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: 0933910
Sex: F
Age: 41
State: NY

Vax Date: 12/27/2020
Onset Date: 12/28/2020
Rec V Date: 01/11/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: pain on injection site, myalgia

Other Meds: multivitamins

Current Illness: none

ID: 0933911
Sex: F
Age: 39
State: TX

Vax Date: 01/06/2021
Onset Date: 01/11/2021
Rec V Date: 01/11/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Moderna COVID-19 vaccine EUA

Other Meds:

Current Illness:

ID: 0933912
Sex: F
Age: 41
State: KY

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/11/2021
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: Allergies to penicillin, amoxicillin, and bactrim.

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

Symptoms: On January 6, 2021, exactly one week after receiving my first dose of the Moderna vaccine, I woke up to my injection site being red, swollen, hot, and itchy. The area of redness has gotten bigger each day and is still hot and itchy with induration.

Other Meds: None

Current Illness: None

ID: 0933913
Sex: F
Age: 65
State: IN

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/11/2021
Hospital: Y

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

Lab Data:

Allergies: gabapentin, guaifenesin, Penicillins (PCN)

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Upon assessment resident noted to have increased respirations, lungs CTA. Resident c/o increased fatigue and muscle aches. VS 202/180, 118, 22, 97.1, 96%.

Other Meds: Prescription 03/19/2019 - Open Ended metoprolol succinate tablet extended release 24 hr; 50 mg; amt: 50 mg; oral Special Instructions: Hold for SBP <100 or HR <60 Once A Day; Upon Rising Prescription 07/12/2019 - Open Ended Ampyra (dalfamp

Current Illness:

ID: 0933914
Sex: F
Age: 35
State: FL

Vax Date: 01/04/2021
Onset Date: 01/09/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: Left side supraclavicular/infraclavicular/axillary lymph node enlargement starting on Saturday evening after Monday vaccination. By Sunday left arm soreness in area where vaccination was given. No pain in other arm or swelling in right side.

Other Meds: Zoloft, Zyrtec, Famotadine, unisom, aldara

Current Illness: no

ID: 0933915
Sex: F
Age: 31
State: IN

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/11/2021
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: received first dose of moderna vaccine; approximately 3 mins later feet became numb. Hands became numb. felt flushed. progressed into vago-vagal reaction; was instructed to lie down in bed provided in clinic. patient felt better after lying for 40 minutes and left clinic. Proceeded to work from home the rest of the day. Approxmiately two hours later felt throat tightening/swelling. resolved with benedryl.. Patient has had previous vaso-vagal reaction to all three doses of HPV vaccine series.

Other Meds:

Current Illness:

ID: 0933916
Sex: F
Age: 30
State: CA

Vax Date: 12/18/2020
Onset Date: 12/24/2020
Rec V Date: 01/11/2021
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: hives- like breaking out on fore head a lot of swelling in face numbness glands swollen under tongue

Other Meds:

Current Illness:

ID: 0933917
Sex: F
Age: 80
State: MI

Vax Date: 01/07/2021
Onset Date: 01/09/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Right deltoid sore, tender to touch with a large reddened area, area 11x8cm

Other Meds:

Current Illness:

ID: 0933918
Sex: F
Age: 65
State: MN

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Shellfish, sulfa drug, PPD preservatives

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pain in the left shoulder and left base of the neck. Patient received her COVID vaccine on 1/7/2021 in the left arm and developed the pain in her left upper shoulder the following morning on 1/8/2021 and continues through today (1/11/2021). Patient has not seen a provider or received treatment at this time, but will see her PCP today.

Other Meds:

Current Illness:

ID: 0933919
Sex: F
Age: 26
State: MT

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/11/2021
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: fever, headache, nausea, body aches, fatigue-symptoms resolved

Other Meds:

Current Illness:

ID: 0933920
Sex: F
Age: 86
State: TX

Vax Date: 12/28/2020
Onset Date: 01/05/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Codeine, talwin, cipro

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

Symptoms: Itching at injection site and around, redness and hot to touch, 3-4 in redness around injection site, soreness for first few day after injection

Other Meds: IMBRUVICA, probiotic, Allura, Methenamine, Macrodantin

Current Illness: N/A

ID: 0933921
Sex: M
Age: 57
State: AZ

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/11/2021
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:

Symptom List: Rash, Urticaria

Symptoms: MED STAFF INJECTED PATIENT, TISSUE FELT TIGHT, MED/SYRINGE GENTLY PRESSED INTO SKIN AND NEEDLE RETRACTED, POSS. LOSS OF VACCINE (UNKNOWN AMOUNT) NOTED. PT. LEFT ALERT/ORIENTED

Other Meds:

Current Illness:

ID: 0933922
Sex: F
Age: 33
State: MN

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Strawberries

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

Symptoms: Patient was transferred to me at 2:04pm reporting that she had her COVID-19 vaccine at OTC op center with you around 11:30 today- About 1.5 hours later, around 1pm, she noted slight itching at the injection site that had progressed to a ?warm feeling? in her neck with hive type rash. She denied any breathing issues and reported having an allergy to strawberries, has rec?d vaccines in the past with no issues. She was on her way into town from home to get Benadryl and Zyrtec and was planning to stay in town to see if her symptoms resolved and stay by the clinic/hospital just in case. We called her back at 3:23pm and she reported feeling better-advised her to sign up for VSafe app., continue monitoring and f/u with ED if symptoms warranted. She gave you permission to submit reaction into VARES on her behalf.

Other Meds: None at this time

Current Illness: none that was known

ID: 0933923
Sex: F
Age:
State: IN

Vax Date: 01/09/2021
Onset Date: 01/10/2021
Rec V Date: 01/11/2021
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: aspirin, morphine, coconut, oysters, muscles, bacon

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

Symptoms: Rash, fatigue, joint pain, low grade fever, chills, nausea, muscle pain

Other Meds: Gabbapentin, montelukast, atorvastatin, flutisicone, hydrochloric acid (ear drops), claritin, lexapro,

Current Illness: none

ID: 0933924
Sex: F
Age: 22
State: NY

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/11/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Rash on neck Hives on neck, chest and back

Other Meds: Omeprazole Librax Norgee (birth control) Topical tretinoin gel

Current Illness: Tested positive for COVID19 on December 4th, 2020.

ID: 0933925
Sex: M
Age: 49
State: PR

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/11/2021
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: No

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

Symptoms: 5 days with fever. Headache, muscle pain, cough, trouble breathing, diarrhea, nausea, no appetite etc.

Other Meds: Gatorade, Tylenol, aspirin

Current Illness: No

ID: 0933926
Sex: F
Age: 52
State: TX

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/11/2021
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:

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

Symptoms: Left arm pit pain, left neck pain, intermittent left ear pain. Tolerable mild discomfort. No treatment.

Other Meds:

Current Illness:

ID: 0933927
Sex: F
Age: 59
State:

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Localized swelling at COVID vaccine injection site, along with itching and rash.

Other Meds:

Current Illness:

ID: 0933928
Sex: F
Age: 68
State: FL

Vax Date: 01/03/2021
Onset Date: 01/04/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 1 day after vaccine, chills, body aches, headache. 2 days later was feeling better but noticed lots of hair loss during shower. Noticed lots of hair on pillow, concerned with handfuls of hair loss.

Other Meds: n/a

Current Illness: n/a

ID: 0933929
Sex: F
Age: 89
State: IA

Vax Date: 12/28/2020
Onset Date: 01/10/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Cephalexin, Cephalosporins, Sulfa Antibiotics

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

Symptoms: rash to arm, antibiotics started 1/10/21, rash area has extended slightly since 1/10/21

Other Meds: Tylenol, Biofreeze, sinemet, chlorhexadine mouth wash, florinef, levothyroxine, melatonin, nitrofurantoin, prolia, refresh tears, senna

Current Illness: syncopal episode, intermittant/chronic

ID: 0933930
Sex: F
Age: 26
State: AL

Vax Date: 10/12/2020
Onset Date: 10/28/2020
Rec V Date: 01/11/2021
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:

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

Symptoms: 36 weeks pregnant as of 1/12/2021 left arm neuropathy

Other Meds:

Current Illness:

ID: 0933931
Sex: F
Age: 21
State: WA

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin, Penicillins

Symptom List: Unevaluable event

Symptoms: the left arm went numb (the same arm that was administered), vomiting, body shakes, fingers and toes turned blue

Other Meds: Quetiapine, tri-low sprintec

Current Illness: n/a

ID: 0933932
Sex: F
Age: 28
State: KY

Vax Date: 12/07/2020
Onset Date: 12/09/2020
Rec V Date: 01/11/2021
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: Petroleum, latex

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

Symptoms: Patient went to the emergency department 2 days after receiving a varicella vaccine complaining of syncopal episodes, headache, dizziness, nausea, and redness, swelling around injection site. She was treated with cephalexin and doxycycline.

Other Meds: Levothyroxin, Metformin, Ditropan

Current Illness:

ID: 0933933
Sex: M
Age: 57
State: FL

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/11/2021
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: none

Symptom List: Injection site pain, Pain

Symptoms: Pain in the location of vaccine and increase temperature in the area. Pain was moderate and lasted 3 days

Other Meds: none

Current Illness: none

ID: 0933934
Sex: F
Age: 64
State: NC

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: blanchable erythematous pruritic rash to back, chest, abdomen occurring 1 week after vaccine and lasting a week at time of visit. Looks like hives but does not come and go. No resp concerns.

Other Meds: Aspirin

Current Illness: none

ID: 0933935
Sex: F
Age: 43
State: MA

Vax Date: 01/02/2021
Onset Date: 01/10/2021
Rec V Date: 01/11/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

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

Symptoms: Sever thrombocytopenia (platelet count 2,000) 8 days following Moderna COVID vaccine. Clinically suspicious for ITP.

Other Meds: Omeprazole

Current Illness: None

ID: 0933936
Sex: F
Age: 70
State: AR

Vax Date: 01/07/2021
Onset Date: 01/11/2021
Rec V Date: 01/11/2021
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: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Stomach cramps/nausea

Other Meds: Vitamin D3

Current Illness: None

ID: 0933937
Sex: M
Age: 73
State: FL

Vax Date: 01/02/2021
Onset Date: 01/10/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Moderna COVID-10 Vaccine EUA: Woke up on Jan 10 with injection site red, swollen (hard) and itchy. Less red on Jan 11, but still swollen and itchy. No obvious detrimental effect, but want to report the condition.

Other Meds: Fenofibrate, losartan potassium, niacin ER, Levothyrozine, fish oil, multi vitamin, baby aspirin

Current Illness: None

ID: 0933938
Sex: F
Age: 58
State: PR

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/11/2021
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: Allergy to Benadryl

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

Symptoms: Patient refers developed general malaise, headache, feverish, joint pain, nausea and left arm pain

Other Meds: None

Current Illness: None

ID: 0933939
Sex: F
Age: 50
State: CO

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Flexeril

Symptom List: Nausea

Symptoms: severe headache-took Naprosyn and Maxalt with slight reduction in intensity but did not relieve-eased by 2nd day out from vaccine myalgias throughout both arms and legs-rest-eased by 2nd day out from vaccine

Other Meds: Levothyroxine; Advil; Tylenol; NAPROSYN

Current Illness: N/A

ID: 0933940
Sex: F
Age: 49
State: NY

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Seasonal, Pollen, Seafood

Symptom List: Injection site pain

Symptoms: Swelling to B/L hands, itching and rash to right hand. Patient advised to use OTC antihistamine and follow up with PCP.

Other Meds: Amlodipine, Timolol opthal, HCTZ

Current Illness: None

ID: 0933941
Sex: M
Age: 50
State: NH

Vax Date: 12/28/2020
Onset Date: 01/01/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Seasonal allergies, no known drug allergies

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

Symptoms: One week following injection, 4 x 4 inch reddened rash area noted at injection site. Area was slightly raised and mildly itchy. Lasted about two days.

Other Meds: None

Current Illness: None

ID: 0933942
Sex: F
Age: 38
State: NJ

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/11/2021
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: within minutes entire body numbness and "hot", followed by full body erythema. Was transported to the ED for treatment.

Other Meds: keppra

Current Illness: none

ID: 0933943
Sex: F
Age: 64
State: MA

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 01/11/2021
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: approximately 12 hours after receiving, I felt like I was coming down with COVID again. Having just recovered last month, it felt like a recurrent nightmare. Shaking chills, slight temp, body aches, exhaustion. It lasted overnight and into the following day until approximately 3pm when I was able to get out of bed and drink water.

Other Meds: Blood pressure meds -Atenolol-Chlorthalidone 50mg, Rosuvastatin 20 mg.

Current Illness: On-set of COVID November 26, 2020. Sick for 2 weeks. December 11th feeling better.

ID: 0933944
Sex: M
Age:
State: AZ

Vax Date:
Onset Date:
Rec V Date: 01/11/2021
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: propylene glycol !!!!!!!

Symptom List: Erythema, Pruritus

Symptoms: None stated.

Other Meds: Omeprazol 40mg Eliquis 5mg

Current Illness:

ID: 0933945
Sex: F
Age: 32
State: IL

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 01/11/2021
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:

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

Symptoms: 1/11 "less than 24 hrs, work Sunday night, hands were red, right one swollen. Continued on and off at work when benadryl and chlortabs started wearing off. As night continued y face is a little swollen, headache, hypersensitive skin, sore tired"

Other Meds:

Current Illness:

ID: 0933946
Sex: F
Age: 11
State: NM

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/11/2021
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: No known allergies

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

Symptoms: Provider documentation of event provided below: Pt has an adverse reaction to a vaccine that she received at visit (likely HPV). She got up to go to the bathroom and felt dizzy. She because weak and unresponsive. She was taken to room by staff safely. Vitals taken. HR was low in the low 70;s initially. BPs normal. Patient was in and out of responsiveness. She never had any trouble breathing. Evaluated every 20 min. Before leaving was alert and oriented X3. Was eventually able to walk out of the clinic without dizziness. Tylenol was given for headache. ER precautions printed and sent home with father.

Other Meds: None.

Current Illness: Pt reported dysuria at time of vaccination

ID: 0933947
Sex: F
Age: 27
State: VA

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/11/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Experienced fatigue and headaches beginning approximately 24 hours after vaccine injection. The fatigue and headaches were most severe on the between 24-33 hours after injection then gradually subsided until adverse events were eliminated on Day 3, approximately 57 hours post injection. No treatment was taken to lessen side effects, simply rest.

Other Meds: Oral contraceptive (Vienva)

Current Illness: none

ID: 0933948
Sex: F
Age: 23
State: TN

Vax Date: 01/08/2021
Onset Date: 01/10/2021
Rec V Date: 01/11/2021
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: Dust mites, tree pollens, grass pollens, and other seasonal allergies

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

Symptoms: Initially had a very sore arm day of, then on the second night my entire body became itchy and I had welts similar to those from allergy shots around my body and the itchyness has lessened however I am still itchy.

Other Meds: Allegra, Lo Loestrin Fe, Immune Defense 7 in 1 immune support, and vita fusion women's gummy vitamins

Current Illness: nothing

ID: 0933949
Sex: F
Age: 59
State: MT

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/11/2021
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:

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

Symptoms: nausea in the head, fatigue, muscle soreness-resolved

Other Meds:

Current Illness:

ID: 0933950
Sex: F
Age: 42
State: DC

Vax Date: 01/05/2021
Onset Date: 01/07/2021
Rec V Date: 01/11/2021
Hospital: Y

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

Lab Data:

Allergies: mushrooms Humira Pen (site reaction) dextromethorphan erythromycin (nausea & vomitting) sulfaSALAzine (hives)

Symptom List: Pain in extremity

Symptoms: Received vaccine on 1/5, began having swelling in bilateral hands and lower extremities on 1/7, along with fatigue. On 1/8 she reports new swelling started in her face (eyes and cheeks). Swelling has not improved today and fatigue has worsened.

Other Meds: crestor nexium trazodone zanaflex synthroid

Current Illness:

ID: 0933951
Sex: F
Age: 31
State: NJ

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: Dairy sensitive, soy allergy

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

Symptoms: After 24 hours of receiving vaccine my lower back started to ache, I experienced body chills and my skin was sensitive to touch. This lasted for about 6 hours. I was also light headed and woozy for about 3 hours. The next morning all of these symptoms were gone.

Other Meds: Zyrtec once a day and multi vitamin

Current Illness: None

ID: 0933952
Sex: F
Age: 38
State: WI

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/11/2021
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, Allegra

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

Symptoms: Felt and appeared flushed, as well as feeling her throat closing up and being "unable to breathe" within 6 hours of receiving the immunization

Other Meds:

Current Illness:

ID: 0933953
Sex: F
Age: 36
State: MD

Vax Date: 12/31/2020
Onset Date: 01/03/2021
Rec V Date: 01/11/2021
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:

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

Symptoms: Starting 3 days after the vaccine (1/3/21) she had a severe headache. The next day she also had nausea and a mild cough. She was tested for COVID which was negative. She felt better by 1/5/21, but had muscle aches and fatigue on 1/7/21 and 1/9/21.

Other Meds:

Current Illness:

ID: 0933954
Sex: F
Age: 49
State: NE

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/11/2021
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: Morphine

Symptom List: Vomiting

Symptoms: 1/08/21 I was very fatigued, and a little bit of body aches. 01/09/21 I was very lethargic and had body aches, mostly in my joints

Other Meds: Blood Pressure Medication

Current Illness: None

ID: 0933955
Sex: F
Age: 32
State: MT

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/11/2021
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: Sulfa drugs

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I had a headache for about 48 hours after receiving the vaccine. Drinking water, taking ibuprofen and sleep id not help. I also had the typical sore arm.

Other Meds: prenatal vitamins, vitamin D, biotin, multivitamin

Current Illness:

ID: 0933956
Sex: F
Age: 84
State: CA

Vax Date: 12/26/2020
Onset Date: 12/28/2020
Rec V Date: 01/11/2021
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: penicillin, sulfa

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

Symptoms: rcvd shingles vaccine 2nd dose. a few days later I started having swelling and a red blotch on my red. A few days later I noticed red like sunburn on the inside of my sides. It lasted for about a week.

Other Meds: various medications

Current Illness: no

ID: 0933957
Sex: F
Age: 64
State: WI

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/11/2021
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: Ace Inhibitors, Lipitor, Sulfa, RITUXIMAB - anaphylaxis on fourth infusion dose. ( Used for ITP)

Symptom List: Injection site swelling, Limb discomfort

Symptoms: As per RN documentation, Pt with hx of anaphylaxis with the 4th infusion dose of Rotuxin a couple years ago. PCP discussed benefit to prevent complications of COVID vaccine outweighs risk to get COVID vaccine. Discussed this as well with patient. She agrees to get the vaccine. ? I stayed with the RN and patient for 30 minutes post vaccination and she had no symptoms other than BP and Pulse elevated further to 150s/90s. P upper 80s. She was transitioned to anther office with plan to continue observation for another 15 mins and recheck her BP. ? About 45-50 mins post vaccine, she reported her lower arms and right side of her neck felt swollen but had no SOB or mouth swelling or itching. She was talking in normal sentences. Her face became more flushed as well as the posterior aspect of her forearms and she said the neck felt more swollen. Epi Pen was administered at 8:40 am and EMS was contacted. Her BP was 160/100, pulse ox 96%, RR 26, Pulse 88. ? Transferred to ED.

Other Meds: AsA 81 mg, Vit D3, Diclofenac gel, fluoxetine 20mg, meloxicam 7.5 mg, Multivit, rosuvastatin 20mg, spironolactone 100m, verapamil SR 180 mg

Current Illness:

ID: 0933958
Sex: M
Age: 36
State:

Vax Date: 01/01/2021
Onset Date: 01/09/2021
Rec V Date: 01/11/2021
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: Extreme body ache, chills, headache, vomiting, chest pain, difficulty breathing, sore throat. Tylenol & ibuprofen eased body ache, chills, headache but did nothing for chest pain, difficulty breathing, sore throat. So far, symptoms continue approximately 72 hours after receiving vaccine.

Other Meds:

Current Illness:

ID: 0933959
Sex: F
Age: 37
State: IN

Vax Date: 01/09/2021
Onset Date: 01/10/2021
Rec V Date: 01/11/2021
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: PCN

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

Symptoms: 100.4 fever Significant body aches Significant Fatigue Headache Joint Pain

Other Meds: Wellbutrin XL Ambien

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm