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: 1085722
Sex: F
Age: 56
State: CA

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: Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient felt dizzy approximately 10-15 minutes after administration of vaccine. Patient started feeling better after 5 to 10 minutes. She waited in office for a total of 1 hour before going home. She said she felt like she was back to baseline.

Other Meds:

Current Illness: unknown

ID: 1085723
Sex: M
Age: 38
State: TX

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: No

Symptom List: Anxiety, Dyspnoea

Symptoms: Swollen lymph nodes at the collar bone and neck. Acute pain in left arm and shoulder

Other Meds: Losartan (100 mg/daily)

Current Illness: No

ID: 1085724
Sex: F
Age: 59
State: CA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
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: Sulfa

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

Symptoms: Sore arm, stiff neck, headache and fatigue. Headache and fatigue lasted for 2-3 days.

Other Meds: Triamterene-hctz 37.5-25 mg Tons of vitamins Lion's Manes Mushroom supplements

Current Illness: None

ID: 1085725
Sex: F
Age: 69
State: OH

Vax Date: 02/09/2021
Onset Date: 02/16/2021
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: None.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient reported that 7 days AFTER receiving her vaccine her shoulder felt hard to the touch and felt hot. This lasted for 2 days. She self treated with ibuprofen and did not seek any medical care.

Other Meds: Unknown. Tried to call patient, no answer and no call back so far. She has not filled any medications at our pharmacy.

Current Illness: None know.

ID: 1085726
Sex: F
Age: 31
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Unknown

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

Symptoms: Pt received her first dose of the COVID19 Moderna vaccine. While sitting in observation pt reported feeling like her heart was beating fast and loud. BP 118/80, HR 80, O2sat 98%, evaluated by MD. Pt refused EMS evaluation and reported feeling better within a few minutes.

Other Meds: Unable to view in notes

Current Illness: Unable to view in notes

ID: 1085727
Sex: F
Age: 75
State: NY

Vax Date: 02/27/2021
Onset Date: 03/08/2021
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: None

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

Symptoms: Itching, swelling, and redness apx. 3inches in diameter about 2 inches below injection site.

Other Meds: Synthroid 88 Losartan 100 Norvasc 10 Hydrochlorothiazide 12.5 Rosuvastatin 20 Potassium CLER 20 Vitamin D Magnesium 250 Miralax

Current Illness: No

ID: 1085730
Sex: M
Age: 71
State: UT

Vax Date: 02/16/2021
Onset Date: 02/24/2021
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: strawberries, melons, banana, cats

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Deep red rash about 3cm in diameter with hardness underneath about 5-6cm and swelling. Also swelling in lymph under arm. Dr. was seen who ordered a course of antibiotics and steroids after which the swelling and redness resolved.

Other Meds: Omeprazole, Vitamin D, Vitamin B-12

Current Illness: kidney stones both kidneys Lithotrypsy of L. ureter for stone that was too big to pass

ID: 1085731
Sex: M
Age: 31
State: FL

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: fatigue and lightheadedness

Other Meds: None

Current Illness: NOne

ID: 1085732
Sex: F
Age: 76
State: NJ

Vax Date: 02/17/2021
Onset Date: 02/20/2021
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: ACE inhibitors

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Three days after vaccination I developed a red, itchy rash which was hot to touch on my upper left arm. It proceeded to increase in size and intensity for three more days before I started taking Benadryl. At its peak it covered almost my total upper arm and extended laterally about 2-3 inches.

Other Meds: Losartan Diltiazem Hydrochlorthiazide Vitamin D Asmanax inhaler Restasis eye drops

Current Illness:

ID: 1085733
Sex: F
Age: 50
State: MA

Vax Date: 02/23/2021
Onset Date: 03/02/2021
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: Sulfa antibiotics, Augmentin, hydrocodone, oxycodone

Symptom List: Diarrhoea, Nasal congestion

Symptoms: After receiving the vaccine, my arm was sore, but no more than expected - it was like getting the flu vaccine. A week later, I noticed I had a hive around the injection site. It was about 2x3 inches, sore, hot, and bumpy. It stayed that way for about two days, then got super itchy and remained tender and hot. About day five, the hive part became more of a ring and started to expand. I'm now a week in and the hive ring has expanded to about half of my upper arm. The itching has started to subside. It's still warm to the touch, but not hot. The reaction may have been exacerbated by another issue - several years ago I had the shoulder on the same side as the injection replaced and had an allergic reaction to the dermabond used to seal the surgical incision and to the pain meds. I'm also allergic to the metal used in the replacement. The scar reacts by getting red, hot, puffy, and itchy whenever my allergies are bothering me. The injection reaction area included the incision and it's been a major part of the issue. While this may have contributed to the strength of the reaction, the "hive circle" has expanded in all directions - not just over the scar.

Other Meds: Levothyroxine, Allegra

Current Illness: none

ID: 1085735
Sex: F
Age: 59
State: OK

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Itchy rash all over body this morning

Other Meds:

Current Illness:

ID: 1085736
Sex: F
Age: 37
State:

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: VACCINE L ARM @0732. DURING CHECK OUT, AFTER 15 MINUTES, REPORTED RACING HEART, "HEAD WOOZY", AND FATIGUE. ON EXAM, SOME SLURRING OF SPEACH AND EYES CLOSED- IMPROVED AFTER 10 MINUTES. MEDS: CYMBALTA, CELEBREX, ZYRTEC, MINIPRES. MINITORED ADDITIONAL 30 MINS. WALKING, TRANSFERRED TO STRETCHER WITHOUT DIFFICULTY. RELEASED AT 0830.

Other Meds:

Current Illness:

ID: 1085737
Sex: F
Age: 73
State: MD

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: IM
Vax Site: LA

Lab Data:

Allergies: hayfever, animal dander, sulfa

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

Symptoms: fever 100 degrees, lethargy, aches, cold symptoms, tiredness , dizziness Janssen COVID-19 Vaccine EUA

Other Meds: melatonin, xanax, zoloft, calcium, vitamins C, D3, B12, biotin, magnesium, fiber gummies, meloxicam

Current Illness: none

ID: 1085739
Sex: F
Age: 69
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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: Dizziness

Other Meds: Advair Diskus 500 mcg-50 mcg inhalation powder, 1 puffs, Inh-Oral, BID, 3 refills, Needs Medication Refill Albuterol (Eqv-Proventil HFA) 90 mcg/inh inhalation aerosol, 2 puffs, Buccal, Q6H, 11 refills albuterol 2.5 mg/3 mL (0.083%) inha

Current Illness: none

ID: 1085740
Sex: F
Age: 24
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Amoxicillin

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

Symptoms: warmth, redness, edema, hard around injection site, pain to injection site

Other Meds: Adderall, lexapro, metformin, MTV

Current Illness: NA

ID: 1085741
Sex: F
Age: 57
State: IN

Vax Date: 03/01/2021
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: IV Contrast Dye and Prilosec (years ago)

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

Symptoms: Anaphylaxis - rash and hives from head to toes, severe itching, difficulty breathing, and chest pain. Oxygen Saturation was at 87 when I arrived. Treated with dexamethasone sod phosphate PF last given at 5:45 PM, diphenhydrAMINE (Benadryl) last given at 5:45 PM, EPINEPHrine last given at 5:45 PM, famotine last given at 6:08 PM, GI cocktail oral suspension last given at 6:44 PM, hydrocortisone last given at 8:18 PM, LORazepam last given at 5:48 and 6:45 PM, ondansetron last given at 5:48.

Other Meds: Aspirin 81 MG EC tablet 1 po qd; buPropion 300 MGXL tablet 1 po qd; cholecalciferol 1000 UNIT tablet po qd; escitalopram 10 MG 1 po qd; estradiol 0.5 MG tablet 1 po qd, fish oil omega-e fatty acids 1000 MG capsule, lisinopril 10 MG tablet

Current Illness: None

ID: 1085742
Sex: M
Age: 50
State: PA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/09/2021
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: NKDA

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

Symptoms: Mild nausea/dizziness. Monitored for 30 minutes. BP 129/77 HR 75. Released.

Other Meds: Unknown

Current Illness: n/a

ID: 1085743
Sex: F
Age: 50
State: IL

Vax Date: 02/12/2021
Onset Date: 02/12/2021
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: Bee Allergy, Nausea to cecolr

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Face Flush, Swelling, - Prescribed- Zyrtec- Within 24x sysmptoms cleared up.

Other Meds: Prescription: Lamictal 100mg x2, Metoprorpyl 200mg x1, Ezetimibe 10mg x1, Deloxitine 60mg x1, Pantoprazole 40mg x1, Vitamin D 50,000 x1 per week

Current Illness: No

ID: 1085744
Sex: M
Age: 39
State: CA

Vax Date: 03/09/2021
Onset Date: 03/09/2021
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: possible anti malaria medication

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: numbness, upper lip and nasal passage, dizziness.

Other Meds: n/a

Current Illness: n/a

ID: 1085745
Sex: F
Age: 53
State: TX

Vax Date: 03/09/2021
Onset Date: 03/09/2021
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: None

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

Symptoms: Received vaccine on 3/4. Noticed swelling under right on 3/5 in the afternoon. Minimal under left eye. Right eye more painful. On Monday 3/8 noticed swelling to right side of upper lip lasting through Tuesday 3/9. Described as painful, numb, and tingling. Stated she felt short of breath until morning of 3/9 with chills. At time of report right upper lip swollen but pt. says has decreased. Took Zyrtec, and Advil for relief. Pt. received fillers for under both eyes and lip on June 6, 2020. Swelling occurred where injection of filler was placed.

Other Meds: Armour Thyroid; Taytulla

Current Illness: None

ID: 1085746
Sex: F
Age: 68
State: MN

Vax Date: 03/01/2021
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: 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: 7 days after vaccination developed fasiculations in Left deltoid muscle for several hours - enough to keep me awake No other known reason for these.

Other Meds: Aspirin Metoprolol

Current Illness: none

ID: 1085747
Sex: F
Age: 46
State:

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:

Symptom List: Unevaluable event

Symptoms: ABOUT 10 MIN AFTER VACCINATION, PT FELT WARM WITH SOME SOB AND TINGLING IN HER BODY + RINGING IN HER EARS. HUSBAND WENT TO GET HELP AND PT FELL OUT OF HER CHAIR WITH LOSS OF CONSIOUSNESS. PT RECOVERED IMMEDIATELY WITHOUT CONFUSION,. VITALS BP: 102/71 HR: 81. PMH STROKE 2008 WITH RESIDUAL L WEAKNESS. MEDS: ASPIRIN, ZYRTEC, FLONATE. NO PREVIOUS VACCINE REACTIONS OR ANAPHYLAXIS. EMS CALLED TO TRANSPORT TO ER. VASOVAGAL LIKELY.

Other Meds:

Current Illness:

ID: 1085748
Sex: M
Age: 44
State: NC

Vax Date: 03/01/2021
Onset Date: 03/04/2021
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: None

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

Symptoms: Contacted Shingles a few Days after the first vaccine on left forehead above eye.

Other Meds: None

Current Illness: None

ID: 1085749
Sex: F
Age: 66
State: OH

Vax Date: 02/26/2021
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: Percocet '08, Yeast '15, Penicillin '14, Lipitor '16, Tramadol '18, Estroven '19, Abmeren '20, Zofran '20, Morphine '20 > ALL OPIODS

Symptom List: Injection site pain, Pain

Symptoms: At 2:30 am on Friday 3/5/21 my left jaw started hurting and my lips started developing extremely fever blisters completely around my mouth and on my lips. I developed a rash on my right hand, left thumb, left hand, and forehead. I have a 1.25" lump in a lymph node under my left chin. I went to an Urgent Care on 3/6 and they surmised that I was having a reaction to one of the meds I've been on for years. On Monday 3/8/21, I went to my dermatologist and she's telling me NOT TO GET THE SECOND SHOT, because of the severe allergic reactions I'm having to the FRIST SHOT. I've been taking steroids, doubled up on my Valacyclovir to 1000 MG/day until these outrageous fever blisters are gone and cleared up. The blisters were up to one inch x 1/2 inch x 1/2 inch. The dermatologist has me putting Aquaphor on my lips and rashes. She gave me a shot of Kenalog 80 MG. She says the lump will take over six months to go away!!!!!!!!!!! I'm absolutely terrified to get the second shot and don't want to die. MORE IMPORTANTLY, what do I do now to indicate that I'm fully vaccinated if I can?t take the second shot?????

Other Meds: Levoflaxacin 750 MG / Sinus Infections Levothyroxine 0.112 MCG / Thyroid Lisinopril-HCZ 10/12.5 MG / Blood Pressure - 1/2 as of 9/9/20 Lorazepam 1MG / Anxiety, Stress, & Sleep Montelukast Sod 10 MG / Allergies [Claritin] Pravastatin Sodium

Current Illness: NONE

ID: 1085750
Sex: F
Age: 57
State: FL

Vax Date: 02/01/2021
Onset Date: 02/25/2021
Rec V Date: 03/09/2021
Hospital: Y

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

Lab Data:

Allergies: sulfa, augmenten, levaquin, meloxicam,

Symptom List: Injection site pain, Menorrhagia

Symptoms: APPENDICITIS

Other Meds: Zoloft, calcium with vitamin D, biotin,

Current Illness: none

ID: 1085751
Sex: M
Age: 65
State: MD

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: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Janssen COVID-19 Vaccine EUA. Side effect has been getting tired with little exertion.

Other Meds: On many prescription medications

Current Illness: None

ID: 1085752
Sex: F
Age: 67
State: ID

Vax Date: 03/04/2021
Onset Date: 03/04/2021
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: sulfur

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: vomiting, diarrhea, chills Thursday 9:00 PM to Friday 9:00 AM rash over entire body, pins and needles effects Friday 8:00 PM to Saturday 10:00 rash continues but not as severe to currently Tuesday at noon Jaundice, elevated liver enzymes, and elevated billirubin started Saturday to currently Tuesday at noon

Other Meds: Aller-tec, Escitalopram, Famotidine, Fluticasone, Letrozole, Levothyroxine, Metoclopramide, Pantoprazole, Probiotic, Vesicare Taxol, Avastin

Current Illness:

ID: 1085753
Sex: F
Age: 23
State: MI

Vax Date: 02/11/2021
Onset Date: 02/11/2021
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: nausea, headache, vomiting, feeling the urge to pass out every 15 minutes for a week after receiving the vaccine.

Other Meds: none

Current Illness: none

ID: 1085754
Sex: F
Age: 29
State: CT

Vax Date: 03/09/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Unable to view in VAMS

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

Symptoms: Pt received her first dose of the Moderna COVID19 vaccine. While sitting in observation the pt reported a new onset of headache, nausea, and dizziness. BP 141/108, 120/86. HR 90,86. O2sat 99%. Pt takes Hydrochlorothiazide for BP medication. Pt was evaluated by EMS. Pt signed refusal for transport to the ED and was advised to follow up with her PCP.

Other Meds: Unable to view in VAMS

Current Illness: Unknown

ID: 1085755
Sex: M
Age: 42
State: CA

Vax Date: 02/15/2021
Onset Date: 02/15/2021
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: PCN

Symptom List: Nausea

Symptoms: THIS PATIENT IS A 42 YO MALE WHO STARTED TO COMPLAIN OF LIGHTHEADEDNESS/DIZZINESS/FEELING FLUSHED ABOUT 30 MINUTES AFTER RECIEVING VACCINE. PATIENT WAS INITIALLYVISUALLY MONITORED FOR 15 MINUTES WITH NO SIDE EFFECTS. PATIENT LEAFT THE CLINIC SITE, AND RETURNED ABOUT 15 MINUTES LATER REPORTING SYMPTOMS ABOVE. PATIENT A&OX4, GCS 15, NOMAL SKINS. PATIENT DENIES HEADACHE, CHEST PAIN, SHORTNESS OF BREATH. EKG COMPLETED, NO STEMI OBSERVED. PATIENT LED INTO QUIET/DARK ROOM TO REST AND FOR CONTINUED MONITORING OF BLOOD PRESSURE. DUE TO NO CHANGE IN ELEVASTED BP, RECOMMENDATION WAS MADE TO TRANSPORT PATIENT TO CLOSEST ED. PATIENT VERBALLY AGREED. PATIENT WAS ABLE TO WALK WITH ASSISTANCE TO AMR UNIT AND PATIENT CARE WAS HANDED OVER TO UNIT PARAMEDIC. PATIENT TRANSFERRED WITHOUT INCIDENT. LAST NOTED BP ON SITE WAS 176/132 IN A SUPINE POSITION.

Other Meds: NONE REPORTED

Current Illness: NONE REPORTED

ID: 1085756
Sex: F
Age: 35
State: TX

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Severe body aches. Stiff neck muscles, unable to turn head. Tiredness. All those symptoms started before 10p on 3/8/21. 5am on 3/9 same above symptoms plus temp of 100.2. No change in body aches or stiffness. Temp at 3p was 102

Other Meds:

Current Illness:

ID: 1085757
Sex: F
Age: 42
State: WA

Vax Date: 02/02/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Codeine

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

Symptoms: On Feb 8, 6 days after dose 1 of the phizer vaccine, I developed a small patch of itchy bumps on my chest, very slightly to the left of center. On February 14, I developed three more patches of itchy, painful vessicles on my left arm, along a single dermasone. My doctor and I suspected shingles, and the diagnosis was confirmed by a blood test. As of March 9, the patches are still visible but much improved, nearly gone but still a bit red and mildly itchy.

Other Meds: Vitamin D & C, NAC, Zinc, CalMag

Current Illness: None

ID: 1085758
Sex: F
Age: 30
State: TX

Vax Date: 03/03/2021
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:

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

Symptoms: swollen lymph nodes left armpit (injection arm)

Other Meds:

Current Illness:

ID: 1085759
Sex: F
Age: 73
State: NM

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Tremor

Symptoms: pt received shot and after a few minutes started feeling dizzy and faint.....pt sat in lobby for about an hour and a half and we checked blood pressure several times and it was 160/80, and it stayed high for a long time until patient took some valium she had. It then went down to 145/69.....pt was also very cold......pt ate something and drank some water. After an hour and a half pt was able to get up and walk away. Patient was offered medical attention from ambulance but refused. Pt said she would go to urgent care if needed she lives near one.

Other Meds:

Current Illness: none indicated

ID: 1085760
Sex: F
Age: 82
State: WI

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none known

Symptom List: Erythema, Pruritus

Symptoms: On the first evening I had a fever and joint pains which resolves by the next morning, On 02/03/2021 I had diarrhea on awakening and about two hours later, after doing morning chores including carrying and lifting 4 gallons of water, I fainted,which included having another episode of diarrhea while I was out. I was seen by emergency medical personnel, had an EKG, and then my children, with whom I live, took me to see my primary care provider who ordered some basic blood tests: a CBC and panel. All blood tests were normal as well as the EKG, I assume. We think the faint was perhaps triggered by the diarrhea and exertion of chores in addition to the vaccine's effect . Since then I have had fatigue.

Other Meds: glucosamine/chondroitin, magnesium, vitamin C, vitamin D, lisinopril, simvastatin, Coenzyme Q10, hydrochlorothiazide.

Current Illness: high blood pressure, hyperlipidemia

ID: 1085761
Sex: F
Age: 43
State: MA

Vax Date: 02/24/2021
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: erythromycin

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

Symptoms: s/p 1st moderna vaccine on day 11 c/o sensation throat closing, all over body itchiness, rash and bumps on arms and legs. She called her PCP who informed her to take prednisone 40 mg and her symptoms resolved. Patient referred to allergy MD for consult

Other Meds: no

Current Illness: none

ID: 1085762
Sex: M
Age: 19
State: MS

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Red Dye #15

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

Symptoms: Patient received # 1 in L deltoid per staff took papers (Pfizer) check list from patient. Nursing student came to the car. Asked him about his paperwork. Patient was explaining that the staff had taken his paperwork and had already given his first vaccine. The nursing student gave the patient a second dose of Pfized vaccine in the L Deltoid. Patient observed 30 days without incident.

Other Meds: Norvax; Albuterol

Current Illness: None

ID: 1085763
Sex: F
Age: 62
State: CA

Vax Date: 01/08/2021
Onset Date: 01/08/2021
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: penicillin; sulpha; codeine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: The first reaction - 15 minutes after the vaccine - I felt really dizzy and loopy. She told me, I think you better sit back down. I felt better after sitting there for 30 minutes after. I didn't get dizzy again. I finished my workday. Next morning, I woke up with a fever 100.8 (about). I woke up with sore muscles - I tend to get sore muscles easily but I felt more sore than normal and I had a headache. Fever stopped after 24 hours. Note: I also get dizzy really easily - and so it isn't difficult for something to make me dizzy. I also felt really tired. And over the weekend, I felt nauseated (not initially but over the weekend.) And that lasted until about midday Monday (over the weekend) to be getting better . I took Tylenol and I rested. That helped with the symptoms.

Other Meds: Fluoxetine - I take 60 mg a day; Buspirone - 10 mg twice a day; Trazadone - 50 mg 2 at bedtime; Oxybutynin - 5 mg; Propranolol - 80 mg in total once a day; Nortriptyline - 30 mg once a day; Nitrofurantoin Monohydrate - 100 mg; Armor Thyr

Current Illness: none

ID: 1085764
Sex: F
Age: 27
State: NC

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Amoxicillin

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

Symptoms: Full body shakes, chills, body aches, brain throbbing, fatigue, nerve zings, lightheaded

Other Meds: Lexapro Nitrofurantoin

Current Illness: Uti

ID: 1085765
Sex: F
Age: 68
State: NY

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

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:

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

Symptoms: Family reported patient had COVID vaccine around 10am. Pt came home at 11am, and was extremely lethargic.They helped her get undressed and in bed, but then patient became very rigid and flailed her arms as if she was having a seizure, only lasted about a minute, she was very lethargic after barely arousable, then again became very lethargic and arms flailed for about one minute. Pt then projectile vomited. Advised calling 911 and patient was taken and admitted into hospital.

Other Meds:

Current Illness:

ID: 1085766
Sex: F
Age: 58
State: HI

Vax Date: 03/02/2021
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: none

Symptom List: Pain in extremity

Symptoms: injection site is now swollen and stiff, 1 week after injection. After the shot, experienced a little swelling and pain, but it went away within 2 days. Now, 1 week later, it is back.

Other Meds: levothyroxin

Current Illness: none

ID: 1085767
Sex: M
Age: 75
State: OH

Vax Date: 02/23/2021
Onset Date: 03/01/2021
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: dizziness

Other Meds: Flax seed oil, Mirolax multi vitamins turmeric,fish oil,beta sitosterol, leutein and zeaxanthin, saw palmetto, 81 mg aspirin

Current Illness: Sinus infection

ID: 1085768
Sex: F
Age: 43
State: MD

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Allergic to shellfish, no known medication allergies

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

Symptoms: local reaction on left arm, red, warm and 3" red circle, increased HR 100-110 BPM (my normal is about70)

Other Meds: Fluticasone/Salmeterol 113/41 mcg one puff BID, Albuterol HFA MDI PRN, Chlorthalidone 25 mg 1 tablet BID, Loratadine 10 mg QD

Current Illness: None

ID: 1085769
Sex: F
Age: 42
State: NY

Vax Date: 03/05/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: chlorhexidine

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

Symptoms: I had known side effects beginning 6 hours after injection and lasting until about 36 hours after injection including fatigue, nausea, chills, low fever, and muscle soreness. 4 days after injection I began experiencing shortness of breath and dizziness similar to when I had COVID-19 in March and April of 2020.

Other Meds:

Current Illness:

ID: 1085770
Sex: F
Age: 46
State: CA

Vax Date: 01/14/2021
Onset Date: 01/21/2021
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: no

Symptom List: Vomiting

Symptoms: On day 7 after 1st shot, the site of the shot became red, hot, swollen (about the size of a half dollar). Throughout the next 7 days, it expanded to the width of my arm and then faded away. No lasting marks on arm at all.

Other Meds: Birth Control, Women's One-a-Day vitamin

Current Illness: none

ID: 1085771
Sex: M
Age: 77
State: PA

Vax Date: 03/04/2021
Onset Date: 03/05/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Severe Chills Fever Full body ache - joints/muscles Lost Balance - fell twice Incoherent Confusion ulcers in mouth and on tongue Swollen lips no strength - could not stand up on my own dehydration

Other Meds: Amiodipine Besylate - 5mg once a day Sertraline HCL tabs - 100 mg once a day B12 3000 mcg - once a day Centrum Silver - once a day Baby aspirin 81 mg - once a day

Current Illness: none

ID: 1085772
Sex: F
Age: 79
State: MI

Vax Date: 03/03/2021
Onset Date: 03/05/2021
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: Erythromycin

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

Symptoms: Skin rash on the palm of the hands, looks like erythema multiforme developed about 2 days fa was immunized on 2-27-21. The rash developed 8 days later on 3-7-21. Seen here in the urgent care on 3-9-21 and treated with topical steroid, advise to get the second immunization. No shortness of breath or life-threatening symptoms.

Other Meds: Alprazolam, Bupropion

Current Illness: none

ID: 1085773
Sex: F
Age: 44
State: AZ

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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: NAPROXEN, PERCOVET, VICODIN

Symptom List: Injection site swelling, Limb discomfort

Symptoms: WITHIN 15 MINUTES, PATIENT EXPERIENCED SWELLING/NUMBNESS TO LIPS, FEELS SWELLING IN THROAT, SHORTNESS OF BREATH

Other Meds: AMLODIPINE 10 MG QD, LISINOPRIL 20 MG QD, METFORMIN

Current Illness: NONE

ID: 1085774
Sex: M
Age: 51
State: ID

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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: penicillin

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

Symptoms: Headache, sore at injection site (which felt like I'd been punched in the shoulder the next day), fatigue, runny nose, sneezing (like the worst of my allergies, before I got them under control years ago)

Other Meds: Montelukast, Claritin-D, Florical, Alive multi-vitamin for men 50+

Current Illness:

ID: 1085775
Sex: M
Age: 66
State: IL

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: nka

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

Symptoms: patient came in for "second shot" had a letter telling him to come in, patient marked it was for his shingles shot but it wasn't ever conveyed to staff fully. Was entered into system for a covid shot as that is the current pressing thing going on. Spoke with patient and asked if he had his card to fill out for his second covid vaccine but apparently the patient didn't hear. After giving the vaccine patient mentioned he was not here for covid vaccine but was here for shingles vaccine, checked with patient several times over the next few days, no adverse response.

Other Meds: prilosec,norvasc, flonase

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm