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: 1092576
Sex: M
Age: 59
State: CT

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: severe shivering for an hour as I mounted a fever of 103.3 I ameliorated it by taking Tylenol and Ibuprohen every alternate 2 hours.

Other Meds: Effexor XR Vit. D.

Current Illness:

ID: 1092577
Sex: F
Age: 39
State: MN

Vax Date: 03/10/2021
Onset Date: 03/11/2021
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: Vasovagal syncope event 18 hrs post injection. Severe headache Muscle pain and weakness Slight swelling in injected arm and hand

Other Meds: cyclobenzaprine 5 MG/Daily

Current Illness: None

ID: 1092578
Sex: F
Age: 78
State: WI

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/11/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: LTC Pharmacy was notified of a potential vaccine related hospital admission on 3/8/2021. The following information was gathered from discussion with RPH at Hospital. The patient received second dose of Pfizer COVID vaccine on 2/26/2021. The patient then had nausea, vomiting, and poor oral intake. On 2/27/2021, the patient went to the bathroom and while on the toilet, had a vasovagal event which led to her hitting the side of the face while falling. Patient was then taken to the hospital for evaluation. The patient does have a pacemaker but the cause of the event was determined to likely be due to dehydration. Lab work was performed and pertinent lab values include: potassium of 3.1, SCr of 0.8, and BUN of 13. The patient received potassium supplementation and IV hydration in the hospital. Patient was discharged on 2/28/2021. Of note, the patient does have a pacemaker and a follow-up appointment with cardiology to evaluate the pacemaker was scheduled upon discharge.

Other Meds:

Current Illness:

ID: 1092579
Sex: F
Age: 56
State: CA

Vax Date: 03/06/2021
Onset Date: 03/06/2021
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: lidocaine, lisinopril, nifedipine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: c/o itching and hives, benadryl 25 mg po given, continued to monitor, improved with benadryl 15 minutes post administration.

Other Meds: hydralazine 25 mg po tid, carvedilol 3.125 mg po bid, amlodipine 10 mg po daily, levothyroxine 50 mcg po daily, climara 0,0375 mg/24 hr topical qweek, losartan 50 mg po bid, cephalexin 500 mg po tid,

Current Illness: htn

ID: 1092580
Sex: F
Age: 50
State: CO

Vax Date: 02/25/2021
Onset Date: 03/06/2021
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: None

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

Symptoms: I got shingles rash started on 3/6/21 and it still hasn?t cleared up.

Other Meds: None

Current Illness: None

ID: 1092581
Sex: F
Age: 37
State:

Vax Date: 03/01/2021
Onset Date: 03/10/2021
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: Swelling, itching, redness at injection site

Other Meds:

Current Illness:

ID: 1092582
Sex: F
Age: 86
State:

Vax Date: 01/27/2021
Onset Date: 02/16/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Received 1st dose of Moderna COVID-19 vaccine on 1/27/2021 (patient did receive 2nd dose on 2/24/2021). Patient vacations during winter and was scheduled to come back in April of 2020, however, due to pandemic travel restrictions was unable to return home until October of 2020. Patient was seen in ED on 2/2/21 for UTI. On 2/4/21 patient returned to ED with chief complaint of headache. ED note states patient was fine at previous visit but during this encounter she had an altered mental status. Patient is admitted due to encephalopathy secondary to focal status epilepticus, for which she is discharge with a new prescription for Keppra for seizures, and possible UTI. Test revealed high IgG for virus (IgG is present during prolonged infections, while IgM is present at infection start and little IgM was found). No seizure activity on EEG after initiation of anti-epileptic therapy with gradual improvement in mentation back to baseline. Etiology of seizure disorder unclear. This event followed a COVID-19 vaccine and another case of status epilepticus was seen for another patient who had just previously received the vaccine, prompting the suspicion this could be related to the vaccine.

Other Meds:

Current Illness:

ID: 1092583
Sex: F
Age: 66
State: MS

Vax Date: 03/06/2021
Onset Date: 03/06/2021
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: Procaine Compazine

Symptom List: Pharyngeal swelling

Symptoms: After 15 minutes my heart began pounding and then my head started hurting and SS I arrived home, I became nauseated and began vomiting which lasted 6 days. I?m still very weak and unsure if I should take the second dose. I thought I was going to die.

Other Meds: Norco 6 hours prior to injection for severe back pain.

Current Illness: None

ID: 1092584
Sex: F
Age: 33
State: CA

Vax Date: 02/02/2021
Onset Date: 02/03/2021
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: Bactrim, erythromycin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The day of the injection I began with a headache and sore arm but for the most part was fine. Then around 7:00 pm that day I started to get the body aches and so I went to go lay down for bed. I started to shake uncontrollably, have horrible body aches and chills, I went from hot to cold to hot again all through the night, i had a fever all night long, bad stomach cramps, super nausea all night long, and bad headache. This last all the way into the following night having me miss a whole day of work because I couldn't get out of bed. Since this second shot I have had severe heart palpitations, prolong period, blurred vision and severe body aches.

Other Meds:

Current Illness:

ID: 1092585
Sex: M
Age: 67
State: NH

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shellfish.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Sore arm at vaccination site. Fever at 101. Persisted from onset through 24 hours. Has not resolved. Tylenol.

Other Meds: 50mg Nitrfuroantin, 40 MG Omeprozale, Vitamin C, Vitamin D, Saw palmetto, resveratrol, Calcium/Magnesium, Bergamot, Red Yeast Rice.

Current Illness: Sudden Hearing Loss. 1/23. Prednisone tapers completed 2/226

ID: 1092586
Sex: F
Age: 30
State: KY

Vax Date: 03/01/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa antibiotics

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

Symptoms: Rash in injection site. Hives covering entire body.

Other Meds: N/A

Current Illness:

ID: 1092587
Sex: M
Age: 40
State: KY

Vax Date: 02/04/2021
Onset Date: 02/22/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Bell's Palsy started on 02/2221

Other Meds: Purinethol

Current Illness: None

ID: 1092588
Sex: F
Age: 56
State: LA

Vax Date: 03/05/2021
Onset Date: 03/06/2021
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: none

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

Symptoms: right after injection the joint in left knee, which had been previously injured, started burning. Then the next day, vision in right eye changed and already had optic nerve damage due to MS.

Other Meds: Triamterine 37.5mg, Olmesartan 2omg, Fluoxetine 20mg (2 daily), Synthroid 88mcg, Vit D 10,000u daily

Current Illness: Multiple Sclerosis, Bilateral Menieres

ID: 1092589
Sex: F
Age: 27
State: IL

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: no

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

Symptoms: start with arm hurt, and then headache, dizziness. and these symptoms getting worse along with time. I start to feel cold at night time, but the room temp was 70 which is not cold for me. I started to shiver with cold. my hands and feet were freezing cold. at the same time feel my body is so hot but cold. I started to sweat. after I feel less dizzy, I use an oral thermometer, it was showing 38.5 degrees. I was still boiling hot this morning. and then I took some Tylenol for my body ache and fever. and then i went back to sleep for 6hrs.

Other Meds: none

Current Illness: no

ID: 1092590
Sex: F
Age: 79
State: MT

Vax Date: 02/24/2021
Onset Date: 02/25/2021
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: Demerol, Macrodantin, meperidine, Neosporin

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

Symptoms: Patient said she developed local erythema/swelling/itching to injection site and that it spread to her chest and abdomen. She developed a "bronchial cough" about 48 hours after receiving vaccine. She wanted antibiotics for cough from her primary care because her husband is having surgery on 3/15/21 and wanted to make sure she could go into the hospital with him. Her primary care provider prescribed her Ceftin 500 mg. She has taken Ceftin before without any allergic reaction. She said as soon as she started taking the Ceftin her entire body became itchy "down to her fingers" and had hives from head to toe. Also reports mild shortness of breath. Her provider was unsure whether the reaction was from the Ceftin with the vaccine or the Ceftin itself. Patient said her primary care may do some testing to find out if she is allergic to Ceftin.

Other Meds: Singulair, ramipril, Crestor, Xarelto, Toprol-XL, Tikosyn, aspirin, vitamin D, Lyrica, vaginal Estrace

Current Illness: none

ID: 1092591
Sex: F
Age: 60
State: TX

Vax Date: 03/03/2021
Onset Date: 03/09/2021
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: Penicillin Erythromycin Skelaxin

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

Symptoms: injection site started to itch Tuesday evening. Wednesday morning arm was swollen, red, very itchy and warm to the touch - symptoms are still occurring on Thursday evening and arm is even redder..

Other Meds: Glucosamine 1500MG/Chondroiton 1200MG Vitamin D3 Fish Oil Women's One-A-Day Losartan 50 MG 2 x a day CBD Oil Escitalopram 10 MG Alendronate 70 MG

Current Illness: none

ID: 1092592
Sex: M
Age: 47
State: NJ

Vax Date: 02/16/2021
Onset Date: 03/10/2021
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: None that I know of

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

Symptoms: Huge underarm swelling with pain associated.

Other Meds: Welbutrin Rittilan Testostrone

Current Illness: None

ID: 1092593
Sex: F
Age: 65
State: NV

Vax Date: 02/23/2021
Onset Date: 03/02/2021
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: No allergies, but sensitive to tetracycline, dust, molds, pollen, dog dander, some foods: dairy, wheat, corn, soy, garlic, tomatoes, eggs

Symptom List: Ear pain, Hypoaesthesia

Symptoms: After 3.5 hours, the injection site got sore. By the next day, it was painful and swollen. By the following day, it was 80 % better. After that, it seemed fine. About ten days later, I noticed that the injection site had become dense and a little sore. Within a few more days, I started having pectoralis muscle spasms, and I can no longer raise my right hand to my mouth, to my opposite shoulder or overhead. Trying to make those motions causes me to cry out in pain. I can't sleep on that shoulder, and need help getting dressed. I get acute pain from moving it in other ways, too.

Other Meds: Estradiol transdermal system, .1 mg/day Cyanocobalamin 1000mcg/ml injectable, 1ml

Current Illness: None

ID: 1092594
Sex: F
Age: 24
State: NH

Vax Date: 03/07/2021
Onset Date: 03/07/2021
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: no

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Sunday night, my heart started pounding really hard. I went to ER - Medical Center. They did an EKG and took my vitals. I had a fever (slight) and chills and was nauseous. Put ONDANSETRON -4 mg. The nausea didn't go away and I couldn't eat or drink without vomiting until today. I couldn't eat or drink or was very tired and groggy and miserable. Today I had another trip to the ER Medical, I got on an antibiotic and anti-nausea medication (GETHALEXIN - 500 mg for the GI) (METOCLOPRAMIGE HCL - 5 mg- for nausea) from the hospital and I had a shot that went into my immune system. They also found a UTI today.

Other Meds: no

Current Illness: no

Date Died:

ID: 1092595
Sex: F
Age: 70
State: TX

Vax Date: 02/01/2021
Onset Date: 02/05/2021
Rec V Date: 03/11/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

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

Symptoms: A high risk employee received 1st vaccine dose of Moderna through the Health Center (HC) on 2/1/2021. This patient was seen as an employee only and was not established patient of the HC. The patient reported "having symptoms of Bronchititis" on 2/5/2021 prior to being hospitalized for 7 days (2/5/21 to 2/12/21). On 2/12/2021, an ER visit at Medical Center & transported to General Hospital on 2/13/21. On 3/11/2021, we were notified that the patient died on 3/10/21.

Other Meds: N/A

Current Illness: N/A

ID: 1092596
Sex: F
Age: 32
State: WI

Vax Date: 02/25/2021
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: Allergic to clonidine and sensitive to fentynal. Potentially allergic to shellfish. Allergic to animals such as cats, dogs, horses. Also allergic to dust mites and molds.

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

Symptoms: Developed a red ring/rash that was 2 inches diameter around injection site. The ring was about 1/4 inch thick. Was hot to touch. Doesn?t itch or hurt really, although I did scratch it at one point and that was very painful. I did not notice the rash until my mom saw it yesterday, so I?m not sure if that was the first day or not. It has faded significantly overnight but is still present. The day before my mom noticed the rash on me, I had sore shoulder muscles (both sides) and do not remember lifting anything. However, my back has been in pain so could be related to that. The only other side effects I had with the injection were a slight headache the day after and nausea/pooping more frequently (but not diarrhea) 4 days later, which I know are not unexpected side effects.

Other Meds: Strattera, Loratadine, Lamotrigine, Buspirone, Vitamin B12 and Vitamin D. Had taken Tizanidine within 24 hours before receiving the COVID vaccine as well.

Current Illness: None that I can think of

ID: 1092597
Sex: F
Age: 71
State: CA

Vax Date: 02/10/2021
Onset Date: 02/13/2021
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: zoledronic acid

Symptom List: Unevaluable event

Symptoms: severe outbreak of genital herpes 2 days after both vaccines

Other Meds: atorvastatin and pristiq

Current Illness: h/o genital HSV

ID: 1092598
Sex: F
Age: 42
State: MD

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: LA

Lab Data:

Allergies: None

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

Symptoms: Significant headache, body aches, and body chills began onset at 8:30 pm and persisted until 12:00 pm on Thursday 3/11. Soreness at site of injection also occurred.

Other Meds: Methyl B-vitamin complex, vitamin D, iron, magnesium, D-mannose

Current Illness: None

ID: 1092599
Sex: F
Age: 63
State: ND

Vax Date: 12/30/2020
Onset Date: 01/11/2021
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: NSAIDS-anaphylactic peanut butter Diazide

Symptom List: Injection site pain, Pain

Symptoms: Headache and stiff neck across my shoulders and couldn't turn my head. I developed a fever and cough 12 days after the shot 101-102 degrees. I was sent for Covid -19 test but the PCR test was negative. I was given an Augmentin and took Tylenol and probiotics. I recovered and had no fever after three days but I still felt congested and I had a cough. I restarted my Methotrexate about the same time I recovered.

Other Meds: Methotrexate- on Sundays ( skipped taking for two weeks on 10th and 17th for second dose) Folic Acid Vitamin D Fish Oil Fibercon Turmeric Vitamin B 12 Calcium 600

Current Illness:

ID: 1092600
Sex: M
Age: 68
State: NJ

Vax Date: 03/10/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Mild chills, loss of appetite

Other Meds: Motrin Methotrexate Folic acid Omeprazole

Current Illness: None

ID: 1092601
Sex: F
Age: 54
State: CO

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: SYR
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: Second COVID vaccine at 11.13 am. Sat to wait 15 minutes. After 7 minutes felt very light headed. Was asked to sit in recliner. Heart palpitation. BP 166/92. Started having red blotches on both arms. Waited 10 minutes. BP 148/84. Sat 15 minutes. BP 132/80. Tried to stand up. Starting feeling dizzy right away. Nauseated. Heart palpitation. BP 152/85. Was given 25 mg Benadryl and orange juice. Doctor came . stood up again. Light headed. Was transferred to an exam room. Was given zofran for nausea. Lay down for half and hour. Felt much better. Left to go home. Slept. Better. Still slightly light headed

Other Meds: Vitamin D 10000 mg. Biotin. Omeprazole. Benadryl 25 mg

Current Illness: N/A

ID: 1092602
Sex: F
Age: 41
State: TX

Vax Date: 03/03/2021
Onset Date: 03/11/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: REDNESS, ITCHINESS AT INJECTION SITE, ABOUT 1.5-2 INCHES IN DIAMETER, WARM TO THE TOUCH. TAKING BENADRYL, TYLENOL AND APPYING ICE PACK EVERY 15-20 MINUTES.

Other Meds:

Current Illness:

ID: 1092604
Sex: F
Age: 52
State: VA

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: LATEX, VANCOMYCIN

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: SORE VACCINATION SITE FOR 1 ST DAY, THEN KNOT UNDER SKIN, SWELLING, REDNESS, HEAT, ITCHING, SORENESS FOR DAYS 2,3,4 AND CONTINUING

Other Meds: ARMOUR THYROID, DOXYCYCLINE;

Current Illness: NONE

ID: 1092605
Sex: F
Age: 69
State: FL

Vax Date: 03/10/2021
Onset Date: 03/11/2021
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: most oral prescribed pain medications, fire ants

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

Symptoms: On the morning of the day after my Moderna I woke up with a very swollen red arm at the injection site which was tender and warm to touch. I also experienced left ear pain with a slight headache.

Other Meds: Losartan 100mg / Lexapro 20mg daily/ omeprezole20mg daily/ Vitamins.

Current Illness: none

ID: 1092606
Sex: M
Age: 64
State: MO

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: None, as stated on Vaccine Admistration Record and Informed Consent

Symptom List: Nausea

Symptoms: 10 minutes after receiving the vaccine, the patient claimed he was feeling light headed and needed to lay down. After speaking, his eyes then went closed, and he clenched his fists and he started coughing up liquid. He was not responsive. He was moved to the ground and turned on his side. He became alert about 3 minutes after becoming unresponsive. He claimed this happens to him when he is at doctor's offices or receiving vaccines/procedures. He claimed it was "normal." He said he felt fine/normal, and this has happened in the past, though he did not mention this to the pharmacist prior to administration. 911 was called and examined him. He was allowed to go home on his own, did not go to the hospital.

Other Meds: Unknown; not a patient at our pharmacy.

Current Illness: None, per Vaccine Administration Record and Informed Consent

ID: 1092607
Sex: F
Age: 61
State: MO

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: Sulfa, walnuts, wasp stings

Symptom List: Injection site pain

Symptoms: Dizziness at 5 to ten minutes of injection , elevated blood pressure. Dizziness was improving after 30 minutes so I was allowed to leave the vaccination facility shortness of Breath started 35 o 40 minutes after injection. When I was was walking out to my car My daughter was in area and picked me up and she had Benadryl Took 2 Benadryl Shortness of breath started to improve after An hour of Benadryl. Hoarse voice improved some but continued to improve after second dose of Benadryl. Now on March 11 I still have a slight hoarse voice but so much better. I?ve been taking Benadryl every 4 to 6 hours regularly per my Dr I don?t have shortness of breath anymore but my chest does feel a little tight

Other Meds: Hydroxychloroquine, Celebrex , pro biotic magnesium, l-glutamine, viraimsD,, vitamin C, zinc

Current Illness: None

ID: 1092608
Sex: F
Age: 33
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: none

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

Symptoms: 5 minutes after receive the dose, patient complaint not feel good. Her BP was normal. No rash. She coughed, felt nausea and throwed up. We monitor her closely, and then she stared shaking and felt so cold. At that time we gave her 2 tablets of 500mg acetaminophen. 10 minutes later, she complain of difficult of breathing, and felt something in her throat, we call 911 and administer 1 dose of epi-pen. 10 minutes later, EMT arrived and took her to the hospital .

Other Meds: 2 tablets of acetaminophen 500mg. 1 dose of epipen.

Current Illness: none

ID: 1092609
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: 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: Patient reports itching at throat area, redness to chest, no hives, no flushing. Patient took 25mg Benadryl, patient has history of allergies after getting flu vaccine. Cleared by EMS

Other Meds:

Current Illness:

ID: 1092610
Sex: F
Age: 66
State: MO

Vax Date: 03/03/2021
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: Sulfa

Symptom List: Tremor

Symptoms: Rash on arm just came up. Also have rash on neck on same side

Other Meds: METOPROLOL SUCC ER 25 Multi vitamin

Current Illness: None

ID: 1092611
Sex: F
Age: 61
State: IN

Vax Date: 02/20/2021
Onset Date: 02/22/2021
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: Trazadone

Symptom List: Erythema, Pruritus

Symptoms: I noticed a couple of days after my vaccine that my tongue felt like I had burned it on hot food. The feeling has changed some. Now it feels as if my tongue is tingling. I can taste good, but it tastes odd. I have also noticed that salty foods taste saltier and sweet foods taste sweeter.

Other Meds: Escitalopram 20MG, Pantoprazole20MG, Multi vitamin, Calcium with vitamin D, Culturelle, Air-borne

Current Illness: None

ID: 1092612
Sex: M
Age: 52
State: IN

Vax Date: 03/08/2021
Onset Date: 03/08/2021
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: No

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

Symptoms: Chills, severe fatigue

Other Meds: Multivitamins, ibuprofen

Current Illness: None

ID: 1092613
Sex: F
Age: 33
State: NC

Vax Date: 02/27/2021
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: N/a

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

Symptoms: Nausea, red splotchy arm, fatigue, body aches

Other Meds: Ibuprofen

Current Illness: N/a

ID: 1092614
Sex: F
Age: 66
State: NE

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

Lab Data:

Allergies: None reported

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: No problems reported during the 15 minute wait post vaccination but when client got out to her car she reported feeling short of breath, dizzy and tightness in throat. Nurses assessed, administered Benadryl 50 mg p.o. and transported her back into the clinic via wheelchair for observation. Client reported symptom improvement within 30 minutes post onset and was released to home with her daughter 65 minutes post vaccination. Client was instructed per Dr. recommendation, to take a longer acting antihistimine (Allegra or Zyrtec) to last through the day. Client was cautioned about drowsiness with the Benadryl and additional antihistimine. She was also asked to check her blood sugar when she got home and to monitor more frequently than normal today. Client was contacted at 5:19 pm today and reports that she is doing well. She did not check her blood sugar until 2 hours post return to home and it was 48. Her provider's nurse and Dr. were contacted during this event.

Other Meds: Actos, Insulin

Current Illness:

ID: 1092615
Sex: F
Age: 39
State: CA

Vax Date: 01/14/2021
Onset Date: 03/08/2021
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: None

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

Symptoms: Right digits 1-3 PIP joint stiffness, tenderness and swelling along with swelling in surrounding tissue, worst in AM or after inactivity; also 1 month of preceding bilateral knee pain worse on left, also worst in AM or after inactivity, unclear if the two are related. As of 3/11/21 no treatment or improvement of either to date

Other Meds: cetirizine prn, topical triamcinolone cream 0.1% prn

Current Illness: None

ID: 1092616
Sex: M
Age: 66
State: TX

Vax Date: 03/11/2021
Onset Date: 03/11/2021
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: Unknown

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

Symptoms: Patient came to receive his 2nd dose of the Moderna COVID-19 vaccine. He initially said that he did not have his vaccination card with him, but self reported that his first dose was on 2-8-2021. Provider had told the patient that he would be due for his second dose in three weeks, which prompted the patient to come in. After giving the vaccine, patient mentioned that he actually did have his card on him, and the date of his first vaccine was identified as actually being 2-18-2021. Patient did not have any immediate reactions and is doing fine to our best knowledge.

Other Meds: Unknown

Current Illness: Unknown

ID: 1092617
Sex: F
Age: 56
State: CA

Vax Date: 02/26/2021
Onset Date: 02/28/2021
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: penicillin

Symptom List: Pain in extremity

Symptoms: initial normal soreness in arm at injection site, followed by fatigue and flulike symptoms going on 14 days now. Some improvement but continue to feel somewhat breathless at times, extreme fatigue (abnormal for me), decreased appetite, muscle aches (severe at times), tightness in my jaw on left side with noticeable jaw clicking that I have never had, and on day 3 woke with severe, noticeable swelling in my left axilla (egg shaped and protruding) and my left neck/jaw -- also seems to be in the lymph node area. Underarm swelling improved but still have a sense of tightness in my neck and jaw.

Other Meds: Armour Thyroid, Pristiq, lexapro, hormone replacement therapy (topical cream and sublingual estrogen drops, oral progesterone capsules), magnesium,

Current Illness: none

ID: 1092618
Sex: F
Age: 76
State: CO

Vax Date: 02/01/2021
Onset Date: 03/08/2021
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: None

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

Symptoms: None stated.

Other Meds: Citalapran Tylenol An antibiotic

Current Illness: UTI

ID: 1092619
Sex: M
Age: 75
State: WA

Vax Date: 03/02/2021
Onset Date: 03/02/2021
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:

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

Symptoms: : I received my first Moderna vaccination yesterday at the clinic. My injection was located about tree inches below my deltoid muscle. My family doctor's reaction was, " Oh no". According to the literature, the efficacy of a misplaced injection could be compromised. She suggested that I contact you (vaccine clinic) for directions. Please advise.

Other Meds:

Current Illness:

ID: 1092620
Sex: M
Age: 72
State: MO

Vax Date: 01/28/2021
Onset Date: 01/30/2021
Rec V Date: 03/11/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

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

Symptoms: On Saturday patient began to feel fatigued. Laid down at 3 pm on 1/30/2021 and woke up Sunday morning at 730. He was feeling tired a little. Within a split second he fell back on the couch, he couldn't speak or move. He was dizzy. He was taken to the ER where he was admitted. He was noted to be in atrial fibrillation in the ambulance. His oxygen levels were below normal and temperature was elevated. He was admitted to the hospital for two weeks and was released in February.

Other Meds:

Current Illness: Patient was Covid positive at the time of vaccination but unaware

ID: 1092621
Sex: F
Age: 52
State: OR

Vax Date: 02/04/2021
Onset Date: 02/06/2021
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: sulfa

Symptom List: Vomiting

Symptoms: Swollen left axilla noticed 2 days after 2nd covid vaccine2/4/21. (same side as the vaccine was given) I had a mammogram done 2/16/21 and was told I had abnormal results in my left lymph nodes in axilla. I had a left axilla ultrasound done 3/9/21 and the lymph nodes are still abnormal. I have been asked to come back in 8 weeks for another ultrasound.

Other Meds: metformin, synthroid, spironolactone, pravastatin, pantoprazole, celexa, calcium, fish oil, b12, vit d,

Current Illness: none

ID: 1092622
Sex: F
Age: 56
State: CO

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: Pollen

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Light headed, fatigue, numbness on lips - felt like swelling at first then had the numbness

Other Meds: Armour Thyroid, Alpha GPC Choline- 300mg, Turmeric 1500mg, Varicosil - Witch Hazel, Horse Chestnut, etc, B12 1000 mg - 3-5 per day, K2+D3 100 mg K2 - 125 mg - 5000 IU D3

Current Illness: None

ID: 1092623
Sex: F
Age: 36
State: AZ

Vax Date: 03/02/2021
Onset Date: 03/02/2021
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: Citrus, danders, pollens (asthma trigers)

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

Symptoms: After first shot (Tuesday, 2/2/2021), there was only arm pain, mild on the day of the dose and acutely painful for the following two days before being completely gone. After second shot (Tuesday, 3/2/2021), arm pain was consistent with first shot timeline but by Wednesday 3/3/2021, there was also a severe headache that formed that felt like my brain was too big for my skull and was pushing painfully out. The pain was dulled slightly but not negated with both Tylenol and Ibprofen (taken separately, 12 hours apart) and lasted until Sunday 3/7/2021. Both shots taken 2 days before menses; neither AER (arm pain/headache) was consistent with normal/expected menses side effects.

Other Meds: Advair 250/50 (2x/day), Albuterol sulfate 90mcg (3-5x/month)

Current Illness: N/A

ID: 1092624
Sex: M
Age: 54
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient experienced a syncopal episode two minutes after receiving Pfizer vaccine. While paramedics were assessing him he had another syncopal episode. He was transported to Northridge hospital for evaluation.

Other Meds: per patient, "no"

Current Illness: per patient, "no"

ID: 1092625
Sex: M
Age: 39
State: MO

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:

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

Symptoms: DUE TO ERROR AT INTAKE PATIENT RECEIVED 3RD DOSE OF COVID (MODERNA) VACCINE.

Other Meds:

Current Illness:

ID: 1092626
Sex: F
Age: 68
State: TX

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

Lab Data:

Allergies: None

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

Symptoms: Fever, severe chills, body aches

Other Meds: Low dose aspirin, vitamins c and d, cinnamon, turmeric, ubiquinol

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm