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: 0934064
Sex: F
Age: 39
State: CO

Vax Date: 12/30/2020
Onset Date: 01/07/2021
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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Injection site red irritated

Other Meds:

Current Illness:

ID: 0934065
Sex: M
Age: 74
State: PA

Vax Date: 12/25/2020
Onset Date: 01/05/2021
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: shingles, severe, ongoing, taking antviral medication

Other Meds:

Current Illness: HTN, dyslipidemia, migraine headache, CAD, impaired glucose tolerance

ID: 0934066
Sex: F
Age: 36
State: UT

Vax Date: 12/23/2020
Onset Date: 12/30/2020
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: no known allergies

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

Symptoms: Patient began to experience neck pain, myalgias, headache on 12/30. Fever on 1/1.

Other Meds: allegra 60mg daily prn, ibuprofen 800mg q6h as needed

Current Illness: unknown

ID: 0934067
Sex: M
Age: 33
State:

Vax Date: 12/29/2020
Onset Date: 01/11/2021
Rec V Date: 01/11/2021
Hospital:

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

Lab Data:

Allergies: N/a

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 2 week post injection. Injection site erythema, itching,warmth. Non spreading. Within 1inch radius of injection site. Not present immediately following injection. No other symptoms at this time. Will continue to self monitor.

Other Meds: N/a

Current Illness: N/a

ID: 0934068
Sex: F
Age: 44
State: CA

Vax Date: 01/02/2021
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:

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

Symptoms: Sore arm quarter sized red bump on arm that was warm to touch, itchy and red. it has now turned into about 3x4 in a oval shape

Other Meds:

Current Illness:

ID: 0934069
Sex: F
Age: 32
State: TN

Vax Date: 01/02/2021
Onset Date: 01/11/2021
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: My arm has a large swollen lump under the skin. It is red and hot to the touch.

Other Meds:

Current Illness:

ID: 0934070
Sex: F
Age: 45
State: MI

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

Lab Data:

Allergies: Penicillin Wellbutrin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: vasovagal episode drop in pulse ox drop in heart rate

Other Meds: Tizanidine - 4mg - 1/day Symbicort - 2 puffs/day Albuterol 90mcg - 2 puffs/as needed Buspirone 15 mg - 2/day Montelukast 10mg/day Lamictal 150mg/day Trazodone 100mg - 2 pills/night Visteril 25mg - 2-3/day Metoprolol 25mg/day Omeprazole 20mg

Current Illness: Obese

ID: 0934071
Sex: F
Age: 27
State: OR

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

Lab Data:

Allergies: Clindamycin

Symptom List: Pharyngeal swelling

Symptoms: Tachycardia and palpitations within 5 minutes of administration. Lasted for about 5 minutes then resolved. Approximately 20 mins after administration of vaccine minor swelling of the throat and limited rash on the throat present. 50 mg oral Benadryl taken an hour after vaccination.

Other Meds: Escitalopram Levothyroxine Isibloom

Current Illness:

ID: 0934072
Sex: F
Age: 48
State: GA

Vax Date: 01/02/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The injection site has a Large bruise with redness, itching, burning and swelling with a lump. I notice this about a week after the vaccine date(01/02/2021). Notice of reaction(01/08/2021)

Other Meds: N/A

Current Illness: Swelling, itching, and burning at the injection site. The injection site has a large bruise with redness.

ID: 0934074
Sex: F
Age: 56
State: MA

Vax Date: 01/06/2021
Onset Date: 01/07/2021
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: no

Symptom List: Diarrhoea, Nasal congestion

Symptoms: eye muscle twitching for 1 day right side head scalp & around right ear pain ( occipital neuralgia) for 4days on going continuously till today 01/11/2021

Other Meds: vitamin D

Current Illness: no

ID: 0934075
Sex: F
Age: 30
State: TX

Vax Date: 01/02/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: 7 days after (01/09/21) getting injection, the injection site became itchy, swollen, and warm to the touch. Before it had a small dime sized red spot at injection site with no reaction or issue. then on the 7th (01/09) day the side was about the size of a 50 cent piece, then on the 8th (01/10) day it had doubled in size and was extremely warm, itchy, and swollen. I did an appointment via virtual health and the doctor diagnosed it as Cellulitis. I was put on a week worth of cephalexin 500mg 4x a day. after 3 doses the swelling and itching went down drastically.

Other Meds: multi vitamin

Current Illness: none

ID: 0934076
Sex: M
Age: 33
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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: NKDA

Symptom List: Rash, Urticaria

Symptoms: Nausea, Diarrhea, Headache, High fever (104), Body aches, Cold chills. Took 1000mg of Tylenol when fever started, 4mg of Zofran when nausea started, both medications helped. All symptoms stopped the following day.

Other Meds: Zyrtec 10mg PO Daily Singular PO Daily Valacyclovir 1000mg PO Daily OTC: Biotin PO Daily

Current Illness: Hx of Covid 19: Oct 2020

ID: 0934077
Sex: F
Age: 65
State: FL

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

Lab Data:

Allergies: Penicillin, erythromycin.

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

Symptoms: I sat for 30 mins after the vaccine at the doctors office. When I got home I started feeling my heart beating and started feeling like my body was raising. After 10 mins I checked my BP 140/90 which is high for me. I took a BP pill. It took a couple of hours for it to come down to normal. Went to sleep and woke up BP normal and a slight headache. My arm was sore lasting about 3 days.

Other Meds:

Current Illness: no

ID: 0934078
Sex: M
Age: 26
State: GA

Vax Date: 01/05/2021
Onset Date: 01/09/2021
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: N/A

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

Symptoms: Overall feeling unwell, self-treated with ibuprofen for muscle aches and Benadryl for sleep aid due to insomnia from feeling sick

Other Meds: Fluoxetine, vyvanse, levocetirizine, albuterol, symbicort

Current Illness: N/A

ID: 0934079
Sex: F
Age: 59
State: CA

Vax Date: 12/29/2020
Onset Date: 12/29/2020
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: PNC, macrodantin, ceftin, Levaquin, valium, busbar

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

Symptoms: 25 min after injection and said she had itching all over her body started at the injection site then spread throughout her body. She was sent to an NP for evaluation. They advised her to take a BENADRYL and see if that resolved. She came back at 1700 to let us know she was somewhat better but would go home and take an additional BENADRYL. Recommended she contact her primary if symptoms persist or go to UC.

Other Meds: Losartan

Current Illness: no

ID: 0934080
Sex: F
Age: 45
State: AZ

Vax Date: 01/11/2021
Onset Date: 01/01/2021
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: N/A

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

Symptoms: N/A

Other Meds: N/A

Current Illness: N/A

ID: 0934081
Sex: F
Age: 4
State: TX

Vax Date: 01/17/2020
Onset Date: 01/19/2020
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: None

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

Symptoms: Large red, warm area on both thighs where vaccines were administered, lasted around 5-7 days ,no fever, no treatment

Other Meds: None

Current Illness: None

ID: 0934082
Sex: F
Age: 41
State: MN

Vax Date: 01/05/2021
Onset Date: 01/05/2021
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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Facial twitching that began about 1-2 hours after injection. The facial twitching lasted about 24 hours.

Other Meds: Multivitamin Vitamin D

Current Illness: none

ID: 0934083
Sex: F
Age: 55
State: AR

Vax Date: 01/08/2021
Onset Date: 01/08/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After giving the vaccine, we realized she had received plasma antibodies 60 days prior.

Other Meds:

Current Illness:

ID: 0934084
Sex: F
Age: 26
State:

Vax Date: 12/31/2020
Onset Date: 01/07/2021
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:

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

Symptoms: injection site red irritated

Other Meds:

Current Illness:

ID: 0934085
Sex: F
Age: 54
State: PR

Vax Date: 01/04/2021
Onset Date: 01/07/2021
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: Oxycodone

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

Symptoms: Apart from normal reactions like pain in injection site, headache, myalgias, on about fourth day, patient starts seeing a cloud-like blurry vision, intermittently, during the day.

Other Meds:

Current Illness:

ID: 0934086
Sex: F
Age: 69
State: TX

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

Lab Data:

Allergies: Penicillin

Symptom List: Unevaluable event

Symptoms: Headache, off kilter, could not seem to wake up. Lasted all day about 24 hours after vaccine. Took Motrin and slept almost 24 hours. Body aches

Other Meds: Simvastin; Amalodapine; low dose aspirin; Flonase; Levothyroxine; olmestartin; melatonin; probiatic

Current Illness: COPD; Graves disease

ID: 0934087
Sex: F
Age: 71
State: IN

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

Lab Data:

Allergies:

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

Symptoms: Moderna covid 19 vaccine: Shot give on Friday, Saturday night during sleeping heart beats up over 115 per min. The beats continued to be over 90 per min thru Sunday night. Monday morning felt tired, but heart rate back to normal66-67 beats per min. Rapid beats were experienced for at least 24 hours. I am not complaining. Doing this only to help !!!!!!

Other Meds:

Current Illness:

ID: 0934088
Sex: U
Age: 35
State:

Vax Date: 01/06/2021
Onset Date: 01/07/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Patient reported fever max 99.8, HA, and muscle pain after receiving her second dose of Covid 19 vaccine. She received the BioNTech Pzfizer Vaccine

Other Meds:

Current Illness:

ID: 0934089
Sex: F
Age: 38
State: WI

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Right Arm Injection Site extremely sore to touch. Woke up in the morning puking. Broken blood vessels in the face, looked like a rash but dissapated over the course of 3 days. Chills, extreme muscle and joint pain. Very nauseous throughout the day and most of the night. Most of the symptoms went away after the first day, but the muscle and joint pain stayed through Sunday and into Monday morning.

Other Meds:

Current Illness:

ID: 0934090
Sex: F
Age: 42
State: IL

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

Lab Data:

Allergies: NONE

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

Symptoms: RED RAISED LUMP AT INJECTION SITE, HOT AND ITCHY ARM. HEADACHE. CHILLS.

Other Meds: FLUOXETINE, TOPIRAMATE, SPIRONOLACTONE

Current Illness: NONE

ID: 0934091
Sex: M
Age: 17
State: IN

Vax Date: 01/09/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient was vaccinated but was out of out of recommended age range. Pharmacist did not recognize error until after injection was complete. Patient did not have any post-injection reaction.

Other Meds: n/a

Current Illness: none

ID: 0934092
Sex: F
Age: 31
State: MO

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: "Fever of 99.8 with chills"

Other Meds:

Current Illness:

ID: 0934093
Sex: M
Age: 49
State: NJ

Vax Date: 12/28/2020
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: Sulfur

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

Symptoms: Chills, temp 99.9, body aches, soreness at the site.. After 3 days it went away. Left arm is still weaker than right arm. Generally tired. Flu like symptoms.

Other Meds: Metoperol

Current Illness: no

ID: 0934094
Sex: F
Age: 37
State: OK

Vax Date: 01/05/2021
Onset Date: 01/05/2021
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: RA

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: Approximately 15 minutes after receiving the vaccine, client started c/o itching to face and lips. Transported to triage area. Where she started c/o burning lips also. vital signs monitored, Benadryl 50mg po given. In a few minutes she reported chest tightness, labored breathing. 1:44pm Epinephrine was given IM. client was on 02 increased to 15 Liters. She admits to decreased chest tightness and itching of face improving. She was taken by ambulance to hospital, where she was admitted overnight for observation. She was given Benadryl and epi X2 more time, once in ambulance and once at the hospital. She denies any problems since then. She did say that approx 3 weeks ago she was a contact to a case of covi

Other Meds: humalog,lantus,omepriazole,topamax,prozac,

Current Illness: migraines, asthma

ID: 0934095
Sex: F
Age: 51
State: NJ

Vax Date: 12/29/2020
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: LA

Lab Data:

Allergies: Erythromycin Walnuts

Symptom List: Injection site pain

Symptoms: Received first dose of vaccine on 12/29/20. Had no reactions and checked in through Vsafe system. On 12/31/20, I lost control of my bladder at work. I did not have the urgency to go, and when I started walking, my bladder emptied. I reported this symptom through Vsafe on that day. This symptom did not happen again. On 1/10/21, I was changing my clothes and my left arm felt itchy. When I itched my arm, I felt little, raised welts. I looked at my arm, and a significant red, irregular shaped spot was on my arm. I could not report this to Vsafe as my check ins had stopped as of 1/6/21. I called my PCP, who directed me to this site to report it.

Other Meds: Doxycycline 75 mg (1 tab a day) Serenol (2 tabs a day) Viracid (2 caps a day) Probiotic (1 cap a day) Vitamin D Spray under the tongue Vitamin B (1 tab daily) Flonase (two squirts each nostril, daily)

Current Illness: None

ID: 0934096
Sex: F
Age: 69
State: CA

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: Naprocin/Naproxen Aspiring (adverse reaction, not allery)

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

Symptoms: Severe swelling of hand joints- especially the right hand. could not bend fingers. Heavy swelling of neck nodules, ears pain - heavy sweating-chills- heavy body ache- fever- heavy migraine type headache Pain of left arm -vaccine site- could not move/left arm for the last three days. Today is the fourth day, Monday, Jan. 11, and still having same symptoms unable to work.

Other Meds: Tumeric gel

Current Illness: N/A

ID: 0934097
Sex: M
Age: 63
State: NY

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: fever of 101.5 body aches headache fatigue

Other Meds: omeprazole fluoxetine hcl valsartan-hctz 320 quetiapine rosuvastatin trazadone bupropion

Current Illness:

ID: 0934098
Sex: F
Age: 33
State:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Fever, chills

Other Meds:

Current Illness:

ID: 0934099
Sex: F
Age: 41
State: IL

Vax Date: 12/28/2020
Onset Date: 12/28/2020
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: IM
Vax Site: LA

Lab Data:

Allergies: ? shellfish (positive skin test but eats shellfish with "no problem")

Symptom List: Erythema, Pruritus

Symptoms: Patient is a 41 y.o. female who presented to the ED with complaints of a reaction after she took the COVID vaccine. Patient is an RN here and had earlier received COVID-19 vaccination (Moderna) around 0130 this afternoon. Soon after she experienced rash which was burning and itchy on her arms thighs and back. She reported to Occ health and was directed to the ED. While in the ED she experienced throat tightness and nausea. She had one episode of diarrhea. No tongue, lip swelling, SOB or difficulty swallowing. Denies any chest pain, palpitations, pre-syncope/syncope. No vomiting abdominal pain. H/o of allergy to fish mix and dust mite.

Other Meds: topomax, melatonin, mirena ring, B12 injection, zyrtec, biotin

Current Illness: none

ID: 0934100
Sex: F
Age: 39
State: TN

Vax Date: 01/06/2021
Onset Date: 01/07/2021
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: n/a

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

Symptoms: fatigue, chills, sweating, nausea, 99.1 fever then progressed to a 103 fever, severe pain in legs, took Tylenol and brought fever down to 101.7. Next day, woke up to sunburn rash on face, trunk to groin and legs, fatigue lasting all day. Next day 1/9, rash was still there, fever reached 100 lasting all day and fatigue.

Other Meds: Omeprazole, Vitamin C, Multivitamin, Claritin

Current Illness: n/a

ID: 0934101
Sex: F
Age: 50
State: GA

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

Lab Data:

Allergies: none

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA Fever 99-100.6 for 72 hours after shot. Body aches for 48 hours. Mild headache for 36 hours

Other Meds: Hydroxychloroquin 400 mg qd Tizanidine 4 mg q hs Meloxican 25 mg q day

Current Illness: None

ID: 0934102
Sex: F
Age: 60
State: OH

Vax Date: 01/06/2021
Onset Date: 01/06/2021
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 drugs

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pain at injection site - 72 hours Chills - 2 hours Fever - (assumed-I did not check it) about 8 hours Headache - 18 hours Body aches - 24 hours Low energy - 36 hours

Other Meds: Metformin, 1500/day Basaglar, 30 units/day Ozempic, 1 unit/week

Current Illness: None

ID: 0934103
Sex: F
Age: 59
State: IN

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

Lab Data:

Allergies: NkA

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

Symptoms: In afternoon had chills headache fatigue injection sit deltoid sore down to elbow

Other Meds: Calcium , vitamin d , zinc ,daily vitamin

Current Illness: NAnA

ID: 0934104
Sex: F
Age: 72
State: CA

Vax Date: 01/06/2021
Onset Date: 01/07/2021
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: Sore arm chills nausea diarrhea dizzy sweats tired headache

Other Meds:

Current Illness:

ID: 0934105
Sex: F
Age: 49
State: NJ

Vax Date: 01/04/2021
Onset Date: 01/04/2021
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: pcn

Symptom List: Pain in extremity

Symptoms: itchy inner ears, face and arms- started within the hour and lasted 6-24 hours hot flashes- no temp 1/4-1/6 off and on fatigued, headache Diarrhea 1/7-1/8

Other Meds: Synthroid, duexes

Current Illness: none

ID: 0934106
Sex: F
Age: 36
State: OH

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulfa

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

Symptoms: Diarrhea, nausea, queasy stomach, sour stomach, headache, fatigue

Other Meds: None

Current Illness: None

ID: 0934107
Sex: F
Age: 37
State:

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

Lab Data:

Allergies:

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

Symptoms: Brain fog, fever, aches lymph pain

Other Meds:

Current Illness:

ID: 0934108
Sex: F
Age: 84
State: OK

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

Lab Data:

Allergies: codiene, terremycin, iodine, phenegren, neiosporin, latex, morphine, demerol

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

Symptoms: At 4:27 pm client stated she was developing a rash on face. BP 220/110, P 80, R16. Epinephrine .5ml given IM at 4:31pm. Reported tongue felt thick and difficulty breathing, BP 210/100, P 64, R 18. Benadryl 50mg given at 4:34pm, rash on face less, BP 178/88, P 60, R 18. Transferred by private vehicle to Hospital at 4:45pm.

Other Meds: unknown

Current Illness:

ID: 0934109
Sex: F
Age: 54
State: MD

Vax Date: 12/30/2020
Onset Date: 12/30/2020
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: Sulfa Drugs, Dilaudid, and nickel metal

Symptom List: Vomiting

Symptoms: A knot formed where the injection was given, which swelled and became red. Monitored the area from 12/30/20 to 1/05/21 and it appeared to be slowly going away. However, in the early morning hours of 1/06/21, I woke up to the injection area intensely itching along with increased swelling , and redness. Thurs 1/07/21 I found myself developing hives and itching all over. I now have areas of hives all over my body except for my face.

Other Meds: Bystolic 5mg, multivitamin, Red Krill Joint Care, blueberry supplement, and cherry supplement

Current Illness: None at the time of vaccination. Mild congestion 12/05/20 & 12/06/20

ID: 0934110
Sex: F
Age: 43
State: TN

Vax Date: 12/30/2020
Onset Date: 01/07/2021
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: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Eight days after the injection (1/7/21), I developed an inflamed rash on my left arm. It was hot to the touch and itched . It was round and approximately 2 inches in diameter. I called my doctor on 1/8/21, and she had me come in and be seen. She diagnosed as cellulitis from a secondary infection at the injection site and prescribed sulfamethoxazole/Trimethoprim 800/160mg every 13 hours for 7 days. The rash started to go away, but on 1/10/21, it began to itch again and became inflamed. On the morning of 1/11/21, it had grown and changed shape. It is now oval and over 3 inches in diameter. It also has a pronounced border. On, that day, I also found out that 2 co-workers had a similar reaction. I spoke with my doctor, who told me to report it to the CDC.

Other Meds: Vitamin D3, zinc, Zyrtec

Current Illness:

ID: 0934111
Sex: F
Age: 77
State: CO

Vax Date: 01/08/2021
Onset Date: 01/10/2021
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: Keflex, Cranberries, zinc, sulfa drugs

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

Symptoms: Body rash

Other Meds: Losartin, Digoxin, Omeprazole, Flecainide, Anastrozole,meloxicam

Current Illness: N/A

ID: 0934112
Sex: F
Age: 53
State: NE

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: percocet , morphine , sulfa, penicellin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: lymphadenopathy under right arm. still on going today

Other Meds: aspirin 81 / bystoloic / levothyroxine 50 mg / lisinopril 20-12.5 / nexium 20 mg / zoloft 50 mg /

Current Illness: no

ID: 0934113
Sex: F
Age: 49
State:

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

Lab Data:

Allergies:

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

Symptoms: chills, aches, lymph pain

Other Meds:

Current Illness:

ID: 0934114
Sex: U
Age: 56
State: OK

Vax Date: 01/06/2021
Onset Date: 01/07/2021
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:

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

Symptoms: Patient reported fever max of 99.8, fatigue, and muscle pain after receiving her second Covid 19 vaccine. She received the BioNTech Pfizer vaccine.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm