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: 1116392
Sex: F
Age: 45
State: GA

Vax Date: 03/11/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
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: THE LEFT DELTOID AREA OF THE ARM TURNED RED AND BECAME TENDER. IT HAS FEVER IN THE AREA

Other Meds:

Current Illness:

ID: 1116393
Sex: M
Age: 17
State: UT

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/19/2021
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: No known allergies

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccine Administered Outside Protocol/Standing order Guidelines (The patient is 17). The patient did not experience any symptoms outside of the normal expected symptoms.

Other Meds: Unknown

Current Illness: None

ID: 1116394
Sex: F
Age: 44
State: IN

Vax Date: 03/12/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
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: Dust Pollen Hay Pine Aleve Shellfish Blueberries Cranberries

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

Symptoms: Patient called our onsite registered nurse on 18MAR21 to report injection site swelling and redness (left deltoid). Patient was advised to take Benadryl at home after work. Patient will follow-up with our onsite nurse as needed.

Other Meds:

Current Illness:

ID: 1116395
Sex: F
Age: 37
State: CA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 03/19/2021
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: The arm was sore for three days and then it resolved after three days. Swollen, red, itchy, hot to touch in the arm that I received the vaccine. I tested positive for Covid-19 after worsening symptoms four days after vaccination. I tested positive five days after vaccination. Seven days after vaccination the arm soreness symptoms returned. It was a little bigger area than the first time. It was red and hot to touch but no swelling this time. I still received the second dose on 02/12/2021 I had lingering fatigue from Covid-19. My arm became inflamed again but only lasted a couple of days.

Other Meds: Vyvanse 60mg Lamotrigine 200 mg Lexapro 20mg Abilify 5mg Adderall 20mg Lisinopril 5mg Vitamin B12 Vitamin D Multivitamin Zinc

Current Illness: Covid-19 within the same week of Vaccination

ID: 1116396
Sex: F
Age: 62
State: GA

Vax Date: 03/14/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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, codeine

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

Symptoms: sore throat, dizziness, right eye pain, diarrhea, leg pain, fatigue, soreness at site area

Other Meds: insulin, synthroid, L-arginine, estradiol, allegra, emergenC, prevagen

Current Illness:

ID: 1116397
Sex: F
Age: 70
State: WA

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 03/19/2021
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: Ace inhibitors

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

Symptoms: My tongue started tingling and got a bit swollen about noon on 1/28/2021. The swelling in my tongue did not go away and persists . I originally thought it was angioedema but when the swelling did not go down I did not know what the problem was! I heard last night about COVID tongue and knew that is what I was/am dealing with. For what it?s worth I thought I?d let you know. I tried to let Vsafe know but did something incorrectly and my message didn?t go through.

Other Meds: Sirolimus, tacrolimus, mycophenalate, Bactrim, rosuvastatin, levothyroxine, ropinrole, adderall, vitamin d3, duloxetine,ezetimibe,

Current Illness:

ID: 1116398
Sex: F
Age: 68
State: NY

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 03/19/2021
Hospital: Y

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

Lab Data:

Allergies: Sulfa, contrast dye, iodinated contrast media, potassium, valium, Cipro, Penicillin, Ceclor, Erythromycin B, Loratadine, Latex, flu vaccine with eggs, egg whites, hepatitis B vaccine, birth control pill ? name, most antibiotics, Motrin and Advil.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: She had the vaccine at the facility where she lives. She fainted less than 24 hours after the vaccine, got up from that and had dry heaves, lost her speech and had loose stools. The aide caught her as she was fainting as she would have fallen on the floor. She said it was weird, she looked at people and it looked like they were 2 dimensional and knew something was wrong, but couldn't figure out what as they attended to her. They asked her questions, but she was not able to speak to them. They apparently spent 2 hours with her, but she doesn't believe it was that long, and then they knew she wanted to go to one Hospital and not the other. She had been loosing words before this happened, but not as bad as this one. This was about the same reaction that she had when she got the COVID virus in January. She was then taken to the hospital where she was given fluids and hydrated her and checked her heart, saw a cardiologist and a neurologist to see if those things caused the fainting and had blood work done. They also did a CAT Scan of her head and neck. They told her that she was fine and was discharged back home after 5 days, which was 3/11/21. Since then she has been very tired, she does have GERD and her stomach has been hurting a lot as well.

Other Meds: Amitiza, 81 mg aspirin, Atorvastatin calcium, Carbidopa/levodopa ER, daily multivitamin, Docusate sodium, Florinef, Melatonin, oyster shell calcium, polyethylene glycol, Ropinirole, vitamin D3.

Current Illness: None.

ID: 1116399
Sex: F
Age: 66
State: TN

Vax Date: 03/12/2021
Onset Date: 03/15/2021
Rec V Date: 03/19/2021
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 known

Symptom List: Pharyngeal swelling

Symptoms: 3 days following the vaccine I felt as though my blood pressure might be elevated. I checked it several times and it was over 200 (208, 212), so I sent to the ER where they did tests and found everything to be normal. BP dropped to 167 while there, so no medication was given. Advised to follow up with primary care doctor, which I did 2 days later. BP still in the 160s. Advised to monitor and if not improved to begin an additional BP medication.. That medication was started today. The vaccine was given through the County Health Department.

Other Meds: atenolol, premarin, claritin

Current Illness: none

Date Died: 03/17/2021

ID: 1116400
Sex: M
Age: 80
State: MN

Vax Date: 01/25/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient passed away within 60 days of receiving the COVID vaccine series

Other Meds:

Current Illness:

ID: 1116401
Sex: M
Age: 60
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Due to mixing error, the patient received the diluent only

Other Meds:

Current Illness:

ID: 1116402
Sex: M
Age: 64
State: MD

Vax Date: 03/09/2021
Onset Date: 03/16/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Had minor pain at injection site beginning 4 hrs after ijection, resolved after 24 hrs. No other side effects until 7 days late (19 Mar). Moderate chills, moderate fatigue, moderate headache began 7 days after first injection, persisting with little change now 80 hrs after onset. One instance diarrhea 60 hrs after first injection. No fever. No joint pain or swelling. Have consulted PC nurse who advises I report this, and self-quarantine while await PCR results. I will report to ER if symptoms significantly worsen, otherwise will check back with PC physician Monday 22 Mar.

Other Meds: 20mg Atorvastatin daily, 20 mg Cetirizine daily

Current Illness: None

ID: 1116403
Sex: M
Age: 42
State: FL

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: 5:59 pm c/o "slight" lightheadedness. denies dizziness blurred vision. Skin W/D

Other Meds: Zorolto

Current Illness: asthma

ID: 1116404
Sex: M
Age: 17
State: WI

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
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: Vaccine given to age inappropriate recipient.

Other Meds:

Current Illness:

ID: 1116405
Sex: F
Age: 41
State: GA

Vax Date: 03/11/2021
Onset Date: 03/13/2021
Rec V Date: 03/19/2021
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: Amoxicillin Injectable Contrast Dye

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

Symptoms: Injured my back during vacuuming on Saturday 3/13. Went to ER on Sun 3/14 from back pain and limited mobility. Received intravenous steroids and lidocaine patch and was prescribed muscle relaxers, lidocaine patches, and ibuprofen 600 to manage pain. Had two chiropractic adjustments on 3/15 and 3/17 for SI joint pain. Only worked 1 out of 5 days this week and still dealing with dull achey pain and limited mobility when sitting, transitioning from positions, and bending over. Had a follow up with an urgent care provider on 3/18 who advised me to continue to rest and take full dose of ibuprofen to mitigate SI joint inflammation.

Other Meds: Amitryptiline 10mg 1x daily Probiotics Vit d3 Vit k2

Current Illness: none

ID: 1116406
Sex: F
Age: 62
State: WA

Vax Date: 03/16/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
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: Avocado; Pennycillian; Ethromycian; Ceclor; Sulfur; Celacin

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

Symptoms: Day 1: muscle soreness and headache that persisted for 3 days; Day 2: Rash on back; Day 3: Rash becomes itchy and spreading to chest and face.

Other Meds: Lisinopril Hctz Tabs 20/12.5; Atorvastatin Tabs 20mg Aspirin Ec Tabs 81 mg; Metformin Hct Tabs 1000 mg; Vitamin D3 5000 IU; Biotin 10,000 mcg; Omega 3 Fish Oil 4000 mg; Release dietary Supplement

Current Illness: none

Date Died: 03/18/2021

ID: 1116407
Sex: M
Age: 59
State: KS

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 03/19/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient got sick over the weekend. Went to facility on 03/02/2021 and then passed on 03/18/2021

Other Meds:

Current Illness:

Date Died: 03/07/2021

ID: 1116408
Sex: F
Age: 75
State: AL

Vax Date: 02/02/2021
Onset Date: 02/10/2021
Rec V Date: 03/19/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: severe internal bleeding fluid build up around lungs/heart high heart rate low blood pressure low oxygen liver failure death

Other Meds: Warfarin

Current Illness:

ID: 1116409
Sex: F
Age: 68
State: SC

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
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: 10 minutes after receiving 2nd dose of moderna covid Vaccine patient complained about itching and burning at and near site of injection. Her arm was red from scratching. Patient denied any reaction for first dose of vaccine. Patient denied and SOB or swelling around eyes nose or mouth. Patient denied and itching in mouth or throat or any other site besides site of injection. Patient was offered benadryl for local itching but denied any. Patient was advised to stay close to pharmacy for further observation for 40 more minutes. After 15 minutes of the reaction patient said itching and burning was subsiding and felt no other signs or symptoms of itching or allergic reaction. Patient was advised if any other side effect including what to look out for in regards to severe side effects and what to do in the event of those side effects.

Other Meds: Unknown

Current Illness: Unknown

ID: 1116411
Sex: F
Age: 67
State: CT

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: sulfur iron morphine latex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 24 hours after vaccine, hard lump, swollen and pink, moderate chills. The next day, bigger lump, swollen, all just below injection and red, moderate chills, a bit itchy, nausea., and painful. Same on 3rd day but much bigger redness spreading down arm, 2 1/2 by 2 1/2' hard mass and red, itchy, painful, chills and nausea. Next morning called Dr. I am taking amoxicillin-clav 875-125ng tab. Three days later mass is turning from red to pink and retreating. Still hurts and now bruses show around the injection site, which I thought was strange. The vaccine actually hurt when given (I get injections every three months, so I know what they will feel like, but this hurt and went very deeply and then burned). I felt warm afterwards for about 10 minutes.

Other Meds: Baclofen Clonazepam probiotic vitamin B12

Current Illness:

ID: 1116412
Sex: F
Age: 37
State: CA

Vax Date: 03/11/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
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: At 10:00am PST on 03/19/2021, the upper part of my left arm broke out into a rash and hives developed as did extreme soreness. I think it is called "Covid Arm." I took a Claritin to help the itchiness go away and went back to working normally.

Other Meds:

Current Illness:

ID: 1116413
Sex: F
Age: 50
State: OH

Vax Date: 03/13/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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: nka

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

Symptoms: Skin all the way to the side of right of the injection site, the shoulder is very sore to the touch and some swelling.

Other Meds: 25 mg Zoloft

Current Illness:

ID: 1116414
Sex: F
Age: 28
State: CA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
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: Unevaluable event

Symptoms: 09:28am: Pt received vaccine 09:38am: Pt complained of itchy throat. (B/P 129/72, pulse = 77, o2 sat = 99% 10:00am: pt complained itchy throat remains the same. 10:12 am: Benadryl 10ml give po x 1 (12.5mg/5ml) 10:20am: Pt states that itchy throat is resolving. pt discharged. 11:37 am: contacted pt at home. she said itchy throat continues to get better. Reminded to go to E.R if symptoms worsens

Other Meds: none

Current Illness: none

ID: 1116415
Sex: M
Age: 61
State: FL

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
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: N/A

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

Symptoms: Cold sweat at 2am Achy all over and especially upper joints Injection site sore Cannot get warm Slight intestinal discomfort

Other Meds: N/A

Current Illness: N/A

ID: 1116416
Sex: F
Age: 42
State: CA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
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: Penicillin

Symptom List: Injection site pain, Pain

Symptoms: Nausea and headache

Other Meds: Singular

Current Illness: None

ID: 1116417
Sex: F
Age: 89
State: WA

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: patient reported 20 minutes of visual hallucinations about 15-17 hours after 2nd dose of COVID-19 vaccine and passed out for possibly 5 minutes. during fall she injured right low leg, but no evidence of DVT on exam today (6 days after fall).

Other Meds: ramipril, metoprolol, rosuvastatin, aspirin

Current Illness: no reported acute illness prior to vaccination

ID: 1116418
Sex: F
Age: 42
State: NY

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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: Ibuprofen, Penicillin

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

Symptoms: Patient reported low grade itching almost immediately after the second dose on 3/17/21 and continued though date of incident. Headache started 3/18/21 and continued through date of incident. While sitting at work on 3/19/21, patient reported a sudden onset of sharp pain in her left sternum. CHS Healthcare Paramedic conducted an assessment and reports no dizziness or nausea, clear breath sounds O2 WNL, non-smoker, chest pain with a deep breath and while at rest. Provided 324 mg aspirin and 0.4 mg nitro with no resolution of symptoms. Patient transported to Unity Hospital for further evaluation.

Other Meds: unknown

Current Illness: unknown

ID: 1116419
Sex: F
Age: 16
State: NJ

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 03/19/2021
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: Peanut, tree nut, omnicef, gluten intolerance

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Began complaining that she was short of breath at 10pm on 3/16, needed nebulizer treatment for wheezing on 3/17 at 1am, could not get wheezing under control with 2 nebulizer treatments at home, so went to ER at 2am. Was dosed 16 puffs of albuterol over about 40 minutes. Vomited and then administered IV fluids and blood was drawn/chest x-ray performed. Discharged at 6am on 3/17.

Other Meds: Zoloft, Protonix, Q-Var, Pro-Air, Zyrtec, Allegra, Patanase, Pataday, Vitamin D, Vitamin B, IB Guard, Trazadone

Current Illness: None

ID: 1116420
Sex: F
Age: 66
State: NC

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: Reactions to keflex

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fever from 100.3 to 101.0 Fahrenheit, terrible headache that would not stop for 3 days, terrible joint pain and body aches, diarrhea Symptoms lasted from March 14-March 18, 2021. Missed 3 days of work due to illness.

Other Meds: Tylenol, Claritin, citalopram, atorvastatin, D3-5000 iI

Current Illness: None

ID: 1116421
Sex: F
Age: 34
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Due to a mixing error, the patient only received the diluent

Other Meds:

Current Illness:

ID: 1116422
Sex: M
Age: 66
State: AR

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/19/2021
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: Fever, chills, headache, diarrhea, shoulder ache, balance issue Tylenol for fever was resolved by 3/17/21 Still weak and diarrhea on 3/19/21

Other Meds: Dilantin, atorvastatin

Current Illness:

ID: 1116423
Sex: M
Age: 22
State: CO

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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: Injection site pain

Symptoms: Around 10pm, I was suddenly very tired and could not stop yawning. I typically am up until 12-1 most nights so this was out of the ordinary. While getting ready for bed I became very nauseous and almost threw up. I had waves of nausea for around 20 minutes. When I stood up I had chills throughout my body and my skin was covered in goosebumps. A little later, my vision started to go black and I felt dizzy and light-headed. I went to bed shortly after in hopes of sleeping it off (probably 10:45-11). Around 2 am the following morning, I woke up and had a hot flash (could have been a fever but I did not check my temperature). I was able to fall back asleep and felt normal when I woke up at 7:30 am.

Other Meds: N/A

Current Illness: N/A

ID: 1116424
Sex: M
Age: 23
State: IL

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: PCN

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

Symptoms: Syncope episode, nausea and vomiting .Patient needed a minute to catch breath. Patient stated felt better after a minute.

Other Meds: Unknown

Current Illness: Depression

ID: 1116425
Sex: F
Age: 69
State: GA

Vax Date: 02/08/2021
Onset Date: 02/13/2021
Rec V Date: 03/19/2021
Hospital: Y

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: Major stroke that required surgery and 18 days in the hospital.

Other Meds: MONTELUKAST 10MG, LEVOTHYROXINE .088MG, NORETHINDRONE 5MG, ESOMEPHRAZOLE MAGNESIUM 40MG AND MELOXICAM 15MG.

Current Illness: None

ID: 1116426
Sex: F
Age: 43
State: CA

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/19/2021
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: Shellfish derived products

Symptom List: Tremor

Symptoms: Initially at the 30 min mark post vaccination patient complained of itchiness all over body, mild redness noted on upper extremities and upper back. About 45 minutes post vaccination patient complained of throat discomfort. Treatment provided was adult dose Epi pen of 0.3mg , solumedrol 125mg and Benadryl 50mg. Patient taken by ambulance at 6:00pm

Other Meds: Levothyoxine (tab), and Fluticasone (inh)

Current Illness: none reported

ID: 1116427
Sex: F
Age: 54
State: FL

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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: I had the Moderna vaccine (first dose) 8 days ago and for the next two days my arm at the injection site was tender, red and there was a firm lump. Now 8 days later the injection site is still red and blotchy, still a firmness in that area and it itches badly. I'm just concerned since it's been over a week and wonder when it will clear up and if I should get the second dose.

Other Meds: None

Current Illness: None

ID: 1116429
Sex: F
Age: 80
State: RI

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Generalized body aches, mild headache, feeling extremely cold, extra tired

Other Meds: Aspirin 81mg. 2x a day Meloxicam 15 mg daily Pantoprazole4 mg daily Tylenol 1000 mg three x a day The above meds are temporary after a total knee replacement Following meds are usual daily Lasix 40 mg daily Levothyroxine 50 mcg daily Fish o

Current Illness: Total knee replacement

ID: 1116430
Sex: M
Age: 54
State: PA

Vax Date: 03/13/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: On Friday, March 19 around 9:10am I had seizures - loss of awareness, very pale, shaking (but not quite convulsions). This happened before 25 years ago and is likely unrelated to the vaccine. Expected cold/flu-like symptoms did occur on March 14 and part of March 15 but things have been fine since then. I've followed up with my GCP and am scheduling a Neuro appointment for followup.

Other Meds: none

Current Illness: none

ID: 1116431
Sex: M
Age: 85
State: NJ

Vax Date: 03/01/2021
Onset Date: 03/03/2021
Rec V Date: 03/19/2021
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 known drug allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: temporary blindness for 10 minutes in one eye

Other Meds: none reported

Current Illness: n/a

ID: 1116432
Sex: M
Age: 66
State: MI

Vax Date: 03/12/2021
Onset Date: 03/14/2021
Rec V Date: 03/19/2021
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: knda

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

Symptoms: Patient reported pain in his arm with swelling. He also has axillary lymphadenopathy with severe pain in the right arm post vaccine

Other Meds: crestor, lisinopril

Current Illness: None

ID: 1116433
Sex: F
Age: 23
State: PA

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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: Sulfer Drugs Amoxicillin

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

Symptoms: Fever, severe migraine, nasal congestion, nausea.

Other Meds: Humira Flagyll

Current Illness: Had Covid back in December

ID: 1116434
Sex: F
Age: 40
State: NJ

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 03/19/2021
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

Symptom List: Pain in extremity

Symptoms: Around noon, I had flu-like symptoms - very tired, chills (no fever) and very achy. I was exhausted. That lasted through the evening. And a little bit on the 5th. By the night of the 5th, I was fine - it was completely gone other than the hives that I was still dealing with from first vaccine adverse symptoms. Because the hives were still going on, I started taking (on Saturday) Ambien - 10 mg; and Prednisone - 20 mg and then by Monday, the 8th)I increased it to 30 mg. Friday, the 12th, Xolair injection - one injection each arm - 150 ml. Because the hives were still breaking out. These did not help right away with the hives. That injection is every four week and I had the second one on March 12th and an appt with my allergist to talk about all of this. As of yesterday, March 18, I had the first day of NO BREAKTHROUGH HIVES. Note: A couple of days before one week after the second vaccine - I started to having a shaky/jittery feeling. I talked to my doctors, and they think that may have come from the Prednisone and the Levothyroxine .

Other Meds: 50 mcg - Levothyroxine; Vit D 1000 IUs; 40 mg Zyrtec; Pepsid - 40 in morning and 40 in night

Current Illness: hives - adverse symptoms experienced after vaccine dose 1 of Moderna

ID: 1116435
Sex: M
Age: 70
State: FL

Vax Date: 02/13/2021
Onset Date: 02/16/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: iodine, contrast dyes, msg

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

Symptoms: pt stated that he got the covid vax he developed head ache and fatigue. Around the 4th day he started having a tickling and numbness around the mouth area. On 3/1/2021 he felt a difference and could tell something was going. He went to see his PCP on 3/2/2021. He was diagnosed w/ Bells Palsy. He did not give him any meds that day. When he got home his symptoms got worse. He contacted his PCP which then prescribed steroids and baclofen. Pt is applying warm compresses and messages. He has also had acupuncture. His left eyebrow is downward and the left side of his mouth is drooping. He feels like he has sand in left eye.

Other Meds: tenofovir disoproxil, amlodipine 5mg, multivitamin, B complex

Current Illness: no

Date Died: 03/16/2021

ID: 1116436
Sex: F
Age: 90
State: MN

Vax Date: 01/27/2021
Onset Date: 03/16/2021
Rec V Date: 03/19/2021
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: Patient passed away within 60 days of receiving the COVID vaccine series

Other Meds:

Current Illness:

ID: 1116437
Sex: F
Age: 66
State: CA

Vax Date: 03/10/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: cutaneous hypersensitivity in left arm red circle 3" itchy, tender on vaccine area and armpit

Other Meds: no

Current Illness: no

ID: 1116438
Sex: M
Age: 29
State: MI

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/19/2021
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: PENICILLIN AMOXICILLIN

Symptom List: Vomiting

Symptoms: PATIENT GIVEN VACCINATION, NEW TO FACILITY AND RECEIVE CONSENT FROM GUARDIAN. RX GIVEN AND VACCINE THEN GIVEN. NOTICED PATIENT HAD VACCINES SERIES ADMINISTERED PRIOR TO ADMISSION AT THIS FACILITY. RECEIVED 3 COVID-19 MODERNA VACCINES.

Other Meds: CLYNDAMYCIN TOPICAL BID VALIUM 5MG PO TID BENADRYL 50 MG PO AT HS DEPAKOTE 500MG PO BID HALDOL 10MG PO AT HS MIRALAX 17GM PO AT HS RISPERDAL 3MG PO BID

Current Illness: STREP THROAT 3/10

ID: 1116439
Sex: F
Age: 63
State: PA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/19/2021
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: penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt received vaccine at 1231 and within 10 minutes reported feeling "shaky" with a warm tingling feeling all over. She was moved via wheelchair to an observation area. Initial vitals at 1245 98% on room air, 100 HR, BP 157/94. Pt stated she was feeling better and was then escorted at 1330 to the bathroom via wheelchair. Upon her return, she reported now experiencing chills and was shaky. Vitals at 1340 were 176/86, 96%, and HR 99. Pt denied SOB, fullness in mouth, and itchiness. Further vitals: 1357 175/85, 96%, HR94. 1405 183/105, HR 107, 97%.; 1406 173/80, HR 104, 97%. It was determined by RN that 911 would should be called to further evaluate the patient. Patient was taken via EMS to the hospital with her husband in attendance.

Other Meds: lisinopril, pravastatin, breo inhaler, rescue albuterol, femotidine, dramamine

Current Illness:

ID: 1116440
Sex: F
Age: 65
State: MN

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/19/2021
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: Due to a mixing error, the patient only received the diluent

Other Meds:

Current Illness:

ID: 1116441
Sex: M
Age: 42
State: MA

Vax Date: 02/08/2021
Onset Date: 02/12/2021
Rec V Date: 03/19/2021
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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Came down with Shingles virus shortly after getting first COVID vaccine.

Other Meds: None

Current Illness: None

ID: 1116442
Sex: F
Age: 66
State: NV

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient didn't feel well, bone pain to the extend that she felt her bones were going to crack in her feet. She has decided not to get the 2nd dose after discussing with her physician.

Other Meds:

Current Illness:

ID: 1116443
Sex: M
Age: 37
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: dizzy, felt faint, BP low 80-90s systolic per patient. 3 days later with chest tightness, right side radiating to right AC

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm