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: 1091789
Sex: F
Age: 74
State: OH

Vax Date: 03/08/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: patient had chest pain, went to ER, and was found to have heart attack

Other Meds:

Current Illness:

ID: 1091790
Sex: M
Age: 73
State: VA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/11/2021
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: Server pain in left shoulder and pain in legs. Went to ER and they will not give me anything for pain otc meds to nothing.

Other Meds: None

Current Illness: None

ID: 1091791
Sex: F
Age: 70
State: IN

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
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: Milk

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

Symptoms: Chest pains an hour after shot , lasted 15-20 minutes Shortness of breath 4 1/2 hours after shot, lasted 10 minutes Both symptoms have not recurred since

Other Meds: Levothyroxine, atorvastatin, CoQ10, Vitamin B complex, Vitamin D, Calcium, Pepcid, Sinus Probiotic, Gastrointestinal Probiotic

Current Illness: Sinus infection

ID: 1091792
Sex: F
Age: 71
State: GA

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

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

Lab Data:

Allergies: NKDA; Dust

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient presented for second COVID-19 vaccine today 3/11/21, but patient had developed pruritic, erythematous lesions on bilateral arms approximately one week following administration of first vaccine on 2/11/21. Pt reported lesions were increasing in size and spreading. 2nd vaccine dose was not given today. Patient was referred to walk-in clinic and received prescription for 10-day course of PO steroids and is scheduled to follow up with PCP on 4/1/21.

Other Meds: Aleve PRN, vitamin D supplement, albuterol inhaler PRN

Current Illness: N/A

ID: 1091793
Sex: F
Age: 25
State: MI

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

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

Lab Data:

Allergies: NKA

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

Symptoms: About four minutes after receiving the vaccination, patient complained of nausea and feeling lightheaded with some tingling in both of her arms. Received vaccine at 2:20 pm, symptoms began 2:24 pm. Vital signs stable, HR 101, BP 101/72, oxygen 96% on room air. Symptoms resolved at about 2:40 pm. Monitored in room for 30 minutes. Patient discharged at 2:50 pm. She states symptoms have completely resolved.

Other Meds: Metoprolol (just started taking this week)

Current Illness: n.a

ID: 1091794
Sex: F
Age: 53
State: TX

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

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

Symptoms: Patient reports feeling light pressure on her throat. Patient reports symptoms resolved in 10-15 minutes. Cleared by EMS

Other Meds:

Current Illness:

ID: 1091795
Sex: F
Age: 73
State: IN

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: rampiril,ibandronic acis, alendronic acid

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: fever, chills, lethargy, joint pain, muscle pain, loss of appetite, nausea

Other Meds: Levothyroxine, bisoprolol, spriolactone, temisarten, pravastatin, omeprazole, ca+, babyasa

Current Illness: NONE

ID: 1091796
Sex: M
Age: 76
State: HI

Vax Date: 01/16/2021
Onset Date: 02/01/2021
Rec V Date: 03/11/2021
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: Approximately two weeks after receiving my first dose of the vaccine, I started experiencing upper body bilateral joint pain, primarily in shoulders and wrists. This pain has continued since then for approximately six weeks now. In addition, my right arm, hand, and fingers are swollen, and the tips of my fingers on the right hand feel slightly numb. I have been taking acetaminophen, ibuprofen, and naproxen, but still have the symptoms described above.

Other Meds: hydrochlorothiazide, levothryroxine, omeprazole, simvastatin, tamulosin, Ca+vit D

Current Illness: none

ID: 1091797
Sex: F
Age: 51
State: AL

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

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

Lab Data:

Allergies: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Within a couple of minutes of vaccination, I experienced shortness of breath, rapid heart rate, and disorientation. I remained under observation for one hour, at which point I was able to drive home. The symptoms decreased but remained until late that night. On Friday evening, January 15, I developed an ear infection in both ears, a large dark bruise approximately the size of my hand behind my left knee, and the worst HSV outbreak of my lifetime. The bruise dissipated after approximately one week. I have had recurrent HSV outbreaks almost continuously since that time. I still have the ear infection. I called my doctor twice to request antibiotics for my ears, but she thought the infection would clear up without them. After 5.5 weeks I called a third time and cefdinir 300mg twice daily antibiotic was prescribed for 10 days. The ear infection remained after completion of the antibiotic course. I began a new course of the same medicine without a break in treatment and am now on day 15 of antibiotics. the infection is improving but not gone.

Other Meds: Pantoprazole 40mg Mesalamine suppostory Mesalamine ER capsules .375 gram x 4 Melatonin 10mg Zinc 100mg Vegan Omega-3 Multivitamin L-lysine 500mg Iron 65mg Gingko Biloba 120mg D3 10,000 IU C 3000mg Super B complex B12 2500mcg Turmeric tea 2

Current Illness: N/A

ID: 1091798
Sex: U
Age:
State: CO

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/11/2021
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: I was schedule for my vaccinations. The vaccinations were schedule to occur on campus. My first vaccination was scheduled for Sunday, Feb 14th, 2021, at 315pm. My second vaccination was scheduled for Friday, Mar 5th, 2021, at 10am. I didn't realize until I was receiving a follow-up exam with my primary physician on 3.8.2021 that my second vaccine was administered at the 19 day mark, rather than after 21 days, as per Pfizer vaccination protocol. This must have also occurred with many other vaccine recipients who received their initial vaccination on the same day as I received mine. While there have been no adverse effects that I can tell, I was instructed by my doctor to report the issue.

Other Meds:

Current Illness:

Date Died: 02/25/2021

ID: 1091799
Sex: M
Age: 64
State: KY

Vax Date: 01/12/2021
Onset Date: 02/25/2021
Rec V Date: 03/11/2021
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: none listed

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

Symptoms: Became COVID-positive, pneumonia, ARDS, hospitalized for hypoxia 2/21/2021, death 2/25/2021

Other Meds: Lactobacillus Acidophilus (Acidophilus Lactobacilli) 1 Each Capsule, 1 CAPSULE PO QID, #100 CAPSULE 0 Refills 9/14/19 Sulfamethoxazole/Trimethoprim (Sulfamethoxazole-Tmp Ds Tablet) 1 Each Tablet, 1 EACH PO Q12 for 8 Days, #16 TAB 0 Refills

Current Illness: UTI

ID: 1091800
Sex: F
Age: 49
State: TN

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
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: Morphine

Symptom List: Rash, Urticaria

Symptoms: Almost immediately I turned a bright shade of pink on both arms and my neck and chest area. I was lightheaded and dizzy. My blood pressure dropped to 87/57 (normally have high BP). I had a hard time catching my breath. These symptoms came in waves about every 15 minutes. I was monitored for 2 hours until I felt well enough to go home. I arrived at home a little after 5:00 pm and started having a very bad migraine. I had fever, (101.8) chills, and trouble walking. My legs felt like they weighed 100 pounds each. Every joint in my body ached. I was extremely lethargic for the remainder of the evening. The next day, 03/10/2021 I continued to suffer from the same symptoms as I had on the first day. I was unable to return to work. I could not drive safely. I attempted to be active and it resulted in being dizzy and very faint. The migraines are incredibly painful I have had migraines for years but these were the worst I have ever experienced. I am now on day 3 (03/11/2021) and I am still unable to work. I have extreme fatigue and headaches. I am reporting this event to hopefully help in research of the vaccine. I believe in science and will do whatever is asked of me to help this progress.

Other Meds: Lisinopril Omlodipine

Current Illness:

ID: 1091801
Sex: M
Age: 56
State: VA

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: This was reported to me by RN. Patient received 2nd Moderna vaccine on the 21st day interval after receiving the first dose of Moderna Covid vaccine on 2/15/21.

Other Meds: unknown

Current Illness: N/A

ID: 1091802
Sex: F
Age: 46
State: IL

Vax Date: 02/11/2021
Onset Date: 02/19/2021
Rec V Date: 03/11/2021
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: The team member reported her heart was racing, she became dizzy, nauseated, flushed, and felt like she was going to pass out.

Other Meds:

Current Illness:

ID: 1091803
Sex: F
Age: 34
State: MI

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 03/11/2021
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: Ibuprofen, Capflex

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

Symptoms: I exp chills, fever,headache(flu like symptoms) lasting 48 hrs.

Other Meds: Synthroid 75 mcg daily

Current Illness: No

ID: 1091804
Sex: M
Age: 16
State: NV

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Given to out of age group during POD event

Other Meds: none

Current Illness: none

ID: 1091805
Sex: F
Age: 21
State: NY

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/11/2021
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 allergies to pollen, trees, grass, flowers "bad response" to other vaccines in the past like Tdap Shellfish

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

Symptoms: 5 mins post 1st dose vaccination patient began feeling nauseous, throat felt tight with mild pain when swallowing, tingling sensation from the chest down to her toes, facial flushing, and dizziness. She states these symptoms are common due to her history of EDS but today they are slightly worse since she got the vaccine. She was brought to the medical evaluation area via wheelchair and evaluated by us and EMS. Patient was administered Benardyl 50mg and provided orange juice and water. Vitals taken throughout and were slightly high in the beginning and then stabilized. Patient states her throat felt better and the tingling localized to her hands after 5 mins. Patient was monitored for over 45 mins. She was instructed to contact her PCP and her allergist to be cleared for her second vaccine dose. She was informed her 2nd dose should be administered at a facility where she can be observed closely. She declined transport to the hospital but agreed to follow up to the ER with any worsening signs of anaphylaxis. The nausea resolved and she felt less groggy upon leaving with her boyfriend.

Other Meds: Camirese Lo Sertraline Xopenex HCI

Current Illness:

ID: 1091806
Sex: M
Age: 53
State: IN

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: Uloric

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Numbness of scalp, face, ear and neck on right side. Started around 1:30 PM the day after injection of the vaccine. Symptoms persist 24 hours later.

Other Meds: Lisinopril, Testosterone, Pepcid, Claritin

Current Illness: None

ID: 1091807
Sex: F
Age: 78
State: IN

Vax Date: 02/18/2021
Onset Date: 02/27/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: Animal dander,mold,pollen, seafood during pregnancy,

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Inflammation beginning on 10th. day, with redness, heat, itching at site, which increased daily until saw MD at Clinic on day 15.

Other Meds: Verapamil, glucosamine,sertraline, omeprazole, quinapril HCTZ, pravastatin, vitamin, lutein, COQ10.

Current Illness: None

ID: 1091808
Sex: M
Age: 83
State: MD

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/11/2021
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 listed

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

Symptoms: Patient may have inadvertently been given 1cc of Moderna COVID vaccine instead of 0.5cc. Patient was notified. State of MD was notified

Other Meds: none listed

Current Illness: none at time of vaccination

ID: 1091809
Sex: F
Age: 73
State: MO

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: Hx of severe allergic reaction

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

Symptoms: Case reported that in the night she would have periods of chills, H/A, and joint pain. Woke up a couple of times but it did not prevent her from getting rest.

Other Meds: unknown

Current Illness: None reported

ID: 1091810
Sex: F
Age: 70
State: MN

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: Unevaluable event

Symptoms: Hoarseness, joint and muscle aches, chills, dizziness, diarrhea. Symptoms present upon waking next day after vaccine and have continued for 36 hours. They are unresolved at this time.

Other Meds: Omeprazole/zettabytes/Flovent Multivitamin/calcium/magnesium/Vit D/VitB

Current Illness: None

ID: 1091811
Sex: M
Age: 41
State: OH

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: Janssen COVID-19 Vaccine EUA. Approximately 15 hours after the vaccine the left eyelid began swelling. the swelling has lasted for 36 hours

Other Meds:

Current Illness:

ID: 1091812
Sex: F
Age: 61
State: IN

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: Sulfa

Symptom List: Injection site pain, Pain

Symptoms: Third and fourth fingers of left hand (vaccination arm) went completely numb for 2 hours. Massaged for 2 hours and numbness changed to tingling for another 10 hours. Within 24 hours of vaccination time symptoms cleared.

Other Meds: Benedryl, Motrin PM

Current Illness: None

ID: 1091813
Sex: F
Age: 62
State: OH

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: contrast dye

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient arrived to the outpatient vaccine clinic for her scheduled appointment. Immediately after receiving the vaccine, the patient felt chest pain, dizziness, and passed out. She had swelling of the tongue, lips, eyes, and throat. Patient was admitted to the hospital and treated for anaphylaxis with epinephrine, benadryl, famotidine, methylprednisolone, Duoneb and tylenol. Patient is currently still in the hospital but her condition is stable.

Other Meds: amlodipine fluoxetine hydrochlorothiazide levothyroxine losartan metoprolol succinate mirtazapine Percocet Xtampza Lyrica Chantix Tylenol

Current Illness: N/A

ID: 1091814
Sex: F
Age: 72
State: MI

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: no known listed with pharmacy/consent form

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

Symptoms: Patient was monitored and at 30 minutes, patient stated feeling itchy with slight rash/redness developing on neck/chest area. Patient stated feeling increased heartrate, however heart rate and sp02 were check twice and at normal levels. Administration of benadryl 50 mg was given. Patient did not have any signs of anaphylaxis , after 1 hour patient still had itchy feeling/rash but no other issues. Patient was recommended to seek medical attention. Contacted later and patient was doing ok with no other symptoms besides tiredness/fatigue from vaccine.

Other Meds: Unknown

Current Illness: unknown

ID: 1091815
Sex: M
Age: 62
State: NV

Vax Date: 12/30/2020
Onset Date: 01/08/2021
Rec V Date: 03/11/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After my vaccine, I went to the hospital because I experienced weakness some shortness of breath and some tremors. I am a doctor of training, one aspect the aspect of covid-19 affects testosterone. I got Covid after my first dose. I am still having some symptoms and scheduled to return back to work the third week of March 2021.

Other Meds: alodipem

Current Illness: none

ID: 1091816
Sex: M
Age: 64
State: HI

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: amiodarone, amlodipine, metoprolol, iodine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Subjective fever highest recorded 99.5, chills, myalgias, and fatigue.

Other Meds: Basaglar, Dilaudid, Bystolic, Bumex, clonidine, BuSpar, lisinopril,

Current Illness: Had a COPD exacerbation and was given a Z-pak on 2/11

ID: 1091817
Sex: F
Age: 58
State: OH

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: Arythimiacin

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

Symptoms: 1st dose. About 5 mins I could taste vaccine. 30 mins later my palette and roof of my mouth becoming tingly /numb. It then proceeded to my tongue . A few mins later proceeded to my lips. That all lasted about an hour. Later last night, same evening as receiving 1st dose. Around 11 hours later. My gums where tingling . Not as strong as earlier right after receiving the Moderna vaccine. That lasted about 45 mins.

Other Meds: Levothyroxine

Current Illness: None

ID: 1091820
Sex: F
Age: 34
State: DC

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

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

Lab Data:

Allergies: Denies

Symptom List: Nausea

Symptoms: Approximately 5 minutes after her second dose of the vaccine, patient stated she felt a "bad feeling" in her stomach and subsequently vomited a large amount of liquid in the post vaccination observation area. We transported her to the Health Unit where she was evaluated and observed approximately 2 hours. Patient's vital signs remained in a normal range. Her physical exam was unremarkable. Stated she felt fine prior to getting her vaccine. She stated she felt much better when she left our Health Unit and returned to work.

Other Meds: None

Current Illness: Denies

ID: 1091821
Sex: F
Age: 62
State: NJ

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: Patient received her second dose of vaccine at 6:40 PM. After the minute observation period, she left the facility en route to her home. When she got to her car, she felt that the base of her tongue was swollen. She returned back to the vaccination center. At 7:05 PM, she was assessed by the post vaccine RN. BP 155/98, HR 103. O2 Sat 98% RA. She continues to verbalize that she feels minor swelling of tongue and "congested" nostrils. 7:15 PM BP 174/112 HR 103 O2 - 97% RA. Patient was also assessed by pharmacy. Epi-pen was not administered. Patient's symptoms were not improving. EMS called to transport patient to hospital for adverse reaction and increased blood pressure. BP 165/102 HR 103. Patient transported to hospital via stretcher.

Other Meds: Ciclopirox 0.77% Protonix 40 mg Rosuvastatin 5 mg Triamcinolone acetonide 0.1% topical cream

Current Illness: None reported

ID: 1091822
Sex: F
Age: 50
State: CA

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

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

Lab Data:

Allergies: Unk

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

Symptoms: Patient was observed in observation area. Patient was sitting in a chair and fainted to the ground. Patient did not notify RN?s in observation that she was feeling faint, lightheaded or had any symptoms. Code was called for EMS to patient side and safety measures were taken.

Other Meds: Unk

Current Illness:

ID: 1091823
Sex: F
Age: 60
State: IN

Vax Date: 02/15/2021
Onset Date: 02/22/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Enlarged lymph nodes following 1st shot-- Diagnostic Mammogram and ultrasound; Severe Diarrhea for 48hrs following 2nd shot. Pain in arm for about 4 days following both shots

Other Meds: Metformin, Sertraline, Pravastin and Dietary supplements.

Current Illness: None

ID: 1091824
Sex: F
Age: 45
State: WY

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: Sore muscle in upper arm of injection site, moderate headache lasting in to the next day, some mildly sore muscles in shoulders and neck area, and mildly upset stomach the evening of the day of the injection.

Other Meds: Daily Multi-Vitamin

Current Illness: None

ID: 1091825
Sex: F
Age: 21
State: NY

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

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

Lab Data:

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: patient c/o dizziness and decides to lie down on the floor to avoid falling. Was placed on wheelchair and transfer to the observation room and was observed for 45 minutes. vital signs stable. bp= 110/70 HR =104, lung clear. Patient reports this happens every time she goes to doctor or hospital; she gets very anxious and feels dizzy. History of anxiety on medication. Patient was feeling well and able to go home on her own, she had a friend accompanying her at the vaccine sight.

Other Meds: Zolof 50 mg once a day

Current Illness:

ID: 1091827
Sex: M
Age: 69
State: MI

Vax Date: 02/26/2021
Onset Date: 03/05/2021
Rec V Date: 03/11/2021
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: Poison ivy, bee stings.

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

Symptoms: Rash on and around injection site, slightly raised and itchy. Took benadryl, went away in 7 days.

Other Meds: Flovent, Flomax, Simvastatin, provigil "Modafinil", celais. Multiple vitamin, leutin, vitamin c, vitamin a, vitamin K-2, amino acids.

Current Illness: None

ID: 1091828
Sex: F
Age: 91
State: NE

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 03/11/2021
Hospital: Y

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, per son.

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

Symptoms: As reported by son and by DON of Medical Center: 02.06.2021 Son reports that patient had spoken with her daughter the morning of 02.06 via phone and that patient sounded fine. Patient's son tried to call her around 3:30 or 4 and there was no answer. Son called the facility where patient resided and staff went to check on her, where they found patient on the floor, conscious. Patient was communicating fine when they found her. It is unclear if she bumped her head when she fell, but patient deteriorated and was taken to ER where a CT was done and it was determined patient had a brain bleed as well as a UTI. Patient was admitted to hospital. Patient subsequently had a stroke while in hospital. Patient was discharged to rehab facility on 02.23.2021 and while she has regained the ability to walk with a walker and some use of her right hand, she remains unable to speak.

Other Meds: Aspirin 81 mg EC tablet, calcium carbonate-vitamin D3 600 mg, calcium 200 unit Cap, clopidogrel 75 mg tablet, desonide 0.05% cream, iosartan 50 mg, metroprolol 100 mg, multivitamin oral, pantoprazole 40 mg tablet, pravastatin 20 mg tablet,

Current Illness: UTI at time of admission to hospital on 02.06.2021

ID: 1091829
Sex: F
Age: 46
State: CA

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

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 1. Severe body aches, pain all over body; fever for 24 hours 2. Soreness in left armpit, starting approximately two days after the injection and lasting approximately 5-7 days.

Other Meds: Magnesium and Vitamin D3 gummy vitamins

Current Illness: None

ID: 1091831
Sex: F
Age: 26
State: TX

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/11/2021
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: Allergic to penicillin, and bar soap

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

Symptoms: Starting about 1 minute after vaccination I became extremely dizzy, blacked out/lost vision, had shortness of breath and a tight chest, lost feeling in my hand and fingers on my left side (the side I got the vaccine), was sweating but felt cold flowing through my body. These feelings lasted for about 30 minutes and my vision and feeling in my fingers and hand came back as the dizziness subsided and my body temp returned to normal. Around 40 minutes after the vaccine I started experiencing echoing in my left ear (the side I got the vaccine on) and soreness around the vaccination site. The echoing in my left ear lasted about 30 minutes and then subsided. The arm pain spread to the rest of my arm and I began to get a headache. About 4 hours after the vaccine I began to experience intense back, hip, foot and hand pain making me unable to do any regular activities. The back pain feels like intensely sharp pain in my spine and hurts to the gentle touch. I previously had no back pain prior to the vaccine. The muscles surrounding my spine up to my shoulders were also painful/sore. This pain subsided after 6 days. On about the 4th day after the vaccine I began experiencing underarm and breast pain on the side I got the vaccine. It is now exactly 1 week since my vaccination and I am still experiencing the underarm and breast pain. I have experienced lethargy since vaccination.

Other Meds: Propranolol Lamotrigine Trazodone Cambia

Current Illness:

ID: 1091832
Sex: F
Age: 75
State: IA

Vax Date: 03/03/2021
Onset Date: 03/07/2021
Rec V Date: 03/11/2021
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: No known allergies

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

Symptoms: Patient developed Right sided Bells Palsy 3 days after having COVID 19 vaccine. Patient continues to have symptoms on 03/11/2021.

Other Meds: Metformin, Atorvastatin, glimepiride and low dose ASA.

Current Illness: None

ID: 1091833
Sex: F
Age: 48
State: TX

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies: Yellow cheese - hives.

Symptom List: Pain in extremity

Symptoms: Angioedema of the right side of the patient's face from the inferior orbit down, sparing the upper lip, and involving the lower lip. Accompanied by numbness for a few hours which then subsided, with lingering tenderness upon palpation.

Other Meds: ACCU-CHEK AVIVA PLUS TEST STRP Strp atorvastatin (LIPITOR) 40 MG tablet BD ULTRA-FINE NANO PEN NEEDLE 32 gauge x 5/32" Ndle blood-glucose meter (GLUCOSE MONITORING KIT) kit FARXIGA 10 mg Tab insulin degludec (TRESIBA FLEXTOUCH U-200) 200 un

Current Illness: None.

ID: 1091834
Sex: F
Age: 71
State: NY

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 03/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient reports that she experienced back pain, nausea, vomiting, chills, low grade fever within 24 hours of receiving the vaccine. Those symptoms did subside. Patient's husband called to report that after 5 days of having no symptoms on 03/11/2021 she has the same symptoms again of nausea, vomiting, back pain, fatigue, and weakness. I advised her husband to contact her primary care office to schedule an appointment.

Other Meds:

Current Illness:

ID: 1091835
Sex: F
Age: 63
State: MD

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/11/2021
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 listed

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

Symptoms: Patient may have inadvertently been given 1cc of Moderna COVID vaccine instead of 0.5cc. Patient was notified. State of MD was notified

Other Meds: none listed

Current Illness: not at time of vaccination

ID: 1091836
Sex: F
Age: 48
State: MS

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/11/2021
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: Bactrim

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

Symptoms: Fever of 101, shaking, chills, headache, joints hurt, sbody stiff, achy all over, fatigue, general not feeling well which all lasted 24 hours and began 12 hours exactly after shot, dizzy (vertigo) and nausea, fatigue, and headache, began 2 days after shot and is still on going

Other Meds: Metformin, lisinopril, protonix, actos, Lasix, vitamin D, elderberry, zinc

Current Illness:

ID: 1091837
Sex: M
Age: 79
State: FL

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: Novocaine, Percocet, Ciprofloxacin, Tetracycline.

Symptom List: Vomiting

Symptoms: He woke up the next day after the vaccine he did not know where he was and was confused. He did not take his medications, did not remember to take it. He came out to his wife and she heard some noise and he looked over to the dog dish to refill it and didn't refill it as he usually does. Just a lot of forgetful things that he did. He had dizziness and was hanging on the door frame and went to bed, and told his wife that he did not know anything and did not know what he was doing. They took him to the doctor and was seen by the doctor who checked his VS and said that he was okay, and told them that he was having a reaction to the vaccine, and was starting to come around and remembering things while he was in the doctors office. They were advised to take him home and let him rest, and he did and didn't eat until last evening. He had the same reaction that he had when he had the COVID virus. He knew everything this morning and back to his baseline.

Other Meds: Digoxin, Lisinopril, Amlodipine, Atorvastatin, potassium, Furosemide, metformin, metoprolol, Eliquis, Sertraline, Metrocarbamol. Fish oil, vitamin C, vitamin E, vitamin B12, vitamin D, zinc, elderberry gummies.

Current Illness: None.

ID: 1091839
Sex: F
Age: 17
State: MN

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/11/2021
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 listed

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient is not 18 years old (COVID19 Moderna vaccine is recommended in the EUA for 18 years old and older). No adverse outcomes. Patient's mother accompanied her at the vaccination clinic and gave verbal consent.

Other Meds: Not known

Current Illness: None Listed

ID: 1091840
Sex: F
Age: 69
State: FL

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: TAPE, PENICILLIN, COPPER

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

Symptoms: PATIENT DEVELOPED SKIN RASH AND ITCHINESS INVOLVING ARMS AND LEGS FOLLOWING DAY OF THE VACCINE. STARTED IN ANTIHISTAMINES FOR RASH AND ITCHINESS.

Other Meds: GLIPIZIDE 10MG, ASPIRIN 81 MG, METOPROLOL 25MG, METFORMIN 1000MG, LOVASTATIN 20MG, LISINOPRIL 40MG, OMEPRAZOLE 20MG

Current Illness: NONE

ID: 1091841
Sex: M
Age: 22
State: CA

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/11/2021
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: The patient was given the vaccine at 1200 noon on 3/9/21 The patient reports left side facial swelling and upper lip swelling. The patient was prescribed benadryl 25 mg 1 tab po q 6 hours The patient was instructed on using a cool pack The patient was instructed on 911 precautions for worsening swelling of face, lips tongue or throat or shortness of breath or trouble breathing

Other Meds: None

Current Illness: Not Applicable

ID: 1091842
Sex: F
Age: 73
State: WI

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

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

Lab Data:

Allergies: unknown

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

Symptoms: When administering vaccine into right arm resistance was met and only 0.2 ml of vaccine was able to be injected. Upon speaking to the patient, she reported that she does get bi-weekly haldol injections in that arm. Per cdc recommendations, dose was repeated in opposite arm and full dose was given.

Other Meds: unknown

Current Illness: unknown

ID: 1091843
Sex: F
Age: 42
State: IL

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/11/2021
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:

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

Symptoms: employee received covid vaccine in Lt deltoid. Soon after developed red itchy rash. Given 25 mg Bendadryl orally. C/o feeling dizzy and pins and needles in extremities. Given Benadryl 25mg and Solumedrol 125mg IVP. Monitored until 2:45 pm. Symptoms subsided and patient was discharged home. Followed up same evening and next day. Patient stated by the next day symptoms were gone.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm