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: 1123689
Sex: F
Age: 55
State: IN

Vax Date: 03/12/2021
Onset Date: 03/14/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: 48 hrs after vaccination severe stomach cramps/pain after eating spicy food (curry) 4 days after vaccination severe stomach cramps/pain after eating spciy food 4 days after vaccine armpit of vaccine site arm (left) had dark/purpleish discolored area about 5 cm and moderate swelling . Discoloration has now resolved, slight swelling remains.

Other Meds: citalopram 10 mg QD

Current Illness: none

ID: 1123690
Sex: F
Age: 21
State: TX

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: The patient has refractory epilepsy but seizures are generally well controlled (1 seizure every months). Her first seizure followed ~30 minutes after vaccination and she continued to have 6 additional seizures over the course of several hours, requiring admission to the hospital for several days as she recovered from her post-ictal state. She was febrile on admission to 100.5F. Mother of patient noted that she has never had this many seizures in a single day before.

Other Meds: clobazam, Epidiolex, fycompa, levetiracetam

Current Illness: none

ID: 1123691
Sex: F
Age: 30
State: MN

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Adhesive allergy (rash)

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

Symptoms: Received the covid19 vaccine at 11am. Started feeling very cold around 2pm (nail beds were turning purple). By 4pm I had a headache, body aches, upset stomach, tired, fever, and chills. My fever would go up and down, highest was 103.2 reached that temp 3 times. By 2am my mother drove me to the ER. I was diagnosed with a migraine and was given IV fluids and an IV migraine cocktail. After receiving the fluids and meds I felt much better and was released back home. I periodically have pain in the injection site.

Other Meds: Multivitamin (OTC/OLLY) Sprintec 0.25-35 mg Lisinopril 5mg Sertraline 100mg

Current Illness: None

ID: 1123692
Sex: M
Age: 17
State: OK

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: On 03/18/21 at approximately 0:930am patient presented to be vaccinated with the Moderna vaccine, against the Covid 19 virus. Upon arrival at my station, patient had passed through our registration process and advanced to the vaccination station. Upon arrival at my station, I reviewed his chart and concluded that, based on his responses that he met the criteria to be vaccinated. I vaccinated patient and upon escorting him to our observation area I discovered that his age was not sufficient in order to qualify for the vaccination. I immediately reported this error to our clinician who was entering the data. I was later contacted by our supervisor of the error and that I needed to vett every

Other Meds:

Current Illness:

ID: 1123693
Sex: M
Age: 49
State: MO

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Janssen COVID-19 Vaccine EUA almost immediate, ongoing fever, chills, body aches, stuffy nose mild relief with ibuprofen

Other Meds: none

Current Illness: none

ID: 1123694
Sex: F
Age: 66
State:

Vax Date: 01/22/2021
Onset Date: 02/11/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Shortness of breath fever Covid-19

Other Meds:

Current Illness:

ID: 1123696
Sex: F
Age: 57
State: TN

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt presented 3/22/2021 with 4 d hx of rash, consistent with significant zoster over left side of chest wall. Pt says pain began approx 4 hours after covid (moderna) vaccine, rash began the next day (approx 20 hours after covid vaccine). rash progressed over the next few days, is very painful and very widespread in the one left anterior chest wall dermatome.

Other Meds: Atorvastatin 40mg once daily

Current Illness: Hypertension , Hyperlipidemia

ID: 1123697
Sex: F
Age: 17
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Vaccine administered Outside Protocol. Age 17 at time of vaccine and protocol calls for patient to be 18 years old. Vaccine authorized electronically by mother online.

Other Meds:

Current Illness:

ID: 1123698
Sex: M
Age: 53
State: TX

Vax Date: 03/10/2021
Onset Date: 03/16/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Redness and peeling skin to right posterior arm that extends to right underarm.

Other Meds: None

Current Illness: None

ID: 1123699
Sex: F
Age: 64
State: OH

Vax Date: 03/10/2021
Onset Date: 03/12/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Diarrhea, watery stool, edema left hand, my algae, arthralgia of both hands

Other Meds:

Current Illness:

ID: 1123700
Sex: F
Age: 60
State: FL

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: none known

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

Symptoms: day of vaccination, watery stool, stomach ache, tired, painful to lift arm up and down day after vaccination - Painful to lift arm up and down - light headed, fuzzy head, fatique, nausea two days after vaccination - Painful to lift arm up and down very light headed, fatique and nausea Three days after vaccination - arm sore but better, still light headed but better, fatique, nausea Four days after vaccination - arm better, very little light headedness, some fatique, nausea better

Other Meds: Armor Thyroid 75mg one time daily, 1000 vitamin c, selenium, zinc, bcomplex

Current Illness: n/a

ID: 1123701
Sex: F
Age: 79
State: OR

Vax Date: 02/24/2021
Onset Date: 03/03/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Ibuprofen Opioids

Symptom List: Rash, Urticaria

Symptoms: Severe headache 1 week and 2 weeks after vaccination and ongoing low grade headache since first episode. Partial response to acetaminophen.

Other Meds: Severe headache that lasted 5 hours 1 weeks and then again at 2 weeks after vaccine, plus low grade constant headache since then.

Current Illness:

ID: 1123702
Sex: M
Age: 47
State: NY

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

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

Lab Data:

Allergies: na

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

Symptoms: Pt reports decrease hearing to bilateral ears after vaccine administration Observed for 45 mins reported slight improvement in difficulty hearing Pt was educated to follow up PCP or visit ER if symptom doesnt improve or gets worse Pt verbalized understanding

Other Meds: na

Current Illness: na

ID: 1123703
Sex: M
Age: 11
State: MI

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

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

Lab Data:

Allergies: None

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

Symptoms: None

Other Meds: None

Current Illness: none

ID: 1123704
Sex: F
Age: 61
State: FL

Vax Date: 03/19/2021
Onset Date: 03/21/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: none known

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

Symptoms: Bruising on right arm near elbow, right ribs, and right knee and shin

Other Meds: synthroid 75mcg

Current Illness: none

ID: 1123705
Sex: F
Age: 63
State: NY

Vax Date: 02/23/2021
Onset Date: 02/26/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Sena laxatives

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

Symptoms: Persistent Itchy red rash on chest, arms, and legs. Zyrtec and Cortisone cream are not effective.

Other Meds: Anastazole, Synthroid, Vitamin D, Docusate Sodium

Current Illness: none

ID: 1123706
Sex: F
Age: 76
State: CO

Vax Date: 03/11/2021
Onset Date: 03/13/2021
Rec V Date: 03/22/2021
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: Developed a reddish pink rash that lasted about 3 days and itched really bad. Left a slight soreness for a couple days after.

Other Meds:

Current Illness:

ID: 1123707
Sex: F
Age: 61
State: KY

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

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

Lab Data:

Allergies: Lithium

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received vaccine then sat in the observation area. I was called over when she looked pale and felt dizzy a few minutes after receiving the vaccine. We took her vitals and her O2 was 98%, HR 61, and BP 92/67. Her normal BP is in the 110s. No history of syncopal episodes or diabetes. Patient then became unresponsive to questions and stared off into the distance for about 10 seconds. She never lost consciousness. She proceeded to gurgle up vomit and I called 911. She became responsive again and able to converse normally, but still felt dizzy. We wheeled her to the front, and EMS arrived. She agreed to go to the hospital due to the concern for her unresponsive episode, inability to walk on her own, and living by herself.

Other Meds:

Current Illness:

ID: 1123708
Sex: F
Age: 24
State: CA

Vax Date: 03/20/2021
Onset Date: 03/21/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Soreness at injection site night of vaccine. Headache and nausea the next morning (13 hours after injection). Fever of 101 degrees later that evening (20 hours after injection). Fever subsided during the night (~28 hours) and headache persisted into the next day. Treatment with Tylenol helped somewhat.

Other Meds: None

Current Illness: None

ID: 1123709
Sex: F
Age: 64
State:

Vax Date: 12/22/2020
Onset Date: 12/25/2020
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: SHORTNESS OF BREATH FEVER Covid-19

Other Meds:

Current Illness:

ID: 1123710
Sex: M
Age: 65
State: IL

Vax Date: 03/11/2021
Onset Date: 03/22/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Allergen Reactions ? Eggs Or Egg-Derived Products Rash ? Keflex [Cephalexin] Rash

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

Symptoms: 65 y.o. male who presents with chest pain. Patient reports he has been having intermittent chest pain since Friday. Patient reports the episodes last only a few minutes to maximum 2 hr. Patient states his episode of chest pain hit him this morning around 7:00 a.m. after he got up. Patient reports his pain is currently a 4/10. He describes it as a sharp pressure located in the center of his chest. He denies any radiation the pain. Patient denies any associated symptoms of shortness of breath, lightheadedness, dizziness, diaphoresis, nausea, or vomiting. Patient does have cardiac risk factors including hypertension, hyperlipidemia, diabetes, family history, obesity, and former smoker. Of note, patient states he was recently diagnosed with angina and placed on metoprolol and given sublingual nitro to take as needed. Patient reports he has not used his sublingual nitros. Patient sees HCP. Patient had exercise stress test with nuclear scan that was negative in January of 2021.

Other Meds: Current Outpatient Medications: ? acetaminophen (TYLENOL) 500 MG tablet, Take 500 mg by mouth 3 times daily as needed for Pain, Disp: , Rfl: ? aspirin 81 MG EC tablet, Take 81 mg by mouth daily, Disp: , Rfl: ? atorvaSTATin (LIPITOR) 1

Current Illness:

ID: 1123711
Sex: F
Age: 30
State: KS

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Notes (Nurse Practitioner) ? ? Family Medicine Cosigned by: MD at 3/19/2021 9:22 AM Expand AllCollapse All Clinic 3/18/2021 Patient: Date: 3/18/2021 Subjective Patient is a 30 y.o. female who was seen at COVID Vaccine Clinic today for her second dose of the COVID 19 vaccination. She was given the Pfizer vaccination in the right deltoid muscle. During her 15 minute waiting period after the injection, the patient began to experience paresthesia down R arm. She denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, lightheadedness, dizziness, facial swelling, lip swelling, tongue swelling and weakness in arm. This provider was notified of patient reaction and she was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to rapid progression of symptoms. PMH insignificant 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 + paresthesia in R arm: Previous Reactions: none Objective Vitals Vitals: 03/18/21 1430 BP: 108/62 Pulse: 72 SpO2: 100% Physical Exam Constitutional: General: She is not in acute distress. Appearance: Normal appearance. She is well-developed. She is not diaphoretic. HENT: Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: Oropharynx is clear. Eyes: Extraocular Movements: Extraocular movements intact. Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulses: Normal pulses. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. No wheezing. Skin: General: Skin is warm and dry. Neurological: General: No focal deficit present. Mental Status: She is alert and oriented to person, place, and time. Cranial Nerves: No facial asymmetry. Sensory: Sensation is intact. Motor: No weakness. Coordination: Coordination is intact. Gait: Gait normal. Comments: + 5/5 strength against resistance to bilateral upper extremities. Pt able to put on her own sweater without difficulty or assistance. Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. Assessment/Plan Treatment included: ice pack Follow up response to treatment: fair. Patient discharge: Stable to go home and follow up with PCP. Differential Diagnosis: Local reaction (arm pain, bleeding/bruising, mechanical irritation, localized rash) Suspect superficial nerve secondary to injection. Discussed ice/warm cloth, movement of R arm. Follow up with pcp as needed. We will check in with her tomorrow via phone. Pt voiced appreciation of evaluation today. Nurse Practitioner Electronically Signed 3/18/2021 8:58 AM

Other Meds:

Current Illness:

ID: 1123712
Sex: F
Age: 76
State: NJ

Vax Date: 03/10/2021
Onset Date: 03/12/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: No Known Allergies

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

Symptoms: EUA Pfizer -BioNTech vaccine 3 days after vaccine, patient complained about facial droop. She saw her PCP who diagnosed her with Bell's Palsy. She was prescribed acyclovir and prednisone. 4 days after the vaccine, she began to feel dry eyes, and difficulty swallowing. She was advised that symptoms will improve with time and steroids and to return to the ED if she experiences voice changed or cannot tolerate liquids.

Other Meds: amlodipine 5mg , losarta 100mg, omeprazole 20mg, baclofen 10mg, metoprolol xl 50mg, fosamax 70mg, aspirin ec 81mg, lipitor 40mg, hydrochlorthiazide 25mg

Current Illness:

ID: 1123713
Sex: M
Age: 0
State: NY

Vax Date: 03/22/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: no problem with first dose, head to toe rash with itching with second

Other Meds: none

Current Illness: none

ID: 1123714
Sex: M
Age: 73
State: PA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Dilaudid

Symptom List: Injection site pain, Menorrhagia

Symptoms: Shortly after sitting down in post vaccination area, patient's stomach was upset and he vomited small to moderate amount of brownish colored fluid. Color pale, VSS - 118/70-94-20, Oxygen Saturation 96% on RA. Vomiting passed and patient was released to home accompanied by son

Other Meds: Antihypertensive medication, Parkinson medication

Current Illness: TIA, Stomach issues x 2 weeks as per patient

ID: 1123715
Sex: F
Age: 50
State: MD

Vax Date: 01/01/2021
Onset Date:
Rec V Date: 03/22/2021
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: fever for 2 days / started / the / night she received the adjuvant component; muscle pain / experiencing muscle, back, and joint pain; joint pain / experiencing muscle, back, and joint pain; back pain is excruciating / muscle, back, and joint pain; arm pain / pain has been "excruciating" in the left arm; This case was reported by a consumer via call center representative and described the occurrence of fever in a 50-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Concomitant products included Herpes zoster (Shingrix). In January 2021, the patient received Shingrix (intramuscular). On an unknown date, less than a day after receiving Shingrix, the patient experienced fever, muscle pain, joint pain, back pain and pain in arm. On an unknown date, the outcome of the fever and muscle pain were not recovered/not resolved and the outcome of the joint pain, back pain and pain in arm were unknown. It was unknown if the reporter considered the fever, muscle pain, joint pain, back pain and pain in arm to be related to Shingrix. Additional details were provided as follows: The patient stated after one week was called back in to get the complete 1st dose of the Shingrix and reported experiencing soreness in the arms, and a slight fever that occurred that same night after getting the complete dose. The patient stated that the pain was still ongoing and that was suffering every day it was affecting joints and her back pain was excruciating. The reporter consented to follow up. Not all information was available. The patient did give permission to follow up with their HCP. This case linked with US2021AMR016885 and US2021016995, reported by same reporter. Notes:As the patient called back to complete dose os Shingrix the patient received initially received adjuvant suspension and now received only liquid portion so not capture rechangelled a positive.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR016885:same patient (FU2 and 1st dose case), same reporter

Other Meds:

Current Illness:

ID: 1123716
Sex: M
Age: 82
State:

Vax Date: 01/26/2021
Onset Date: 03/12/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Shortness of breath Covid

Other Meds:

Current Illness:

ID: 1123717
Sex: F
Age: 73
State: CA

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Sulfa kiwi fruit

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Extreme pain left arm, headache, fever chills, muscle and joint aches, exhaustion. Symptoms for 48 hours slowly reducing by day 3.

Other Meds: Levothyroxin 137 mcg 1 per day Potassium Citrate ER 15 MEQ (1620 MG) 1 tab 2x per day Estrodiol 0.5 mg 1 x per day Acetaminophen 650mg 2 x per day (for arthritis) Calcium 500 mg/500 Vitamin D/40 mcg Vitamin K ? 1 per day D3 2000 Units ? 1 p

Current Illness: none

ID: 1123718
Sex: F
Age: 50
State: CA

Vax Date: 03/09/2021
Onset Date: 03/12/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: shellfish

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

Symptoms: 4-5 days of Diarrhea. Ongoing dizziness/vertigo.

Other Meds:

Current Illness:

ID: 1123719
Sex: M
Age: 59
State: MA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Spironolactone (Breast swelling)

Symptom List: Nausea

Symptoms: Patient reported feeling dizzy shortly after receiving his COVID19 vaccination. Denied Chest pain or SOB

Other Meds: Metformin, Glimepiride, Atorvastatin, ProAir, Sertraline, Spironolactone, Trulicity, Lisinopril, Lantus, Gabapentin, Aspirin, Lasix, Acetaminophen, Meloxicam, Ketoconazole topical, High potency multivitamin, Penlac nail lacquer

Current Illness:

ID: 1123720
Sex: F
Age: 57
State: CA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 03/22/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: Biaxin

Symptom List: Injection site pain

Symptoms: One day after vaccine my eye felt slightly irritated. The next day I felt a little swelling in the corner of my left eye on the same side of vaccine. It became visible as an irritation on the outside corner of my eye. It was very painful and my lower eyelid was swollen. I was trying to massage but the pain seemed to be internal. There was a large red pimple like lesion inside my eyelid. I went to an eye doctor and was diagnosed with an internal sty on my eye. I have never had a Sty before. I was prescribed an antibiotic and it not not resolve so I was prescribed a antibiotic cream which helped. The lesion burst by then. I took two to three weeks to resolve. I since also received the second dose. I had a very strong immune response to the second dose. Chills, headaches and all over body ache. I was unable to work for two days. I was bed ridden for two days. My Asthma seemed very reactive during that time. My Asthma seemed worse for a few weeks and it is still a little worse than normal.

Other Meds: Albuterol Symbicort Claritin Singular

Current Illness:

ID: 1123722
Sex: M
Age: 55
State:

Vax Date: 10/01/2020
Onset Date:
Rec V Date: 03/22/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

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

Symptoms: tenderness at the injections site; This case was reported by a consumer via call center representative and described the occurrence of injection site tenderness in a 55-year-old male patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included testosterone injection. Concurrent medical conditions included hiv infection. In October 2020, the patient received the 1st dose of Shingrix (intramuscular). On an unknown date, less than 5 months after receiving Shingrix, the patient experienced injection site tenderness. On an unknown date, the outcome of the injection site tenderness was recovered/resolved. It was unknown if the reporter considered the injection site tenderness to be related to Shingrix. Additional details were provided as follows: The patient had reported the case for himself. The patient received 1st dose on left arm. The patient experienced tenderness at the injections site on his left arm which was hardly noticeable and it was a little sore for a while and then resolved. The patient did blood work every 3 months for 20 years. On 21st December 2020, the patient had hand surgery for dupuytrens. The reporter consented to follow-up. For tolerance of 2nd dose, refer case US2021AMR035399.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR035399:same patient, Same reporter

Other Meds:

Current Illness: HIV infection

ID: 1123723
Sex: M
Age: 29
State: IN

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

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

Symptoms: Knot in right arm where shot was administered. Knot was hot for over 2 days. Knot was tender to the touch

Other Meds:

Current Illness:

ID: 1123724
Sex: F
Age: 67
State: NY

Vax Date: 03/17/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
Hospital:

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Lab Data:

Allergies: sulfar penicillin

Symptom List: Tremor

Symptoms: I was walking out of my apartment building to my car inside the garage on Friday at 6:00 pm. As I was walking, my arms & legs began to feel heavy. By the time I reached the garage I was feeling extremely fatigued. I got inside of my car and thought to myself that I've never felt this tired in all of my life. I then felt very cold and decided it was best to go back upstairs. When I into my apartment unit - my cats greeted me as if I was gone for an extremely long time - and I noticed the sun coming in through my windows when the sun should have been on the other side of the building at 6:00 pm. Both the cats & the sunshine told me something was very wrong. I looked at the clock - it said 8:08. I put on the tv and discovered it was 8:08 A.M. on Saturday morning. I had fallen asleep (or passed out) in my car from 6pm Friday evening until 8am Saturday morning. I have no sleeping disorders & do not require naps during the day. Today I still feel fatigued, but only slightly. From the time I entered my car at 6pm Friday - until the time I exited my car at 8am Saturday - it felt as though only moments had passed. I had no idea I had fallen asleep or passed out.

Other Meds: none

Current Illness: none

ID: 1123725
Sex: M
Age: 58
State: CA

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Site injection pain, headache, chills, fatigue.

Other Meds: Lisinopril, Simvastatin, Finasteride, Omeprazole and 81 mg aspirin

Current Illness: Positive for Covid 19 one month prior.

ID: 1123726
Sex: F
Age: 35
State: TX

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
Hospital: Y

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

Lab Data:

Allergies: None listed on Prevaccination Checklist for COVID-19 Vaccine

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

Symptoms: 1515 - Moderna vaccine given, Left Deltoid IM 1530 - Patient complains of eyes itching and left side of face, Dr. notified, Patient awake and alert with no signs of distress 1540 - Dr. arrived to patients bedside. Patient complains of itching and mild swelling sensation to mouth. V/S; 143/84, 89, 18, 99%RA 1545 - Benadryl 50mg IM administered to LUOQ, verbal order by Dr. , administered by Nurse 1555 - Patient stated some better but complains of periodic tingling down left leg. Dexamethasone 4mg IM to Right Deltoid, verbal order by Dr., administered by Nurse. O2 remains at 99%RA. Dr. at patients bedside. Dr. consulted. 1615 - Patient ambulatory out of clinic and taken to ED, accompanied by Medical assistant and Dr. Patient stable and in no apparent distress.

Other Meds: Unknown

Current Illness: Unknown

ID: 1123727
Sex: M
Age: 57
State:

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
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Vax Site:

Lab Data:

Allergies:

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

Symptoms: Following covid 19 vaccine client reported sweating with obvious pallor. He was cold and clammy. He was unresponsive prior for approximately 30 seconds with mild seizure activity with spontaneous movement of eyes with jerking. He was monitored by EMS and evaluated by a Dr. His car seat was reclined, no Epi pen given . Blood Pressure was 82/48 initially with pulse 65 and RR 12. He was transported to EMS vehicle on site and monitored then released home. He was advised to follow up with ER for further treatment if needed.

Other Meds:

Current Illness:

ID: 1123728
Sex: F
Age: 29
State: VA

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

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient stated that her injection site became very painful and warm. Patient then stated that her entire body became warm & that was the last thing she remember. Patient witnessed falling out of chair onto the floor. Patient was easily aroused. Patient did hit her head of the floor and abrasion was noted on her forehead. Patient was assessed and vital signs were as follows: Oxygen saturation-96%, pulse rate-66, BP-141/82.

Other Meds:

Current Illness:

ID: 1123729
Sex: F
Age: 43
State: CA

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

Vax Type:
Manufacturer:
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Lab Data:

Allergies: Aspirin and pineapples

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

Symptoms: Lightheadedness,dizziness,fatigue,heart palpitations,hives immediately after the vaccine was administered. I was laid on a hospital gurney for over an hour and observed by nurses and they gave me fluids and had me do some breathing exercises to slow down my breathing&placed a cool towel on my forehead. Once I arrived at home I parked and began to walk towards my became dizzy and fell and hurt my right arm,knees&hands. I went to urgent care,my vitals were normal and I was screened for Covid and my results came back negative for Covid and influenza. The urgent care doctor ordered lab work in which I had done the next day and the results came back normal.

Other Meds:

Current Illness:

ID: 1123730
Sex: F
Age: 42
State: MI

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: NA

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

Symptoms: Injection site pain, swelling down arm to elbow and around shoulder -- started within 20 minutes of injection and lasted 4 days 9 hour post injection = Fatigue 24 hours post injection = Diarrhea Nausea Dizziness Headache

Other Meds: Nexium Lexapro Propranalol

Current Illness: NA

ID: 1123731
Sex: F
Age: 66
State: AR

Vax Date: 12/01/2020
Onset Date:
Rec V Date: 03/22/2021
Hospital:

Vax Type:
Manufacturer:
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Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: arm was swollen; a lot of pain / aches; This case was reported by a consumer via call center representative and described the occurrence of swelling arm in a 66-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. In December 2020, the patient received the 1st dose of Shingrix. On an unknown date, less than 2 months after receiving Shingrix, the patient experienced swelling arm and pain. The patient was treated with magnesium sulfate, potassium nos, zinc (Epson Salt Soak), methyl salicylate (Icy Hot) and non-drug therapy (Heating Pad (Nos)). On an unknown date, the outcome of the swelling arm and pain were unknown. It was unknown if the reporter considered the swelling arm and pain to be related to Shingrix. Additional details were provided as follows: This case was reported by patient herself. The patient received 1st dose of Shingrix in her left arm and her arm was swollen and she also experienced extreme pain for 2 months and she mentioned that she had a lot of pain for a month. The patient used Epson salts bath, Icy hot and heating pads to treat the pain. Reporter mentioned that the pain was resolved but still every now and then it was aching a little bit and also stated that she would not get the 2nd dose. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1123732
Sex: F
Age: 58
State: AZ

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/22/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
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Vax Site:

Lab Data:

Allergies: IV contrast dye

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

Symptoms: As I was driving home my face started to burn like a bad sunburn. When I got home my face was blotchy and my eyes started to swell. I took benedryl and applied a cool pack. Redness and swelling around mybeyes lasted for 2+ days. Still not feeling well and have scheduled a doctor appointment for tomorrow.

Other Meds: None

Current Illness: None

ID: 1123733
Sex: F
Age: 45
State: CO

Vax Date: 03/19/2021
Onset Date: 03/22/2021
Rec V Date: 03/22/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
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Lab Data:

Allergies: Quinoa Nickel

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

Symptoms: Systemic itchiness starting around the face/head. Arm also itches along with torso. Right arm is starting to show signs of a rash near & below injection site.

Other Meds: Divigel (estrogen) Vitamin C Vitamin D Multivitamin Prilosec Claritin Lutein

Current Illness:

ID: 1123734
Sex: F
Age: 74
State: MA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Bactrim, Nitrofuranoine, Baclofen

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

Symptoms: Ballistic movement entire body, worse lying down. Lasted 12 days.

Other Meds: Desiperine, Vitamin D, Fish Oil, Calcium, Magnesium, Evening Primrose Oil, Vitamin C

Current Illness: N/A

ID: 1123735
Sex: F
Age: 76
State:

Vax Date: 01/27/2021
Onset Date: 02/24/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: generalized weakness shortness of breath Covid-19

Other Meds:

Current Illness:

ID: 1123736
Sex: F
Age: 49
State: NE

Vax Date: 03/07/2021
Onset Date:
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Day 1 Sweats, Severe Headache, Fatigue and aches Day 2 Headaches and Sweats Day 3 Profuse sweating, fatigue, headache and aches Day 4 Sweats, Headache Day 5 HIVES, Headache Day 6 HIVES, ANAPHYLAXIC Swelling in hands, feet, tongue & throat. Had to go to the ER! Day 7 Swelling, hives Day 8 Hives Day 9 Hives Day 10 Hives Day 11 Hives Day 12 started to subside

Other Meds:

Current Illness:

Date Died: 03/20/2021

ID: 1123737
Sex: F
Age: 86
State: MO

Vax Date: 02/25/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PATIENT PASSED AWAY ON 3.20.2021

Other Meds:

Current Illness:

ID: 1123738
Sex: F
Age: 46
State: TX

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: headache, highfever, chills, nausea, swollen arm (red/ hot to touch) skin sensitivity, body / joint aches

Other Meds: ibuprofen

Current Illness: none

ID: 1123739
Sex: F
Age: 44
State: NC

Vax Date: 03/20/2021
Onset Date: 03/21/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs and amoxicillin

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

Symptoms: Upper left arm soreness around site of injection was distinct and noticeable after I woke up on 3/21; Soreness lasted all day but was gone upon waking on 3/22

Other Meds: NatureThroid, Lexapro, Buspar, spironolactone, estrogen, progesterone, albuterol, metformin, magnesium, multivitamin, CoQ10, alpha lipoic acid, Viviscal

Current Illness: None

ID: 1123740
Sex: F
Age: 34
State: GA

Vax Date: 03/10/2021
Onset Date: 03/15/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Started with itching at injection site that spread to red itchy bumps on both hands, fingers, toes, soles of feet, elbows and knees.

Other Meds: Marena IUD

Current Illness:

Total 2021 VAERS Injuries: 704,237

Page last modified: 26 October 2021 2:21am