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: 1073870
Sex: F
Age: 29
State: PA

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

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient displayed signs and symptoms of vaso vagal reaction 5-7 mins post vaccine : dizziness, nausea, vomiting, no rash present. Pt was given an ice pack, water and started feeling better about 20 to 30 minutes later. No medical treatment was necessary

Other Meds:

Current Illness:

ID: 1073872
Sex: F
Age: 58
State: CT

Vax Date: 02/10/2021
Onset Date: 02/19/2021
Rec V Date: 03/04/2021
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: Sulfa, avocado, dust, hay fever

Symptom List: Anxiety, Dyspnoea

Symptoms: 2/19 began to spike fevers at night ranging to 100.4-101.5. This lasted for 11 nights. Fever at first started late afternoon and continued through night, then would start later and later at night.

Other Meds: Norvasc, Pritoq, Bupropion, probiotic, fish oil, b-complex, d-mannose

Current Illness: None

ID: 1073873
Sex: F
Age: 17
State: CA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/04/2021
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: Advil

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

Symptoms: 17 yo F in post vac are reports nausea, dizziness, headache 4 mins after vaccination. Denies other s/s, speaks clear and complete. No respiratory distress noted. Two set of vitals taken, WNLs. . Monitored for 30 mins, s/s continued and have increased, post vac nurse recommended medical attention. Mom declined EMS transport. Mom stated she would take pt to a local urgent care.

Other Meds: non stated

Current Illness: non stated

ID: 1073874
Sex: M
Age: 49
State: TN

Vax Date: 12/18/2020
Onset Date: 02/21/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Diagnosed with bilateral ear infections and herpes zoster (shingles).

Other Meds: Synthroid, Simvastatin, Zyrtec, Omeprazole, multi-vitamin

Current Illness: None

ID: 1073875
Sex: F
Age: 21
State:

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/04/2021
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: blacked out for a moment, shaky before blacking out. Evaluated by EMS-Cleared

Other Meds:

Current Illness:

ID: 1073876
Sex: F
Age: 40
State: CA

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 03/04/2021
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: Numerous outdoor allergens (pollens/etc), more allergic to indoor allergens (dust/etc), allergic to dogs and cats, allergic to NSAID drugs. After receiving vaccine I have had almost one severe allergic reaction per day: horrible rash from wearing latex food prep gloves (and wear them frequently with no issue), red, swollen face and shortness of breath after putting hand cream on my face, super flushed and congested after one glass of wine. My body is freaking out and allergic to EVERYTHING all of a sudden.

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

Symptoms: Rash from latex: Rx steroid ointment for earlier unrelated rash, Benadryl Wine flush/congestion: nothing Face swelling/redness/shortness of breath: Benadryl

Other Meds: Daily use of Zyrtec and OTC steroid nasal spray

Current Illness: None

ID: 1073877
Sex: M
Age: 65
State: MA

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/04/2021
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: Penicillin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pain in joints Temperature (100.0)

Other Meds: pravastatin 80 MG tablet meloxicam 15 MG tablet triamterene-hydrochlorothiazide 37.5-25 MG per capsule omeprazole 20 MG delayed release capsule Aspirin 81 mg

Current Illness: None

ID: 1073878
Sex: F
Age: 66
State: IL

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

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

Lab Data:

Allergies: allergies to cleaning supplies, odors

Symptom List: Pharyngeal swelling

Symptoms: Patient states 30 minutes after vaccine felt dizzy and headache when standing up, no improvement with sitting down. Patient alert, denies shortness of breath, or wheezing, but still lightheaded even with monitoring and fluids, so taken to ER

Other Meds:

Current Illness:

ID: 1073879
Sex: F
Age: 58
State: TX

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

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

Lab Data:

Allergies: Unknown.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received 3rd dose of Covid19 Pfizer vaccine on 3/3 due to facility not keeping proper records. Patient condition unknown at the time of reporting.

Other Meds: Unknown.

Current Illness: Unknown.

ID: 1073880
Sex: F
Age: 52
State: MD

Vax Date: 02/26/2021
Onset Date: 03/05/2021
Rec V Date: 03/04/2021
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: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 6 days after the shot, experience itchiness, swelling at the injection site (my left arm) and injection site is hard and little warm

Other Meds: Lisinopryl

Current Illness: None

ID: 1073881
Sex: F
Age: 31
State: VA

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Fever of 101.5F, chills, migraine, severe body aches, stomach ache, nausea, no appetite, not able to sleep, constant coughing, dry mouth, short of breath, and bruising at injection site. Adverse event lasted approximately 2.5 - 3 days.

Other Meds: Sprintec (daily birth control) and Meloxicam (15 mg daily)

Current Illness: Tested positive for COVID-19 on 12/21/20 and was still dealing with lingering COVID complications (nerve pains)

ID: 1073882
Sex: F
Age: 74
State: WA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/04/2021
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: Cephalosporins: hives and itching Nitrofurantoin: itching Adhesives: rash

Symptom List: Rash, Urticaria

Symptoms: 10:00 patient received second pfizer vaccine 10:40 reported feeling a flushing sensation x 1 approx 10:30, provided bottled water to drink, denies any difficulty breathing, throat swelling, or tongue swelling 11:00 finished bottle of water feeling fine left vaccine clinic accompanied by her husband 11:30 returned to vaccine clinic c/o thick tongue and difficulty swallowing, denies difficulty breathing. Sent to ED. ED note states that patient presented after "near syncopal episode" after developing lightheadedness and flushing after vaccination. Similar episode an hour later (prompting return to medical center). Denied chest pain or shortness of breath on presentation to ED. Described difficulty swallowing and "thick tongue" leading to her presenting back to clinic, but asymptomatic when arrived to ED. Oropharynx free of any swelling. EKG done but only showed sinus bradycardia. Patient observed multiple hours then discharged without any medical intervention taken.

Other Meds: Multivitamin

Current Illness: Acute UTI

ID: 1073883
Sex: F
Age: 26
State:

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

Symptoms: Weekness fatigue nausea vomiting for 24 hrs

Other Meds:

Current Illness:

ID: 1073884
Sex: F
Age: 75
State: WA

Vax Date: 03/02/2021
Onset Date: 03/03/2021
Rec V Date: 03/04/2021
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:

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

Symptoms: Severe sweating, blurred vision and passing out

Other Meds: Clonazepam Prozac calcium Omeprazole fish oil D3 81mg aspirin Aleve

Current Illness:

ID: 1073885
Sex: M
Age: 34
State:

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

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

Symptoms: pressure in throat, cough, difficulty breathing, dizzy. Refused transport. Evaluated by EMS-Cleared

Other Meds:

Current Illness:

ID: 1073886
Sex: F
Age: 26
State: WI

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/04/2021
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: Patient found unresponsive in recovery area at 6pm. Patient skin color gray, cool, unresponsive, no pulse noted by writer. Writer sternal rubbed patient and called name multiple times. Staff arrived to assist and writer sent one to call 911 and one staff member to get wheelchair to tranport patient to recovery area. While waiting for wheelchair after about 2 minutes patient regained consciousness, but still gray and not fully responsive. Patient stated she could see me but vision very blurry. Writer and LPN tranported patient to recovery and took vitals. Patient awake at this time. VS 110/80, 95%SpO2, pulse 76 at 6:06pm. Recheck of BP 132/110 at 6:14pm. Patient skin PWD. EMT's arrived assessed patient, took EKG-WNL, VSS stable, BP slightly elevated. EMT's offered to transport patient via amb to ER, patient declined. Writer released patient to boyfriend to drive her home.

Other Meds: unknown

Current Illness: none

ID: 1073887
Sex: F
Age: 24
State: NY

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

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA caused injection site pain and soreness in left arm, muscle soreness in neck and fatigue

Other Meds: Aspirin, synthroid

Current Illness:

ID: 1073888
Sex: F
Age: 44
State: CA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/04/2021
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: Tightness in throat; BPs 152/99 (pulse 120), 138/89 (pulse 105). O2 sats 98%, 96%. History of anxiety.

Other Meds:

Current Illness:

ID: 1073889
Sex: F
Age: 80
State: AZ

Vax Date: 01/24/2021
Onset Date: 02/27/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Red circular area on right are. Itchy, sore. Appeared about 4 days after second dose of Zmoderna.

Other Meds: Thyroid tab, statin, progesterone, estrogen patch, multi vitamins, presser-vision, alpha lipoic acid,

Current Illness: None. Please note: this occurred after my second dose of Moderna

ID: 1073890
Sex: F
Age: 73
State: NY

Vax Date: 03/01/2021
Onset Date: 03/04/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: Sulfur, feso4, lipitor, pcn. erytromycin,

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

Symptoms: Severe headache, severe itchiness to scalp, eyes, ears, face, neck, chest, back, arms

Other Meds: Amlodipine, lisinopril, baby aspirin, colace, nexium, vitD3, vit.B12, probiotics, gabapentin, digest assure,

Current Illness:

ID: 1073891
Sex: F
Age: 66
State: GA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/04/2021
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: None.

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

Symptoms: .Headache left temple. Vision loss in right eye for approximately 10 minutes. Could see only whiteness. During that time saw flashes of blue arrows flashing facing each other?s, also 2 imagines of black shapes like fish facing each other. As vision returned sight was shaded and hazel. Episode lasted for period about 25 minutes .

Other Meds: Calcium , celexa, folic acid, pantoprazole.

Current Illness:

ID: 1073892
Sex: F
Age: 73
State: TX

Vax Date: 03/01/2021
Onset Date: 03/03/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies: Codeine makes me sick

Symptom List: Unevaluable event

Symptoms: dizzy and throwing up from 4 pm until 2 am

Other Meds: Losartan,-hydrochlorthiazide , furosemede, levothyroxine, clairitin, vitamenD

Current Illness:

ID: 1073893
Sex: M
Age: 67
State: CA

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/04/2021
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: Norco; gives me a rash

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

Symptoms: Day 1: Pain at injection site (moderna 2nd shot) Day 2: Flu symptoms; muscle pain; low fever; mild headache; queasy stomach; lasting approx 12 hrs until it started to abate. Symptoms gone by morning of day 3. Day 3: Rash started; heaviest on ankles and up calves and thighs; lesser on forearms but very noticeable red minimally raised blotches. Not painful or itchy. Mostly gone by Day 6; telltale signs of rash still present on ankles (smallish red cluster of spotting slowly disappearing.

Other Meds: Simvastatin; Timolol Maleate; Claritin, Sudafed

Current Illness:

ID: 1073894
Sex: F
Age: 79
State: FL

Vax Date: 03/07/2021
Onset Date: 03/03/2021
Rec V Date: 03/04/2021
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: darvon novocain oxycodone penicillins promethazine sulfa

Symptom List: Injection site pain, Pain

Symptoms: patient had sore shoulders for a few days after the vaccine. woke up 3/3/2021 with left shoulder pain and unable to lift left arm. left arm was the vaccine site. concern for SIRVA.

Other Meds: asa 81mg biotin 1mg advair bid centrum silver potassium cloride 8meq roflumilast 500mg tiotropium maxzide 37.5-25mg

Current Illness: COPD/Asthma HTN

Date Died: 02/22/2021

ID: 1073895
Sex: M
Age: 77
State: WA

Vax Date: 01/28/2021
Onset Date: 02/22/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient passed away after getting the 1st dose of COVID vaccine. He seemed otherwise very healthy.

Other Meds:

Current Illness:

ID: 1073896
Sex: M
Age: 74
State: MA

Vax Date: 02/19/2021
Onset Date: 02/24/2021
Rec V Date: 03/04/2021
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: none

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

Symptoms: broke out in shingles from left hand to shoulder, medication precribed

Other Meds: Tramadol, multi-vitamin, simulaise, etc

Current Illness: none

ID: 1073897
Sex: F
Age: 51
State: WI

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

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Severe head ache in the sides of my head and behind my eyes. After 24 hours the headache is still very very intense. Tylenol didn't help, neither summatriptan, my usual medicine for migraines.

Other Meds: Losartan

Current Illness: Hysterectomy on Jan 25. 4 times to the ER because of bleeding. Uterine artery was bleeding (internal hemorrhage). A month later they detected the problem and (hopefully) fixed it.

ID: 1073898
Sex: F
Age: 25
State: AL

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

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

Lab Data:

Allergies: BACTRIM AND ZITHROMAX

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient has history of fainting after vaccines,blood work,or steroids shots. Patient started feeling nauseous after about 4 minutes then started to loose color in skin. Placed cool compresses to patient neck and forehead. Had patient lie down in supine position with feet elevated with cold compressed still applied. Patient stayed in this position until started feeling better, then had patient sit for a few minutes then gradually moved patient to chair. Observed patient in chair for around 30 minutes before patient facility. Patient never fainted just had the feeling.

Other Meds: NONE REPORTED

Current Illness: NONE REPORTED

ID: 1073899
Sex: F
Age: 53
State: MN

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/04/2021
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: Eggs, peanuts, raspberries.

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

Symptoms: March 2, 2021 1. At vaccination site, severe itchiness, dizzy, felt really hot, sweaty. Nurse took blood pressure 120 over 80. Stayed for 1/2 hour (9:10-9:41 a.m.). 2. Drove to work . All symptoms persisted, entire body turned bright red (like sunburn), extreme shaking. Checked in with school MA (nurse) . Blood pressure 140 over 80. Temperature 100. Extreme agitation and heightened senses. 3. sent me to Urgent Care seen at 11:35 a.m.. Same symptoms persisted. Blood pressure 143/94. Temperature 98.8. Was prescribed 2 Benedryl now, 1 every 4-6 hours as long as have itching. 2 at night for next 7 days. Prescribed Prednisone (10 mg) 4 one day, 4 next day - decrease dosage for 8 days. 4. Took prednisone- heightened senses, agitation increased. Migraine. Outer body exhausted, inner pure adreneline that would not decrease. March 3, 2021 1. Most symptoms lessened. Went to work . Checked in with MA (nurse) and told her that I wanted to stop the prednisone. She recommended that I take the dose. Took 4 tablets (10 mg) at 9:40 a.m. Heightened senses (light, sound, touch, taste), agitation, shakiness. brought me to in . Doctor told me to stop the prednisone as I have a history of anxiety. Exhaustion, heightened senses, agitation remained the rest of the day. March 4, 2021 1. Lessened symptoms. Four 20-minute recurrence episodes between the hours of 9 a.m. and 5 p.m.

Other Meds: Cod liver oil, calcium, Mood +

Current Illness: None

ID: 1073900
Sex: F
Age: 24
State: MD

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Muscle spasms overnight, vertigo with headache, nausea, body aches, and fever the next day

Other Meds: Zoloft Birth control

Current Illness:

ID: 1073901
Sex: F
Age: 63
State: GA

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

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

Lab Data:

Allergies: sulfa drugs

Symptom List: Injection site pain

Symptoms: Patient with no history of fainting after receiving vaccines reported feeling faint 15 minutes after receiving first COVID vaccine. When patient was unable to clearly answer the pharmacist, 911 was called. Patient was assessed by EMS and it was determined patient experienced a vagal response. Patient remained in pharmacy until she felt better, approximately 1 hour after the side effect initially occurred.

Other Meds: not known

Current Illness: not known

Date Died: 03/04/2021

ID: 1073902
Sex: F
Age: 80
State: WA

Vax Date: 01/29/2021
Onset Date: 02/25/2021
Rec V Date: 03/04/2021
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:

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

Symptoms: Patient seemed otherwise healthy before the vaccination. Patient was hospitalized then shortly passed after getting the 1st dose.

Other Meds:

Current Illness:

ID: 1073903
Sex: F
Age: 52
State: CA

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

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

Symptoms: An hour after my shot my left check was numb, lower left eye numb, left ear numb and left side of my tongue is numb. It is still numb as I type this.

Other Meds: none

Current Illness: none

ID: 1073904
Sex: F
Age: 68
State: TX

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/04/2021
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: Unknown.

Symptom List: Tremor

Symptoms: Patient received a 3rd dose of the Covid19 Pfizer vaccine due to facilities incomplete record keeping. Patient condition unknown at the time of reporting.

Other Meds: Unknown.

Current Illness: Unknown.

ID: 1073905
Sex: M
Age: 33
State: TX

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/04/2021
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: Erythema, Pruritus

Symptoms: lightheadedness after about 5 minutes followed by confusion and loss of consciousness. Brief seizure and short-term aphasia.

Other Meds: None

Current Illness: None

ID: 1073906
Sex: F
Age: 72
State: FL

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 03/04/2021
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: None

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

Symptoms: Rash (almost blister) on upper arm on either side of injection site. Still mark and small bruise today March 4, 20121

Other Meds: Escitalopram, Levothyroxin, Quetiapine Fumarite

Current Illness:

ID: 1073907
Sex: F
Age: 50
State: MS

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/04/2021
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: Bactrim

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

Symptoms: About 30 minutes after shot started having the sensation of swimmers ear(only in left ear/shot was given in left arm. This continued for a couple hours and then started having ringing in both ears(gradually increased in loudness and then that nite abt 530 increased to loud chirping).Has not stopped so far. Know it?s not adverse but side effect of shot. Hopefully will subside.

Other Meds: Claritin daily.

Current Illness: None

ID: 1073908
Sex: F
Age: 27
State: CA

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

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Cough and eye redness (may have begun before vaccine dose). BP 138/93 (pulse 74), 98% O2 sat.

Other Meds:

Current Illness:

ID: 1073909
Sex: F
Age: 48
State: IN

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/04/2021
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: sulfa

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

Symptoms: woke up in night with a lot of pain in my left arm. 3 days later and my upper arm is red, very sore from shoulder to elbow and underneath my arm-armpit area, and a raised area. i have been taking ES tylenol every 5 hours and icing it. if im late taking a dose, my arm starts throbbing. if not better in next couple days, I will make dr apt to have evaluated.

Other Meds: premarin allegra tylenol

Current Illness: none

ID: 1073910
Sex: F
Age: 78
State: CO

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 03/04/2021
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: Yes

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

Symptoms: When I got the vaccine it hurt so much that I jumped. It felt like it burned for like 3min. The next day I had shortness of breath & I fainted the next thing I seen when I woke up was the paramedics taking me in to the ambulance to do an EKG. Everything was good except my blood pressure dropped. I was not taken to the hospital.

Other Meds: Yes

Current Illness: No

ID: 1073911
Sex: F
Age: 19
State: CA

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

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

Lab Data:

Allergies: NKDA

Symptom List: Pain in extremity

Symptoms: 11A1 19 y old pt received 1 st dose Moderna vaccine, after 5 mins she had episode of syncope, fell from her chair and bump her head. She had seizure for about 10 seconds. After seizure she was A/O x4 , neurologically intact, good PERRLA. Her BP was 95/65, HR 59, O2 sat 98 RA. Pt able to speak and was aware of the situation. 911 was called to take the pt to the hospital for head injury to R/O any abnormality.

Other Meds: No

Current Illness: None

ID: 1073912
Sex: F
Age: 69
State: MN

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

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

Lab Data:

Allergies: Bee venom, tramadol, hydrochlorothiazide, contrast media, poppy, codeine

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

Symptoms: Throat swelling, dysphagia, shortness of breath

Other Meds:

Current Illness:

ID: 1073913
Sex: M
Age: 28
State: WA

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 03/04/2021
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: None

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

Symptoms: I have felt horrible since receiving the second dose of Moderna. I felt profoundly fatigued, sore all over, and nauseated for 18 or so hours. Since then I have been feeling nauseated after I eat. I cannot eat like I normally do and it has been almost five days. If this persists through the weekend I will visit my doctor next week.

Other Meds: None

Current Illness: None

ID: 1073914
Sex: F
Age: 31
State: NY

Vax Date: 02/24/2021
Onset Date: 03/04/2021
Rec V Date: 03/04/2021
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: sulfa drugs

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

Symptoms: Covid Arm- large red hive at injection sight 8 days after injection. Itchy and warm to the touch.

Other Meds: birth control.

Current Illness:

ID: 1073915
Sex: F
Age: 70
State: WA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/04/2021
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: None

Symptom List: Vomiting

Symptoms: 0805 pt received second dose pfizer vaccine 0810 pt reports "right afterward" noticing that her tongue felt numb. denies respiratory distress. No previous history of anaphylaxis with any vaccine or medication or other source. No problem with first dose pfizer other than sore arm, fatigue. 0825 pt states numbness progressing toward back of tongue 0830 pt escorted to ED Per ED note: Patient received second Covid vaccine at 8:05 AM, noted onset of central, not lateralized, tongue tingling without swelling/pain after receiving the shot, still notes able to feel pressure on tongue. Has never had a reaction to previous vaccines, including first dose of Covid vaccine 3 weeks ago. Denies any tongue biting or recent trauma to the tongue. She does feel as if the tingling is extending further back since onset...Patient states she can swallow fine without pain, no vision changes, hearing changes, taste changes, lesions in her mouth, facial asymmetry, shortness of breath, headache, rashes, swelling. Denies fevers, chills, URI symptoms, chest pain, palpitations, lightheadedness, nausea, vomiting, abdominal pain, change in bowel habits, change in urination. Vitals stable, no evidence of anaphylaxis on exam. Ruled out CVA, atypical MI, migraine, GERD, trauma. Thought possibly vaccine reaction. Patient was monitored in the emergency department for 4 hours after vaccine, without airway swelling or compromise. Discharged home but still with continued tongue tingling with preserved sensation.

Other Meds: Alendronate, budesonide nasal spray, cholecalciferol, ibuprofen (PRN)

Current Illness:

ID: 1073916
Sex: F
Age: 69
State: LA

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/04/2021
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: codeine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: laryngitis - I haven't been able to talk all week.

Other Meds: pantaprozole, omega 3, magnesium, turmeric, boswellia, acetaminophen, Loratadine

Current Illness: nonw

ID: 1073917
Sex: M
Age: 31
State: NY

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 03/04/2021
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

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

Symptoms: Chills started 14 hours after and lasted for 4 hours.

Other Meds: None

Current Illness: None

ID: 1073918
Sex: F
Age: 84
State: CA

Vax Date: 02/27/2021
Onset Date: 02/28/2021
Rec V Date: 03/04/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Son/caregiver called to report patient was experiencing a decreased mental acuity accompanied with fatigue and loss of appetite after receiving her 2nd dose of Moderna Covid 19 vaccine since Febuary 27th, 2021. Son describer the symptoms as progressive starting after receiving the vaccine. It was recommend the patient's primary care provider be contacted to receive further advice.

Other Meds:

Current Illness:

ID: 1073919
Sex: F
Age: 64
State: AL

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

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

Lab Data:

Allergies: NKA

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

Symptoms: Blurred vision left eye

Other Meds: Durizol eye drops Cocopt eye drops Ilevro eye drops Zetia 10 mg Vitamin D. OTC Immune -C. OTC

Current Illness:

ID: 1073920
Sex: F
Age: 63
State: CA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/04/2021
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: PCN Lisionpril-cough

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

Symptoms: 3/4/21 1005am pt started complaining of feeling flush, restless, and anxious. pt states that she does not feel right and that there is something wrong. then pt reported that her legs felt numb.First RN and Second, RN was present to assist pt. pt was put on 4L of O2 by mask. Dr was called to assist. pt was moved from sitting in chair to laying on floor with legs elevated. pt reporting that her hands and legs were feeling numb. per Dr pts lungs were clear with good air exchange. pt alert and oriented to self, place, and time. 1012am BP 141/81 P 71 SaO2- 100% BS 99 pt still feeling flush and restless with anxiousness increasing. upper lip swelling. questionable tongue swelling. hand and feet numbness. pt states does not feel right. V.O. Dr 25mg Benadryl IM now administered to the right deltoid IM, RN 1020am BP- 162/100 P- 72 SaO2- 100% pt still feeling flush and restless with anxiousness. still with some upper lip swelling. questionable tongue swelling. hand and feet numbness is still reported. pt states she still does not feel right. husband is now with pt at her side and trying to calm her. pt is c/o some SOB, per Dr pts lungs are still clear. pt remained alert to self, time, and place. V.O. Dr. Albuterol neb treatment now attempted to start neb treatment however pt was not tolerating neb. ok by Dr to stop neb treatment. 1025am called AMR V.O. Dr 1mg Epinephrine now administered 1mg Epinephrine IM right deltoid. P. , RN 1027am pt wanting to sit up. states cannot get comfortable laying down. assisted pt to sit up. pt is less anxious. reports to feel less restless. decrease upper lip swelling and tongue swelling. pt reports that she is starting to feel a little better. pt is feeling less numbness in hands and feet. BP-141/58 P-99 SaO2-100% 1037am pt starting to complain of feeling flush, restless, and anxious again pt states that she does not feel right and that there is something wrong again. pt again reporting that her hands and feet felt numb. per Dr - pts lungs still clear with good air exchange. pt remains alert to self, place, and time. per Dr draw up another dose of Epi while waiting for AMR, AMR arrived prior to drawing up second dose of Epi. 1039am AMR arrived. transferd pt from floor to gurney and trnsported pt to ER. ................................................................... RN March 4, 2021 3:20 PM

Other Meds: Norco 10-325 Duloxetine Amytriptyline Rosuvastiatin dicolfenac baclofen patnoprazole gabpentin ferous sulfate montelukast Fluticasone albuterol neb and MDI combinvent dulera

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm