM

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 03/02/2021
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: no known allergies

Symptom List: Rash, Urticaria

Symptoms: 28-year-old female, medical assistant employee presents to urgent care 45 minutes after receiving her second dose of covered vaccine, presents to urgent care complaining of a 4 of 10 throbbing headache and left ear/lateral neck pain. She has not taken anything for pain, having come straight from work/vaccination clinic. She tolerated her first dose of vaccine well.

Other Meds: Prenatal Multivitamins: By Mouth, once a day

Current Illness: unknown

ID: 1066774
Sex: F
Age: 35
State: MN

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

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

Lab Data:

Allergies: Seasonal and pets

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

Symptoms: Tachycardia (racing heart), fever, chills, severe joint pain and muscle aches, headache, dizziness lasting for 18 hours. Severe pain in left arm and armpit.

Other Meds: Vitamin D, d-mannose, Zyrtec

Current Illness: none

ID: 1066775
Sex: F
Age: 69
State: CA

Vax Date: 02/16/2021
Onset Date: 02/24/2021
Rec V Date: 03/02/2021
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: none

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

Symptoms: itching; hot; red; slightly swollen 2" round circle at injection site on left arm; no pain; no fever

Other Meds: topamax; metoprolol succinate ER; one-a-day vitamin

Current Illness: none

ID: 1066777
Sex: M
Age: 62
State: OH

Vax Date: 02/27/2021
Onset Date: 02/28/2021
Rec V Date: 03/02/2021
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: Sulphur

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

Symptoms: Shortness of Breath

Other Meds: Benedryl, Advil

Current Illness: Allergy

ID: 1066778
Sex: F
Age: 80
State: TX

Vax Date: 02/26/2021
Onset Date: 03/01/2021
Rec V Date: 03/02/2021
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: Iodine

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

Symptoms: Rash at the injection site, approximately 5CM wide and 10 CM long

Other Meds: Vesicare, Verapamil, Synthroid, Clonazepam, ASA, Pepcid, Vitamin E, Multi-Vit, Lutein, Garlic & Parsely, Probiotic, Milk thistle, Miralax

Current Illness: None

ID: 1066779
Sex: M
Age: 73
State: MI

Vax Date: 02/27/2021
Onset Date: 03/01/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Dizziness, Nausea and vomiting for 10-20 minutes. Light headedness for 24 hours.

Other Meds: Losartan Potassium 11mg, Rosuvastatin Calcium 20mg, Metformin Hydrochloride 1700mg, Gabapentin 100mg

Current Illness: None

ID: 1066780
Sex: M
Age: 35
State: MD

Vax Date: 02/11/2021
Onset Date: 02/25/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: swollen tongue, sore throat, itchy and irritated lips

Other Meds: flovent, albuterol, testosterone cypionate, vitamin D, buspirone, Escitalopram, montelukast

Current Illness: none

ID: 1066781
Sex: F
Age: 65
State: NJ

Vax Date: 02/24/2021
Onset Date: 03/02/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: None known.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Redness and itchy at injection site. Big red mark at site of injection. It is about 3 inches in diameter. It appeared 6 days after getting second Pfizer shot. Had no reaction to first shot.

Other Meds: Atenolol, Quinapril Hydrochloride and Omeprazole

Current Illness: None.

ID: 1066782
Sex: F
Age: 34
State: FL

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

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

Lab Data:

Allergies: Hay fever allergies to pollen, mold, and feathers

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

Symptoms: 9:30 mild shortness of breath and itching eyes 10:00 swollen tongue and throat, lightheadedness and visual disturbances (black spots in field of vision), increasing shortness of breath 10:30 increasingly severe difficulties breathing (like trying to drink ice cream through a straw), minor wheezing, itching, trippy strange lightheaded feeling, chest pressure, swollen throat and tongue 11:00 severe itching especially head, neck, ears; breathing takes focus and energy 12:00 midnight slight easing of respiratory symptoms, breathing still difficult but less of a strain. Severe abdominal pain 3am slight difficulties breathing still but greatly improved, throat like sandpaper, headache and moderate abdominal pain Next day: flu like symptoms with fever, aches, nausea, diarrhea, vomiting, lack of concentration, chills, tiredness Did not seek treatment, symptoms resolved by early AM

Other Meds: Vitamin b complex Vitamin D Magnesium

Current Illness: Very low ferritin and mild anemia

ID: 1066783
Sex: M
Age: 69
State: DE

Vax Date: 02/01/2021
Onset Date: 02/05/2021
Rec V Date: 03/02/2021
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: caffeine

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

Symptoms: Large , itchy rash on shin and lower left leg after 1st shot. Still exists after 2nd shot.

Other Meds: Lisinopril, Flonase

Current Illness: None

ID: 1066784
Sex: F
Age: 55
State: MA

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: Penicillian

Symptom List: Unevaluable event

Symptoms: Severe Muscle pain throughout my entire left side and severe joint pain left side only. Severe arm pain at the site of injection. This pain was severe visceral pain and lasted for over 6+ weeks. Only on my left side. The pain was present when simply sitting as well as during activity. There are still days when the pain returns for no reason at all. The pain is deep inside my left thigh and lower leg. I need to take ibuprophen to decrease the discomfort.

Other Meds: None

Current Illness: None

ID: 1066785
Sex: F
Age: 69
State: CA

Vax Date: 02/23/2021
Onset Date: 02/25/2021
Rec V Date: 03/02/2021
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: PCN

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

Symptoms: Bells palsy developed 2 d later.

Other Meds: acetaminophen 325 mg oral tablet, 650 mg= 2 tab, Oral, q6hr, PRN, 1 refills meloxicam 7.5 mg oral tablet, 7.5 mg= 1 tab, Oral, Daily, 2 refills Moisture Eyes PM ophthalmic ointment, 1 app, OPHTH-Both, Once a day (at bedtime), PRN Narcan

Current Illness: None

ID: 1066786
Sex: F
Age: 43
State: MA

Vax Date: 02/06/2021
Onset Date: 02/09/2021
Rec V Date: 03/02/2021
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: Sulfa

Symptom List: Injection site pain, Pain

Symptoms: Rash

Other Meds: Multivitamin, prebiotic, vitamin D

Current Illness: None

ID: 1066787
Sex: F
Age: 87
State: AR

Vax Date: 02/24/2021
Onset Date: 02/26/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: Percocet

Symptom List: Injection site pain, Menorrhagia

Symptoms: Rash since 36 hours after vaccination and progressively worsening. Patient had taken OTC Benadryl prior to coming to our office. Prescribed prednisone 10mg dose pack on 3/2/21. Patient just seen in our office this afternoon.

Other Meds: Xarelto 15MG Oral Tablet TAKE 1 TABLET BY MOUTH ONCE DAILY acetaminophen-hydrocodone 325 mg-5 mg oral tablet 1 1/2 Tablet(s) 4 times a day as needed back pain mirtazapine 30 mg oral tablet 1 tablet one time a day at bedtime for sleep cyclob

Current Illness: None

ID: 1066788
Sex: F
Age: 28
State: TN

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Symptoms started 6 hours post vaccination: headache, fever (102 F) muscle and joint pain, chills and fatigue, this symptoms lasted for 12 hours the they went away for 48 hours. Symptoms came back: extreme muscle and joint pain and headaches, nausea, fatigue and sever brain fog. I experienced a ?water? sensation inside my head every time I would move my head I would have sever nausea. After 5 days I got medical attention on 2/25/2021. Doctor encouraged me to call and report my symptoms.

Other Meds: None

Current Illness: None

ID: 1066789
Sex: F
Age: 74
State: CA

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 03/02/2021
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: 2x3 inch red spot that sometimes itches, just to the left of injection site, began almost immediately and still there 9 days later

Other Meds: none

Current Illness: none

ID: 1066791
Sex: F
Age: 72
State: WI

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

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I had a hip replacement in my left leg in 2002. The evening that I had my vaccine I had quite a bit of pain in that hip. It did go away by the following morning but I felt that you might want to know about it.

Other Meds: Excedrin and these supplements: black seed oil, CoQ10, flaxseed oil, calcium, dandelion root, slippery elm bark, multi-vitamin, vitamin c, milk thistle, bilberry, mushroom immune formula, black elderberry, oil of oregano, beet root, hawt

Current Illness: None

ID: 1066793
Sex: M
Age: 81
State: AZ

Vax Date: 02/12/2021
Onset Date: 02/26/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Was scheduled before 4 day grace period and was sent away when we tried to get 2nd Dose on 02/26/21 at same facility

Other Meds:

Current Illness:

ID: 1066794
Sex: M
Age: 60
State: TX

Vax Date: 02/26/2021
Onset Date: 02/28/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Large swelling in armpit nearest injection site.

Other Meds: Telmisartan Rosuvastatin Levothyroxin

Current Illness: None

ID: 1066795
Sex: M
Age: 34
State: NC

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Felt tired slightly achy around 8:00PM. When to bed and woke up with symptoms. Fever 101, chills, body aches. Symptoms did not self resolve. Took 800mg Ibuprofen and symptoms slowly resolved by 8 AM the next morning.

Other Meds: none

Current Illness: none

ID: 1066796
Sex: M
Age: 69
State: AZ

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

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

Lab Data:

Allergies: None

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

Symptoms: Moderate Dizziness and Fatigue. Went to bed and slept almost 5 hours. No adverse effects after waking up, however I am still somewhat tired.

Other Meds: Diabetic Medications, HBP Medications, also Retacrit injections to increase Red Blood Count

Current Illness: None

ID: 1066797
Sex: M
Age: 90
State: OH

Vax Date: 02/25/2021
Onset Date: 02/27/2021
Rec V Date: 03/02/2021
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: Penicillin and x-ray die.

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

Symptoms: Woke with severe Body Aches , chills and fatigue Two days later shoulder pain, rash at swollen site.

Other Meds: Torsemide 10 MG, 1 tab daily Spironolactone Tab 25 MG 1/2 tab daily, Quinapril Hydrochloride Tab 40 MG 1 Tab daily, Rosuvastatin Calcium Tab 10, twice a week. Azopt SUS 1% OP - in still 1 drop into both eyes twice daily

Current Illness: None

ID: 1066798
Sex: F
Age: 75
State: ID

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/02/2021
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: NKDA

Symptom List: Tremor

Symptoms: itching tongue face lips, mild swollen tongue and lips, neck pain, hoarse voice, cough, pale. Progressively worse in order listed over 10 minutes. Chewable benadryl 12.5 mg x 4 given. Pt reported improved symptoms within 10 minutes and was asymptomatic at 30 minutes.

Other Meds: None

Current Illness: None

ID: 1066799
Sex: F
Age: 91
State: OR

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient was given 0.5 ml, IM, rt deltoid, Moderna vaccine instead of the Pfizer vaccine for the second shot in the Covid vaccine series. No immediate adverse reaction from patient after 15 mins of monitoring.

Other Meds:

Current Illness:

ID: 1066800
Sex: F
Age: 45
State: CA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/02/2021
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: pt with sensation of tingling of the right lower leg 10 min after first covid vaccination. pt denies, rash, flushing, hives, chest pain, palpitation, shortness of breath, wheezing , stridor or altered mental status. symptoms resolved 40 min without intervention except observation and reassurance. pt instructed to follow up with pcp

Other Meds: none

Current Illness: none

ID: 1066801
Sex: M
Age: 69
State: CO

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 03/02/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: sore arm overnight

Other Meds:

Current Illness:

ID: 1066802
Sex: F
Age: 39
State: MN

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 03/02/2021
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: Felt like a baseball in my arm, could not move my arm to the side for three days, then still tender to touch for another 3 days. I could move my arm forward, just not side or backwards.

Other Meds: Spironolacone, allegra, azelastine

Current Illness:

ID: 1066803
Sex: F
Age: 47
State: NC

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/02/2021
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: None

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

Symptoms: Was fine after vaccine was given, 2 hours later arm was sore, 3 hours later face was flushed and felt warm. Started feeling off, 5 hours after receiving vaccine I had the chills and felt achy all over. Took 500 mg of Tylenol felt better but had a low grade fever 100.4. 12 hours after shot was given woke up at midnight chills, body aches, heart racing, chest felt very heavy, mouth was watering, felt a little nauseous. Chills got worse all night, shaking, teeth chattering, took temperature at 6:00am fever was 103.1. Felt terrible whole body ached, arm where injection was given was very painful to move. Took 250 mg of Tylenol stayed in bed two and half hours later fever was lower 100.5. Body aches all day, bad headache that was all over my head, shoulders, arm where shot was given, and lower back were the most sore. Drank lots of water, Now 29 hours post vaccine no more fever but still body aches and headache. Took 250mg Tylenol. Slept fine woke up next day and only symptom was headache. 48 hours post vaccine. 72 hours after feel better just a headache but tolerable.

Other Meds: None

Current Illness: Covid positive December 13, 2020

ID: 1066804
Sex: M
Age: 22
State: MD

Vax Date: 02/01/2021
Onset Date: 02/05/2021
Rec V Date: 03/02/2021
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: none

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

Symptoms: skin rash developped 4-5 days after vaccination. asymptomatic oval shaped pink papules with colarette of scale and some with central necrosis. skin biopsy diagnosed as Pityriasis Lichenoides et varieliformis Acuta: PLEVA

Other Meds: none

Current Illness: aphthous ulcer

ID: 1066805
Sex: F
Age: 36
State: CA

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

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

Lab Data:

Allergies: nka

Symptom List: Pain in extremity

Symptoms: Within 5 minutes of vaccine left arm felt heavy and numb. Pt kept extra 15 minutes. Heavy feelin and numbness resolved prior to leaving with her husband.

Other Meds: none

Current Illness: none

ID: 1066806
Sex: F
Age: 18
State: NH

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Roughly 16 hours after receiving the first Moderna vaccine for COVID, woke up with dizziness, loss of vision for a few minutes, shakiness, low grade fever, paleness, shaky walking ability, nausea, and loss of bowels in her clothing.

Other Meds: Levoxyl, zyrtec, vitamin D, birth control pill, flintstone's multi-vitamin

Current Illness: None

ID: 1066807
Sex: F
Age: 32
State: NY

Vax Date: 01/30/2021
Onset Date: 02/11/2021
Rec V Date: 03/02/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: environmental allergies only

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

Symptoms: Gestational hypertension systolic 150, diastolic 100-109. Was first observed at during labor but did not continue through the course of that hospital stay. Patient was discharged 2/9 and instructed to monitor blood pressure at home once a day. Patient reports feeling slightly short of breath at home and symptoms were worsening. Patient experienced lightheadedness on 2/11. 2/11 was instructed to come to the hospital

Other Meds: Pre natal, monthly allergy shots

Current Illness:

ID: 1066808
Sex: F
Age: 44
State: PA

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 03/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: CHIEF COMPLAINT: SWELLING IN ANKLES X24 HOURS. PATIENT EXPERIENCED SWELLING IN MOST JOINTS THE MORNING AFTER RECEIVING HER SECOND COVID-19 VACCINATION; THIS BEGAN AT APPROX. 08:00AM ON 2-25-21 AND LASTED FOR A TOTAL OF 24 HOURS. SWELLING WAS MAINLY LOCALIZED TO ANKLES, WRISTS, FINGERS (IN ORDER OF SEVERITY.) PATIENT EXPERIENCED FEVER AT APPROX. 23:59PM ON 2-25-21 WHICH WAS RESOLVED BY THE FOLLOWING MORNING S/P TREATMENT WITH IBUOROFEN OTC. ALL SX (SWELLING/FEVER RESOLVED BY 08:00AM ON 2-26-21.

Other Meds:

Current Illness:

ID: 1066809
Sex: F
Age: 80
State: CA

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/02/2021
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: None

Symptom List: Vomiting

Symptoms: I woke up next morning with a Herpes outbreak. I usually have a warning in advance. The site (on my lower backside) tingles and warns me of what is coming. This was different. No warning. Two bumps (or lumps) were there where they always appear. I haven't had an outbreak for at least 6 months. My feeling is that is came on from the vaccine, though I have no proof other than it came after the shot. It may have come on earlier than 7 a.m., but I wasn't aware of it until I woke up. I usually take valacyclovir 500 mg when it starts but I am going to wait a few days as I don't want it to interfere with the vaccine. However I will check with my doctor to get his advice.

Other Meds: Levothyroxine 0.05 mg 1 per day

Current Illness: None

ID: 1066810
Sex: M
Age: 44
State: OH

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 03/02/2021
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: UNKNOWN

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: CLIENT STATES LEFT UPPER ARM DISCOMFORT BEGAN SOON AFTER VACCINATION ADMINISTRATION AND CONTINUED 3-7 DAYS OF MODERATE TO SEVERE DISCOMFORT. HE STATES THERE IS LINGERING DISCOMFORTT,MUSCLE WEAKNESS, AND DECREASED RANGE OF MOTION. HE DID RECEIVE THE 2ND DOSE OF MODERNA ON 2/9/2021, AND AFTER THIS DOSE DISCOMFORT LASTED 3-4 DAYS, BUT HAS SINCE CEASED. WHEN ASKED- HE INDICATES AREA OF INJECTION WAS APPROXIMATELY 3" BELOW THE ACRONIUM PROCESS. NO DISCOLORATION OR OTHER INDICATION VISIBLE TODAY. LEFT ARM WAS OBSERVED TO MOVE IN ALL DIRECTIONS.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1066811
Sex: F
Age: 45
State: WI

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

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

Lab Data:

Allergies:

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

Symptoms: Patient received 2nd Moderna vaccine at 1145. At approximately 1157 patient complained of feeling dizzy and chest discomfort. BP 160/82, pulse 81 and regular. At 1204 BP 151/93, pulse 78. At 1209 patient complained of increased dizziness and chest pain. BP 165/105, pulse 86. Patient was taken to ED.

Other Meds:

Current Illness:

ID: 1066812
Sex: F
Age: 42
State: HI

Vax Date: 02/27/2021
Onset Date: 03/01/2021
Rec V Date: 03/02/2021
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: Azithromycin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Large red circle around the site. Arm very sore and itchy. Taking antihistamine reduced symptoms. Circle about 4 inches in diameter.

Other Meds:

Current Illness:

ID: 1066813
Sex: M
Age: 61
State: NJ

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

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

Lab Data:

Allergies: NKA

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

Symptoms: On 3/2 there was the 3rd visit clinic for this facility. They registered this patient to receive their second dose. Only upon returning to the pharmacy to process the paperwork did our records indicate that he in fact has already received 2 previous doses. Facility was contacted, and internal reporting was completed.

Other Meds: unknown

Current Illness:

ID: 1066814
Sex: F
Age: 48
State: TX

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 03/02/2021
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: Penicillin

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

Symptoms: Dizziness tiredness headache nausea body aches no energy

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm