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: 0918456
Sex: F
Age: 30
State: OK

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

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

Lab Data:

Allergies: Did not disclose any allergies. Denied previous anapylactic reactions.

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient began to experience symptoms shortly after vaccination. Pt became flushed and developed red splotches over chest and neck. C/o difficulty swallowing and some GI upset. Began to shake uncontrollably. Initial BP was 149/99 and HR 118. O2 sats at 99%. Administered 25mg of benadryl and monitored patient for approximately 1 hour. After about 30-45 minute, her vitals stabilized at 120/80, Pulse 90, O2 at 100% on room air. D/C'd home at 1:32pm. 24 hours later patient c/o of hives and flushing off and on. Also complained of some GI upset and fatigue. Pt was able to return to work on 1/3/2021.

Other Meds: Unknown

Current Illness: Did not disclose other illnesses

ID: 0918457
Sex: U
Age: 25
State: RI

Vax Date: 12/18/2020
Onset Date: 12/20/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: Neck developed a rash

Other Meds: N/A

Current Illness: N/A

ID: 0918458
Sex: F
Age: 50
State: OH

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: 2am onset (12/30/20) fever to 103, chills, aches. Severe Headache. All symptoms lasted until 8am on 12/31/20 when all symptoms went away except for fatigue that lasted for the next 24 hours.

Other Meds: Losartan 25 mg daily

Current Illness: none

ID: 0918459
Sex: F
Age: 95
State: IA

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

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: REPORTED DIZZINESS AND WEAKNESS IN LEGS AFTER RECEIVING VACCINE. HAD A PREVIOUS REACTION TO FLU VACCINE. WAS MONITORED FOR 30 MINUTES.

Other Meds:

Current Illness:

ID: 0918460
Sex: F
Age: 31
State: TN

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

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

Lab Data:

Allergies: None

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

Symptoms: My lips have been numb since receiving the vaccine.

Other Meds: None

Current Illness: None

ID: 0918461
Sex: F
Age: 47
State: VA

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

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

Lab Data:

Allergies: Sulfa medication

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

Symptoms: 12-29-20 the night of the shot I had cold chills,alittle headache,just alittle facial tingling, joint pain,hot flashes and very tired and sore arm. Day 2 started with sore arm and with back radiating in different part of my back and hot flashes, very tired Day 3 starting with more back pain and some mood swings and very tired. Day 4 to present back pain a lot more and joint pain.

Other Meds: none

Current Illness: none

ID: 0918462
Sex: M
Age: 35
State:

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

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

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Chills, myalgias and low gray temperature 99.7.

Other Meds: None

Current Illness: None

ID: 0918463
Sex: M
Age: 25
State: TX

Vax Date: 12/26/2020
Onset Date: 01/02/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Pharyngeal swelling

Symptoms: 01/02/21 itching all over body -hives developed except for neck and face; Benadryl dose, resolves then returns 6 hrs later. Hives have not resolved, hives developed on neck and face 01/03/21 in PM. Benadryl treatment continues

Other Meds: Cingular, ADVAIR DISKUS

Current Illness: N/A

ID: 0918464
Sex: F
Age: 43
State: MA

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

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

Lab Data:

Allergies: Sulfa and shellfish

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: No treatment at this time

Other Meds: Xyzal and daily multi-vitamin

Current Illness: headache on 1/3/2021 at 8am

ID: 0918465
Sex: F
Age: 38
State: WA

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

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

Lab Data:

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: On day 8 after the vaccine, developed increased soreness, redness and itch over L deltoid (~ 3" by 2" oval at vaccine site) and also from anterior L shoulder (~ 1" thick streak) stretching about 4 inches toward chest, just under clavicle. Also have headache and some fatigue/malaise, though unclear if this is related to vaccine or several nights of poor sleep with a teething baby.

Other Meds: Prenatal Vitamins

Current Illness: None

ID: 0918466
Sex: F
Age: 64
State: NE

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

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

Lab Data:

Allergies:

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

Symptoms: LATE EVENING OF 12/30/20 DEVELOPED FEVER, CHILLS, VOMITING, BODY ACHES, AND FATIGUE. LASTED 3 DAYS. IS NOW RESOLVED.

Other Meds:

Current Illness:

ID: 0918467
Sex: F
Age: 58
State: MI

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

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

Lab Data:

Allergies: Codeine, Aspirin, Procada, and she'll fish

Symptom List: Rash, Urticaria

Symptoms: Stuffed up head and sneezing. Started on 1-3-2021. I get this every year.

Other Meds: Multivitamin, metformin,creator, trulicity, Tylenol,, Nasacort, lisinopril, hydroChlorothiazide, vitamin d3, Allegra

Current Illness: None

ID: 0918468
Sex: F
Age: 29
State: OH

Vax Date: 12/28/2020
Onset Date: 01/02/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Bulky painful axillary lymphadenopathy each 1-2 cm on the same side as the injection, erythema and warmth around the injection

Other Meds: None

Current Illness: None

ID: 0918469
Sex: F
Age: 31
State: OH

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

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

Lab Data:

Allergies: NO KNOWN ALLERGIES

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

Symptoms: PT REPORTED HYPOTENSION/BRADYCARDIC EPISODE, BODY ACHES, CHILLS, FEVER, MALAISE FOR 2.5 DAYS. PT WENT TO HOSPITAL FOLLOWING REACTION. SHE WAS NOT HOSPITALIZED, SEVERE SYMPTOMS RESOLVED WITH REST AND HYDRATION. CONSULTED WITH PCP AND MONITORED FREQUENTLY.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 0918470
Sex: F
Age: 59
State: VA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 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: TONGUE ITCHING AT 0940; RECEIVED VACCINE AT 0721. REFERRED HER TO HER PCP.

Other Meds:

Current Illness:

ID: 0918471
Sex: F
Age: 36
State: NY

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

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

Lab Data:

Allergies: N/A

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

Symptoms: 12/22/2021 VACCINE @ 0630 12/22/2021 12:00 RED, SWOLLEN ARM. ROUND, 4 CM CIRCUMFERENTIAL. FIRM EDEMA. PERSISTED THROUGHOUT WEEK. LOOKED LIKE 'SECOND DELTOID' 1/4/2021 STILL MILD REDNESS, ITCHINESS. VERY MILD SWELLING. CONFERRED WITH DR. VIA EMAIL. 'KEEP EYE ON IT'. IMPROVING BUT STILL VISIBLE.

Other Meds: CELEBREX, PLAQUENIL

Current Illness: N/A

ID: 0918472
Sex: M
Age: 66
State: WV

Vax Date: 12/23/2020
Onset Date: 12/28/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: indocin

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

Symptoms: generalized weakness

Other Meds: levothyroxine, cyancobalamin, cyclobenzaprine, albuterol, propropranolol, gabapentin, budesonide inhaler, melatonin, folic acid, cyancobalamin, metaformin, zaleplon, allpurinol, lisinopril, cholecalcif, thiamine, piglotazone, omeprazole, gl

Current Illness: htn, hep c, nicotine dependence, dm, vid d def, obesity, heari

ID: 0918473
Sex: F
Age: 40
State: KY

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

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: sore arm for 48 hours, headache for 48 hours and burning/hot eyes for48 hours

Other Meds: wellbutrin, lexapro

Current Illness: none

ID: 0918474
Sex: F
Age: 38
State: TX

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

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

Lab Data:

Allergies: Sulfa

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Day of vaccine: Nausea that lasted about 6 hours. 8 days after vaccine: Site where vaccine was administered light red,itchy, warm to touch, and area was hard. Topical Benadryl cream applied to site: no longer itched. 9 days after vaccine: Site was now bright red and warm and itchy Topical Benadryl applied to site and Oral benadryl dose taken as well. 10 days after vaccine: Site light pink no longer warm or itchy

Other Meds: Levothyroxine 112 mcg

Current Illness: N/A

ID: 0918475
Sex: F
Age: 31
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: fatigue low grade fever body aches

Other Meds:

Current Illness:

ID: 0918476
Sex: F
Age: 43
State: AZ

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Chills, rigors, body aches, headache, low body temp - started 24 hours after vaccine administration and lasted about 8 hours.

Other Meds: None

Current Illness: None

ID: 0918477
Sex: F
Age: 37
State: KS

Vax Date: 12/23/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: 12/31/20 & 01/01/21- Right side axillary lymph node swelling and tenderness 01/01/20 - Right side cervical lymph node swelling 01/01/20 - injection site swelling, warmth, and redness 01/02/20 - extreme fatigue 01/03/20 - fatigue 01/04/20 - fatigue

Other Meds: N/A

Current Illness: N/A

ID: 0918478
Sex: F
Age: 59
State: NY

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

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

Lab Data:

Allergies: penicillin, latex, vancomycin

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

Symptoms: This is not an adverse event report. This is a report of administration at an alternative site per the subject's request. Per the subject's request, this vaccine was administered IM to the right gluteus muscle. No adverse event was reported.

Other Meds: Not recorded during this visit.

Current Illness: Not recorded during this visit.

ID: 0918479
Sex: F
Age: 37
State: NH

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

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

Lab Data:

Allergies: Patient Denies

Symptom List: Injection site pain, Pain

Symptoms: The patient is a 37-year-old female presenting to the emergency department with an allergic reaction after receiving a Covid vaccine. Began having palpitations and flushing 5 minutes after the injection. Reported a heaviness in her throat. This has not improved but not worsening. Reports some difficulty swallowing. Denies any difficulty breathing. Denies rash. Has never had similar symptoms previously. Denies fever chills nausea vomiting lightheadedness or dizziness. Symptoms have been constant since onset. Has not taken anything to alleviate her symptoms.? Review of Systems Constitutional: Negative for activity change, chills and fever. HENT: Negative for congestion and rhinorrhea. Throat swelling trouble swallowing Eyes: Negative for pain and visual disturbance. Respiratory: Negative for chest tightness and shortness of breath. Cardiovascular: Positive for palpitations. Negative for chest pain. Gastrointestinal: Negative for abdominal pain, nausea and vomiting. Endocrine: Negative for polydipsia and polyuria. Genitourinary: Negative for dysuria and flank pain. Musculoskeletal: Negative for back pain and myalgias. Skin: Negative for rash and wound. Neurological: Negative for weakness and headaches. Psychiatric/Behavioral: Negative for confusion and suicidal ideas. All other systems reviewed and are negative. BP 114/69 | Pulse (!) 106 | Temp 36.9 ?C (98.5 ?F) (Oral) | Resp 21 | Ht 162.6 cm (5' 4") | Wt 84 kg (185 lb 3 oz) | SpO2 98% | BMI 31.79 kg/m? Physical Exam Vitals signs and nursing note reviewed. Constitutional: General: She is not in acute distress. Appearance: She is well-developed. HENT: Mouth/Throat: Comments: Uvula slightly edematous, tongue does not appear swollen, lips are not swollen, no stridor, breathing comfortably and speaking in full sentences Eyes: Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Neck: Musculoskeletal: Normal range of motion and neck supple. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. No stridor. Abdominal: Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. There is no guarding or rebound. Skin: General: Skin is warm and dry. Capillary Refill: Capillary refill takes less than 2 seconds. Findings: No rash. Comments: No obvious rash Neurological: Mental Status: She is alert and oriented to person, place, and time. Cranial Nerves: No cranial nerve deficit.

Other Meds: No Listed

Current Illness: No

ID: 0918480
Sex: F
Age: 59
State: NC

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Not allergic, but I don't take codeine because it makes me nauseous.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Woke up achy all over with fever and chills. BP was high, so took meds, but didn't help even after taking again later. Contacted physician and advised to come in. Different BP med given that helped. Woke up tired the next morning.

Other Meds: Lisinopril Propanol HCTZ Trintelix Multi-vitamins

Current Illness:

ID: 0918481
Sex: F
Age: 51
State:

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

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

Lab Data:

Allergies: None

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

Symptoms: Patient felt lightheaded for approximately 15 minutes

Other Meds:

Current Illness:

ID: 0918482
Sex: F
Age: 55
State: TN

Vax Date: 01/02/2021
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fever of 103.5 that would not go down with acetaminophen for over 6 hours.

Other Meds: None

Current Illness: None

ID: 0918483
Sex: F
Age: 51
State: TX

Vax Date: 12/18/2020
Onset Date: 01/02/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Ear pain pulling sensation, down my neck numbness jaw locking on same side of injection

Other Meds: None

Current Illness: None

ID: 0918484
Sex: F
Age: 33
State: OH

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

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

Lab Data:

Allergies: Penicillin

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

Symptoms: About 12 hours after the vaccine I started to have body aches and chills. I took Ibruprofen that evening and when I woke up the next morning I had a low grade fever of 99.5, I took Ibruprofen that morning and began sweating. I was sweaty/clammy all day, had a headache and tired. Around 4pm I took a 1.5 hour nap and felt better after that. The next morning I believe I had another low grade fever because I was really cold when I went to sleep, but woke up sweating. After that I have not had any symptoms.

Other Meds: Ibruprofen

Current Illness:

ID: 0918485
Sex: F
Age: 64
State: NE

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

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

Lab Data:

Allergies: NONE

Symptom List: Nausea

Symptoms: Chills starting date of vaccine administration. Fever (100.2) for 24 hours. Red, swollen, itchy arm at injection site for 5 days. Body aches for 72 hours. Headache for 36 hours.

Other Meds:

Current Illness: Covid positive 10/28/2020

ID: 0918486
Sex: F
Age: 57
State: NE

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

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

Lab Data:

Allergies: nuts

Symptom List: Injection site pain

Symptoms: I administered the vaccine and because the patient has a history of anaphylaxis to nuts, we instructed her to stay in the observation area for 30 minutes, instead of the standard 15 minutes. Patient agreed and was monitored by medical staff in the observation area. She began to feel an adverse reaction (which will be described in further detail by Healthcare staff filling our their VAERS report), and was given supportive measures. She did not have to be transferred out of the observation area, and felt completely recovered after intervention were provided. Please see the additional VAERS report filed on this patient.

Other Meds:

Current Illness:

Date Died: 01/04/2021

ID: 0918487
Sex: M
Age: 93
State: MI

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

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

Lab Data:

Allergies: Beta Adrenergic Blockers

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

Symptoms: Two days post vaccine patient went into cardiac arrest and passed away.

Other Meds: Loratadine, Plavix, flomax, Lisinopril, atrovastatin, amlodipine, Pentoxifylline, ASA, Donepezil, trazodone, Metoprolol tartrate.

Current Illness: NSTEMI, Dementia, TIA, COVID-19, HTN, CVA, PVD

ID: 0918488
Sex: F
Age: 18
State: PA

Vax Date: 12/21/2020
Onset Date: 12/25/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Amoxicillin, Sulfa Drugs

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

Symptoms: Covid 19, Fever, Chills, Body Aches, Headache, Left arm numbness, chest tightness

Other Meds: Birth Control

Current Illness: NA

ID: 0918489
Sex: F
Age: 66
State: WA

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

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

Lab Data:

Allergies: Penicillin, Bacterium

Symptom List: Tremor

Symptoms: 12/31/20 nausea, resolved later in the day, back feeling itchy, hives began to appear01/01/20 back itchy, nausea, vomit several times; 01/02/20 back itchy, nausea, vomit several times, hives covering back; 01/03/20 back itchy, nausea, vomit several times in late after/ early evening. 01/04/2020 hives; all other symptoms resolved

Other Meds: Metformin 500mg

Current Illness: Sinus infection-viral

ID: 0918490
Sex: F
Age: 56
State: RI

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient stated to this nurse @ 1100. Stated she had pain @ injection site to L arm. States that, "the needle went in to deep and touched her bone".

Other Meds:

Current Illness:

ID: 0918491
Sex: M
Age: 40
State: ME

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

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

Lab Data:

Allergies: Betadine (Povidone Iodine) Coconut Flavor Gabapentin Percocet (Oxycodone-Acetaminophen) Sulfa Antibiotics Rash

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

Symptoms: This is a 40 y.o. female who presents with abrupt onset of nausea vomiting, diarrhea, myalgias, headache about 2 hours after receiving her 1st Moderna COVID-19 vaccine at 1300 hrs.. She describes myalgias extending from the area of her left deltoid injection site over her shoulders and over her entire upper body. No neck or back pain. She describes diffuse throbbing headache with no positional component. She has had relentless nausea vomiting and retching. She has been up vomiting stomach contents to bile multiple times. She has had loose watery brown diarrhea multiple times. She describes diffuse abdominal crampy pain with increased tearing retching and vomiting. She denies any shortness of breath cough or wheezing. Voice is normal. No swallowing dysfunction or pain. No intraoral or facial swelling. She denies rash or pruritus. No arthralgias. Patient reports prior anaphylaxis with shortness of breath and tight airways, difficulty speaking and swallowing, and relationship to coconut ingestion few years prior. No other known food/nut reactions. Patient is a CNA for care at home. Last Covid test was 2 weeks ago which was negative. She reports she has been tested every 2 weeks routinely. Review of Systems Cardiovascular: Negative for chest pain and palpitations. Gastrointestinal: Positive for abdominal pain, diarrhea and nausea. Negative for vomiting. Musculoskeletal: Positive for myalgias. Negative for arthralgias, back pain and neck pain. Neurological: Positive for headaches. Negative for dizziness, weakness and numbness. Physical Exam BP 126/73 | Pulse 120 | Temp 37.1 ?C (98.8 ?F) | Resp 18 | Ht 1.575 m (5' 2") | Wt 68 kg (150 lb) | SpO2 100% | BMI 27.44 kg/m? ED Course as of Dec 30 2340 Wed Dec 30, 2020 2128 Reevaluation: Nausea improved. Abdominal cramping resolved. No further diarrhea or vomiting. Still complains of headache and muscle cramping through her upper shoulders and arm. Will remedicate with steroid and acetaminophen 2258 Reevaluation: Patient improved. Pain/myalgias improved. Headache now mild and dull. Continues with no further.nausea vomiting or diarrhea. She would like to try fluids at this time. Assuming toleration we will plan on discharge home. 2326 Reevaluation: Patient feels improved. Headache essentially gone. Taking p.o. fluids well. Discharge instructions discussed. She is very familiar with an EpiPen because of her daughter's prior use. Discharge instructions discussed. ASSESSMENT and PLAN This is a 40 y.o. female who presents with nausea vomiting diarrhea, myalgias, diffuse abdominal cramping, severe global headache, onset about 2 hours after first dose Moderna COVID-19 vaccine. Exam with intact mental status, neurologic system. Abdomen with some diffuse tenderness but no evidence of peritoneal sign. She had diffuse palpable soft tissue muscular type tenderness through her upper extremity shoulder and bilateral paraspinal back. She had no meningeal signs. She had no cardiorespiratory signs or symptoms. Her chest was clear. Voice normal. Swallowing normal. Oropharyngeal region normal. Initial ED ED management focused on rehydration, antiemetics and subsequent treatment for presumptive anaphylaxis with likely system involvement gastrointestinal and neurologic. She was treated with Solu-Medrol, famotidine and acetaminophen. She improved during ED course and did not require epinephrine. Symptoms at ED reevaluation/discharge were resolved. Clinical impression favors anaphylaxis over medication side effect given time course and abrupt onset of symptomatology and signs. She has a distant history of anaphylaxis to coconut-based product in her past. She has no history of ongoing allergic chronic history otherwise. Other organ systems appeared stable at onset and through ED course including cardiovascular and pulmonary. Plan is for discharge home with rest fluids. She will have a course of steroids/prednisone and famotidine. She was sent home with an EpiPen and understands use and precautions. Discussed ED "return immediately if" parameters with patient. Ongoing FOLLOW UP evaluation/care coordination via PCP recommended. Patient voices good understanding of current evaluation, follow-up & return recommendations and discharge instructions. Encounter Diagnosis Anaphylaxis due to vaccination, initial encounter Plan: -d/c home. No work next 2 days. Off work note provided -COVID-19 testing pending -rest with activity as tolerated -diet as tolerated & increased fluids as discussed -acetaminophen PRN -Prednisone 40 mg daily to finish 4 more days -Famotidine 40 mg daily to finish 4 more days -Zofran as needed (patient has at home) -Loratadine 10 mg OTC as needed -PCP f/u -ED return for interval worsening -instructions discussed & as documented

Other Meds: bisacodyl 10 MG Supp docusate sodium 50 MG Cap Sennosides (senna) 8.6 MG Tab clobetasol propionate 0.05 % Ointment lidocaine 5 % Patch cetirizine 10 MG Tab citalopram 40 MG Tab acetaminophen 500 MG Tab

Current Illness: Colitis 12/5/2020

ID: 0918492
Sex: F
Age: 47
State: OH

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

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

Lab Data:

Allergies: Unknown

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

Symptoms: Caregiver developed a metallic taste in her mouth and nausea twelve minutes after the vaccine injection (1404). Sixteen minutes after the start of the symptoms (14:20), the symptoms lessened. She was given soda crackers and water. At 14:54, she denied any nausea nor metallic taste in her mouth. She was allowed to leave observation area. Caregiver was called the next morning (01/01/21 @ 9:00 am) for a follow-up conversation. She stated that at 2am on 1/1/21, she developed a fever (101) and chills. She went to the Emergency room who performed a CXR, lab work, IV fluids and IV medication (Toradol) to help fever. She states a COVID test was completed and the result was negative per caregiver. She was discharged to home with an antibiotic and told her diagnosis was "possible reaction to the COVID vaccine and Flash pneumonia." Caregiver spoke to over the phone on 1/4/21 at 10 am. She states she is starting feeling better yesterday and has no complaints today. She is still on antibiotics by mouth and is scheduled to work tonight.

Other Meds: Insulin IV continuous infusion

Current Illness: Diabetes

ID: 0918493
Sex: F
Age: 41
State: OH

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

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

Lab Data:

Allergies: dexamethasone (no reaction given), hydrocodone (no reactions given), flu vaccine (redness and swelling of arm on two separate occasions after receiving flu vaccine, no respiratory distress, no throat swelling, no difficulty breathing, no anaphylaxis)

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: ?Moderna COVID- 19 Vaccine EUA? Flu vaccine allergy discussed at length with patient prior to Moderna vaccine. Patient's arm became red and very swollen on two separate occasions after receiving flu vaccine but patient did NOT experience difficulty breathing, respiratory distress, throat swelling, shortness of breath, or anaphylaxis. Approximately 11 minutes after receiving Moderna vaccine, patient complained of warmth and redness at injection site. Immediately after this complaint, patient began to faint and complain of difficulty breathing and pain when breathing. Rapid response was called. Patient continued to complain of painful inspirations and difficulty breathing. EpiPen, albuterol inhaler, and diphenhydramine IM were administered. Patient improved and was transported to emergency room for further monitoring. Patient improved in emergency room and was discharged sooner after.

Other Meds:

Current Illness:

ID: 0918494
Sex: F
Age: 53
State: CA

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

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

Lab Data:

Allergies: states some food intolerance, never an anaphylactic reaction. tape sensitivity. Reports sensitive to hypoxy resins.

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

Symptoms: Employee reports to this writer that within 2 minutes of vaccine recieved she experienced dizziness, felt presyncopal,, facial flushing, throat pressure, had elevated BP, itchy cheeks, nausea, chest pressure. Went to ER where they treated her like she had an anxiety attack. No epi given. Patient consulted with her own private ENT?allergist Dr. the next day who states it sounded like a reaction and prescribed Xyzal

Other Meds:

Current Illness:

ID: 0918495
Sex: F
Age: 41
State: MO

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Augmentin

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

Symptoms: is 5 X 5.5 CM. States redness started on 12/23/2020, redness expanded 12/28/2020 and swelling increased. States the area is painful and redness has heat. Does not feel the skin is taught.

Other Meds:

Current Illness:

ID: 0918496
Sex: F
Age: 47
State: CA

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Arm pain on the second day Saturday, Not able to lift arm

Other Meds:

Current Illness:

ID: 0918497
Sex: F
Age: 33
State: IA

Vax Date: 12/26/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Knot developed distal to the injection site 2 days following injection which remained until 8 days following the infection when it turned into a circular rash with associated itching

Other Meds:

Current Illness:

ID: 0918498
Sex: F
Age: 47
State: NY

Vax Date: 12/26/2020
Onset Date: 12/27/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: bees, had immune desensitization from age 15-23

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

Symptoms: has rash to lower back/ribs/hips/back of neck - itchy - denies trouble breathing - "tongue feels tingly", no itchiness in throat

Other Meds: none reported

Current Illness:

ID: 0918499
Sex: F
Age: 27
State: WI

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

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

Lab Data:

Allergies: clindamycin

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

Symptoms: lightheaded, dizzy, tunnel vision, sweaty, felt like passing out within minutes of receiving vaccine.

Other Meds:

Current Illness:

ID: 0918500
Sex: F
Age: 55
State: KY

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: tomatoes, bee stings, grass pollen, tree pollen,

Symptom List: Vomiting

Symptoms: Development of cellulitis at injection site. Treated at Hospital on 1/3/20 emergency department. With follow up visit scheduled on 1/6/2021 with physician.

Other Meds: valsartan 320mg

Current Illness: none

ID: 0918501
Sex: M
Age: 49
State: MS

Vax Date: 12/24/2020
Onset Date: 12/29/2020
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Employee tested positive for Covid-19 5 days after shot

Other Meds: unknown

Current Illness: Employee reported being tired at time of vaccination.

ID: 0918502
Sex: F
Age: 72
State: MD

Vax Date: 01/02/2021
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Moderna COVID-19 Vaccine Patient reported the following via an email following vaccination: "I had the vaccine on Saturday and only had a slight sore arm but last night my tongue is slightly swollen and very sore and the roof of my mouth ? kind of like I after you burn your mouth on something and the aftermath."

Other Meds:

Current Illness:

ID: 0918504
Sex: F
Age: 60
State: NY

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

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

Lab Data:

Allergies: Not recorded at this visit

Symptom List: Injection site swelling, Limb discomfort

Symptoms: This is not an adverse event report. This is a report of administration at an alternative site per the subject's request. Per the subject's request, this vaccine was administered IM to the left gluteus muscle.

Other Meds: Not recorded at this visit

Current Illness: Not recorded at this visit

ID: 0918505
Sex: F
Age: 43
State: PA

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

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

Lab Data:

Allergies: LATEX

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

Symptoms: ACHINESS TO LEFT ARM. 7 HOURS AFTER RECEIVING VACCINE EXTREMELY PAINFUL WITH DECREASE ROM.

Other Meds: MACROBIA

Current Illness: UNKNOWN

ID: 0918506
Sex: M
Age: 54
State: WA

Vax Date: 01/02/2021
Onset Date: 01/03/2021
Rec V Date: 01/04/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Dizziness started in the early morning approximately 12 hours after vaccination. The sx's come in waves and affect my balance. Sx's are sometimes exacerbated by change in position and first occurred whenever I rolled over in bed. The sx's also occurred while sitting at a desk working on my computer. No benefit from Eply's maneuvers. No nystagmus with Dix Hallpike maneuver. Meclizine seemed to be helpful. Sx's have persisted this morning, 1/4/2020.

Other Meds: Vitamin C, Vitamin D, Zinc, Fish oil, B12, levothyroxine, Zyrtec

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm