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: 0918169
Sex: U
Age:
State: MO

Vax Date:
Onset Date:
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: gave Adacel to an 18 month old with no adverse event; Initial information received on 29-Dec-2020 regarding an unsolicited valid non-serious case from a nurse. This case involves a 18 month old patient who was administered diphtheria-2/tetanus/5 ac pertussis vaccine (Adacel) by mistake (product use issue) (batch number: U6830AA and expiration date: unknown) 4th dose via unknown route in unknown administration site for prophylactic vaccination. The patient's medical history, medical treatment(s), vaccination(s), family history and concomitant medications were not provided. This was an actual medication error case due to the event product use issue (latency: unknown). At the time of reporting, no adverse event was reported. No laboratory data was reported. Disclaimer: This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in directive 2001/83/ec and module VI of the good Pharmacovigilance practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 0918170
Sex: F
Age: 52
State: PA

Vax Date: 10/20/2020
Onset Date: 10/22/2020
Rec V Date: 01/04/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: congestion in her head; tender and painful at the injection site; sore throat; bad cough; achy; Initial information received on 29-Dec-2020 regarding an unsolicited valid non-serious case from a consumer (patient). This case involves a 52 years old female patient who experienced sore throat (oropharyngeal pain), bad cough (cough), was achy (pain), had congestion in her head (head discomfort) and was tender and painful at the injection site (vaccination site pain), while she received vaccine influenza quadrival a-b vaccine [Fluzone Quadrivalent]. The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included sodium (NA). On 20-Oct-2020, the patient received a dose of suspect INFLUENZA QUADRIVAL A-B VACCINE (with unknown strength, formulation, dose, frequency, lot number and expiration date) via unknown route in the right arm for prophylaxis vaccination. On 22-Oct-2020, 2 days after administration of suspect vaccine, sore throat (oropharyngeal pain), bad cough (cough), achy (pain) and stated intense for 3-4 days. On an unknown date, (latency unknown) after administration of suspect vaccine, had congestion in her head (head discomfort) but it was less troublesome than the cough and was tender and painful at the injection site (vaccination site pain). She has had flu vaccines before but did not knew the brand and had not done well with them and stated for many years she did not get a flu vaccine due to this but had to take care of her dad so did this year. No laboratory data was provided. Patient received inhalers and had 2 courses of 10 days steroids, codeine type syrup for cough and it was not reported if the patient received a corrective treatment for other events. At the time of report, the outcome was not resolved for cough and head discomfort while unknown for other events. There would be no information available on the batch number for this case.

Other Meds: NA

Current Illness:

ID: 0918171
Sex: M
Age: 11
State: PA

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: patient received 2 doses of the Fluzone Quadrivalent prefilled syringe 10 minutes apart yesterday with no specific side effects or symptoms; Initial information regarding an unsolicited valid non-serious case received from a healthcare professional on 29-Dec-2020. This case involves a 11-year-old male patient who received 2 doses of the INFLUENZA QUADRIVAL A-B VACCINE [FLUZONE QUADRIVALENT] prefilled syringe 10 minutes apart yesterday with no specific side effects or symptoms (lot UT71151A, expiration date: 30-Jun-2021) for prophylactic vaccination (extra dose administered). The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medication was unknown. This was an actual medication error case due to the event extra dose administered (latency: on the same day). At the time of reporting, no adverse event was reported. Disclaimer: this suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in directive 2001/83/ec and module VI of the good Pharmacovigilance practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. There will be no information available regarding batch number in this case.

Other Meds:

Current Illness:

ID: 0918173
Sex: U
Age:
State: TX

Vax Date: 12/29/2020
Onset Date:
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Menactra mistakenly for HIB with no adverse event; Initial information received on 30-Dec-2020 regarding an unsolicited valid non-serious case from an other health professional. This case involves a 2 month old patient of unknown gender who was administered MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE [MENACTRA] (lot: U6745AB; expiry date 21-Oct-2021) mistakenly for HAEMOPHILUS TYPE B (HIB) VACCINE [HIB] (lot and expiry date unknown) (wrong product administered) both via unknown route in unknown administration site for prophylactic vaccination. The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications were not reported. On 29-Dec-2020, the patient was given correct vaccine and had no reaction to the vaccine. This was an actual medication error case due to the wrong product administered (latency: same day). At the time of reporting, no adverse event was reported. No laboratory data was reported. Disclaimer: This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in directive 2001/83/ec and module VI of the good Pharmacovigilance practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 0918175
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient had swollen lymph nodes under his left arm 3 days after injection was administered. He stayed he had surgery to remove lymph nodes in June 2020.

Other Meds:

Current Illness:

ID: 0918176
Sex: F
Age: 44
State: NC

Vax Date: 01/02/2021
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
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: none

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

Symptoms: Arm pain at injection site, fatigue, mild headache, swollen lymph nodes

Other Meds: Lamictal, zoloft, multivitamin, clonazepam

Current Illness: none

ID: 0918177
Sex: F
Age: 68
State: KY

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/04/2021
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: No

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: riggors, fever,, severe body aches, flank pain, headache, eyes hurt

Other Meds: Ibuprofen

Current Illness: Knee surgery one month prior

ID: 0918178
Sex: M
Age: 26
State: RI

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

Symptom List: Pharyngeal swelling

Symptoms: Patient was anxious when arrived. After receiving the vaccine, felt light headed and revealed he has "spells" of anxiety similar to current experience. Became diaphoretic and needed to lie down.

Other Meds: None

Current Illness:

ID: 0918179
Sex: F
Age: 43
State: PA

Vax Date: 12/22/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: cats, dogs, pitted fruit raspberries seasonal

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: itching, redness and swelling at injection sight. Took Benadryl on 12/31. Reappeared on 1/1, visited Er, got dexamethasone, Pepcid po and bendaryl

Other Meds: humara fluoxetine lorsartan/hctz wellbutrin xl protonix vit d 50,000 singulair

Current Illness:

ID: 0918180
Sex: F
Age: 39
State: NY

Vax Date: 12/28/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
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: NKDA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Itchy around the vaccine site, stiff muscle, sore arm

Other Meds: Metoprolol succinate Escitalopram

Current Illness: None

ID: 0918181
Sex: F
Age: 52
State: OH

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
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: Muscle aches, palm size red ring for 3 days, day 4 rash, Diarrhea, vomiting, arm sore 3 days.

Other Meds: Singulair 10mg

Current Illness: N/A

ID: 0918182
Sex: F
Age: 53
State: RI

Vax Date: 01/03/2021
Onset Date: 01/04/2021
Rec V Date: 01/04/2021
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: codeine, erythromycin, sulfa, hydrocodone

Symptom List: Rash, Urticaria

Symptoms: shortness of breath, hypotension, presumed anaphylaxis

Other Meds: patient denies

Current Illness: patient denies

ID: 0918183
Sex: F
Age: 31
State: RI

Vax Date: 12/27/2020
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Swollen lymph node in left arm 1 week later Swelling in left arm at injection site 1 week later

Other Meds: None

Current Illness: None

ID: 0918184
Sex: M
Age: 60
State: MA

Vax Date: 01/03/2021
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
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: Erythromycin, Niacin

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

Symptoms: Pain at site of injection

Other Meds: Simvastatin, FlowMax, Omega-3

Current Illness: two, low-grade, low-stage bladder tumors

ID: 0918185
Sex: F
Age: 32
State: MI

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Painful/sore joints (shoulders and elbows) for two days. Almost went for treatment after about 48 hrs, but got through a rough night and the next morning it was gone.

Other Meds: Claritin

Current Illness: None

ID: 0918186
Sex: F
Age: 35
State: IN

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Moderate local reaction. Swelling, redness, pain, hot to touch, itchy for 5+ days.

Other Meds: None

Current Illness: None

ID: 0918187
Sex: F
Age: 39
State:

Vax Date: 12/26/2020
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
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: sulfa, ragweed

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

Symptoms: Mild swelling, pain, and itching at the injection site 8 days after injection

Other Meds: cetirizine 10 mg Viactiv 1000 mg calcium/400 IU Vit D

Current Illness: none

ID: 0918188
Sex: F
Age: 58
State: FL

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: MODERNA COVID 19 VACCINE EUA PAIN TENDERNESS SWELLING/ FATIGUE, HEADACHE, MUSCLE PAIN, JOINT PAIN, CHILLS/ THEN CAME THE ALL OVER BODY RASH AND I STILL HAVE THIS

Other Meds:

Current Illness:

ID: 0918189
Sex: F
Age: 60
State: IN

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: penicillin, morphine, cipro

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pfizer-BioNtech COVID-19 Vaccin EUA-. Severe Dizziness, light- headed.

Other Meds: omeprazole, atorvastatin, pilocarpine, baclofen, synthroid, super c complex

Current Illness: none

ID: 0918190
Sex: F
Age: 61
State: MA

Vax Date: 12/23/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Redness to the area after a week. resolved

Other Meds: Fish Oil, Vit D

Current Illness: none

ID: 0918191
Sex: F
Age: 45
State: IL

Vax Date: 12/29/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
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: Penicillin Erythromyacin Tape/Band Aids Dairy Lactose

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

Symptoms: Thursday 12/29/20 : Started wheezing, I am using my nebulizer but the wheezing seems to be getting worse My throat also is swollen and red. Fatigue/sleeping a lot Headache

Other Meds: Diclofenac Fluticasone Prop Nose Spray 2 puffs spiriva inhaler Symbicort 160 FREESTYLE LIBRE 14 DAY SENSOR KIT Vitamin D Calcium w Vitamin D COQ10 Vitamin Probiotic Vitamin Protonix/Pantoprazole Montelukast-Singulair lipitor/atorvastatin

Current Illness: Diverticululitis Flare Up

ID: 0918192
Sex: F
Age: 52
State: OH

Vax Date: 12/31/2020
Onset Date: 01/02/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Doryx; Biaxin; Etodolac; Omnicef Mushrooms & Mussels

Symptom List: Unevaluable event

Symptoms: Very swollen lymph node in front of my left ear.

Other Meds: Allegra B12 Amlodipine Citalopram Omeprazole Synthroid Benadryl

Current Illness: N/A

ID: 0918193
Sex: M
Age: 61
State: NY

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
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: Hazelnuts.

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

Symptoms: Flue like symptoms but no fever.

Other Meds: Low dose aspirin.

Current Illness: None

ID: 0918194
Sex: F
Age: 27
State: NH

Vax Date: 12/29/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
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: sudafed

Symptom List: Injection site pain, Pain

Symptoms: I am currently breastfeeding my 11 month old son. On Thursday, December 31st, 2020 (2 days after receiving my vaccine), my son developed a fever x24-36hours and diarrhea that is still on going as of today (1/4/2021). There are no known exposures for my son and his illness. I am reporting this as a possible reaction to the Moderna COVID 19 vaccine I received that could have some how passed through the breastmilk to him.

Other Meds: birth control, prenatal vitamins, vit D supplement, sunflower lethacin supplement

Current Illness: n/a

ID: 0918195
Sex: F
Age: 39
State: OH

Vax Date: 12/23/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Injection site pain, Menorrhagia

Symptoms: About 1 week after receiving the vaccine (on 12/31/2020) I developed an itchy, raised, and red hive-like rash at the injection site. It got worse over the next day, and I put some steroid cream on it. It went away gradually and was completely resolved by 1/03/2021

Other Meds: Multivitamin

Current Illness: N/A

ID: 0918196
Sex: M
Age: 65
State: WV

Vax Date: 12/23/2020
Onset Date:
Rec V Date: 01/04/2021
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: nka

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

Symptoms: redness and swollen to inj site, rash to hands Benadryl given for sysmptoms

Other Meds: acetaminophen 325mg 2 tabs daily, albuterol inhaler 90 mcg 2 puffs q4, prn, asa 81 mg daily, atorvastatin ca 80 mg daily, lisinopril 10 mg daily, budesonide 80/formoter 4.5 inhaler 2 puffs twice a day, cholecalciferol 50, 000 units take 1 c

Current Illness: Malignant neoplasm of skin, vit d def., ischemic cardiomyopathy, COPD, chronic kidney disease, microscopic hematuria, cad, hyperglycemia, hyperlipidemia, etoh abuse, nicotine dependence, polyosteoarthritis, knee pain, cervicalgia, disorder of kidney and ureter, artificial knee joint

ID: 0918197
Sex: F
Age: 26
State: CT

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
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: Sulfa based drugs, penicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Arm soreness at injection site, worse than a flu shot and starting an hour after the shot and lasting approx 2 days. Increased phelgm production for approx 24 hours following injection.

Other Meds: Allegra allergy medication. Biotin supplement.

Current Illness: N/A

ID: 0918198
Sex: F
Age: 48
State:

Vax Date: 12/24/2020
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
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: Moderna COVID-19 Vaccine On day 9 after injection, began to get itching at the injection site. Now on day 10 with red area ~ 5 cm x 3 cm. Mild fatigue on day 9 as well.

Other Meds: Humira (held for 10 days prior to injection), Celebrex, escitalopram, Vitamin D, Biotin/collagen, folic acid, potassium citrate, slow Mag (magnesium), Myrbetriq,

Current Illness: none- occasional sinus fullness, seems to be allergies

ID: 0918199
Sex: F
Age: 26
State: NH

Vax Date: 12/28/2020
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
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: None known.

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

Symptoms: Moderna COVID-19 Vaccine EUA

Other Meds: Mirena IUD, vitamin d3, fish oil, magnesium, loratidine

Current Illness: None.

ID: 0918200
Sex: F
Age: 27
State: FL

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/04/2021
Hospital: Y

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: Pfizer-BioNTech COVID-19 Vaccine EUA - Patient witnessed another patient with syncope prior to her injection. She was already anxious about receiving vaccination and this increased her anxiety, though she proceeded with immunization. Patient was in 15 min observation window in a chair and began to feel light-headed like she may pass out. A SWAT was called. With RN assistance, patient was lowered to the floor, with no loss of consciousness. Patient was pale and reported anxiety, racing /pounding heart, and felt hot with facial flushing. Patient was transferred to ED and was noted to be tachycardic (120s), but dropped to 80s. She noted that this episode felt different than her prior syncopal episodes associated with anemia. Patient was observed for 5 hours and discharged to home. Patient returned to ED roughly 2.5 hours later complaining of continued dizziness and unsteady gate. Patient was pale and anxious. Patient reported had not eaten/drank enough during her shift and received vaccine immediately post a stressful shift. Additionally, patient witnessed another patient have syncopal episode prior to her receiving her vaccine which made her anxious. Patient was given IV fluids and had electrolytes replacement. Patient additionally received diazepam. Patient was discharged at 2358 on 12/23. Patient returned to ED on 12/24 at 0239 complaining of near syncope and lightheadedness. Patient had tachycardia and self-reported palpitations. Received IV fluids and observation on telemetry with no rhythm disturbance. Patient discharged 1428 on 12/24. On 12/29, patient returned to ED at 0326 for continued dizziness, fatigue and near syncope. Was admitted for cardiac evaluation. Noted to have unprovoked tachycardia and was discharged with a Halter Monitor to evaluate cardiac symptoms. patient was discharged 12/31 at 1619

Other Meds: Unknown

Current Illness: Unknown

ID: 0918201
Sex: F
Age: 50
State: VA

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
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: Received the injection on Wednesday afternoon. I woke up around 3am with an excruciating headache, started vomiting around 6am and continued until 7:30pm. The headache continued and as of this morning 1/4 the headache is still there and my stomach is not settled completely.

Other Meds: Wellbutrin

Current Illness: None

ID: 0918202
Sex: M
Age: 54
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received the vaccine and had slight chest tightness, had a slight headache and has mild nausea. He worked the day and still has the symptoms at 1:30 pm

Other Meds:

Current Illness:

ID: 0918203
Sex: F
Age: 50
State: VA

Vax Date: 12/19/2020
Onset Date: 12/19/2020
Rec V Date: 01/04/2021
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: calamari

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

Symptoms: Pt developed urticaria on both arms 4 hours after COVID vaccine administration. Pt received dexamethasone 10mg IM for treatment and diphenhydramine PO 25 mg. Symptoms subsequently resolved.

Other Meds:

Current Illness: none

ID: 0918204
Sex: F
Age: 27
State: OH

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
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: NKA

Symptom List: Tremor

Symptoms: I received the Moderna COVID-19 vaccine on Tuesday, December 29th at work and on Wednesday, December 30th when I woke up my entire neck had broken out in hives. I did not have hives anywhere else or any other reaction. After taking 25 mg of Benadryl po and applying hydrocortisone cream, the hives had cleared up about 75%. I continued to use the hydrocortisone cream throughout the day, but the hives/redness had fully cleared up by Saturday, January 2nd.

Other Meds: None

Current Illness: None

ID: 0918205
Sex: F
Age: 44
State:

Vax Date: 12/21/2020
Onset Date: 12/23/2020
Rec V Date: 01/04/2021
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: Swollen L armpit, medial, at same side of vaccine. Resolved in 2 days with ibuprofen

Other Meds:

Current Illness:

ID: 0918206
Sex: F
Age: 30
State: MA

Vax Date: 12/22/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
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:

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

Symptoms: Circular redness at injection site about 2 inch in diameter.

Other Meds:

Current Illness:

ID: 0918207
Sex: M
Age: 54
State: FL

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Flu like symptoms (fever, chills, aches, fatigue, headache); redness, swelling, warmth and firmness at injection site

Other Meds: Nothing prior

Current Illness: None

ID: 0918208
Sex: M
Age: 62
State: IN

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/04/2021
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: Pcn.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Stuffy nose tingling lips tingling face i took 50 mg of over the counter benedryl..symptoms resolved

Other Meds: Quinnipiac hctz......atorvastatin...asa 80mg

Current Illness:

ID: 0918209
Sex: F
Age: 52
State: VA

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
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: NKA

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

Symptoms: Arm soreness Arm swelling Headache Right side neck pain Bumps on both cheeks (face)

Other Meds: Xanax Zoloft Atenol

Current Illness: NonFa

ID: 0918210
Sex: F
Age: 31
State: VA

Vax Date: 12/18/2020
Onset Date: 12/18/2020
Rec V Date: 01/04/2021
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:

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

Symptoms: Patient experienced feeling flushed and nauseated after receiving covid vaccine injection. Declines ED evaluation. No further symptoms reported on 12/19 follow-up

Other Meds:

Current Illness:

ID: 0918211
Sex: F
Age: 52
State: FL

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital: Y

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

Lab Data:

Allergies: Benzonatate - brochospasm and laryngospasm requiring intubation NSAIDS - petichiae Keflex - rash - tolerates cefepime Lanolin - rash Septra - rash

Symptom List: Pain in extremity

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA - Patient with history of anaphylaxis requiring intubation to benzonatate. Patient answered "no" to questionnaire about allergic reactions prior to vaccination. 11 minutes after vaccination, patient reported tingling of lips and swelling of face. Developed hoarseness. SWAT was called and patient given benadryl and taken to ED (1055). Patient received steroids and H1/H2 blockers in addition to epinephrine. Patient brought to ICU for monitoring. Patient continued on therapy and was discharged 1/2 at 1113. Patient returned to ED on 1/3 at 1558 with macular papular rash on leg, chest and back with itching on eyelids and face. No respiratory involvement. Patient given benadryl and predinisone and discharged from ED at 2016.

Other Meds: Unknown

Current Illness: Unknown

ID: 0918212
Sex: F
Age: 46
State: MI

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
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: Generalized body aches that evening, same day as injection. Woke up the next morning, 12/31/2020 with a headache, fever of 100.2, and fatigue

Other Meds: None

Current Illness: None

ID: 0918213
Sex: M
Age: 59
State: OH

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
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: Patient knows there is a blood pressure medication that puts him into liver failure, but he is not sure which one

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

Symptoms: Patient had chills and a fever that started on 12/30/2020 @ 12:00am. The highest fever recorded was 100.6. He took Tylenol on 12/30/2020 @ 6:00am. His symptoms resolved on 12/30/2020 at 8:30pm.

Other Meds: Blood pressure medication - patient is unsure of the name

Current Illness: None

ID: 0918214
Sex: F
Age: 43
State: MD

Vax Date: 12/29/2020
Onset Date: 01/02/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Anterior cervical lymphadenopathy on the ipsilateral side of the vaccination. It seemed to begin on the third day but was most pronounced and painful on the fourth day.

Other Meds: none

Current Illness: none

ID: 0918215
Sex: F
Age: 30
State: NC

Vax Date: 12/22/2020
Onset Date: 12/27/2020
Rec V Date: 01/04/2021
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: n/a

Symptom List: Vomiting

Symptoms: Increasing redness and itchiness, swelling, and discomfort at injection site on R arm, delayed response not present at time of injection, symptoms began 12/27/20 and gradually worsened since then, no improving. Tried Benadryl and cold compresses, as well as Tyelnol.

Other Meds: Gianvi, Levothyroxine, Loratadine, Pristiq

Current Illness: none

ID: 0918216
Sex: F
Age: 39
State: SC

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Body aches, stomach cramping, rash on abdomen, arms. Start of period early (last period 12/22). Itchy all over

Other Meds: NONE

Current Illness: none

ID: 0918217
Sex: F
Age: 55
State: ID

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/04/2021
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 developed muscle twitching, fatigue, dizziness and headache minutes after vaccine was given. Day after vaccine given, patient developed small red area around injection site that also had swelling and was warm to touch. No fever or other complication.

Other Meds:

Current Illness:

ID: 0918218
Sex: F
Age: 38
State: MA

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
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: Strawberries

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Hives and facial swelling. Swelling within the ears. Migrain. Nausea.

Other Meds: Celexa 40 mg Seroquel 40 mg

Current Illness: N/A

ID: 0918219
Sex: F
Age: 79
State: DE

Vax Date: 12/20/2020
Onset Date: 12/21/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs

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

Symptoms: As I stated on previous page, had no ill effects from the first shingle shot on 10/21/20 given by Staff at Pharmacy. Had 2nd shot on 12/20/21 by, PA at Pharmacy. Woke up around 2:00 a.m. and the room and bed felt like it was spinning and tilting, never had that feeling before.

Other Meds: Atorvastatin 20 mg Calcium 1200

Current Illness: None

ID: 0918220
Sex: F
Age: 52
State: NY

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
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: Shellfish

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

Symptoms: Severe joint pain, especially in hips, knees and hands lasting approximately 72 hours after first onset of symptoms. Treatment Tylenol/NSAIDs. Resolved on its own.

Other Meds: Edarbyclor

Current Illness: Hypertension

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm