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: 1116255
Sex: F
Age: 71
State: WA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: After receiving 2nd dose: Redness, swelling, pain, itching and "hot to the touch. Redness injection site 4" diameter 5 days. Fever for 3 days. >than 102 at times Extreme chills, joint ache and muscle aches Bowel cramping Increased fatigue after day 3

Other Meds:

Current Illness:

ID: 1116256
Sex: F
Age: 66
State: CA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: shellfish, sulfa drugs

Symptom List: Anxiety, Dyspnoea

Symptoms: Tingling and numbness of lips within 30 minutes of injection 25 mg benadryl within a few hours, numbness subsided this also happened with first dose

Other Meds: none

Current Illness: none

ID: 1116257
Sex: F
Age: 60
State: AK

Vax Date: 03/09/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Had vaccine on Tuesday, 3/9 and on Thrusday night and Friday evening , my right elbow area was very sore. The pain is very localized and responded to a couple of days of ibuprophen. Started again this week and the arm is swollen/inflammed. Uncomfortable for daily activities like typing or eating. Does respond to ibuprophen. Trying to rest it and have it in sling to rest it.

Other Meds: Olmesartan Medoxomil-HCTZ 20-125 Symbicort Vitamin D Tumeric

Current Illness: none

ID: 1116258
Sex: F
Age: 49
State: TX

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: codeine and latex

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Itching on my legs. no welts or hives. just itchy skin overnight. when I woke up I did have welts and where any pressure is applied to my skin a welt forms and swells and itches. (example, I held my purse strap on my shoulder and when I put my purse down there was itchy redness and a welt where the strap applied pressure.) These welts are all over my body. Back, under my breasts, legs, arms etc. and one on my face.

Other Meds: doxycycline hyclate, vitamin D, zinc, calcium

Current Illness: Covid-02/04/2021

Date Died: 02/13/2021

ID: 1116259
Sex: M
Age:
State: CA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Death; not able to stand up or walk; extreme weakness; he did not feel well; not able to stand up or walk; A spontaneous report was received from the patient's wife concerning a male (age not provided) who experienced extreme weakness/asthenia, did not feel well/malaise, unable to walk/gait inability, and unable to stand/dysstasia. The patient's medical history included lung disease which required oxygen support. Per patient's wife, no concomitant products were in use within two weeks of the event. The patient's wife also stated he does not take any daily medications. On 21 Jan 2021, prior to the onset of events, the patient received the first of two planned doses of mRNA-1273 ( Batch number 029L20A) by injection into his left arm for prophylaxis of Covid-19 infection. After receiving the vaccine, the patient's wife stated he did not feel well. He experienced extreme weakness. He was not able to stand up or walk for the first few days after getting the shot. "He could not walk even 3 steps and get in the car". On 09 Feb 2021, the patient felt a little bit better and could walk from one bedroom to another. No Medications were used to treat the patient's symptoms. No relevant medical tests were provided. The patient had an appointment with his healthcare provider (date and time not provided) and was told he could not get the second dose of vaccine unless he got better. The patient's wife stated she is not blaming the vaccine because her husband had a lung disease prior to getting the vaccine. His doctor said, (per his wife) this lung disease had weakened him to the point he could not drive his car anymore. His brain was fine before the vaccine. On 03 Mar 2021, the patient's wife called to say that the patient had finally passed away on 13 Feb 2021. The second dose of mRNA-1273 was withheld in response to the events while waiting for the patient's condition to improve however; it was never given due to the patient's death. The events of did not feel well, extreme weakness, unable to walk, and unable to stand were not resolved (presumably) prior to the patient's death. The patient died on 13 Feb 2021. The cause of death was not provided. Plans for an autopsy were not provided. Company Comment: The reported events, death, malaise, asthenia, gait inability, and dysstasia were considered possibly related to mRNA-1273.; Reporter's Comments: This is a case of death in a male subject with a hx of lung disease requiring oxygen, who died 23 days after receiving first dose of vaccine. Very limited information is available and based on the reporter's causality assessment the event is considered unlikely related to the vaccine"; Reported Cause(s) of Death: cause of death unknown

Other Meds:

Current Illness: Lung disease (on oxygen support prior to vaccination)

ID: 1116260
Sex: M
Age: 49
State:

Vax Date: 03/01/2021
Onset Date: 03/14/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: fever, altered mental status, aseptic meningitis.

Other Meds: none

Current Illness: none

ID: 1116261
Sex: F
Age: 56
State: CT

Vax Date: 01/25/2021
Onset Date: 02/16/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: IVP dye Tessalon Pearls Z-pack

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 2/16/21 Rash that started on right chest wall. had physician assistant look at it and stated looks like herpes zoster. 2/17/21 did not progress and no pain did not think it was herpes zoster. 2/18/21 went to emergency department and diagnosed with shingles

Other Meds: Vitamin D Valsartan Diclofenac Eftradiol-norethindrone Synthroid Symbicort inhaler Protonix

Current Illness:

ID: 1116262
Sex: F
Age: 57
State: AZ

Vax Date: 03/04/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: codiene

Symptom List: Pharyngeal swelling

Symptoms: Fever of 101 Chills Headache Body aches Fatigue

Other Meds: Losartan, 50mg Vitamin D3 50mcg Flaxseed Oil, 1400 mg Centrum Multivitamin

Current Illness: none

ID: 1116263
Sex: F
Age: 70
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Due to an error in mixing, the patient received the diluent only

Other Meds:

Current Illness:

ID: 1116264
Sex: M
Age: 24
State: VA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient became hot and receiving the injection and he passed out. Upon arrival, patient was sweating profusely and was pale.

Other Meds:

Current Illness:

ID: 1116265
Sex: F
Age: 63
State: MT

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: Betadine

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

Symptoms: At abut 8am March 11 - about 12 hours after receiving vaccine - I got very achy, particularly in my arms and back. I had a headache. My temp reached 102.2 but went down by taking Tylenol. I was very tired and slept most of the day. The second day, March 12, I felt somewhat better but was still very tired and I slept about 3 hours. By 6pm that night - 48 hours after having my vaccine - I felt fine. Note: I think I had Covid last November. I was sick for about 5 days. My test at that time was negative, my husband's positive. We had the same symptoms.

Other Meds: Venlafaxine HCI ER, 75mg Estra/Noreth 0.5-0.1 mg Pramipexole Dihydrocholoride 0.25 mg

Current Illness: none

ID: 1116266
Sex: F
Age: 54
State: NJ

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient received 2nd dose less than 24 days from 1st dose at only 23 days apart.

Other Meds:

Current Illness:

ID: 1116267
Sex: F
Age: 16
State: NH

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: No sx, Pt not in the correct age range for this vaccine.

Other Meds: None

Current Illness: None

ID: 1116268
Sex: F
Age: 64
State:

Vax Date: 01/27/2021
Onset Date:
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: She didn't receive the full dose; Red patch, is hot; It can be itchy; Arm is still red and swollen; Arm is still red and swollen; A spontaneous report (United States) was received from a consumer concerning a 64-year-old, female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced arm has a big red patch/erythema, was hot/feeling hot, swollen/swelling, it can be itchy/pruritis and did not receive full dose/accidental underdose. The patient's medical history was not provided. No relevant concomitant medications were reported. On 27 Jan 2021, prior to the onset of the events, the patient received their dose of mRNA-1273 (Batch Number: 028L20a) for prophylaxis of COVID-19 infection. On an unspecified date, the patient experienced the events big red patch, red patch was hot and swollen. The patient stated big red patch can be itchy. The doctor was concerned that some of the band aid went into arm or the patient did not received full dose. Treatment details included cephalexin and a topical cream fluocinonide. Action taken with mRNA-1273 with respect to the events was not reported. The outcome of the event, accidental underdose was considered as resolved. The outcome of the events, big red patch, red patch was hot and swollen and itchy was not reported.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the se events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1116269
Sex: M
Age:
State: GA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: Patient stated that he felt faint and started to sweat profusely, got very pale in color. as soon as he received his vaccine. This was approximately 1140. I then laid him back in the drivers seat, put a cold wet cloth on his neck and forehead. Initial vital signs were: 97% 02, 60 pulse and 116/62 BP. He states that he has high blood pressure. Pressures taken every 5 minutes, 98%, 65 pulse 102/68 pulse, 1152: 118/70, 98, 71. 1156: 118/78, 98,81 1158: 124/84, 99%, 72

Other Meds: n/a

Current Illness: n/a

ID: 1116270
Sex: F
Age: 82
State: VA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Incorrect Reconstitution

Other Meds:

Current Illness:

ID: 1116271
Sex: F
Age: 62
State: ND

Vax Date: 02/24/2021
Onset Date: 03/04/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: itching,bruising at injection site, down to elbow

Other Meds: celebrex, once a day

Current Illness:

ID: 1116272
Sex: F
Age: 22
State: VA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 09:55 --pt received injection (pt has hx of nausea but no vomiting with any needle injection including blood draw) 10:00--Pt reports nausea and dizziness ---Paramedics called. Pt refused IV fluid --so no IV was inserted. 10:04---Pt vomits. No blood noted. (B/P = 110/60, o2=99%, pulse = 80, R20 10:07--Paramedics arrived--Pt refused Paramedics. B/P93/61 (pt reports that B/P is normal for her. 10:19 ----pt states that she feels better after the vomit --Discharged. pt ambulated with no assistance. denied any dizziness or nausea.

Other Meds: None

Current Illness: None

ID: 1116273
Sex: F
Age: 50
State: FL

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: sesame seed, trees, grass, fragrances, dog hairs,

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Large irratating knots over my body mostly on the left side.

Other Meds: Losartan, Symbicort, Singular, Hydrochlorothiazide, Flonase

Current Illness:

ID: 1116274
Sex: M
Age: 57
State: MA

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

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

Lab Data:

Allergies: hazelnut sage sulfite

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

Symptoms: abnormal sensation throughout the left side of his face associated headache in the back left side of the head normal examination

Other Meds: FLUTICASONE PROPIONATE LATANOPROST LOSARTAN MECLIZINE VALACYCLOVIR CETIRIZINE [ALL DAY ALLERGY (CETIRIZINE)] CHOLECALCIFEROL (VITAMIN D3) CYANOCOBALAMIN (VITAMIN B-12) [VITAMIN B-12] RED YEAST RICE VITAMIN B COMPLEX

Current Illness: n/a

ID: 1116275
Sex: F
Age: 76
State: PA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: Codeine, Cipro

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

Symptoms: Pt reported "feeling funny" several minutes after receiving the vaccine. The individual was moved from a vaccination pod to an observation area where she was monitored and observed for 30 minutes. Vitals: 1340 95/63, HR 82, 94% on room air; 1350 100/64, HR 70, 94% on room air. Pt verified symptoms resolved and was escorted via ambulation out of facility.

Other Meds: xanax, statin

Current Illness: Hypertension, cholesterol, anxiety, stroke

ID: 1116276
Sex: F
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Cytoquin storm; Severe inflammation in nerves; Severe inflammation in muscle; A spontaneous report was received from a healthcare professional concerning a female patient of unspecified age who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the events cytokine storm, sever nerves inflammation (central nervous system inflammation) and severe muscle inflammation(myositis) The patient's medical history was not reported. Concomitant products information was not reported. On unspecified date, prior to the onset of event the patient received their one of two planned doses of mRNA-1273 (batch number:unknown) for prophylaxis of COVID-19 infection. On unspecified date after receiving vaccine the patient experienced the events cytokine storm, severe nerves and muscle inflammation. Action taken with mRNA-1273 in response to the event was not provided. Treatment information was not provided. On 26 Feb 2021 the outcome of the events cytokine storm, severe nerves and muscle inflammation was unknown.; Reporter's Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested

Other Meds:

Current Illness:

ID: 1116278
Sex: F
Age: 28
State: PA

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient passed out after receiving the Pfizer covid vaccine from a sitting chair position.

Other Meds:

Current Illness:

ID: 1116279
Sex: F
Age: 48
State: PA

Vax Date: 03/08/2021
Onset Date: 03/15/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: Azithromycin

Symptom List: Injection site pain, Pain

Symptoms: Left arm swelling, red patch (about 4 inches by 4 inches) near injection site, itching, painful gland under arm. Symptoms began 7 days after injection. Symptoms are improving.

Other Meds: None

Current Illness: None

ID: 1116280
Sex: F
Age: 68
State: IN

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

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

Lab Data:

Allergies: Welbutrin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Nausea joint pain muscle pain headache tiredness

Other Meds: Numerous

Current Illness: Migraine

ID: 1116281
Sex: U
Age:
State: IL

Vax Date:
Onset Date:
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: CHILLS AND HEADACHES

Other Meds:

Current Illness:

ID: 1116282
Sex: F
Age: 64
State: WI

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: Keflex

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: In the same area as my shingles virus, which is well on its way to healing, I developed a rash about 6 or 7 hours after the vaccine. The rash is small red markings that look like hives and it is unbelievably itchy. I took benadryl which reduced the itching within 4 hours, but did not appear to impact the rash. Today is day 1 after my vaccine, so I am watching the rash to see if and how it progresses over the next 48 hours.

Other Meds: Sumatriptan, Gabapentin, Ibuprofen, Red Yeast Rice, CoQ10, Vitamin D, Omega 3 Fish Oil, Vitamin B Complex, Digestive Enzymes, Candida Cleanse Supplement

Current Illness: Shingles. I completed a week of Valtrex the day before my vaccine and was on Gabapentin at the time of the vaccine.

ID: 1116283
Sex: F
Age: 56
State: MO

Vax Date: 01/27/2021
Onset Date: 02/01/2021
Rec V Date: 03/19/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: C. Diff bacterial infection; A spontaneous report was received from a consumer concerning a 56-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced Clostridium difficile infection. The patient's medical history included a broken nose in early January. No relevant concomitant medications were reported. On 27 Jan 2021, approximately one week prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Batch Number: 030L20A) intramuscularly for prophylaxis of COVID-19 infection. On an unspecified date, the patient was hospitalized for Clostridium difficile infection. No treatment information was provided. Action taken with mRNA-1273 in response to the event Clostridium difficile infection was not reported. The outcome of the event Clostridium difficile infection was not reported.; Reporter's Comments: Very limited information regarding the events has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1116284
Sex: F
Age: 50
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: 0

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

Symptoms: Strong metallic taste in mouth

Other Meds: 0

Current Illness: 0

ID: 1116285
Sex: F
Age: 67
State:

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: NUMBNESS IN UPPER LIP AND NOSE, CHECKED OUT BY EMS AND VITALS TAKEN, MONITORED AND THE RELEASED

Other Meds:

Current Illness:

ID: 1116286
Sex: F
Age: 63
State: IN

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Headache, body aches, fever, chills, light-headed, nauseous, heart rate went from 92-176 in a few minutes.

Other Meds: Omeprazole

Current Illness: None

ID: 1116287
Sex: M
Age: 57
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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Allergies:

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

Symptoms: Due to an error in mixing, the patient received only the diluent

Other Meds:

Current Illness:

ID: 1116288
Sex: F
Age: 43
State: IL

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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Allergies:

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

Symptoms: Pain at injection site, large red area surrounding injection site

Other Meds:

Current Illness:

ID: 1116289
Sex: F
Age: 72
State: OR

Vax Date: 02/27/2021
Onset Date: 02/28/2021
Rec V Date: 03/19/2021
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Lab Data:

Allergies: chantix

Symptom List: Tremor

Symptoms: sore arm, chills, and extreme urge to urinate lasted 1 hr took oxycodone/tylenol. exhausted next 24hr

Other Meds: lisinopril , atorvastin, mult vit vit b complex magnesuium aspirin 81

Current Illness: none

ID: 1116290
Sex: F
Age: 77
State: AZ

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/19/2021
Hospital:

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Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: still having problems breathing; anaphylactic reaction; A spontaneous report was received from a consumer concerning a77-year-old, female patient who developed anaphylactic reaction and still having problems breathing (dyspnea). The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received the unknown of two planned doses of mRNA-1273 (Batch number: 030M20A) on 24 Feb 2021 intramuscularly at unknown injection site for prophylaxis of COVID-19 infection. On 24 Feb 2021 the patient experienced anaphylactic reaction (lips went numb, face went numb, blood pressure went up, heart rate went up, her throat closed, and she couldn't breathe or talk). An ambulance was called and the patient was transferred to the ER (emergency room) where they administered intravenous diphenhydramine. Five hours later, the patient was okay, but reported that as of 25 Feb 2021, they are still having problems breathing. Treatment of the events included prednisone and diphenhydramine. Action taken with mRNA-1273 in response to the event was not provided. The event anaphylactic reaction was considered resolved. The outcome of the event, still having problems breathing, was unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1116291
Sex: F
Age: 63
State: CA

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 03/19/2021
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Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: When I first got it, I felt okay, but as I was walking out, I felt disoriented and had to sit down. I was very lightheaded and uneasy. I stayed about an hour because I was scared to drive. I later got chills and fever for about 24 hours. I eventually developed shortness of breath, headaches, dizziness, tightness in my throat, bruising in my legs and painful lymph nodes in my neck and arms. One day, I felt like I was having a mini-stroke. It only lasted for a brief period and then went away. That has occurred multiple times. My doctor thinks some of my issues were due to anxiety, but I don't agree because I'm fine now.

Other Meds: Vitamins C and D

Current Illness:

ID: 1116292
Sex: F
Age: 56
State: NC

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
Hospital:

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Lab Data:

Allergies: Pain medicines, Sulfa drugs

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

Symptoms: Large area swollen, dark red rash, dizziness, sick feeling

Other Meds: Rosuvastatin 10 mg, Diltiazem 180 mg, Diltiazem 180 mg, Trazodone 50 mg, Cetirizine 10 mg, Buspirone 5 mg, Pantoprazole 20 mg, Ibuprofen 200 mg (3 tablets)

Current Illness:

ID: 1116293
Sex: F
Age: 62
State: IN

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
Hospital:

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Lab Data:

Allergies: Nsaids, sulfa

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Slight fever, chills, nausea. Lasted about 10 hours.

Other Meds: None

Current Illness: None

ID: 1116294
Sex: F
Age: 68
State: MN

Vax Date: 03/01/2021
Onset Date: 03/08/2021
Rec V Date: 03/19/2021
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Lab Data:

Allergies: No known allergies

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

Symptoms: Day of vaccine - violent vomiting; Day 3 - Forearms began to itch, rash appeared during evening. I applied Hydrocortisone; Day 4 to present -rash has spread over arms, down my legs, and lower back region. Today - I applied Hydrocortisone and took a Benadryl pill. This rash itches!!

Other Meds: Tolterodine 4mg tab; Mirtrazapine 7.5 mg.tag; Pravastatin 20 mg tab; Trazadone 50 mg tab; Venlafaxine HGL 225 mg

Current Illness: None

ID: 1116295
Sex: M
Age: 15
State: HI

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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Allergies: Amoxicillin

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

Symptoms: Pt developed hives on his back and his eyes started to swell 3 hours after administration. MOP gave pt Benadryl and symptoms subsided.

Other Meds: clindamycin phosphate, 1 %, SOLUTION, TOPICAL; benzoyl peroxide, 5 %, CLEANSER, TOPICAL; Carboxymethylcellulose Sodium, 0.5 %, (Refresh Tears) Drops, Ophthalmic

Current Illness: ACNE VULGARIS

ID: 1116296
Sex: F
Age: 40
State: NJ

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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Allergies: none

Symptom List: Pain in extremity

Symptoms: I began to feel very itchy all over my body within 30-60 minutes, I felt swollen in my hand, feet, tongue, my mouth and throat felt itchy, the itching got so bad that i had hives in some places such as my forearm and legs and skin just felt like it was on fire, I had issues breathing and felt as though someone was sitting on my chest, i have been shortness of breath since and have trouble catching my breath.. This was all that same night. The next day I had the same issues adding the sore arm of the injection site and feeling very tired all day. the next day from there am I am feeling better but am still experiencing shortness of breath, I am using my inhaler, I am still itchy but not as severe as the first night or next day. The arm tenderness has gone unless you touch the injection site and am no longer feeling over tired.

Other Meds: Zyrtec, Flonase, biotin, oil of oregano, proair

Current Illness: allergies

ID: 1116297
Sex: F
Age: 74
State: VA

Vax Date: 11/17/2020
Onset Date: 11/18/2020
Rec V Date: 03/19/2021
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Lab Data:

Allergies: Yes. All of above

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

Symptoms: None stated.

Other Meds: Tylenol Zyrtec

Current Illness: None

ID: 1116298
Sex: M
Age: 57
State: CT

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 03/19/2021
Hospital:

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Allergies: Chocolate

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

Symptoms: Headache, fever of 101 and chills

Other Meds: Montelukast, Flovent. Azelastine-fluticasone nasal spray, Allegra.

Current Illness: none

ID: 1116299
Sex: F
Age: 80
State: KS

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 03/19/2021
Hospital: Y

Vax Type:
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Allergies:

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

Symptoms: Vibrating from my waist to my neck; Atrial fibrillation; Really tired; Felt lousy; Extreme thirst; I've lost 8 lbs from the last month or two; A spontaneous report was received from an consumer concerning a 70 years old, female patient who experienced atrial fibrillation, tired out, vibrating from waist to neck, felt lousy, extreme thirst and lost 8 lbs last month. The patient's medical history was not provided. Concomitant product use was none by the reporter. On 01 Feb 2021, prior to the onset of the symptoms, the patient received the first of two planned doses of mRNA-1273 (Batch number: 027L20A) in left arm for prophylaxis of COVID-19 infection. On 01 Mar 2021, prior to the onset of the symptoms, the patient received the second of two planned doses of mRNA-1273 (Batch number not provided) in left arm for prophylaxis of COVID-19 infection. The patient experienced the events tired since an unknown date in Feb 2021; vibrating from my waist to my neck, atrial fibrillation, felt lousy, extreme thirst and lost 8 lbs last month all since 06 Feb 2021. The patient was hospitalized on 06 Feb 2021 and was discharged on 07 Feb 2021. Laboratory investigations included echocardiogram which "turned out ok" and EKG "was ok" both performed on an unknown date in Feb 2021. Treatment for the event included diltiazem and Eliquis both since an unknown date for an unknown indication. The patient received both scheduled doses of mRNA-1273; therefore, action taken with the drug in response to the events is not applicable. The outcome of the events felt very tired, vibrating from my waist to my neck, atrial fibrillation, felt lousy, extreme thirst and lost 8 lbs last month were unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1116300
Sex: M
Age: 67
State: CA

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
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Lab Data:

Allergies: NONE KNOWN

Symptom List: Vomiting

Symptoms: FEVER, CHILLS, HEADACHE, JOINT ACHES, MUSCLE ACHES, NAUSEA, SKIN HURT ON CHEST

Other Meds: ASPIRIN 81 MG. 40 MG OF ATORVASTATIN

Current Illness: NONE

ID: 1116301
Sex: M
Age: 74
State: MD

Vax Date: 03/09/2021
Onset Date: 03/11/2021
Rec V Date: 03/19/2021
Hospital: Y

Vax Type:
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Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Platelets dropped to 1 by March 14, Treated with 2 infusions of platelets and IG drip with prednisone. Platelet count rose to 35 on March 16 and was released from hospital. Platelet count at 165 on march 19, 2021.

Other Meds: lisinopril-hydrocholothiazine 20-12.5 LEVOthyrosine 75 MCG atorvastatin 10 MG

Current Illness: None

ID: 1116302
Sex: F
Age: 54
State: IL

Vax Date: 02/28/2021
Onset Date: 03/08/2021
Rec V Date: 03/19/2021
Hospital:

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Lab Data:

Allergies:

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

Symptoms: Moderna arm?sore arm resolved 3 days after vaccination but then returned 8 days after injection

Other Meds: levothyroxine, P5P, niacinamide, turmeric, glucosamine & MSM, psyllium husk

Current Illness:

ID: 1116303
Sex: M
Age: 1
State: VT

Vax Date: 10/01/2020
Onset Date: 10/06/2020
Rec V Date: 03/19/2021
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Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Developed a fever and fatigue six days after vaccination (10/6/2020). Fever resolved by 10/13/2020 but took about 6 weeks until his mood and energy were back to baseline.

Other Meds: None

Current Illness: None

ID: 1116304
Sex: M
Age: 46
State: KS

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

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Allergies:

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

Symptoms: Progress Notes (Nurse Practitioner) Family Medicine Cosigned by: MD at 3/18/2021 2:57 PM Expand AllCollapse All Subjective male who was seen at Clinic today for his first dose of the COVID 19 vaccination. He was given the Pfizer vaccination in the left deltoid muscle. During his 15 minute waiting period after the injection, the patient began to experience lightheadedness. He denied rash, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, itching, dizziness, facial swelling, lip swelling and tongue swelling. This provider was notified of patient reaction and he was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to blood pressure abnormality , chest pain, collapse, hypotension and rapid progression of symptoms. Pmh: htn, hld and sleep apnea. ALLERGY REVIEW OF SYSTEMS: Patient denies chills, fever, malaise/fatigue, facial swelling, sore throat, frequent throat clearing, eyes watering, eyes itching, cough, chest tightness, shortness of breath, wheezing, rash, hives, itching of skin, vomiting, abdominal pain, muscle aches, joint pain, dizziness and headaches (negative for headaches) Denies vision changes.: +lightheaded, lips tingling: Previous Reactions: none Objective Vitals Vitals: 03/16/21 1429 03/16/21 1432 BP: (!) 182/96 (!) 173/105 Pulse: 86 SpO2: 99% Physical Exam Vitals reviewed. Constitutional: General: He is not in acute distress. Appearance: He is obese. He is not ill-appearing. HENT: Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: Oropharynx is clear. Eyes: Extraocular Movements: Extraocular movements intact. Conjunctiva/sclera: Conjunctivae normal. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds and air entry. Skin: General: Skin is warm. Coloration: Skin is not pale. Findings: No rash. Neurological: General: No focal deficit present. Mental Status: He is alert and oriented to person, place, and time. Psychiatric: Mood and Affect: Mood normal. Thought Content: Thought content normal. Judgment: Judgment normal. Tingling resolved. Still feeling lightheaded. Pt rested and had snacks and water. Slowly lightheadedness was reducing in severity. After 15 minutes of observation, he was able to stand w/o increased lightheadedness. He ambulates the bay w/o difficulty. Assessment/Plan Treatment included: water and snacks Follow up response to treatment: good. Patient discharge: Stable to go home and follow up with PCP. Differential Diagnosis: Vaccine-Related Anxiety (include misc mental health) and Red flag symptoms (CP, SOB, NVD, Visual/Neuro concerns) Lightheadedness/elevated bp. Anxiety as well. Review of his prior bp numbers in epic records show fluctuation of his bp ranging from 180's to 140's. Recommended that he monitor bp at home. He doesn't have red flag symptoms related to elevated bp. He's to follow up with pcp accordingly. Electronically Signed 3/16/2021 2:29 PM

Other Meds:

Current Illness:

ID: 1116305
Sex: F
Age: 64
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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Lab Data:

Allergies:

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

Symptoms: Due to an error in mixing, the patient received diluent only

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 704,237

Page last modified: 26 October 2021 2:21am