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: 1112579
Sex: F
Age: 42
State: NJ

Vax Date: 03/03/2021
Onset Date: 03/07/2021
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: Knda

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pulmonary embolism resulting in sudden death

Other Meds: Mesalamine 1.2 g three times a day

Current Illness: None

ID: 1112580
Sex: F
Age: 66
State: OH

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none known

Symptom List: Anxiety, Dyspnoea

Symptoms: Developed shortness of breath, wheezing approximately 5 minutes after receiving first dose of vaccine.

Other Meds: unknown

Current Illness: none known

ID: 1112581
Sex: F
Age: 55
State:

Vax Date: 03/07/2021
Onset Date: 03/07/2021
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:

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

Symptoms: elevated bp, increased heart rate, dehydration, dizziness, fainting, lasting 2 hours, over 3rd and 4th hours after fluids given and rest symptoms went away

Other Meds:

Current Illness:

ID: 1112582
Sex: F
Age: 73
State: TX

Vax Date: 01/09/2021
Onset Date: 01/09/2021
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: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 1630 73 year old female received Moderna COVID 19 vaccine in left deltoid administered by LPN. Patient received in post vaccination observation with difficulty breathing, diaphoresis, chills, weakness. Patient has history of asthma and HTN. Patient took 2 puffs of her Ventolin HFA 90mcg and was given water. Patient able to breathe easier after using inhaler/ Also assessed by onsite paramedic. V/S BP 170/80 RR 16 HR 74 SPO2 98% 1700 Patient has no further symptoms, able to speak clearly and coherently. BP 170/80 Patient left observation area with husband.

Other Meds: Ventolin

Current Illness: Asthma, HTN

ID: 1112583
Sex: F
Age: 54
State: MI

Vax Date: 01/07/2021
Onset Date: 01/09/2021
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: None

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

Symptoms: Swollen lymph nodes in left axillary the size of a tennis ball for about 4 days but not completely subsided after 2 months. Painful kidneys for 4 days followed but low back pain for 3 days.

Other Meds: Omeprazole, IBU

Current Illness: None

ID: 1112584
Sex: F
Age: 47
State: CA

Vax Date: 03/18/2021
Onset Date: 03/18/2021
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: none per pt

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

Symptoms: Adverse reaction after receiving the COVID-19 vaccine in Vaccine Clinic. Medications: Fludrocortisone 0.1mg (pt took med prior to vaccine) No current outpatient medications on file. Allergies: Pt reports anaphylaxis x2 as a child after receiving vaccine (varicella and MMR) Not on File Medical history: "low blood pressure" per pt No past medical history on file. This was vaccine dose 0.3ml Pfizer Lot# ER2613 given @ 2:55pm Describe adverse reaction: Per pt "itchy throat" and "knot in my throat" Tachycardia to 110's Hypertension 120-150/80' Employee was monitored for 30minutes. Vaccine @ 1455 and pt started to c/o "itchy throat" @ 1515. Pt requested water and was able to swallow w/o difficulty. C/o feeling dizzy and warm. VS continued to be taken while pt sat on gurney. MERT called @ 1527 and arrived @ 1534. Pt taken to ED. AOD present @ 1530 and escorted pt via gurney to ED w/ MERT @ 1540. A/O x3, following commands, RR 20's. No difficulty breathing. 15:21 128/86 100% RA HR107 RR20 15:27 157/84 100% RA HR100 RR20 15:33 125/85 100%RA HR114 RR20 Anaphylaxis symptoms: Per pt "itchy throat" and "knot in my throat" Tachycardia to 110's Hypertension 120-150/80' Anaphylaxis plan: Anaphylaxis kit within reach. Pt also brought her own Epi pen. Not used. MERT called. Vasovagal symptoms: Dizziness Vasovagal plan: Pt remained seated and gurney brought to clinic. Administration error: NONE MERT called YES @ 1527 Transferred to ED VAERS report number: Email sent to OHS and patient documented in adverse reaction log.

Other Meds: Fludrocortisone 0.1mg

Current Illness: none per pt

Date Died: 03/06/2021

ID: 1112585
Sex: M
Age: 72
State: AZ

Vax Date: 01/28/2021
Onset Date: 02/18/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: patient diagnosed with covid on 2.18.2021 and died of covid 3.6.2021

Other Meds: zyrtec 10 mg daily generic tylenol 2 bid gas relief 126 mcg prn ducolax as needed pepto as neededvit d3 2000 units 2 qd vit b12 1000 mg 1qd asa 81 mg qd

Current Illness: hbp thyroid copd severe sleep apnea renal failure renal transplant 2016

ID: 1112586
Sex: F
Age: 39
State: TX

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Complaint of left sided deficit( numbness and tingling on cheek, forearm and leg, left side feels heavier than right side.

Other Meds: None

Current Illness: None

ID: 1112587
Sex: M
Age: 77
State: OH

Vax Date: 03/17/2021
Onset Date: 03/18/2021
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: Darvocet - palpitations

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient presented to ED with complaints of severe fatigue and generalized weakness. He complains of chills as well. WBC found to be elevated. No electrolyte abnormalities found. Patient is suspected to have a urinary tract infection. Patient received ceftriaxone for UTI. Patient was admitted to the hospital.

Other Meds: Vitamin B12, paroxetine, pantoprazole, memantine, meclizine, levothyroxine, furosemide, folic acid, ferrous sulfate, diltiazem, digoxin, carvedilol, calcium-vitamin D, atorvastatin, Vitamin C, Eliquis

Current Illness:

ID: 1112588
Sex: F
Age: 40
State: TX

Vax Date: 02/26/2021
Onset Date: 03/07/2021
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: Amoxicillin Robitussin Penicillin Shrimp chips

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Entire body weakness and muscle pain Sore throat Headache/dizziness Swelling of the left arm Concentrated rashes on left arm near injection site and the area was swollen over a week with pain on the area where rashes appeared; underneath the arm there is a dotted dark color looking like a bruise and painful.

Other Meds: Adult Multi-vitamins Airborne Vitamin D-3 Nutri-Calm (herbal) Wild Alaskan Fish Oil Chloraseptic (Sorethroat)

Current Illness: None

ID: 1112589
Sex: F
Age: 33
State: CA

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: SYR
Vax Site: LA

Lab Data:

Allergies: penicillins, cipro, wellbutrin

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

Symptoms: Client is a 33 y.o. female who received the Covid-19 Vaccine, BNT162b2 (PF) 30 mcg/0.3 mL IM Susp, Lot ER2613 on 3/18/2021. The patient experienced the following reaction(s) during the immediate of observation: 2:35pm Patient with witnessed syncopal episode during observation period. + head strike and loss of consciousness. Patient gained consciousness after about 30 seconds. No seizure activity noted. Denies SOB and difficulty breathing. Patient alert and verbal. Patient was treated/managed as follows: 2:40pm VS BP 144/74, HR 99, RR 20, 99% on room air. Patient alert and oriented. C/o soreness to shoulder. Reports PMH psychogenic nonepileptic seizures induced by anxiety and stress, anxiety, and depression. 2:50pm VS BP 140/82, HR 87, RR 18, O2 sat 97% on room air. Patient reports mild headache and soreness to shoulder. 2:50pm 911 called. Patient given educational material regarding vaccine and advised to continue to self-monitor per the agency guidance. 3:17pm EMT arrived. VS BP 133/83, HR 83, RR 18, O2 sat 97% on room air. Patient reports feeling better. Patient refused transfer to hospital for further evaluation. 3:26pm Patient wheel chaired to car accompanied by mother, grandmother, and RN

Other Meds: protonix, zoloft, gapentin

Current Illness: none

ID: 1112590
Sex: F
Age: 34
State: OH

Vax Date: 03/02/2021
Onset Date: 03/12/2021
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: Bright red itchy rash with pain on upper arm around injecting site. Took Zyrtec and seems to be clearing it up.

Other Meds: N/A

Current Illness: N/A

ID: 1112591
Sex: M
Age: 65
State: IN

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:
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: Head ache, chills, body ache, extreme fatigue, unable to keep awake

Other Meds: Metformin 500mg Lipitor 20mg Jardiance 10mg Lisinopril 40 mg

Current Illness: None

ID: 1112592
Sex: F
Age: 47
State: CA

Vax Date: 03/06/2021
Onset Date: 03/06/2021
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: heavy period 2 weeks early with menstrual cramps, fatigue, chills, nausea, diziness

Other Meds: Levothyroxine, Zyrtec, Nasacort, Multivitamins, Evening Primrose, Glucosamine chondroitin, turmeric, MSM

Current Illness:

ID: 1112593
Sex: M
Age: 28
State: CA

Vax Date: 03/13/2021
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: bactrim allergy

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

Symptoms: rash on chest and neck and abdomen

Other Meds: none

Current Illness: none

ID: 1112594
Sex: F
Age: 54
State: OR

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

Lab Data:

Allergies: none

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

Symptoms: Approximately 0.1 ml of vaccine dose leaked back out of the vaccine site after the injection, There was no appreciable bleeding associated with the leakage.

Other Meds: none

Current Illness: none

ID: 1112595
Sex: F
Age: 41
State: NY

Vax Date: 03/06/2021
Onset Date: 03/16/2021
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: Phenobarbital, codeine, gluten, shellfish, dairy, morphine

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

Symptoms: Vertigo, headache

Other Meds: Losartan potassium, omeprazole, breo inhaler

Current Illness:

ID: 1112596
Sex: F
Age: 21
State: CA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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: enviromental and some fruits/food(strawberries, avocado, pineapple, shrimp, bananas)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: immediately felt sore on site of injection and within minutes of leaving clinic, i felt sharp pain in my upper left back (still have that discomfort and I looked at my back this a.m. and i have a red bruise like mark) I took advil and laid down, fell asleep and when I tried waking up, I couldn't wake up and when I did wake, I was breathing hard and disoriented. I slept with my mom in fear of having episode again. Around 2:45 am, my mom woke to me shaking like I was having a seizure. it lasted about 30 secs. she called 911 and i was checked out by paramedics, who said my vitals were fine and I should flollow up with medical care. My mom and I agreed that perhaps I needed stress dosing of Cortef. I took stress dosage and have been taking stress dosage all day and so far no more episodes. Now waiting for Doctor to call me back and advise.

Other Meds: Advil, Tylenol, Vitamin D, Zyrtec Cortef, levothyroxine, low ogestrel

Current Illness:

ID: 1112597
Sex: M
Age: 47
State: AZ

Vax Date: 03/18/2021
Onset Date: 03/18/2021
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: knda

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt should have received the 2nd Moderna Vaccine instead or the Johnson % Johnson. Medical records marked that the patient wanted the Johnson Vaccine on the form instead of checking the patient record. I missed this as well

Other Meds: none known

Current Illness: none known

ID: 1112598
Sex: F
Age: 66
State: NJ

Vax Date: 03/18/2021
Onset Date: 03/18/2021
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: Lisinopril Sulfa

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

Symptoms: About a week after my first shot on 2/18/21 I noticed a ringing in my ears. I checked for side effects and did not see it listed. I thought it was just a coincidence. I saw my oncologist and she said that it may be a sign of hearing loss. So I scheduled an upcoming hearing test and ENT visit. Then today I had my second shot and within an hour the ringing in my ears increased significantly. I did further research and found that their are others who have experienced the onset of tinnitus or worsening tinnitus after receiving the vaccine.

Other Meds: Metoprolol 50mg twice daily Valsartan HCTZ 160/12.5 1 daily

Current Illness:

ID: 1112599
Sex: F
Age: 42
State: IN

Vax Date: 03/12/2021
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: Sulfa antibiotics

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

Symptoms: Lymphadenopathy in armpit on same side as vaccination site. Started 4 days after vaccination

Other Meds: Amitriptyline, Seasonique, Magnesium Threonate

Current Illness:

ID: 1112600
Sex: F
Age: 89
State: NJ

Vax Date: 02/26/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: no food allergies sulfa drug allergy (rash)

Symptom List: Unevaluable event

Symptoms: Redness noticed on 10th day

Other Meds: Rosuvastatin 5 mg., Famotidine 50 mg, CoQ-10 400 mg, Tumeric Curcumin 1000mg, Glucosamine Chondroitin sulfate 1100 mg,, calcium, cranberry extract.

Current Illness: none

ID: 1112601
Sex: F
Age: 68
State: PA

Vax Date: 02/25/2021
Onset Date: 02/27/2021
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: Latex, Fentynal

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

Symptoms: Arm was sore that evening and later developed (two days later) a raised red area with a slight rash, about 2.5 inches in diameter. It was slightly itchy. Lasted for one week. No treatment was sought. Also was fatigued for the first 36 hours.

Other Meds: Losartan, Atrovastatin, Synthroid, Vitamin, Calcium, Omega 3, Antioxidant, Glucimean Chondrotin, Baby aspirin, Omeprzole, Singular, Symbicort

Current Illness: None

ID: 1112602
Sex: F
Age: 50
State: OK

Vax Date: 03/08/2021
Onset Date: 03/08/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: patient reports red, sore, itchy arm for 10 days. referred to physicians office for further treatment and evaluation.

Other Meds:

Current Illness:

ID: 1112603
Sex: F
Age: 25
State:

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt vaccinated and then felt lightheaded, diaphoretic, mild nausea. Vitals stable. Given Ondansetron 4mg PO. Patient still slightly lightheaded prior to leaving, but feeling better.

Other Meds:

Current Illness:

ID: 1112604
Sex: F
Age: 29
State: OH

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

Lab Data:

Allergies: none known

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

Symptoms: Approximately 5 minutes after receiving first dose of Pfizer COVID vaccine, patient had syncopal episode with brief seizure activity noted

Other Meds: unkknown

Current Illness: unknown

ID: 1112605
Sex: M
Age: 78
State: PA

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

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: Sulfa

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Received the Vaccine Shot, waited 15 minutes with no issues. Went home, in about 15 minutes had extreme chest pain. Quickly moved to emergency room. Was given nitroglyercin paste on chest, Asprin to chew, Heprin and cardiac cautherization. Cautherization showing no real issues. Eventually the pain was gone. Cardiac doctor mentioned heart possibly being highly stressed earlier. I have some thoughts that it may have been a temporary blood clot, but not proven. Chest pain was very bad until emergency room starting getting it under control. never had that much pain before with previous heart attacks in 2004-05

Other Meds: Losartan 50 mg, Asprin 81mg, Metforman 500mg, Prednisone 5mgCoQ10 200mg, Crestor 20mg, D3 1000 iu, Famotidine 10mg, Restatis

Current Illness: none

ID: 1112606
Sex: M
Age: 56
State: CA

Vax Date: 02/24/2021
Onset Date: 03/15/2021
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: NKDA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: left sided pain on head, numbness, facial droop started 3/15/21

Other Meds: Glocotrol, Glucophage, Reyataz, Viread, Emtriva, Pravachol, Zestril,Lotrisone,

Current Illness: 12/20 possible covid dx pt had diarrhea. no positive covid test.

ID: 1112607
Sex: F
Age: 38
State: OH

Vax Date: 01/04/2021
Onset Date: 03/12/2021
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: Betadine, Clindamycin

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

Symptoms: Patient presented to the same vaccination site as she received 1st dose. Patient was asked if she received Pfizer or Moderna and answered "Pfizer" as she thought she received Pfizer for 1st dose. Patient did not have her CDC dose reminder card. She was guided to the Pfizer second dose documentation station, where the nurse documenting the vaccination did not heed the Epic alert that first dose was Moderna and Pfizer was being documented for 2nd dose. Patient was directed to the Pfizer vaccine administration station and received Pfizer for dose 2 instead of Moderna. The pharmacist in charge discovered an additional Moderna dose in inventory and discovered the potential error. The pharmacist called the patient who described the events reported above and confirmed the error. The patient was educated that the current guidance is to not repeat dose 2 as both vaccines are mRNA vaccines.

Other Meds: None reported

Current Illness: None reported

ID: 1112608
Sex: M
Age: 48
State: IN

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:

Symptom List: Nausea

Symptoms: Received vaccine, proceeded to observation area, while setting there started reading the material regarding the product, started to feel lightheaded got up to alert someone and fainted. Lowered to the floor, HR 78, 98% O2, BP 118/80. At 4:09 BP 116/82 sat patient up and gave water. HR and O2 remained the same. after 15 minutes stood patient up. After a few minutes had patient walk around supervised for 5-10 minutes.

Other Meds:

Current Illness:

ID: 1112609
Sex: M
Age: 21
State:

Vax Date: 03/17/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Injection site pain

Symptoms: headache,nausea. Headache, bodyache, nausea and chills since this morning. Had J&J shot yesterday. HPI:21-year-old male chief complaint of chills, headache fever and nausea. He reports symptoms started in the evening after getting his Johnson & Johnson coronavirus vaccine. He took Tylenol yesterday which helped but he has not taken anything today. 21-year-old male WITH CHIEF COMPLAINT OF FEVERS CHILLS AND HEADACHE. oN ARRIVAL PATIENT IS AFEBRILE nontoxic and in no acute distress. Heart regular rate and rhythm. Patient with no focal neurologic deficits. Plan to treat supportively vaccine reaction. Patient in agreement with plan.

Other Meds: UNK

Current Illness: N/A

ID: 1112610
Sex: M
Age: 26
State: CA

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

Lab Data:

Allergies: None.

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

Symptoms: Client informed RN that he gets lightheaded after getting vaccination because he is afraid of needles. He received the vaccination and started to feel light headed at 1:10 pm. Client was placed on the floor with legs higher.

Other Meds: None.

Current Illness: None.

ID: 1112611
Sex: F
Age: 28
State: TX

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

Lab Data:

Allergies: NKA

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

Symptoms: Needle popped off of patient's arm, as the medicine flowed down her arm. There was small droplet of blood from the needle prick, which I placed gauze and pressure to stop before administering a bandage. I administered another Janssen vaccine at patient's request, almost immediately. Patient was last seen returning to work and interacting with residents, after the 15 minutes of observation.

Other Meds: None

Current Illness: None

ID: 1112612
Sex: F
Age: 78
State: CA

Vax Date: 02/16/2021
Onset Date: 02/17/2021
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:

Symptom List: Tremor

Symptoms: She had her second Dose of COVID-19 vaccine in the afternoon. The next morning, she was confused, had tremors in all 4 extremities, was weak, unable to bear weight, and unable to walk. She remained in this state and bedbound for 3 days. Her husband considered taking her to the ER but was concerned that she would be alone and unable to advocate for herself due to severe confusion. She gradually regained strength and tremors resolved after 1-2 weeks.

Other Meds:

Current Illness:

ID: 1112613
Sex: F
Age: 36
State: CA

Vax Date: 03/17/2021
Onset Date: 03/18/2021
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: N/a

Symptom List: Erythema, Pruritus

Symptoms: Syncopy, persistent fever (101 deg), dizziness, vertigo, sleeplessness, high blood pressure, rapid pulse

Other Meds: Aspirin (60mg), Bystolic (2.5mg), B vitamins

Current Illness: Sinus pressure / allergies

ID: 1112614
Sex: M
Age: 78
State: RI

Vax Date: 03/13/2021
Onset Date: 03/15/2021
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: None known

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

Symptoms: Blood clot in urinary track

Other Meds: Amlodipine Besylate, Atorvastatin, Fosinopril, Aspirin, CoQ10, and Vitamin D3

Current Illness: None

ID: 1112615
Sex: F
Age: 55
State: TX

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

Lab Data:

Allergies: Unsure

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

Symptoms: Needle of syringe was not capped tightly so most of the vaccine liquid leaked out instead of being injected inside patient's arm. Patient was injected another dose in the other arm.

Other Meds: Unsure

Current Illness: Unsure

ID: 1112616
Sex: F
Age: 43
State: TN

Vax Date: 03/03/2021
Onset Date: 03/13/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: REDNESS, SWELLING, WARM

Other Meds:

Current Illness:

ID: 1112617
Sex: F
Age: 69
State: MI

Vax Date: 02/22/2021
Onset Date: 03/02/2021
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: 3/02/21. Very restless sleep followed by 3 days of very achy muscle and joints, strong sensitivity to light, oral sore spots, ( but not open sores ) and a flushed face. There was no fever. I took Tylenol for the aches and stayed restful, napping during the day . By 03/06/21 I felt fine.

Other Meds: Losartan 100 mg daily Pilocarpine 2.5mg bid with food Hydroxychloroquine 200 mg 1 bid Vitamin D3 1000 IU 1 daily

Current Illness: None

ID: 1112618
Sex: F
Age: 71
State: CA

Vax Date: 03/05/2021
Onset Date: 03/13/2021
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: Sulfur Drugs

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

Symptoms: 8 days (Saturday , March 13) after 1st Pfizer shot I experienced severe vertigo. I had to go to the emergency room the following day. After EKG and blood work (all normal) I was prescribed Meclizine 25mg and Ondansetron 4mg and told to make an appointment with Dr. I saw him Tuesday the 16th. He stated that he didn't believe it was due to the vaccine but couldn't say definitively. He prescribed the same medication and set a follow up for Tuesday the 23rd. I am 71 years old and have never had a problem with Vertigo. I am very hesitant to take the second dose;.

Other Meds: Alendronate Sodium 70mg Levothyroxine Sodium 25mg Mature Multi Vitamin D2 Vitamin Calcium Supplement

Current Illness: None

ID: 1112619
Sex: M
Age: 59
State: PA

Vax Date: 03/10/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None known

Symptom List: Pain in extremity

Symptoms: Tingling , burning sensation in legs and feet.

Other Meds: Meteor in 500 mg ER, Lisinopril, Rosuvastatin, GNC Mega Man vitamin, low dose aspirin, Qunol and Zertec

Current Illness: None

ID: 1112620
Sex: F
Age: 67
State: TX

Vax Date: 03/14/2021
Onset Date: 03/14/2021
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: Penicillin Latex

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

Symptoms: 3/14/21: 10:00 pm violent hand tremors - 3 hours 3/14/21: 10:30 pm nausea 3/14/21: 11:00 pm vomiting every hour - 7 hours and off and on the next 48 hours 3/15/21: 10:00 am extreme joint pain 48 hours 3/15/21: 10:00 am headache off and on 72 hours 3/16/21: 3:00 am 102.4 temperature (couple of hours?)16 3/16/21: 12:00 pm sore throat 24 hours 3/16/21: Fatigue Continues 3/16/21: Very dizzy 3/17/21: 3:00 pm injection side tenderness and slight swelling 48 hours 3/18/21: 3:00 pm first time able to get out of bead and shower - slight light headedness

Other Meds: Atacand HCT 32-25mg Cardiotabs Extra Strength Omega 3 Crestor 10mg Cardiotabs Multivitamin Toprol XL 100mg Cardiotabs Turmeric Curcumin Metrformin ER 100mg Pravagen Citracal Plus

Current Illness: Breast Cancer

ID: 1112621
Sex: F
Age: 33
State: NV

Vax Date: 03/12/2021
Onset Date: 03/13/2021
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:

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

Symptoms: I had general fatigue and headaches. The after I woke up my left arm was red and puffy. Overnight the area had doubled in size, itchy and painful. The area was circular and 2-3 inches in diameter. I went to Urgent care and they gave me Benadryl and a Steroid to take. The area is still painful and swollen and is starting to improve. It has been seven days and the area is still red swollen, warm and itchy. I have three more days of Steroid medication left. I just had a headache and fatigue for the first couple of days.

Other Meds: Birth Control Marlissa

Current Illness:

ID: 1112622
Sex: F
Age: 38
State: IL

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

Lab Data:

Allergies: unknown

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

Symptoms: Patient/vaccinator unable to state if patient recieved vaccine due to needle retracting and medication(vaccine) oozing from syringe and patient arm

Other Meds: unknown

Current Illness: unknown

ID: 1112623
Sex: F
Age: 24
State: IN

Vax Date: 03/13/2021
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: About 22.5 hours after vaccine: lips swelled, waited about 6 hours for swelling to go down when they did not, took an all-day allergy pill before bed, lips appeared and felt normal the next morning About 38 hours after vaccine: face rash, red and splotchy in two spots, extremely itchy, applied cortisone cream immediately, redness persisted a little less than 6 hours

Other Meds:

Current Illness:

ID: 1112624
Sex: F
Age: 48
State: CA

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

Lab Data:

Allergies: Sulfa

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient reported having a "scratchy throat" and feeling flushed after receiving the shot, was taken to AR RN area monitored by an RN and MD for 30 minutes. Symptoms improved, patient sent home with ED precautions

Other Meds: none

Current Illness: none

ID: 1112625
Sex: F
Age: 51
State: TX

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: RA

Lab Data:

Allergies:

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

Symptoms: Itchy in all the body starting at 1 pm Fiver starting at 6 pm Severe Itchy and big rashes all the body

Other Meds: Metformin ( seglutomet) 2.5 mg/1,000 mg

Current Illness: Earnings infection 1 week before

ID: 1112626
Sex: F
Age: 65
State: OH

Vax Date: 02/23/2021
Onset Date: 02/23/2021
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: Bee stings- anaphylaxis

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient reports shortly after receiving her first Pfizer COVID-19 vaccine on 2/23/21, she developed flushing of the face followed by erythema of the body, warmth and tingling. This was accompanied by numbness, a change in her vision and mental alertness. Patient reports similar symptoms occurred in the past when she experienced anaphylactic reactions, such as with bee stings.

Other Meds: Unknown

Current Illness:

ID: 1112627
Sex: M
Age: 51
State: CA

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: RA

Lab Data:

Allergies: NKA

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

Symptoms: After immunization, patient immediately felt nausea and complaint of tingling down (r) arm. Patient was very anxious, also complaint of (r) arm burning. Patient takes Gabapetin, Flexaril, ibuprofen. Patiet felt light headedness. Smoker, anxiety, hiatal hernia, chronic neck pain, history of shoulder surgery.

Other Meds: gabapentin flexeril

Current Illness: None

ID: 1112628
Sex: F
Age: 60
State: AZ

Vax Date: 03/07/2021
Onset Date: 03/12/2021
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: Preservatives...rash sometimes

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

Symptoms: I received my vaccine on Sunday March 7 and in the morning of March 12, I woke up to a large bruise with a hard clot on the inside of my right forearm measuring 7cm x 4cm with a large clot in the bruise. I also have a smaller spot which has a firm bump under the skin. I did not hit my arm or injure it during my sleep or before going to bed.

Other Meds: Pravastatin 10mg / aspirin 81mg / plant based calcium 770 mg = 3 pills / chelated magnesium 250 mg 1-2 daily / D-3 1000 IU & K-2 45mcg 1 daily.

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm