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: 0918334
Sex: F
Age: 60
State: NC

Vax Date: 12/29/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Sulfa, HCTZ, Metaclopramide, Macrobid

Symptom List: Dysphagia, Epiglottitis

Symptoms: After about 24 hours: muscle and joint pain; After about 48 hours: intense muscle and joint pain back pain, fever of 101.7, shortness of breath Following day: weakness, extreme fatigue, tachypnea, shortness of breath on exertion Shortness of breath and cough persisted for several days, finally resolved day 6 post vaccine

Other Meds: Pantoprazole, WellbutrinXL, Lisinopril, Amlodipine, Famotidine, Trazodone, Reclast, Vitmin D, Calcium, berberine, multivitamin

Current Illness: none

ID: 0918335
Sex: M
Age: 43
State: OH

Vax Date: 12/26/2020
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Amoxicillin, sulfa

Symptom List: Anxiety, Dyspnoea

Symptoms: 3-in circumferral rash around injection site.

Other Meds:

Current Illness:

ID: 0918336
Sex: F
Age: 78
State: CA

Vax Date: 12/31/2020
Onset Date: 01/02/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: 01/02/21 discomfort, flushing sweat, waves of gastro pain, bloating, explosive bowel movements; 01/03/21 loose, mucous bowel movement, not feeling well; 01/04/21 feeling better, urges for loose bowel movements continue and slight stomach pains.

Other Meds: Amlodipine 2.5 mg, Levothyroxine 88mcg, Simvastatin 20 mg, Vitamin D3, B12, Zinc

Current Illness: N/A

ID: 0918337
Sex: F
Age: 39
State: NY

Vax Date: 12/23/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Mild redness, swelling for 3 days after injection noted by patient. One week after the injection, patient reported developing a "golf ball sized lump" and redness that lasted an additional three days.

Other Meds:

Current Illness:

ID: 0918338
Sex: F
Age: 64
State: MI

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: statin, hydrocodone/acetaminophen, morphine

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

Symptoms: about 4 hours after vaccine, patient passed out and when came to, vomited profusely. Transferred to hospital ED.

Other Meds:

Current Illness: none

ID: 0918339
Sex: F
Age: 55
State: ME

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

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: nuts, soy, wheat,

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

Symptoms: itchy throat then gave benadryl 50mg and famotidine 20mg at 10:09 , Itchy throat persisted and sent patient to ER. On arrival to ER throat and tongue started to swell. ER administered EPIpen and steroids and monitored 2 hours post treatment. Patient had to additional benadryl and pepcid the next evening due to coughing. Patient started oral steroids on 01/02/2020 in the morning.

Other Meds:

Current Illness:

ID: 0918340
Sex: F
Age: 35
State: IA

Vax Date: 12/26/2020
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 8 days after the injection I acutely developed itching, redness, and induration of the injection site. Lasted 24 hours, spread slightly and then started to resolve.

Other Meds: Topamax

Current Illness: No

ID: 0918341
Sex: F
Age: 25
State: WI

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Developed rash on left side of neck one day following vaccination. Vaccine given in Rt deltoid

Other Meds:

Current Illness:

ID: 0918342
Sex: M
Age: 28
State: MD

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Intolerance to lactose

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Woke up to a burning sensation all over my face that quickly spread to my upper torso. I stumbled into the bathroom and removed my pajama shirt to relieve the heat I was experiencing. I ran my hands under luke warm water and the sensation suddenly disappeared as quickly as it came. Later that same day I experienced fatigue and loss of appetite that lasted about 24 hours.

Other Meds: Daily Multivitamin

Current Illness: None

ID: 0918343
Sex: F
Age: 62
State: MO

Vax Date: 12/31/2020
Onset Date: 01/02/2021
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Employee relates at 1:30 AM on Sat., 1-2-21, symptom onset began...fever of 102.8 oral, "raging" HA, cough, chilling/shaking that lasted for 3 hours. Note: employee did test COVID positive on Nov. 9, 2020.

Other Meds:

Current Illness:

ID: 0918344
Sex: F
Age: 37
State: WA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Crestor, percocet, ultram/tramadol

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

Symptoms: Headache and nausea with in hour of vaccine. Vomiting 6 hours after vaccine with extreme dizziness like on a boat.

Other Meds: Lisinopril-hctz 20/25mg bid, niphedipine 60mg daily

Current Illness: None with myself 2 positive COVID19 children in my house at the time of vaccine

ID: 0918345
Sex: F
Age: 36
State: FL

Vax Date: 12/22/2020
Onset Date: 12/28/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Latex

Symptom List: Rash, Urticaria

Symptoms: December 28 developed large red edematous area around injection site. Hot to touch. The area continues at this time despite taking Benadryl and Pepcid every 12 hours as advised by PCP

Other Meds: Wellbutrin 150mg daily

Current Illness: None

ID: 0918346
Sex: F
Age: 42
State:

Vax Date: 10/23/2020
Onset Date: 10/23/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Moderate dizziness/headache post-flu vacc: got vacc. @ approx. 9:45am on 10/23/20: dizzy/headache started abruptly @ approx. 12:20-7:00pm, then on an off for rest of night with mild nausea; mild diarrhea @ 7:00pm (howevercould have been from recent fatty meals). Next day (10/24/20): arm very slightly sore at site the next morning and still some slight nausea. Mild dizziness as going to bed that night (for about 1 hour - felt like vertigo as falling asleep). Fully recovered by morning of 10/25/20.

Other Meds: Allegra (for seasonal allergies, taken as needed - can't recall for sure if it was taken on the morning of the vaccination)

Current Illness: none

ID: 0918347
Sex: F
Age: 40
State: TN

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: FEVER ACHE, CHILLS, Lethargy

Other Meds:

Current Illness:

ID: 0918348
Sex: F
Age: 60
State: PA

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

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

Lab Data:

Allergies: Latex, PCN, Nuts, Avocado

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

Symptoms: * Had sore arm at the vaccine site * Headache began at 7 pm on 3-Jan * Had chills during the night, cold and unable to get warm even with multiple blankets * Severe dizziness and vomiting * Headache not relieved by Ibuprofen; took 25 mg Benadryl at midnight

Other Meds: * Ibuprofen * Multi-Vitamins

Current Illness: None; corneal abrasion

ID: 0918349
Sex: F
Age: 49
State: CT

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, Celexa, Oxycodone

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

Symptoms: Patient felt lightheaded, dizzy, diaphoretic and c/o feeling faint at time of injection. She has a history of anxiety and feels it may that. Repeat BP 149/85 HR 98 POC glucose 98. Patient monitored for 50 minutes after episode began. Patient stated she felt much better and felt comfortable and wanted to leave. Patient escorted out by RN to car. Patient walked out of building with assistance and reported she felt good with the cold air. EMS offered patient to go to ED but patient declined

Other Meds: Naratriptan

Current Illness:

ID: 0918350
Sex: M
Age: 39
State: VT

Vax Date: 12/18/2020
Onset Date: 12/18/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: nausea, elevated pulse, anxious; declined Emergency department evaluation.

Other Meds:

Current Illness:

ID: 0918351
Sex: F
Age: 41
State: OK

Vax Date: 12/18/2020
Onset Date: 12/21/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 12/19/2020-12/20/2020 only experiences soreness of left arm where vaccine received. Woke up early morning 12/21/2020 with moderate swelling of eyelids, face, lips that progressed over several hours before seeking care at Hospital ED. Received IV Benadryl and IV solumedrol. Prescribed oral prednisone dose pack to start next day. Symptoms mostly resolved by that evening.

Other Meds: vitamin c daily, black elderberry supplement daily, aloe vera supplement daily, phentermine daily, pantoprozole 40mg daily

Current Illness: None

ID: 0918352
Sex: F
Age: 55
State: WV

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: wellbutrin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Headache for about 3 hours. Tylenol then fine.

Other Meds: Lexapro Ropinirole multi vitamin probiotic simvastatin

Current Illness: none

ID: 0918353
Sex: F
Age: 41
State: OH

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Pcn, acetaminophen sulfa, tetracycline amoxicillin. (Body rash)

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

Symptoms: Sensation in teeth. Jaw then dizzyness. Headache. Took tylenol at work..then went home and took benadryl. Sensitivity to spoons, metal. Today 1/04 itching and lump at injection site.

Other Meds: Tylenol. After for headache. Felt sensation in teeth and jaw right after. Dizzyness.. took benadryl when home.

Current Illness: No

ID: 0918359
Sex: F
Age: 48
State: MD

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Initially had arm pain in the left deltoid area with mild induration, chills and some bodyaches. Generalized fatigue. Two days ago(1/2/21) a large left supraclavicular lymph node came up, it is a little sore. No redness. Moveable. No coughing or SOB. No difficulty swallowing. No rash to that area. No sore throat or other known cause at this time for the adenopathy

Other Meds:

Current Illness:

ID: 0918360
Sex: F
Age: 45
State: SC

Vax Date: 12/23/2020
Onset Date: 12/26/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: PCN

Symptom List: Unevaluable event

Symptoms: severe cough with chest heaviness and mucous production, fatigue,

Other Meds: Vitamin C, biotin, elderberry, zinc, vitamin D

Current Illness: Had + COVID-19 test on 11/29/20

ID: 0918361
Sex: F
Age: 58
State: TX

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Reglan, Penicillin, Sulfa

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

Symptoms: A few hours after vaccination, I began to feel like I was getting ill, with fatigue and headache. I also experienced swelling at site of injection, along with hives on my face and neck on the same side as the injection. I had swelling in my neck, throat, tongue, lips, ears and eyes with some tingling. There was a red pallor on both of my cheeks. I also had slightly labored breathing. I took antihistamines and tylenol which helped reduce the symptoms within an hour. If I did not continue to take these round the clock for the next 4 days, the symptoms would get worse. Toward the end of the day, symptoms worsened regardless of antihistamine or tylenol and continue to do so as of yesterday, 1/3/2021. Symptoms have gotten better over the last 4 days. Its hard to say if I am fully recovered as in the evenings when I'm more fatigued, I still have the tingling and mild swelling although the redness and hives have abated.

Other Meds:

Current Illness:

ID: 0918362
Sex: M
Age: 60
State: WV

Vax Date: 12/23/2020
Onset Date: 12/27/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Injection site pain, Pain

Symptoms: Patient c/o aches and pains all over and weakness, Tylenol given.

Other Meds: Naproxen 500 mg, 1 tab twice a day for pain, Omeprazole 20 mg take one cap po for stomach, Olanzapine 10 mg take one tab po daily, Cholecalcif 50 mcg d3-2000 units, take 2 tabs po daily for vit replacement.

Current Illness: See list below

ID: 0918363
Sex: M
Age: 65
State: IL

Vax Date: 12/19/2020
Onset Date: 12/20/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: Rash on bilateral arms, abdomen, stomach, legs with itching

Other Meds: BPH medication: silodosin

Current Illness:

ID: 0918364
Sex: F
Age: 45
State: MT

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Developed blisters and sores outside of the vagina. Not sure if it triggered the HPV I had as a teenager.

Other Meds: Trazadone Cyclobenzaprine HCL

Current Illness: N/A

ID: 0918366
Sex: F
Age: 56
State: VT

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: arm tingling

Other Meds:

Current Illness:

ID: 0918367
Sex: F
Age: 37
State: MA

Vax Date: 12/18/2020
Onset Date: 12/18/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Call to EE 12/22 regarding facial numbness/ tingling after vaccine. Notes she received vaccine 12/18. Was fine for first 15 minutes. Within 5-10 minutes of leaving, ee had facial numbness to right side of face and under bottom lip. Sx lasted about 3 hours and resolved 100%. No recurrence.

Other Meds:

Current Illness:

ID: 0918368
Sex: M
Age: 30
State:

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: lightheaded, drank water and laid down for several minutes - symptoms resolved and patient left without further issues

Other Meds:

Current Illness:

ID: 0918369
Sex: F
Age: 29
State: MT

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: fever (101 F), fatigue, chills, body aches, headache, pain in left arm

Other Meds:

Current Illness:

ID: 0918370
Sex: M
Age: 24
State: SC

Vax Date: 12/30/2020
Onset Date: 01/02/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: 7pm 01/02/2021- Right hand became itchy: urticaria appeared across right hand, left wrist, elbow creases, right foot. 1pm 01/03/2021- went for a run while wearing a sterling silver necklace (which has been worn almost every day for past year) began to feel a burning sensation. Took off necklace and had urticaria all around neck where necklace had been. (took ice baths, used lotion, and took 2 tablets of hydroxyzine which all alleviated itchiness and most of the redness/bumps had disappeared when waking up on 01/04/2021).

Other Meds: Vybriid; Truvada; Hydroxyzine Hcl; Magnesium; Vitamin C; Prilosec

Current Illness: None

ID: 0918371
Sex: F
Age: 38
State: WI

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Developed small rash on neck, side that vaccination was administered. Last one hour, no other symptoms

Other Meds:

Current Illness:

ID: 0918372
Sex: U
Age: 59
State: VT

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: left arm injection with hand tingling

Other Meds:

Current Illness:

ID: 0918373
Sex: F
Age: 22
State: VT

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: shortness of breath developed 10 minutes after receiving vaccine. No other syptoms

Other Meds:

Current Illness:

ID: 0918374
Sex: F
Age: 55
State:

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: itching that started @injection site and then spread across body, facial flushing Administered 50 mg of diphenhydramine orally and continued to observe Patient's husband was called and he took her home after approximately 30 mins.

Other Meds:

Current Illness:

ID: 0918375
Sex: F
Age: 50
State: MA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Bees

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

Symptoms: Patient stated she felt she had tachycardia- pulse was 130's for approximately 2 minutes - resolved spontaneously. Patient asked for assistance due to history of SVT's

Other Meds: Zoloft

Current Illness:

ID: 0918376
Sex: F
Age: 59
State: PA

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Chills, headache, exhaustion, fever, lack of appetite

Other Meds: N/A

Current Illness: N/A

ID: 0918377
Sex: F
Age: 60
State:

Vax Date: 12/23/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Received covid 19 first dose on 12-23-20 and on 01-01-21 insertion site became red and itching. On 01-04-21 the redness measures 4cm x 8cm.

Other Meds:

Current Illness:

ID: 0918378
Sex: F
Age: 49
State: CA

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Codeine

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

Symptoms: 12/31/20 7:00PM -7:30 PM chills, abd pain, exhaustion - fatigue; 01/01/21 Next morning severe headache, Motrin 800Mg - fatigue, headache resolved with Motrin, without appetite, sleep all day and night; abd pain resolved. 01/02/21 fatigue, first meal since 12/31/20. 01/03/20 feeling better,

Other Meds: Cymbalta, Tumeric, Vitamin D

Current Illness: N/A

ID: 0918379
Sex: F
Age: 80
State: MI

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Rash on both legs, Made her feel faint. Vomiting. Diarhea. Back hurts in the middle. Loss of taste.

Other Meds: Atenolol, Aspirin 81mg, Vitamin D,

Current Illness: None

ID: 0918380
Sex: F
Age: 25
State: WI

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

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

Lab Data:

Allergies: No

Symptom List: Pain in extremity

Symptoms: Became nauseous, pale, faint after first dose .

Other Meds: Unknown

Current Illness: No

ID: 0918381
Sex: F
Age: 33
State: SD

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: CT IV Dye

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

Symptoms: Fever, body aches, joint paint, headache, all over muscle pain/aches, chills, shaking, nausea, vomiting, diarrhea, and a rash on my neck. Symptoms started 36 hours after vaccine was administered. The rash on my neck started 4 days after the vaccine.

Other Meds: Spironolactone 50mg BID Zyrtec 10mg Daily Nexium 20mg Daily

Current Illness: N/A

ID: 0918382
Sex: F
Age: 62
State: VT

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: left arm numbness

Other Meds:

Current Illness:

ID: 0918383
Sex: F
Age: 35
State: VA

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Keflex ,Percoset

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

Symptoms: Got a really bad headache starting around 5:00 pm on 12/29/20 , Headache remained for about 3 days. 12/30/20 around 11:00 am starting to get severe low back pain radiating to the upper back , breathing taking pain this lasted into the night of 12/31/20. extreme fatigue still currently 1/4/2021 , Agitation and mental offset ( Angry) and emotional for 5 days.

Other Meds: No

Current Illness: Sinus infection was prednisone

ID: 0918384
Sex: F
Age: 37
State: ME

Vax Date: 12/25/2020
Onset Date: 12/25/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Bee-sting

Symptom List: Vomiting

Symptoms: patient started filling flush and warm about 20 mins after vaccination. in standing position felt slightly dizzy and nausea, Laid down felt better but still hot. no medication given. HR was 70 Stats 98. Patient laid down for one hour when she felt better. next two days patient had redness and warmth at site of injection about the size of a quarter.

Other Meds:

Current Illness:

ID: 0918385
Sex: F
Age: 46
State: MN

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: no

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: reported next day waking up and extreme fatigue, chills, fever, local swelling and pain. continued for 12 hours with alternating Tylenol and ibruprophen for pain

Other Meds: no

Current Illness: had appendix removed one month prior

ID: 0918386
Sex: F
Age: 62
State: MA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Patient left building and started to walk to car and turned around with c/o "lump in throat. She c/o tightening in throat and hard to swallow. She was taken to EMS, 50 mg IM was given and symptoms subsided in about one hour with her going home with husband 90 minutes after start of symptoms. O2 sat 100% , BP at start was 170/80, hr-100, and at departure was 120/78, HR-80.

Other Meds: Pepcid, Vitamins

Current Illness:

ID: 0918387
Sex: M
Age: 63
State: NJ

Vax Date: 12/24/2020
Onset Date: 12/28/2020
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: True vertigo - room spinning dizziness, perceived motion, made worse with changes in head position. Nausea and vomiting at extremes of vertiginous symptoms. Also generalized fatigue noted. No fever, chills, diaeresis, headache, hearing loss, loss of taste or smell, cough, or nasal congestion, muscle aches, body aches or myalgias.

Other Meds: none

Current Illness: none

Date Died: 01/01/2021

ID: 0918388
Sex: F
Age: 65
State: FL

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Resident found unresponsive without pulse, respirations at 04:30 CPR performed, expired at 04:52 by Rescue

Other Meds: Albuteral Sulfate Amlodipine Carvedilol Ipratropium Levetiracetam Olanzapine Sodium Chloride Symbicort Valproic Acid

Current Illness: No acute illness at time of vaccination. History of: CVA SCPT Dementia Seizure Disorder HTN COPD

ID: 0918389
Sex: F
Age: 53
State: VA

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: Fever beginning night of vaccine, fever lasted 24 hours, headache lasting 24 hours, large red area on arm below site of injection, tender to the touch and slightly itchy lasting 4 days after injection, sore arm at site of injection

Other Meds: none

Current Illness: cold/cough 3 weeks prior

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm