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: 1084978
Sex: F
Age: 52
State: OR

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/09/2021
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: Nuts

Symptom List: Dysphagia, Epiglottitis

Symptoms: Severe chills, fever and weakness

Other Meds:

Current Illness:

ID: 1084979
Sex: M
Age: 55
State: IN

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 03/09/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Chills, sweating, back ache

Other Meds: None

Current Illness: None

ID: 1084980
Sex: F
Age: 6
State:

Vax Date: 10/16/2020
Onset Date: 10/26/2020
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaculitis; GI symptoms; This case was reported by a physician via sales rep and described the occurrence of gastrointestinal disorder in a 6-year-old female patient who received Flu Seasonal QIV Dresden (Fluarix Tetra 2020-2021 season) (batch number Z7275, expiry date 30th June 2021) for prophylaxis. Co-suspect products included flu seasonal qiv dresden pre-filled syringe device (Fluarix Tetra Pre-Filled Syringe Device) injection syringe for prophylaxis. The patient's past medical history included premature birth (Patient was born 6 weeks premature). On 16th October 2020, the patient received Fluarix Tetra 2020-2021 season and Fluarix Tetra Pre-Filled Syringe Device. On 26th October 2020, 10 days after receiving Fluarix Tetra 2020-2021 season and Fluarix Tetra Pre-Filled Syringe Device, the patient experienced gastrointestinal disorder. On 29th October 2020, the patient experienced vasculitis. On an unknown date, the outcome of the gastrointestinal disorder and vasculitis were unknown. It was unknown if the reporter considered the gastrointestinal disorder and vasculitis to be related to Fluarix Tetra 2020-2021 season and Fluarix Tetra Pre-Filled Syringe Device. This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences. Additional details were provided as follows: The patient along with her mother returned to physician's office on 26th October 2020 with gastrointestinal symptoms and was seen. The patient was seen again by physician on 29th October 2020 and presented with vasculitis. This was 1 of 3 case reported by same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2020AMR047386:same reporter US-GLAXOSMITHKLINE-US2021AMR022342:twin?s case

Other Meds: FLUARIX TETRA Pre-Filled Syringe

Current Illness:

ID: 1084981
Sex: M
Age: 52
State: IN

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache, muscle aches, stuffy nose, chills, fatigue. All very mild. All gone by the following morning.

Other Meds: Plavix 75 mg Rosuvastatin 20 mg Niacin 1000 mg Losartan 25 mg CoQ10 300 mg Metaformin 1000 mg Multivitamin Aspirin 81

Current Illness: NA

ID: 1084983
Sex: F
Age: 29
State: IN

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
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: Cold chills, intense arm pain, heavy sweats, nausea, joint/bone pain, headaches, fatigue

Other Meds:

Current Illness:

ID: 1084984
Sex: F
Age: 73
State: NC

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/09/2021
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: Banana/plantain - anaphylaxis, swelling; ACEI - cough;

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

Symptoms: 73 yo F with renal mass was given her second Covid-19 vaccine IM in her right deltoid (lot# EN6206) on 3/4 at 1312. In the final minutes of this patient's 15 minute observation period, patient was noticed to have pulled her mask down and was looking at the observer as if she wanted to say something. Observer asked pt if she was ok. Patient nodded yes. A minute later, the patient dropped her purse and mumbled something. Patient's arm went up and patient became stiff and started seizing. Observer immediately called for help. Vitals, glucose and oxygen was placed on patient. EMS was called. Provider notified and went to patient who was sitting upright in chair actively having bilateral generalized

Other Meds: warfarin, torsemide, pravastatin, KCL, metoprolol XL,

Current Illness:

ID: 1084985
Sex: M
Age: 55
State: IN

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
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: Nausea body aches

Other Meds: Loratidine Lisinopril Flutocason Artorvardstatin Ibuprofein Aspirin Esomeprazol

Current Illness:

ID: 1084986
Sex: M
Age: 46
State: IL

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 03/09/2021
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 and codeine based products

Symptom List: Pharyngeal swelling

Symptoms: Swelling around the base of the neck (left, right and front) and up the sides of the neck; initially treated with heat/cold therapy and ibuprofen; no impact on the swelling; visits to the primary physician, ER and referral to ENT all unable to explain or alleviate issue

Other Meds: Lisinopril 5mg Famotidine 10mg Xyzal 5mg multi vitamins

Current Illness: NA

ID: 1084989
Sex: F
Age: 46
State: NM

Vax Date: 01/12/2021
Onset Date: 01/14/2021
Rec V Date: 03/09/2021
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; Dairy

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Received dose on 01/12/2021 - left arm - muscle soreness. however on 01/14/2021 developed left axillary lymph node became very swollen and very painful -discomfort. Also became very fatigued and temperature not stable bouncing down to 97.4 - 99.9. these all lasted for about 3 days and then completely went away

Other Meds: Prescribed: metformin 1000mg bid; Hydrochlorothiazide 25mg qd; Lisinopril 20mg qd; Iron supplement 325mg qd Supplements: B12 sublingual 1 dropper qd; Potassium 99mg qd; Magnesium 400mg qd; Gaba 750mg qhs.

Current Illness: none

ID: 1084990
Sex: F
Age: 60
State:

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/09/2021
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: Compazine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I had the most peculiar taste in my mouth. It wasn't entirely a metal taste, but it was strong enough it overwhelmed the taste of everything else for about 6 hours. I could still taste other things, but the primary taste and the one that remained in my mouth was this odd, almost metal taste. The next day (after the taste was gone)- it would have been almost 24 hours from the time of the injection - I was hit with a bad headache and body aches like I haven't had in many years. The body ache was gone the next morning, and the headache lingered another day past that. Today, Tuesday March 9, is the first day I feel like myself again.

Other Meds: Claritin (over-the-counter)

Current Illness: None

ID: 1084991
Sex: F
Age: 51
State: IN

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: Headache, muscle aches, fever over 100. Lasted one day. No treatment, only rest. Day two symptoms were gone.

Other Meds: Fluoxetine HCL 40 mg, Omeprazole DR 20 mg, Fexofenadine HCL 180 mg, Meloxicam 15 mg, Montelukast Sod 10 mg, B-12 2500 mcg

Current Illness: No

ID: 1084992
Sex: F
Age: 53
State: IN

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
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: Allergic to food item: 1. Maryland Blue Crab Allergic to 6 antibiotics: 1. Sulfa 2. Penicilin 3. Biaxin 4. Flagl 5. Clindamycin 6. Omnicef

Symptom List: Rash, Urticaria

Symptoms: My head felt heavy; it felt like my head was surrounded by water. Lots of pressure around my ears. My mind was very foggy; I could not think clearly. It was hard to concentrate and focus. It felt like I was extremely groggy but not sleepy. My think pattern was very slow. My appetite decreased; I felt nauseous a couple of times. No fever. I took 2 Tylenol tablets (regular dose), and laid down to rest for several hours. The longer the day went, the more severe the symptoms become. I took another 2 Tylenol tablets at bedtime, and went to bed earlier. During the day I drank lots of fluids, and ate light food.

Other Meds: Zertec Flonaze Triameterene Daily multi-vitamin

Current Illness: none

ID: 1084994
Sex: M
Age: 86
State: PA

Vax Date: 01/28/2021
Onset Date: 01/31/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: cipro, norvasc, tiazac, lescol,hctz, coreg cr, uloric, atorvastatin

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

Symptoms: Rash arm, neck shoulder on vaccine side and pruritus

Other Meds: Plavix, Ranexa, Vitamin D, Imdur, xarelto, Lasix, metoprolol, pravastatin, lasix

Current Illness: none

ID: 1084995
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 03/09/2021
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: Your form will not let me pass

Other Meds:

Current Illness:

ID: 1084996
Sex: M
Age: 54
State: IN

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: 36 hours of body aches, fever, headache. 48 hours of fatigue.

Other Meds: Benazepril and daily aspirin

Current Illness: None

ID: 1084997
Sex: F
Age: 54
State: FL

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/09/2021
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: nka

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

Symptoms: Client stated that she felt "pain, discomfort in rectum 1 minute after vaccination." Client observed for 20 minutes, reported a decrease in discomfort. Declined further observation. Driven home by spouse.

Other Meds: none

Current Illness: none

ID: 1084998
Sex: F
Age: 73
State: CA

Vax Date: 03/02/2021
Onset Date: 03/05/2021
Rec V Date: 03/09/2021
Hospital: Y

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: Severe skin reaction at site-almost like cellulitis-reddened and extremely swollen

Other Meds:

Current Illness:

ID: 1084999
Sex: M
Age: 55
State: AZ

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Ear pain, Hypoaesthesia

Symptoms: stiff rotator cuff, arm soreness-8-12 hours duration, feeling better today after seeing dr.

Other Meds: none known

Current Illness: no

ID: 1085001
Sex: F
Age: 50
State: IN

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 03/09/2021
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: Fatigue, headache, muscle aches, fever of 100.7

Other Meds: Amlodipine, Wellbutrin, Claritin, daily multi-vitamin

Current Illness: none

ID: 1085002
Sex: F
Age: 58
State: MD

Vax Date: 01/06/2021
Onset Date: 01/14/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

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

Symptoms: I developed severe headache for two to three days after getting the 2nd dose of the Covid-19 vaccine starting approx. 3 hours after the vaccine. I took Celebrex as the head aches were quite severe(7-8/10) with difficulties in focusing due to the pain. I received my first Covid-19 vaccination shot on 12/16/2020 and did not have any significant side effects besides mild pain in my left arm at the injection site the next day and it resolved with no intervention. Then on 01/14/2021 I developed floaters in my right eye that was very sudden around early afternoon that progressed to large black spots obscuring my vision. It was associated with headache and deep eye itching and pain. I was unable to look at the computer and that is when I called my eye doctor and was told to come to see her right away. She then diagnosed me with Posterior Vitreous Detachment and referred me right away to see Dr. retinal specialist.

Other Meds: LOSARTAN 50 mg orally every daily for history of hypertension. My BP is well managed and is always less than 130/80 mm hg. CELEBREX for severe head ache after vaccination for two to 3 days. Took one capsule a day.

Current Illness: Back pain from disc disease and DJD

ID: 1085004
Sex: F
Age: 79
State: IN

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 03/09/2021
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: Occasional dizziness not previously experienced except on rare occasions.

Other Meds: Sertraline, Atorvastatin, Zolpidem Tartrate Complete Multivitamin Women 50+, Calcium, Magnesium, Omega 3

Current Illness: None

ID: 1085005
Sex: F
Age: 74
State: IN

Vax Date: 02/18/2021
Onset Date: 02/26/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Unevaluable event

Symptoms: 8 days after vaccine shot, welt appeared on vaccination arm. 2 X 4 inches. Raised area more than a rash. Itched and stinging sensation. Lasted 10 days.

Other Meds: Synthroid

Current Illness: None

ID: 1085007
Sex: F
Age: 91
State: MN

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 03/09/2021
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:

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

Symptoms: In between the 2nd dose being scheduled and administered, the guidance changed. The injection was given within the 4 day grace period, but was before the 28 day mark.

Other Meds:

Current Illness:

ID: 1085009
Sex: F
Age: 82
State: TX

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/09/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Fatigue, head ache, dizziness, feeling weak

Other Meds:

Current Illness:

ID: 1085010
Sex: F
Age: 26
State: IN

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
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: Injection site pain, Menorrhagia

Symptoms: Startinf 12 hours after vaccine, I experienced a very sore injection site, fever, and body aches. I took Tylenol which lessened symptoms but did not completely make them go away. Symptoms subsided after after 48 hours after vaccine.

Other Meds: Sprintec

Current Illness: None

ID: 1085011
Sex: M
Age: 34
State: CT

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/09/2021
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: unknown

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

Symptoms: Approximately 10 mins post vaccination, staff was alerted by bystander that patient was not responding despite seated position in chair with eyes open. Patient noted to be cool, clammy, weak pulse (radially), dilated pupils. States felt lightheaded. BP stable in 120's systolic. EMS called. By EMS arrival (approximately 5 mins post staff notification of patient condition), color was returning to face. Patient stating felt much better. Transported to local ER and discharged after approximately 2.5 hours. Patient did report had traveled (about 5-6 hours in car) day before, had minimal liquid intake during and after travel, and did not sleep well in local hotel. Reports did eat breakfast prior to vaccination. Spoke with patient around 1140am. Stated was returning from ER. Feeling much better. Discharged without follow up and instructed to ensure he was hydrated, ate, and slept well before 2nd dose. Also instructed to wait 30 mins post vaccination for monitoring after covid #2.

Other Meds: unknown

Current Illness: unknown

ID: 1085013
Sex: M
Age: 71
State: NC

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/09/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Diarrhea began day after vaccination, 6 + stools per day, initially yellow and fishy smelling, now brown water, no blood. appetite good.

Other Meds: atovastatin, lisinopril, metformin

Current Illness: none reported

ID: 1085014
Sex: F
Age: 50
State: IN

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: body aches starting 15 hours post-injection, fatigue starting 17 hours post-injection, fever starting 18 hours post-injection. Fever lasted 6 hours, fatigue and body aches continued into next day lasting 24 hours

Other Meds: multivitamin

Current Illness: none

ID: 1085015
Sex: F
Age: 42
State: VA

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 11:39Chest tightness, clients albuterol inhaler- 11:58 feeling the need to "clear throat", dizziness, leg weakness increased heart rate 25mg benadryl. symptoms resolved at 12:42

Other Meds:

Current Illness:

ID: 1085016
Sex: F
Age: 28
State: MN

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 03/09/2021
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: In between the 2nd dose being scheduled and administered, the guidance changed. The injection was given within the 4 day grace period, but was before the 28 day mark.

Other Meds:

Current Illness:

ID: 1085017
Sex: M
Age: 74
State: IL

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain

Symptoms: Seizure

Other Meds: Sertraline

Current Illness:

ID: 1085018
Sex: F
Age: 69
State:

Vax Date: 02/24/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: Bee stings

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

Symptoms: Large red area at injection site also smaller red blotches below the large area, Seems to be getting worse and covering more of my left arm. Feels warm to the touch, itchy, my arm is sore to the touch at injection site.

Other Meds: Lovastatin 20 mg; Lisinopril 20mg; Paroxetine 20 mg; Vitamin D3 25 mg; Glucosamine 1500 mg; Centrum Silver Vitamin Women 50+; 81 mg aspirin

Current Illness: None

Date Died: 03/05/2021

ID: 1085019
Sex: F
Age: 65
State: WA

Vax Date: 03/03/2020
Onset Date: 03/05/2021
Rec V Date: 03/09/2021
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: Benzodiazepines, celecoxib, codeine, diphenhydramine HCL, inositol Niacinate, Metaxalone, Niacinamide, oxycodone HCL, ASA, horse/equine containing products,, erythromycin base products, shellfish derived, bee venom

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

Symptoms: Had vaccine on 3/3/2021 at approximately 1 PM. She was found on her couch deceased on 3/8/2021. Possible death on 3/5/2021. She called her sister and told sister that back hurt worse than usual and she would lay on the couch and rest. This is where she was found. Unknown if from vaccine, but due to vaccination on Wednesday proceeding her death, report is being filed.

Other Meds: Multi vitamin, promethazine 25 mg, omeprazole 20 mg, cyclobenzaprine, 10 mg, oxycodone/APAP 5/325mg, gabapentin 800 mg, simvastatin 20 mg tab, metformin 1000 mg tab, nortriptyline 50 mg cap, zolpidem 10 mg tab, Ketorolac 60 mg injection 2 t

Current Illness: Chronic pain, HTN, DM, Cervicalgia, nausea, insomnia

ID: 1085020
Sex: F
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 03/09/2021
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: Tremor

Symptoms: Rheumatoid arthritis sometimes flares up and gets sore; Soreness and achiness in right shoulder and arm / felt sore and achy; Soreness and achiness in right shoulder and arm / felt sore and achy; Patient stated it was weird; Inflamed shoulder/during night it was very bad; Lower left eyelid which is inverted, it is bothering her / have to release the muscle; This case was reported by a consumer via other manufacturer and described the occurrence of rheumatoid arthritis flare up in a 78-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Concurrent medical conditions included rheumatoid arthritis (arthritis in right shoulder and arm gets inflamed and sore which was diagnosed in late 2019), autoimmune deficiency syndrome (diagnosed in late 2019) and shoulder arthritis (arthritis in right shoulder). On an unknown date, the patient received Shingrix. On an unknown date, less than 2 years after receiving Shingrix, the patient experienced rheumatoid arthritis flare up (serious criteria GSK medically significant), pain in arm, shoulder pain, weird feeling, flare up of arthritis and entropion. On an unknown date, the outcome of the rheumatoid arthritis flare up and weird feeling were unknown and the outcome of the pain in arm, shoulder pain and flare up of arthritis were recovered/resolved and the outcome of the entropion was not recovered/not resolved. It was unknown if the reporter considered the rheumatoid arthritis flare up, pain in arm, shoulder pain, weird feeling, flare up of arthritis and entropion to be related to Shingrix. Additional details were provided as follows: The reporter was the patient. The age at vaccination was not reported but it could be 77 or 78 years. The rheumatoid arthritis sometimes flares up and gets sore. The routine lab work was done on 2nd February 2021 which had nothing to do with these vaccinations and no other relevant tests were performed. The patient had received Shingrix vaccine in the left arm and experienced soreness and achiness in right shoulder and arm a year ago. The patient received the Pfizer Covid 19 vaccine (batch number EN6201) on 17th February 2021 10:15 at left upper arm intramuscularly and few hours later her right shoulder and right arm felt sore and achy. The reporter stated that it was weird. It hurt on lifting her arm up high and had an inflamed shoulder. The patient also had an inflamed shoulder previously which was pretty good lately but flared up after the vaccine, it was very bad during the night. The reporter was wondering if there was a relationship with the Covid 19 vaccine because she felt like she got the Covid 19 vaccine in the right arm and was asking if she was reacting to the medication. The patient has been scheduled to get the botox injection a week after the reporting date for lower left eyelid which was inverted as it was bothering her.They had to release the muscle through the botox injection.She had called CDC to find out if the botox injection would be effected by the vaccine. The patient's primary care physician asked her to wait a month while on the contrary the opthalmologist said it was okay to get the Covid 19 vaccine. The patient thought she heard something about not mixing botox with the vaccine. No treatment was taken for right shoulder. The patient was not hospitalized or did not visit an emergency room or physician's office. The reporter consented to follow-up but declines to provide health care professional's details.

Other Meds:

Current Illness: Autoimmune deficiency syndrome (diagnosed in late 2019); Shoulder arthritis (arthritis in right shoulder)

ID: 1085022
Sex: F
Age: 66
State: IN

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 03/09/2021
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: Penicillin

Symptom List: Erythema, Pruritus

Symptoms: Fever 100.1, Chills, Ache

Other Meds: Metformin, Lisinopril, Insulin

Current Illness: None

ID: 1085023
Sex: F
Age: 53
State: IN

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: Started with chills about 12 hours after the shot, headaches, nausea, light-headedness (nearly passed out), dry-heaving, fatigue (slept on and off for 24 hours) Symptoms lasted about 36 hours and then I felt fine again.

Other Meds: Zoloft

Current Illness:

ID: 1085024
Sex: F
Age: 26
State: MN

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 03/09/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: In between the 2nd dose being scheduled and administered, the guidance changed. The injection was given within the 4 day grace period, but was before the 28 day mark.

Other Meds:

Current Illness:

ID: 1085025
Sex: M
Age: 58
State: CT

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/09/2021
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: Muscle cramps, nausea , headache, chills, fever 100.4

Other Meds:

Current Illness:

ID: 1085026
Sex: M
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 03/09/2021
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:

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

Symptoms: Tested for Lyme disease during this and it was positive; Flu-like symptoms; Shortness of breath; Fatigue; This case was reported by a physician via sales rep and described the occurrence of lyme disease in a male patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received the 1st dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced lyme disease (serious criteria GSK medically significant), influenza-like symptoms, shortness of breath and fatigue. On an unknown date, the outcome of the lyme disease was unknown and the outcome of the influenza-like symptoms, shortness of breath and fatigue were recovered/resolved. It was unknown if the reporter considered the lyme disease, influenza-like symptoms, shortness of breath and fatigue to be related to Shingrix. Additional details were provided as follows: Age at vaccination was not reported. It was reported that after 1st dose, the patient experienced flu-like illness, shortness of breath, fatigue. It took weeks to resolve. The patient was tested for Lyme disease during this and it was positive. This was his first diagnosis of Lyme disease. This occurred about 1 year ago.

Other Meds:

Current Illness:

ID: 1085027
Sex: M
Age: 52
State: IN

Vax Date: 03/07/2021
Onset Date: 03/09/2021
Rec V Date: 03/09/2021
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: N/A

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

Symptoms: Started developing a sore throat two days after the vaccination.

Other Meds: Levothyroxine 0.112Mg (112Mcg) Tablet Bupropion Xl 300Mg Tablets Venlafaxine Er 75Mg Capsules Indomethacin 50Mg Capsules Topiramate 25Mg Tablets Nortriptyline 25Mg Capsules Viagra 100mg Tablets Metformin Er 500Mg 24Hr Tabs Atorvastatin 40M

Current Illness: N/A

ID: 1085028
Sex: F
Age: 34
State: NJ

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

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

Lab Data:

Allergies: No known allergies

Symptom List: Pain in extremity

Symptoms: Patient and husband arrived to received covid-19 vaccine together, 12:30 pm and 12:45 pm appointments. I informed patients that if they wanted to, they can both enter room together. Both patients were counseled on side effects/ what to expect. Patient was administered the Moderna COVID-19 Vaccine first in left arm. Upon vaccination, patient's arm began to bleed from injection site. I informed patient I would clean her arm, and attempted to hold gauze in place myself. Patient stated she would hold the gauze instead. After applying bandaid and cleaning area, I began process to vaccinate her husband. While vaccinating husband, patient stated she felt dizzy/faint. Patient sat in chair. Husband stated she is prone to fainting spells. I offered EMS services.Husband refused. I elevated patient's legs with other chair. Patient started to become non-responsive. I stated I would use an epi-pen. Patient's husband refused epipen. Informed technician, to contact 911. Informed technician to contact front end manager. Patient continued to be non-responsive. Asked husband if I should get patient juice. Ran to get patient orange juice and straw. Husband wet patient with water. Patient started drinking orange juice through straw. Felt better. Started becoming responsive. PAtient and husband waited for EMS. Refused EMS services.

Other Meds: No known information

Current Illness: No known information

ID: 1085029
Sex: M
Age: 69
State: NM

Vax Date: 02/11/2021
Onset Date: 02/21/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Approximately 10 days after the vaccination I began to develop muscle and joint pain on my left side. two days later I started to have problems breathing and the muscle pain, all on my left side, worsened. A day or two later I developed a fever of 102 and the muscle and joint pain became worse, again all on the left side of my body. To treat the fever I took Motrin, this also helped with the headache. I also had a lose of appetite as these symptoms progressed and lost about 7 pounds. I developed a cough that persisted for about 7 days. These symptoms were intense for about three days and persisted at varying intensity for about 10 days.

Other Meds: Sulfasalazine - 1000mg-twice daily; Folic Acid - 1mg-daily; Methotrexate - 20mg- weekly; Asprin - 81mg- daily

Current Illness: Rheumatoid Arthritis;

ID: 1085030
Sex: F
Age: 66
State: CA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/09/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: vesicular rash right mid-back

Other Meds:

Current Illness:

ID: 1085031
Sex: F
Age: 53
State:

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Fever

Other Meds:

Current Illness:

Date Died: 03/01/2021

ID: 1085032
Sex: F
Age: 58
State: AR

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/09/2021
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: NKA

Symptom List: Vomiting

Symptoms: Patient received dose #2 of her Moderna COVID vaccine on 2/25/21. Patient called in to work the next day 2/26/21 because she was not feeling well. Patient did not show up to work on Monday 3/1/21 and her supervisor, called the PD to check in on her and she was found deceased in her home.

Other Meds: unknown

Current Illness: unknown

ID: 1085034
Sex: M
Age: 33
State: CA

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/09/2021
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: iodine contrast

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient is a 33 y.o. male who received the Moderna lot # 001B21A on 3/9/2021. The patient experienced the following reaction(s) during the immediate of observation: Patient c/o "weird taste in mouth, metallic taste." Patient was treated/managed as follows: PMH of DM and asthma. Patient reports taking metformin and lisinopril at home. Vital signs, monitor 0937 BP 146/92, HR 75, RR 18, O2 sat 97% on room air. Patient reports taste in mouth resolving. 0947 BP 126/90, HR 72, RR 17, O2 sat 97% on room air. Patient reports anxiety and twitching in lips. No swelling noted. Denies numbness and tingling. Water provided. 0954 Patient reports twitching in lips and taste resolved. 1008 Patient reports "feeling better." Patient escorted to car by significant other and documenting nurse. Patient given educational material regarding vaccine and advised to continue to self-monitor per the CDC guidance.

Other Meds: metformin, lisinopril

Current Illness: none

ID: 1085035
Sex: F
Age: 71
State: NY

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 03/09/2021
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: N/A

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

Symptoms: Chills, Headache, Myalgia, Arthralgia, Fatigue, Rash on forearms

Other Meds: hydroxychloroquine, crestor, vitamin d, oxycotin

Current Illness: N/A

ID: 1085036
Sex: F
Age: 74
State: IN

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
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: Lamisil, Crestor, Lipitor, Zocor, Pravachol, Cipro, chromic catgut suture

Symptom List: Injection site swelling, Limb discomfort

Symptoms: nausea, diarrhea, 102 degree fever with chills, slight headache

Other Meds: Livalo 4mg daily, Cranberry 300mg daily, D Mannose 1000mg 2x's daily, Vitamin D 4,000 Units daily, Probiotic Pearls Acicophilus daily, Nystatin oral suspension 100000 U Suspension 1 ml swish in mouth 4x's/day for 10 days

Current Illness: Diverticulitis & given 10 day course of Omnicef & Flagyl, 8 days later CT scan showed acute diverticulitis again & treated with Flagyl & Ceftin. Finished Ceftin 2 days prior & Flagyl 1 day prior to vaccine.

ID: 1085037
Sex: F
Age: 37
State: NJ

Vax Date: 01/22/2021
Onset Date: 02/22/2021
Rec V Date: 03/09/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: 1 month after second dose of the COVID 19 moderna vaccine i developed hazzy /foggy vision associated with headache right > left side and i was evaluated by ophthalmology and all were normal , also was evaluated by ENT and was suspected sinusitis and has been on antibiotics for 10 days now now the right headache has moved to the left side , the hazy vision has gotten better but the headache is persistent and does not respond to OTC medications . Similar symptoms in colleagues 1 month after the 2nd dose of the vaccine .

Other Meds: None

Current Illness: None

ID: 1085038
Sex: M
Age: 50
State: IN

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
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: N/A

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

Symptoms: Chills, shivers, headache, body aches and soreness

Other Meds: N/A

Current Illness: N/A

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm