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: 1110334
Sex: F
Age: 8
State: UT

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: 8 yo female arrived to COVID vaccine clinic with her mother. The mother filled out a consent form for her daughter to be vaccinated and was told by a National Guard member that her daughter could not be vaccinated. Mother continued through process for her own vaccine and after receiving her COVID 19 vaccine, she presented her child's form to the National Guard member/vaccinator and had her child sit in the chair for vaccination. The National Guard member/vaccinator did not verify the age of the child and proceeded to vaccinate her.

Other Meds:

Current Illness:

ID: 1110335
Sex: F
Age: 34
State: NC

Vax Date: 03/09/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Puffy circle around the shot site. About 4" in diameter. Very itchy.

Other Meds: None

Current Illness: None

ID: 1110337
Sex: F
Age: 60
State: IN

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: Penicillin

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

Symptoms: Left side of left arm became numb, down side of arm and three fingers. Left side of left leg also felt numb but half as much as the arm. No treatment. It went away by 10 am the next morning.

Other Meds:

Current Illness:

ID: 1110338
Sex: M
Age: 78
State: VA

Vax Date: 01/28/2021
Onset Date: 01/01/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: On a scale of 1 to 10 with 10 being the most sever, I would estimate my shoulder/arm soreness to be 1 to 2 sore. Only reporting because it has been over 6 weeks since receiving shot. No side effect of 2nd dose, given in the right arm.

Other Meds: Depakote (750 mg,); Effexor (37.5 mg.), baby aspirin

Current Illness: None

ID: 1110340
Sex: F
Age: 41
State: KY

Vax Date: 12/23/2020
Onset Date: 03/05/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: CONGESTION, EAR FULLNESS, SINUS PRESSURE, NOSE BLEEDS- NOTED ON 03/05/2021 PATIENT ACCEPTED ADMINISTRATION OF ANTIBODY INFUSION.

Other Meds: HYZARR, FLONASE, MIRENA, METFORMIN

Current Illness: DENIES

ID: 1110341
Sex: M
Age: 74
State: MI

Vax Date: 02/19/2021
Onset Date: 02/20/2021
Rec V Date: 03/18/2021
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: NKA

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

Symptoms: Pain in shoulder continued for 1 month - he came to our clinic to pick up prescriptions and for his 2nd Shingrix (RZV) dose.

Other Meds:

Current Illness:

ID: 1110342
Sex: F
Age: 20
State: NE

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: Bees

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient felt flushed after vaccine, then started to have increased heart rate and dizziness. patient passed out for an estimate of 15-20 seconds. Patient was sweating. Patient came to and started to feel better. Gave water, after a few minutes patient denied shortness of breath, dizziness, or racing heart. Had patient walk hallways and denied any symptoms after and during walk. No dizziness. Patient did not fall and was assisted to chair by RN before patient passed out for 15-20 seconds.

Other Meds: APRI (Birth Control)

Current Illness: None

ID: 1110343
Sex: F
Age: 29
State: IN

Vax Date: 03/01/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: Injection site soreness, whole body aches, headache lasting for 24 hours

Other Meds: N/A

Current Illness: N/A

ID: 1110344
Sex: F
Age: 57
State: NY

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: Dilaudid and "something else"

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Recipient with history of epilepsy induced by stress started seizing approximately 5-6 minutes after receiving her vaccine. Before onset of first seizure pt reported throat tightness and had a mild dry cough. Dr. (Med eval) evaluated patient- lung sounds clear, pulse strong and steady 92 bpm, heart sounds normal. Pt reported that she felt like she was going to seize. Generalized tonic clonic seizure lasting approximately 1 minute. Post ictal period noted with minimal responsiveness but good color and respirations x 1 minute. Second seizure lasted approximately 1 minute, again generalized tonic-clonic with good color and respirations. Post ictal for approximately 3-4 minutes. Pt was transfered from car to stretcher. Sats 97% on room air. lung sounds clear with good respirations. 3rd generalized tonic clonic seizure ensued (lasting approximately 1 minute). EMS gave 5mg IM midazolam in her right deltoid. Transfered into ambulance, 3 lead EKG reviewed by Med Eval and no acute findings were noted. Recipient transferred to emergency department.

Other Meds: omeprazole, klonopin, two antihypertensive meds

Current Illness: none

ID: 1110345
Sex: F
Age: 38
State: CA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: Vader got, but I don?t think it?s manufactured anymore.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Side effects included arm soreness in the entire upper arm, pain in my back around the lower lung area when I would clear my throat, fever, odd sensation in my entire left arm and cheeks, and some body swelling. The pain in my back when clearing the throat shifted towards my spine, then started to radiate outward. All symptoms gone except for soreness in the arm and the feeling in my cheeks. It feels like when you?ve been numbed by the dentist, and that numb tingly fades, but your mouth doesn?t feel awake.

Other Meds: Prescription medications not taken this day.

Current Illness: None

ID: 1110346
Sex: F
Age: 31
State: TX

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: tetracycline

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

Symptoms: pt stated that she started shaking really bad and her muscles tensed up along w/ fatigue and feeling very hot but no fever. Pt took ibuprofen and that seemed to help. She woke up with another one of these episodes. She feels like she is shaking but her spouse says she was not physically shaking. She also had headache, body aches with pain, nausea, vomiting and can hardly walk. Ibuprofen is not helping with this pain. pt contacted her PCP and was to call us and and take Tylenol or ibuprofen and rest.

Other Meds: no

Current Illness: DX w/ Coronavirus 2/8/2021

ID: 1110347
Sex: F
Age: 41
State: FL

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: n/a

Symptom List: Rash, Urticaria

Symptoms: Tingling in head, light headedness. Stated she is scared. Anxious. V/S 122/56, HR 72, O2 99%.

Other Meds:

Current Illness: n/a

ID: 1110348
Sex: F
Age: 37
State:

Vax Date: 03/14/2021
Onset Date: 03/14/2021
Rec V Date: 03/18/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: pt. developed hives to the Lt. arm & redness to the chest. Medics present. Pt. denies any difficulty swallowing &/or other S/S. Administered Benadryl 50mg PO at 1635. pt. waiting as vaccination site an additional 15 mins to be monitored (45mins total). pt. having someone else drive her home BP: 127/78. HR: 79, RR:16.

Other Meds:

Current Illness:

ID: 1110349
Sex: F
Age: 17
State: GA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt was given vaccine, but is 17 and underage

Other Meds:

Current Illness:

ID: 1110350
Sex: F
Age: 21
State: OK

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/18/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: patient became diaphoretic, had involuntary muscle movement, non verbal for 4-5 seconds.

Other Meds: stated was on beta blocker for nerves but had not taken in 2 months

Current Illness: none

ID: 1110351
Sex: F
Age: 48
State: KS

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: Gluten, hydrocodone, oxicodone, morphine, Demerol, penicillins.

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

Symptoms: Within about six hours, started having violent spasms. Each lasting 45-60 seconds, from neck down. Everything would seize up including jaw. Felt like I was having a seizure but completely conscious. Happened every 2-3 minutes until about 5:00am. Husband had same reaction the next day after his injection.

Other Meds: Zyrtec, singular, Nexium, probiotic, Tramadol, Cymbalta 60mg, diazepam, Azithromycin, Bactrim, albuterol, spiriva, symbicort, dupixent.

Current Illness: Possible vasculitis flare. Drs aren?t sure. EGPA for me is chronic sinus infections and severe asthma. Sinuses & chest congestion nor migraines responding to meds.

ID: 1110353
Sex: F
Age: 35
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: no

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

Symptoms: itching in whole body specially in nose

Other Meds:

Current Illness:

ID: 1110360
Sex: M
Age:
State: CA

Vax Date: 02/04/2021
Onset Date: 02/06/2021
Rec V Date: 03/18/2021
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: he's imagining people are here and he is talking to them/wakes up screaming talking to people who aren't present; Tries to leave the house/ wakes up sometimes and acts as if he is eating and does all of the motions as if he is using a spoon and chewing but he hasn't ate anything; He doesn't recognize where he is; This is a spontaneous report from a contactable consumer. An 87-year-old male patient (also the age at vaccination) received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot: EM9809), first dose via an unspecified route of administration, administered in Arm Right on 04Feb2021 02:45 PM as SINGLE DOSE for covid-19 immunization. Medical history included remission from cancer, he has Hypertension (reported also as High Blood Pressure/Hypertension), thyroid disorder (reported as Thyroid), blood cholesterol abnormal (reported as Cholesterol), light symptoms about once or twice a month of disorientation, vision impaired, a PaceMaker and soft stool (reported as Stool: stool softener). The patient is not aware of any allergies to medications, food, or other products. The patient was vaccinated the most recent COVID-19 vaccine in a hospital. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination the patient was not diagnosed with COVID-19 and not been tested for COVID-19 since the vaccination. The patient had other medications the patient received within 2 weeks of vaccination for High Blood Pressure, Thyroid, Cholesterol, and Stool Softener. It was reported that the patient has had light symptoms about once or twice a month of disorientation. However since he's received the vaccine he has not had any fever with either dose but has throughout the day and night doesn't know where he is, he's imagining people are here and he is talking to them. He doesn't recognize where he is at, at times. He wakes up screaming talking to people who aren't present. Tries to leave the house even though he is vision impaired and has never tried to leave the house on his own. He wakes up sometimes and acts as if he is eating and and does all of the motions as if he is using a spoon and chewing but he hasn't ate anything and there isn't any food near him because he is in his bed. It was reported that the events occurred on 06Feb2021. The events were not considered as serious by the reporter (for any criteria). The outcome of the events was not recovered. No treatment was received for the adverse events.

Other Meds:

Current Illness:

ID: 1110361
Sex: F
Age: 20
State: NY

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: Slight soy allergy

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: - Slight dizziness upon injection and immediately after - Pain in shoulder on vaccine site - Nausea about 7-8 hours post vaccination - Physical and mental exhaustion 10 hours post vaccination - Dizziness again about 22 hours post vaccination - Consistent nausea and exhaustion

Other Meds: None

Current Illness: None

ID: 1110362
Sex: F
Age: 54
State: MI

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Bodily itching, especially in the nose, mouth and arms. The itching started on my hand about 5 mins. after my shot. As the day progressed it began to itch on my legs, back, arms, face, eyes and nose.

Other Meds: Olmesartan HCTZ, Paxil, Xalatan eye drops

Current Illness: none

ID: 1110363
Sex: F
Age: 52
State: NY

Vax Date: 03/05/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: Penicillin

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

Symptoms: I received the Pfizer vaccine on Saturday March 6th. My arm was sore just at the injection site for 2 days and that went away. Tuesday, the 15th, 9 days after receiving the injection, I woke up and my whole arm hurt from my shoulder to my wrist. I thought I?d just slept on it wrong but that usually gets better as the day goes on and is gone the next day. This got worse as the day went on and I have both muscle pain that feels neurological, like a pinched nerve, and joint aches. It?s now Thursday the 18th and my arm still hurts although not as bad as it did Tuesday and yesterday. I don?t know if it?s unrelated but I see many reports of arm paid days later, so I thought it best to report.

Other Meds: Levothyroxine, Wellbutrin

Current Illness: none

ID: 1110364
Sex: F
Age: 22
State: TN

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: The arm where my injection was is sore. This started about an hour after my injection. I woke up this morning and my entire body is aching and feeling sluggish.

Other Meds: Advil Allergy and Sinus

Current Illness: N/A

ID: 1110365
Sex: F
Age: 57
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: After 15 minutes I was released. No sooner than I had left my lips started tingling. I went to grocery store about 1/2 mile away; shopped for a few minutes, maybe 20 minutes. My face started burning like the worse sunburn you ever had. I called my physician's office at 2 p.m. and they worked me in. He prescribed Hydroxyzine 25 mg tablet, 1-2 tablets 4 times a day as needed for itching. The itching started in the doctor's office. It was just my face, now it is my face and arms. I have been taking one (1) pill every 6 hrs. Even taking the 1 pill the itching doesn't stop. I guess I need to take 2. Current time: 10:20 a.m. 3/18/21

Other Meds:

Current Illness:

ID: 1110366
Sex: M
Age: 56
State: MN

Vax Date: 03/16/2021
Onset Date: 03/18/2021
Rec V Date: 03/18/2021
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: Swollen lymph nodes in right armpit. Still on day one of symptom.

Other Meds: Lisinopril, desvenlafaxine

Current Illness: None

ID: 1110367
Sex: M
Age: 67
State: VT

Vax Date: 03/06/2021
Onset Date: 03/08/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: Cashews

Symptom List: Injection site pain, Menorrhagia

Symptoms: Shingles, above my right eyebrow

Other Meds: Oxybutinin and Alfuzosin

Current Illness:

ID: 1110368
Sex: F
Age: 61
State: CO

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/18/2021
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: Reports epinephrine causes hyperventilation

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

Symptoms: Covid vaccine (dose #1, Moderna) administered by RN on 3/11/21. Pt presented on 3/16/21 with sore left arm and palpable bump measuring 3.5x2cm cm. Mild redness, slightly warm site; pt afebrile. Some body aches/chills, bruising/redness at injection side. Mild pain with palpation. Overall improved, but redness remains at injection site. Of note, vaccine was administered with 1" needle; pt is 292 lbs and 1.5" needle indicated. Provider to follow-up again today, 3/18/21.

Other Meds: Acetaminophen, albuterol, Myrbetriq, famotidine, Flovent, metoprolol, pantoprazole

Current Illness:

ID: 1110369
Sex: F
Age: 59
State: MN

Vax Date: 02/25/2021
Onset Date: 03/15/2021
Rec V Date: 03/18/2021
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: Pennicilin, Codeine, Aspirin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: My reaction after the shot was mild, slight headache and fatigue. 2.5 weeks post vaccine I had a Grand Mal Seizure. I don't know whether or not it is related but I had a seizure 30 years ago and no problems since that time so it made me wonder whether or not it was a result of the vaccine.

Other Meds: Dilantin, Lyrica, Trileptal, Metroprolol, Vitamin D

Current Illness: UTI

ID: 1110370
Sex: F
Age: 63
State: PA

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: morphine, tramadol, demerol, doxycycline, erythromycin, iodine, amberen

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt reports arm was immediately sore, then red and hot to touch, swollen and a rash on the arm turned purple. Swelling in lymph nodes near neck and swelling continued to elbow. Patient experienced ear pain. Joint pain in knees and legs after 4 days.

Other Meds: Restasis, Artificial Tears, Bepreve, Rabeprazole, Sucralfate, Potassium chloride, durezol, miralax, phillips colon health, vitamin d3, stool softener, flonase, furosemide, minivelle patch, allegra, montelukast, Otezla, propranolol, amlodipi

Current Illness: Infected nevus, erosive gastritis

ID: 1110371
Sex: F
Age: 37
State: IA

Vax Date: 03/09/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: Sulfa drugs

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

Symptoms: COVID arm - redness, itchiness, and swelling at injection site that began 8 days after shot. It is still occurring so duration is unknown.

Other Meds: Wellbutrin, tizanidine, clonazepam, spironolactone, birth control, zyrtek

Current Illness:

ID: 1110372
Sex: M
Age: 47
State: TX

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Nausea

Symptoms: Pt reporting hives to the underarm and chest with itching

Other Meds: n/a

Current Illness: n/a

ID: 1110373
Sex: M
Age: 60
State: OK

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Chills, very cold, lethargy. I just feel bad. (but not critical)

Other Meds: Vascepa, finasteride and Cialis

Current Illness: None

ID: 1110374
Sex: F
Age: 67
State: AZ

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

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

Lab Data:

Allergies: Percocet

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

Symptoms: Large bright red circle at injection site approximately 2 by 3 inches

Other Meds: Losartan fluoxetine atorvastatin vitamin c vitamin d acidophilus

Current Illness: None

ID: 1110375
Sex: M
Age: 17
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/18/2021
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: The patient was signed up for the Pfizer vaccine which we ran out of doses. The patient said they were fine with Janssen and it was switched at the out window to that vaccine. The patient was 2 months shy of his 18th birthday which Janssen is not indicated for. The patient had no adverse reactions to this point but we wanted it documented.

Other Meds: none

Current Illness: none

ID: 1110376
Sex: F
Age: 44
State: IL

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/18/2021
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: na

Symptom List: Tremor

Symptoms: Right side of face, neck and chest broke out in hives. I had numbing in my lips and tingling on the right side of my body.

Other Meds: claritin

Current Illness: na

ID: 1110377
Sex: M
Age: 28
State: PA

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: At 10 pm I started to experience some moderate body aches. By 1 am, I was in so much pain I could not sleep and started to develop a fever. I drank a ton of fluids, used OTC treatments (Ibuprofen and Motrin) but nothing alleviated the pain. By 10 am I had a sustained fever over 100 degrees. I was in so much pain I was crying in bed. By 3 pm my fever reached 102 degrees. I had to go to the emergency room for IV drip and medication because I couldn't drink enough water to stay hydrated. Once given IV, my temperature plummeted. When the medication they administered wore off, my body started experiencing mild to moderate pains again. Body aches and soreness all over- my muscles feel like they are being squeezed from the inside. I am still feeling a lot of fatigue and pain but it is random and comes and goes along with "hot flashes".

Other Meds: Concerta 36 mg ER

Current Illness: None

ID: 1110378
Sex: F
Age:
State: NY

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/18/2021
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: Ampicillin Sulfa Fragrance

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

Symptoms: Had chills all day of vaccine One week later chills on and off mot severe as first day Developed pain on rt side abdomen a week later which went from rt side abdomen now I. Hip the pain is constant and a week later nauseas in the morning

Other Meds: Synthroid

Current Illness: None

ID: 1110379
Sex: F
Age: 25
State: NY

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Fever, chills, body aches, headache, could not get warm, weak; next day upper back aches, tight chest, left arm pain, sore injection site/very slight bruising

Other Meds: dietary supplements: vitamins A, B12, C, D, Iron, Calcium, Omega 3 fish oil, probiotics, collagen

Current Illness: N/A

ID: 1110380
Sex: F
Age: 33
State: IL

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
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: no

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: tinnitus

Other Meds: Viorele

Current Illness: no

ID: 1110381
Sex: F
Age: 43
State: VA

Vax Date: 03/10/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: 7 days later I have broken out with a rash at or just below injection site. It is sore, itches, red, and warm.

Other Meds: Previcid, Aller-Zyr, saw-palmetto, hydrolyzed collegan, B vitamins

Current Illness: Nine

ID: 1110382
Sex: F
Age: 61
State: AZ

Vax Date: 03/07/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
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: penicillin

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

Symptoms: Rash on vaccine site (upper left arm) chill's, low grade temp (99.9) stomach queasiness. lasted approximately 12 hours

Other Meds: none

Current Illness: none

ID: 1110383
Sex: M
Age: 78
State:

Vax Date: 02/02/2021
Onset Date: 02/20/2021
Rec V Date: 03/18/2021
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:

Symptom List: Pain in extremity

Symptoms: Hypertension, symptoms: Headache

Other Meds: Losarten

Current Illness:

ID: 1110384
Sex: M
Age: 57
State: VT

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: naproxen

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

Symptoms: Received vaccine, had some discomfort at the injection site. Ringing in my ears started a few hours afterward.

Other Meds: multivitamin

Current Illness: none

ID: 1110385
Sex: F
Age: 50
State: SD

Vax Date: 01/09/2021
Onset Date: 03/02/2021
Rec V Date: 03/18/2021
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: No

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

Symptoms: 1st Covid vaccine 12/19/20 Pfizer EH9899 @ 0930 2nd Covid vaccine 1/9/2021 Pfizer EL3246 @ 0930 2/26 Covid symptoms 3/2 tested positive for Covid, lost taste/smell, had covid tongue with ulcers in mouth - seeking medical attention

Other Meds: Fluoxetine, Trazadone, Vitamin D

Current Illness: None

ID: 1110386
Sex: M
Age: 59
State: TN

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/18/2021
Hospital:

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

Lab Data:

Allergies: NONE

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

Symptoms: PT REPORTS AFTER GETTING HOME THE NIGHT HE RECEIVED HIS MODERNA HE HAD LEFT SIDED LIP SWELLING, NO OTHER COMPLAINTS REPORTED.

Other Meds: UNKNOWN

Current Illness: NONE KNOWN

ID: 1110387
Sex: F
Age: 54
State:

Vax Date: 03/14/2021
Onset Date: 03/14/2021
Rec V Date: 03/18/2021
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:

Symptom List: Vomiting

Symptoms: c/o acute onset occipital headache, R. throat swelling, neck swelling, tongue swelling, difficulty swallowing saliva by report. No resp difficulty. Resp 16/min - nlabored SPO2 98%, HR 101, BP 160/85. 12:30pm Epi 0.3mg given R. thigh via auto injector by anaphylactic type reaction. All transport to closest ER.

Other Meds:

Current Illness:

Date Died: 03/14/2021

ID: 1110388
Sex: F
Age: 60
State: PR

Vax Date: 02/01/2021
Onset Date: 02/02/2021
Rec V Date: 03/18/2021
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: Not reported

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: On 2/1/2021 they performed CBC, the result was aseptic bacteria so it came out and she was taken to the hospital. They removed the tube in the hospital, (she remained in the hospital) First she was hospitalized and then she was transferred to the Medical Center Hospital to auscultate bleeding in the stool and to be evaluated by the Gastroenterologist. This specialist performs the necessary studies, they do not give a diagnosis and in the process she dies. The hospital indicated that she had a blood drain and heart failure.

Other Meds: Isorbi 30mg, Metroprolo 25mg, Plavis 75 mg, rosubastatin 20mg

Current Illness: A few days previous to the vaccination the resident was evacuating blood and was suppurating through the PEC tube.

ID: 1110389
Sex: F
Age: 67
State:

Vax Date: 03/13/2021
Onset Date: 03/15/2021
Rec V Date: 03/18/2021
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: itching, swelling, redness at site of injection. swelling/redness about 5inches in diameter

Other Meds:

Current Illness:

ID: 1110390
Sex: F
Age: 38
State: CA

Vax Date: 02/25/2021
Onset Date: 02/27/2021
Rec V Date: 03/18/2021
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: Penicillin, Eggs, Milk

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever of 104 degrees, difficulty breathing, hallucinations, chest congestion, Blood pressure extremely high, heart rate at 135 and above, weakness. Emergency room visit on 2/28/21 following the vaccine. Fever throughout the week until 3/5/21. Shortness of breath led to pulmonologist visit who administered nebulizer and prescribed inhaler, and blood pressure medicine as blood pressure remained elevated. 3 weeks after the vaccine still fighting a cough.

Other Meds: NA

Current Illness: NA

ID: 1110391
Sex: M
Age: 61
State: IN

Vax Date: 02/25/2021
Onset Date: 03/06/2021
Rec V Date: 03/18/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Received vaccine, and no reactions. Nine days after the vaccine slowly had drooping on the right side of his face, numbness on the right side of his face, mainly around the mouth, a little on the eye, hard to close the right eye. General soreness around his mouth when he tries to eat or talk a lot. Limited movement of his face do to swelling, difficulty closing his eye, and headache. Went to the ER on 3/7/21 and admitted him as they believed he had a blood clot, diagnosed him with Bell's palsy on Monday 3/8/21. Was given corticosteroids for 9 days Prednisone 60 mg. The symptoms are slowly improving but still has the Bell's palsy.

Other Meds: 81 mg aspirin, Levothyroxine, Lisinopril, Loratadine, Metformin, Metoprolol, Pantoprazole, Pravastatin, Sulindac, Vitamin E, Vitamin C.

Current Illness: Seasonal allergies.

ID: 1110393
Sex: F
Age: 90
State: SD

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/18/2021
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: NKA

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

Symptoms: Patient received her first dose of the COVID-19 Moderna vaccine. After vaccine administration, it was brought to our attention that patient received monoclonal antibodies 71 days prior to vaccination. Patient did not have any adverse reaction after vaccination. The next day, 3/11/21, Patients daughter was contacted and reported no side effects. Advised to call back if side effects occur. Patients daughter was also contacted 1 week later on 3/17/21 and said patient was doing well, had some diarrhea but that was it.

Other Meds: unknown

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm