VAERS 2021 Database www.vaers.hhs.gov

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

Total Manufacturer

Incidents per State

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

ID: 1116358
Sex: F
Age: 37
State: IL

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

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Headache and chills

Other Meds:

Current Illness:

ID: 1116359
Sex: F
Age: 34
State: OH

Vax Date: 01/25/2021
Onset Date: 02/18/2021
Rec V Date: 03/19/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: After my second vaccine, and few weeks later, I suffered a miscarriage on 02-18-2021. I went to see my OBGYN who performed an ultrasound. My baby at that time was 6 weeks old.

Other Meds:

Current Illness:

ID: 1116360
Sex: M
Age: 63
State: MD

Vax Date: 03/04/2021
Onset Date: 03/07/2021
Rec V Date: 03/19/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: Developed Shingles

Other Meds: None

Current Illness: None

ID: 1116361
Sex: F
Age: 68
State: MO

Vax Date: 02/26/2021
Onset Date: 03/05/2021
Rec V Date: 03/19/2021
Hospital:

Vax Type:
Manufacturer:
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Vax Site:

Lab Data:

Allergies: No known drug allergies

Symptom List:

Symptoms: Left supraclavicular adenopathy. Mobile 1 cm soft lymph node palpation and may have 2 smaller lymph nodes behind it. I honestly don't think this is an adverse reaction, just a vaccine side effect. However, enlarged lymph nodes in this area of the body do tend to cause some concern for more serious underlying illnesses, so I thought it was worth reporting so that if this is a common side effect, other health care providers can be made aware so that patients can be educated to expect this. Thanks.

Other Meds: metformin, omeprazole, aspirin, albuterol, metoprolol, tizanidine, tramadol, levothyroxine, celecoxib, flecainide, cetirizine, polyethylene glycol, melatonin, multivitamin, calcium, flaxseed oil. topicals: nytstatin, betamethasone valerat

Current Illness: Chest pain admission 2/22-23/2021,. Felt to be due to esophagitis.

ID: 1116362
Sex: M
Age: 73
State: WI

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

Vax Type:
Manufacturer:
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Lot:
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Lab Data:

Allergies: No known allergies

Symptom List:

Symptoms: Syncope and generalized weakness. Blood pressure taken 90/50 with a heart rate of 38. First response notified. Blood pressure repeated 113/56 with a heart rate of 40. Patent was transported to the Emergency Department via first response.

Other Meds: econazole 1% topical cream Efudex 5% cream nitroglycerin ferrous sulfate amiodarone Eliquis Lipitor clopidogrel metoprolol tartrate pantoprazole

Current Illness: Abnormal cardiovascular function study Aortic stenosis Atrial fibrillation Barrett esophagus CAD (coronary artery disease) Depression GERD (gastroesophageal reflux disease) H/O squamous cell carcinoma Mitral regurgitation Prostate cancer

ID: 1116363
Sex: F
Age: 41
State: PA

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

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Lab Data:

Allergies: Anaphylaxis (hay, insects)

Symptom List:

Symptoms: Patient scheduled an appointment with her PCP, on 3/17/21. She presented with 2.5 weeks of flushing, sweats, and intermittent pruritic hives since receiving her first COVID-19 vaccine on 2/27/21. She reports that the pruritis and flushing is worse with exercise. For one week, she has had a pink ovoid lesion 2-3 cm in length on right chin and left neck that are now scabbed without drainage. Neck and chin lesions treated with bactroban, patient is already on antihistamines, and instructed her to follow up if worse.

Other Meds: None

Current Illness: None

ID: 1116364
Sex: F
Age: 38
State: OH

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/19/2021
Hospital:

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Lab Data:

Allergies: nkda or known allergies

Symptom List:

Symptoms: significantly worsened anxiety with panic attacks. Issues have been well controlled until night after vaccine. Hasn't felt well since.

Other Meds: zyrtec, glucosamine chondroitin, probiotic, aviane/alesse, meclizine

Current Illness: none. was doing well though worried about the vaccine and COVID infection

ID: 1116365
Sex: F
Age: 30
State: OH

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

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Lab Data:

Allergies: NSAID

Symptom List:

Symptoms: numbness in face and throat tightness lasting about 1 hour. Eventually went away.

Other Meds: n/a

Current Illness: n/a

ID: 1116366
Sex: F
Age: 66
State: WA

Vax Date: 02/27/2021
Onset Date: 03/14/2021
Rec V Date: 03/19/2021
Hospital: Y

Vax Type:
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Lab Data:

Allergies: crab (vomiting)

Symptom List:

Symptoms: RLQ pain (without radiation), nausea, malaise and some constipation. Patient reported pain to be pressure, sharp and shooting, and 7/10 in intensity. Acute appendicitis and localized peritonitis. Patient underwent laparoscopic appendectomy.

Other Meds: amlodipine 2.5 mg tablet by mouth daily, clonidine 0.1 mg tablet by mouth daily, losartan-hctz 50 mg-12.5 mg 1 tablet daily, raloxifene 60 mg tablet daily, vitamin E 400 unit capsule daily

Current Illness: none

ID: 1116367
Sex: M
Age: 64
State: NE

Vax Date: 03/02/2021
Onset Date: 03/09/2021
Rec V Date: 03/19/2021
Hospital: Y

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Symptom List:

Symptoms: Respiratory failure; Shortness of breath; A spontaneous report was received from a health care professional (physician) concerning a 64 year old male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced shortness of breath and respiratory failure. The patient's medical history was not provided. Concomitant medications included amiodarone, apixaban, atorvastatin calcium, vitamin D, dulaglutide, furosemide, hydralazine, insulin, nifedipine and glyceryl trinitrate. On 02-Mar-2021, the patient received his first dose of mRNA-1273 (Lot number: unknown) for prophylaxis of COVID-19 infection. On 09-Mar-2021, the patient started to experience shortness of breath and had respiratory failure. Patient was admitted to the ICU. The patient was treated with antibiotics, IV fluids, paralytics, sedation medications and cardiac medications. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the events 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 event (dyspnea), a causal relationship cannot be excluded. Very limited information regarding respiratory failure has been provided at this time.

Other Meds: AMIODARONE; ELIQUIS; LIPITOR; VITAMIN D [VITAMIN D NOS]; TRULICITY; LASIX [FUROSEMIDE]; HYDRALAZINE; INSULIN; PROCARDIA [NIFEDIPINE]; NITROGLYCERINE

Current Illness:

ID: 1116368
Sex: F
Age: 71
State: AZ

Vax Date: 03/14/2020
Onset Date: 03/15/2021
Rec V Date: 03/19/2021
Hospital:

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Lab Data:

Allergies: Atopic Dermatitis-> allergy symptoms to many things, I keep allergy-free home, but things are starting to bloom. Possibly penicillin, but unlikely. I can take ampicillin, for example.

Symptom List:

Symptoms: Fatigue, shaky, crooked, ache all over, chills. Vaccine was Sunday pm, reaction started after 4-mile walk Monday pm, missed meeting. Took 2 Tylenol, slept. Tues-Thurs: fatigue, chills, aches, diminished over the days. I rested and slept. Today=Friday, declared myself cured, took shorter walk, got tired, normally don?t get tired. *Today I discovered why I felt crooked: right shoulder higher because it?s swollen, down to mid-way between elbow & wrist, down to waist, some of side of body.* Treatment still only rest, but still I'm not so fatigued, aching easy to ignore. Never had fever (temp around 96.8 which is normal for me). I never felt too bad. Except for overpowering fatigue, I felt like doing things.

Other Meds: Montelukast 10mg at night most nights Wal-Zyr antihistamine most mornings Calcium most days Vitamin D3 2000 most days General multivitamin most days

Current Illness: None

ID: 1116369
Sex: F
Age: 62
State: HI

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

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Lab Data:

Allergies: none

Symptom List:

Symptoms: After client completed 15 minute waiting period, she reported feeling "fuzzy" upon standing. Further described as lightheadedness. Also reported HA that started at nape of neck and extended to forehead. HA described at "dull." Pain 2-3 on 0-10 pain scale. VS assessed. 140/90. Pulse 76. Continued assessment. By 1040 reports pain 3-4/10, but pain only located at left side of forehead. Reports feels much better, besides the HA. Felt well enough to leave. Escorted to car--daughter present and driver.

Other Meds: Lisinopril, Celexa, lomeprasol

Current Illness: none

ID: 1116370
Sex: F
Age: 37
State: IN

Vax Date: 03/08/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
Hospital:

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Lab Data:

Allergies: Amoxicillin, adhesives (tape, band aids)

Symptom List:

Symptoms: Raised, itchy rash on injection arm wrist, same rash across mid torso- appeared approximately 10 days after first shot.

Other Meds: NONE

Current Illness: NONE

ID: 1116371
Sex: M
Age: 66
State:

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/19/2021
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Symptom List:

Symptoms: 0701. Since starting the COVID-19 vaccine program, the has always used the doses before they approached the expiration date. This time, there were 16 vials of the Pfizer vaccine that had not been used and set to expire. The labeled expiration date and time were clearly present on the outside of the bag containing the doses. On the morning of 10 March 2021, a pharmacist retrieved 1 vial at 0754 and 7 vials at 1138 from that allocation and provided them to nursing for the day?s administrations. The pharmacy placed those doses in a new amber bag and did not label the bag with an expiration date and time. The nursing team received the vials, diluted and drew up 20 doses that were administered to patients before 1230. The charge nurse did not question the expiration date until after 20 patients had been vaccinated. At that time she messaged the pharmacist to verify the expiration date. The pharmacist indicated that the label did not state am or pm and misinterpreted the expiration time for the doses as 7:01 PM rather than 7:01 AM. There was not a defined double check at the time of distribution from the pharmacy to nursing The remaining 11 vials were quarantined. The pharmacy manager contacted the manufacturer. According to Pfizer it?s recommended to use the thawed vaccine within 120 hours, but can be used up to 144 hours. The doses in question were administered before 125 hours after they were thawed. The remaining expired vials will be wasted and appropriate notifications sent. Assessment: Twenty patients received Pfizer COVID vaccine 5 hours passed the labeled expiration date and time. While exceeding the manufacturer's recommended beyond use dating, the doses were within the acceptable 144 hours post thaw period and still safe for patient administration. There was misinterpretation of the labeled expiration time by the dispensing pharmacist, the container of COVID vaccine vials provided to nursing was not labeled with an expiration date or time, there was not a double check on hand off, the nursing team did not double check the expiration date/time before dilution or administration. Recommendation: When repackaging COVID Vaccine vials for distribution to vaccination centers, a label including the expiration date and time should be placed on the new container. When COVID vaccine is transferred from one location or department to the next, a double check of the product, quantity, integrity and expiration date and time may prevent a recurrence of this situation.

Other Meds:

Current Illness:

ID: 1116372
Sex: F
Age: 82
State: IA

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

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Lab Data:

Allergies: Flourquinolones. Levaquin and cipro and Avalox

Symptom List:

Symptoms: Body aches. Headaches balance and leg pain

Other Meds: Potassium, plavix,valsartan,hydrochloride,amadolpoline

Current Illness: None

Date Died:

ID: 1116373
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 03/19/2021
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Symptom List:

Symptoms: Passed away; so weak she was no longer able to use her walker and declined steadily each daythereafter; A spontaneous report was received from a consumer concerning a 88-year-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced being so weak she was no longer able to use her walker and declined steadily each day thereafter (asthenia) and passed away (death). The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (Batch number not provided) on an unspecified date. On an unspecified date, approximately 15 days prior to the onset of the symptoms, the patient received their second of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. On an unspecified date, two days after their second dose of the vaccine, the patient was so weak that she was no longer able to use her walker and declined steadily each day thereafter. On an unspecified date, 17 days after their second dose of the vaccine, the patient passed away. Treatment information was not provided. The outcome of the event, asthenia, was unknown. The outcome of the event, passed away (death), was fatal. The cause of death was reported as unknown. Plans for an autopsy were not provided.; Reporter's Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death

Other Meds:

Current Illness:

ID: 1116374
Sex: F
Age: 40
State: NJ

Vax Date: 01/07/2021
Onset Date: 01/14/2021
Rec V Date: 03/19/2021
Hospital:

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Lab Data:

Allergies: No

Symptom List:

Symptoms: A week later, my left arm (a couple inches below the injection site) started itching and I developed a small red patch. It grew to a 3x3 inch path by Friday, the 15th. I increased my Zyrtec - taking an extra one each day. It was gone by Sunday, the 17th. It came back on the Wednesday the 20th - at the same spot. I don't think it went away. And then a week later, 1/28/2021 - I had breakthrough hives again - which can be anywhere on my body. Once my hives started - that spot just stayed - it's just there. (I have chronic hives). (My chronic hives - stays in remission with meds). Other than that one Zyrtec, I had been off my hives medication and in remission from hives for an entire year. On the 29th of January, I had the IUD taken out. When my hives started on 28th, I added medications: I increased to 40 mg Zyrtec; Pepsid - 40 in morning and 40 in night - in addition to all my other meds. I was prescribed Singulair - 10 mg in the morning. This did not resolve my hives. Hives actually got worse during the course of that week up until the second vaccine which was on February 4th. Telehealth visit - and I happened to have an annaul allergy doctor visit on January 25th - who looked at it at that time.

Other Meds: 50 mcg - Levothyroxine; 1 - 10 mg Zyrtec per day; Vit D 1000 IUs; Marena IUD - had had it for about 5 weeks at that point

Current Illness: no

ID: 1116375
Sex: M
Age: 17
State: WI

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

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Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccine given to inappropriate age recipient.

Other Meds:

Current Illness:

ID: 1116376
Sex: F
Age: 17
State: WI

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

Vax Type:
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Symptom List:

Symptoms: Vaccine given to incorrect age recipient

Other Meds:

Current Illness:

Date Died: 03/18/2021

ID: 1116377
Sex: M
Age: 91
State: PA

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/19/2021
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Symptom List:

Symptoms: 91 yo father received vaccine, was mobile and alert before first shot, but required wheelchair by second vaccination due to being weak. After second vaccination, was not able to stand or move after 36 hrs, at which point he was taken to the hospital. At hospital, all vital signs were good except an MRI showed cancer in spine. Shot was given 3/1 and my father passed on 3/18. Obviously this shot did not cause metastatic cancer, but I believe it did induce an inflammatory response of some kind that caused it to progress extremely quickly.

Other Meds:

Current Illness:

ID: 1116378
Sex: F
Age: 63
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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Symptom List:

Symptoms: due to a mixing error, the patient received the diluent only

Other Meds:

Current Illness:

ID: 1116379
Sex: F
Age: 73
State: IN

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

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Lab Data:

Allergies: none

Symptom List:

Symptoms: rapid breathing high blood pressure almost fainted super flushed face

Other Meds: na

Current Illness: no

ID: 1116380
Sex: M
Age: 35
State: SD

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

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Symptom List:

Symptoms: Patient had a Pfizer vaccination on 2/10/21, then received a Janssen vaccination on 3/11/21. No adverse reactions occurred with the Janssen vaccination.

Other Meds:

Current Illness:

ID: 1116381
Sex: F
Age: 72
State: MO

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

Vax Type:
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Symptom List:

Symptoms: could not walk; Lethargic; A spontaneous report was received a consumer (patient's husband) for a 72-year old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced she was lethargic and could not walk. The patient had secondary progressive stage MS. On 25-Feb-2021, the patient received her first of two planned doses of mRNA-1273 (Lot number: 011A21A) intramuscularly for prophylaxis of COVID-19 infection. 20 hours after the injection on 26-Feb-2021 she was lethargic and could not walk. Patient's husband called an ambulance and she was transported to the hospital. The patient was hospitalized at the time of reporting. She was currently needing physical therapy. The patient had a similar event 1 year ago. Seriousness criteria for all events was hospitalization. Treatment information was unknown. Action taken with mRNA-1273 was unknown. The outcome of the events 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: MS (had secondary progressive stage MS)

ID: 1116382
Sex: F
Age: 68
State: MI

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

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Lab Data:

Allergies: Demerol, Lisinopril, Morphine, NSAID's, Steroids, Tetracycline

Symptom List:

Symptoms: c/o numbness and tingling of arms, legs and feet @1342 Given 25mg Benadryl I.M. @ 1343 No respiratory symptoms, swelling, redness, or racing heart. No further c/o requested to go home. Released at 1408

Other Meds: Inderal 120mg BID, Cymalta 60 mg daily, D3 daily, Dovonex 0.005% cream, amLodipine 7.5 mg daily, Pravastatin 10mg daily, Iron 325mg daily, Phenobarbital-hyoscine-atropine every 8 hours

Current Illness:

ID: 1116383
Sex: F
Age: 61
State: MI

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/19/2021
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Symptom List:

Symptoms: DOSE AT 12:50 PM, ABOUT 5 PM GOT VERY NAUSEAND LAID DOWN IN BED ABOUT 8:00 PM, WITHIN MINUTES BECAME VERY VERY COLD. WAS VIOLENTLY SHAKING FROM CHILLS, THEN VIOLENT SHAKING WITH MUSCLE TENSION FOR SEVERAL SECONDS THEN RELAXED FOR A FEW MINUTES THEN MORE TENSION. ALL OF THIS ALONG WITH THE CHILLS.I DO NOT KNOW HOW LONG THIS HAPPENED BEFORE I FELL ASLEEP. NEXT DAY WAS VERY TIRED, AND ACHED ALL OVER AND WAS WEAK.

Other Meds: LAMITCAL, PROPANALOL ER, PROTONIX, CIMETIDINE, CETRIZINE, PRILOSEC, CENTRUM MULTI VITAMIN, VITAMIN D3, LITHIUM, ABILIFY, MAGNESIUM

Current Illness:

ID: 1116384
Sex: M
Age: 32
State: CA

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

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Lab Data:

Allergies:

Symptom List:

Symptoms: felt injection, eyes in disarray, unresponsive, vomiting

Other Meds:

Current Illness: stomach bug

ID: 1116385
Sex: F
Age: 39
State: WA

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

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Allergies:

Symptom List:

Symptoms: Not an ADR, but rather an error. Patient had previously received first dose of COVID vaccination series with Moderna vaccine. Showed up for dose 2 and during check-in process was confirmed to receive Moderna and clinic staff wrote "M" on paperwork to designate Moderna vaccine was indicated. Staff member administering dose was working in a cubicle marked "Pfizer" but patient was triaged to her anyway. Overlooked the "M" on paperwork and administered Pfizer vaccine before error was noted. Patient noted error after 15 minute wait period (which was uneventful). Error being reviewed by vaccine clinic staff to determine if workflow changes are needed. Case will be reviewed by vaccine clinic leadership to determine best course for completing vaccination series.

Other Meds:

Current Illness:

Date Died: 03/18/2021

ID: 1116386
Sex: M
Age: 68
State: CO

Vax Date: 03/12/2021
Onset Date: 03/14/2021
Rec V Date: 03/19/2021
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Allergies: cat dander, diazepam

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Symptoms: Patient developed nausea and vomiting 3/14/21. was seen at clinic by this provider 3/16/21 and reported at that time continued fatigue but overall symptom improvement. Vital signs were stable. pt was advised to orally hydrate and routinely monitor blood sugars and f/u as needed. On 3/18/21 patient was found down in his motel room by shelter staff unresponsive. 911 was called. pt transported to hospital by EMS receiving BLS. Clinic staff was advised by family that patient was pronounced dead that date.

Other Meds: synthroid, rosuvastatin, levemir, xarelto, metformin, omeprazole, proair

Current Illness:

ID: 1116387
Sex: F
Age: 66
State: VA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
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Allergies: IV contrast dye; sulfa drugs

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Symptoms: 12:45 Received Pfizer #2 13:00 Felt dizzy, lightheaded; consumed water and chocolate 13:05 Transported to EMS area of observation area; in wheelchair lost consciousness and had brief 15-20 second seizure 13:10 Repeated bouts of emesis. Patient had marked pallor and diaphoresis 13:35 EMS transport arrived, placed IV, gave phenergan, and transported via ambulance to Hospital Center

Other Meds: None

Current Illness: Unknown

ID: 1116388
Sex: F
Age: 21
State: KS

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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Symptoms: Progress Notes Nurse Practitioner COVID VACCINE CLINIC Subjective Patient is a 21 y.o. adult who was seen at SVH COVID Vaccine Clinic today for patient's second dose of the COVID 19 vaccination. Patient was given the Pfizer vaccination in the left deltoid muscle. During patient 15 minute waiting period after the injection, the patient began to experience rash, hives, throat tightness and dizziness. Patient denied difficulty breathing, difficulty swallowing, wheezing, hoarseness, stridor, itching, lightheadedness, facial swelling, lip swelling and tongue swelling. This provider was notified of patient reaction and patient on was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to abdominal pain, blood pressure abnormality , chest pain, collapse, drooling, hypotension, increased swelling, rapid progression of symptoms, respiratory distress, skin changes, tongue swelling and vomiting. ALLERGY REVIEW OF SYSTEMS: Patient complains of frequent throat clearing, itching of skin and headaches CONT negative Eyes negative Respiratory negative GI negative Musculo negative Previous Reactions: Itching with first Covid shot Objective Vitals Vitals: 03/17/21 1501 03/17/21 1508 03/17/21 1523 BP: (!) 157/100 (!) 154/66 (!) 170/65 Pulse: 90 84 90 SpO2: 99% Physical Exam Constitutional: Appearance: Normal appearance. Patient is well-developed. HENT: Head: Normocephalic. Right Ear: Hearing normal. Left Ear: Hearing normal. Nose: Nose normal. Mouth/Throat: Lips: Pink. Mouth: Mucous membranes are moist. No angioedema. Pharynx: Oropharynx is clear. Uvula midline. Eyes: General: Vision grossly intact. Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulses: Normal pulses. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds. Neurological: Mental Status: patient is alert. Psychiatric: Behavior: Behavior is cooperative. Pt had taken benadryl before her visit. She was given Zytec and still had some rash and hives, but the throat tightness had went away. She was given water and crackers while in the bay. Assessment/Plan Treatment included: antihistamines Follow up response to treatment: excellent. Patient discharge: Stable to go home and follow up with PCP. Differential Diagnosis: Vaccine-Related Anxiety (include misc mental health) Left at 3:42 Electronically Signed 3/17/2021 3:40 PM

Other Meds:

Current Illness:

ID: 1116389
Sex: M
Age: 24
State: CO

Vax Date: 03/09/2021
Onset Date: 03/16/2021
Rec V Date: 03/19/2021
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Allergies: N/A

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Symptoms: Ache/pain/fatigue, beginning day after shot, resolved within 2 days Approx 2" red inflamed area on arm at injection sight. Itchy, painful to touch, and warm to touch. Began 9 days after receiving vaccine, not yet resolved but improving

Other Meds: Pantoprazole

Current Illness: N/A

ID: 1116390
Sex: M
Age: 78
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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Symptoms: Due to a mixing error, the patient only received diluent

Other Meds:

Current Illness:

ID: 1116391
Sex: F
Age: 74
State: CA

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/19/2021
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Allergies: Sulphate drugs

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Symptoms: Fatigue, nausea, low grade fever, headache, arm pain from injection site up my arm into my neck, lite headed. Lasted about 10 hours. Stayed home, rested, hydrated, took one Tylenol.

Other Meds: Tylenol L Lysine Niacinamide Vitamin C

Current Illness: None

ID: 1116392
Sex: F
Age: 45
State: GA

Vax Date: 03/11/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
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Symptoms: THE LEFT DELTOID AREA OF THE ARM TURNED RED AND BECAME TENDER. IT HAS FEVER IN THE AREA

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Current Illness:

ID: 1116393
Sex: M
Age: 17
State: UT

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/19/2021
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Allergies: No known allergies

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Symptoms: Vaccine Administered Outside Protocol/Standing order Guidelines (The patient is 17). The patient did not experience any symptoms outside of the normal expected symptoms.

Other Meds: Unknown

Current Illness: None

ID: 1116394
Sex: F
Age: 44
State: IN

Vax Date: 03/12/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
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Allergies: Dust Pollen Hay Pine Aleve Shellfish Blueberries Cranberries

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Symptoms: Patient called our onsite registered nurse on 18MAR21 to report injection site swelling and redness (left deltoid). Patient was advised to take Benadryl at home after work. Patient will follow-up with our onsite nurse as needed.

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Current Illness:

ID: 1116395
Sex: F
Age: 37
State: CA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 03/19/2021
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Symptoms: The arm was sore for three days and then it resolved after three days. Swollen, red, itchy, hot to touch in the arm that I received the vaccine. I tested positive for Covid-19 after worsening symptoms four days after vaccination. I tested positive five days after vaccination. Seven days after vaccination the arm soreness symptoms returned. It was a little bigger area than the first time. It was red and hot to touch but no swelling this time. I still received the second dose on 02/12/2021 I had lingering fatigue from Covid-19. My arm became inflamed again but only lasted a couple of days.

Other Meds: Vyvanse 60mg Lamotrigine 200 mg Lexapro 20mg Abilify 5mg Adderall 20mg Lisinopril 5mg Vitamin B12 Vitamin D Multivitamin Zinc

Current Illness: Covid-19 within the same week of Vaccination

ID: 1116396
Sex: F
Age: 62
State: GA

Vax Date: 03/14/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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Allergies: sulfa, codeine

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Symptoms: sore throat, dizziness, right eye pain, diarrhea, leg pain, fatigue, soreness at site area

Other Meds: insulin, synthroid, L-arginine, estradiol, allegra, emergenC, prevagen

Current Illness:

ID: 1116397
Sex: F
Age: 70
State: WA

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 03/19/2021
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Allergies: Ace inhibitors

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Symptoms: My tongue started tingling and got a bit swollen about noon on 1/28/2021. The swelling in my tongue did not go away and persists . I originally thought it was angioedema but when the swelling did not go down I did not know what the problem was! I heard last night about COVID tongue and knew that is what I was/am dealing with. For what it?s worth I thought I?d let you know. I tried to let Vsafe know but did something incorrectly and my message didn?t go through.

Other Meds: Sirolimus, tacrolimus, mycophenalate, Bactrim, rosuvastatin, levothyroxine, ropinrole, adderall, vitamin d3, duloxetine,ezetimibe,

Current Illness:

ID: 1116398
Sex: F
Age: 68
State: NY

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 03/19/2021
Hospital: Y

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Allergies: Sulfa, contrast dye, iodinated contrast media, potassium, valium, Cipro, Penicillin, Ceclor, Erythromycin B, Loratadine, Latex, flu vaccine with eggs, egg whites, hepatitis B vaccine, birth control pill ? name, most antibiotics, Motrin and Advil.

Symptom List:

Symptoms: She had the vaccine at the facility where she lives. She fainted less than 24 hours after the vaccine, got up from that and had dry heaves, lost her speech and had loose stools. The aide caught her as she was fainting as she would have fallen on the floor. She said it was weird, she looked at people and it looked like they were 2 dimensional and knew something was wrong, but couldn't figure out what as they attended to her. They asked her questions, but she was not able to speak to them. They apparently spent 2 hours with her, but she doesn't believe it was that long, and then they knew she wanted to go to one Hospital and not the other. She had been loosing words before this happened, but not as bad as this one. This was about the same reaction that she had when she got the COVID virus in January. She was then taken to the hospital where she was given fluids and hydrated her and checked her heart, saw a cardiologist and a neurologist to see if those things caused the fainting and had blood work done. They also did a CAT Scan of her head and neck. They told her that she was fine and was discharged back home after 5 days, which was 3/11/21. Since then she has been very tired, she does have GERD and her stomach has been hurting a lot as well.

Other Meds: Amitiza, 81 mg aspirin, Atorvastatin calcium, Carbidopa/levodopa ER, daily multivitamin, Docusate sodium, Florinef, Melatonin, oyster shell calcium, polyethylene glycol, Ropinirole, vitamin D3.

Current Illness: None.

ID: 1116399
Sex: F
Age: 66
State: TN

Vax Date: 03/12/2021
Onset Date: 03/15/2021
Rec V Date: 03/19/2021
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Allergies: none known

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Symptoms: 3 days following the vaccine I felt as though my blood pressure might be elevated. I checked it several times and it was over 200 (208, 212), so I sent to the ER where they did tests and found everything to be normal. BP dropped to 167 while there, so no medication was given. Advised to follow up with primary care doctor, which I did 2 days later. BP still in the 160s. Advised to monitor and if not improved to begin an additional BP medication.. That medication was started today. The vaccine was given through the County Health Department.

Other Meds: atenolol, premarin, claritin

Current Illness: none

Date Died: 03/17/2021

ID: 1116400
Sex: M
Age: 80
State: MN

Vax Date: 01/25/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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Symptoms: Patient passed away within 60 days of receiving the COVID vaccine series

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Current Illness:

ID: 1116401
Sex: M
Age: 60
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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Symptoms: Due to mixing error, the patient received the diluent only

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Current Illness:

ID: 1116402
Sex: M
Age: 64
State: MD

Vax Date: 03/09/2021
Onset Date: 03/16/2021
Rec V Date: 03/19/2021
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Allergies: None

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Symptoms: Had minor pain at injection site beginning 4 hrs after ijection, resolved after 24 hrs. No other side effects until 7 days late (19 Mar). Moderate chills, moderate fatigue, moderate headache began 7 days after first injection, persisting with little change now 80 hrs after onset. One instance diarrhea 60 hrs after first injection. No fever. No joint pain or swelling. Have consulted PC nurse who advises I report this, and self-quarantine while await PCR results. I will report to ER if symptoms significantly worsen, otherwise will check back with PC physician Monday 22 Mar.

Other Meds: 20mg Atorvastatin daily, 20 mg Cetirizine daily

Current Illness: None

ID: 1116403
Sex: M
Age: 42
State: FL

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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Allergies: none

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Symptoms: 5:59 pm c/o "slight" lightheadedness. denies dizziness blurred vision. Skin W/D

Other Meds: Zorolto

Current Illness: asthma

ID: 1116404
Sex: M
Age: 17
State: WI

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
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Symptoms: Vaccine given to age inappropriate recipient.

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Current Illness:

ID: 1116405
Sex: F
Age: 41
State: GA

Vax Date: 03/11/2021
Onset Date: 03/13/2021
Rec V Date: 03/19/2021
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Allergies: Amoxicillin Injectable Contrast Dye

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Symptoms: Injured my back during vacuuming on Saturday 3/13. Went to ER on Sun 3/14 from back pain and limited mobility. Received intravenous steroids and lidocaine patch and was prescribed muscle relaxers, lidocaine patches, and ibuprofen 600 to manage pain. Had two chiropractic adjustments on 3/15 and 3/17 for SI joint pain. Only worked 1 out of 5 days this week and still dealing with dull achey pain and limited mobility when sitting, transitioning from positions, and bending over. Had a follow up with an urgent care provider on 3/18 who advised me to continue to rest and take full dose of ibuprofen to mitigate SI joint inflammation.

Other Meds: Amitryptiline 10mg 1x daily Probiotics Vit d3 Vit k2

Current Illness: none

ID: 1116406
Sex: F
Age: 62
State: WA

Vax Date: 03/16/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
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Allergies: Avocado; Pennycillian; Ethromycian; Ceclor; Sulfur; Celacin

Symptom List:

Symptoms: Day 1: muscle soreness and headache that persisted for 3 days; Day 2: Rash on back; Day 3: Rash becomes itchy and spreading to chest and face.

Other Meds: Lisinopril Hctz Tabs 20/12.5; Atorvastatin Tabs 20mg Aspirin Ec Tabs 81 mg; Metformin Hct Tabs 1000 mg; Vitamin D3 5000 IU; Biotin 10,000 mcg; Omega 3 Fish Oil 4000 mg; Release dietary Supplement

Current Illness: none

Date Died: 03/18/2021

ID: 1116407
Sex: M
Age: 59
State: KS

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 03/19/2021
Hospital: Y

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Symptoms: Patient got sick over the weekend. Went to facility on 03/02/2021 and then passed on 03/18/2021

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm