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: 1122270
Sex: F
Age: 67
State: MD

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
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: LATEX, IODINE, DYES, FOOD COLORING, SULFER, FRAGRANCES, CURRY

Symptom List: Dysphagia, Epiglottitis

Symptoms: DAY 1 - SWELLING AND DSICOMFORT AT INJECTION SITE - USED ICE AND KEPT MOVING ARM A LITTLE NAUSEA AND "BLAH" FEELING LIKE AFTER FLU SHOT WHICH WAS EXPECTED AT THE END OF THE DAY NOTICED THAT MY KNEES AND LEGS WERE SWOLLEN WHICH ONLY HAPPENS WHEN I EAT SHELLFISH - THERE WAS NO OTHER PROBLEM - I KEPT MY LEGS ELEVATED AT NIGHT AND SWELLING WAS DOWN A LITTLE IN THE MORNING. DAY 2 CALLED PRIMARY CARE PHYSICIAN (PCP)- WE AGREED IT WAS OK TO TAKE BENADRYL AND IF DIDN'T CLEAR UP I WOULD NEED TO GO INTO HIS OFFICE FOR EVALUATION. BENADRYL STARTED WORKING AFTERNOON OF DAY 2. ALL SWELLING DOWN ON AFTERNOON OF DAY 4 (SATURDAY 3/20). REPORTED BACK TO PCP ON DAY 6 (MONDAY 3/22).

Other Meds: CARVEDILOL, METFORMIN, BAYER81, ZYRTEC D, VD3-3000, TYLENOL AR

Current Illness:

ID: 1122271
Sex: M
Age: 66
State: MI

Vax Date: 03/10/2021
Onset Date: 03/13/2021
Rec V Date: 03/22/2021
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: Some

Symptom List: Anxiety, Dyspnoea

Symptoms: My lymph nodes swelled three days after the first shot. Got very sore under my arm and got sore in the groin area too but just on the left side. Soreness has decreased but I can still feel it a little bit.

Other Meds: Allopurinol 300mg, Aspirin 81mg, Tamsulosin 0.4 mg, Glimepiride 1 mg, Amlodipine/Benaz 5/20 mg, Vitimin E 180mg, Vitimin K2+D3 25mg, Vitimin D3 75mg, Zinc 50mg, 1 Multivitiman

Current Illness: None

ID: 1122272
Sex: F
Age: 54
State: PA

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: Bee Venom, Vitamin B12, Penicillins, Sulfa Antibiotics

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

Symptoms: Extremely soar arm, then vomiting and tightness of the chest, very weak, extreme headache, loss of voice

Other Meds: Multivitamin, BuPropion, escitalopram, gabapentin, levothyroxine, pantoprazole, Zanix

Current Illness: Fibromyalgia, MCI, Hyperthyroid, Chronic Pain Syndrome, COPD

ID: 1122273
Sex: F
Age: 74
State: MO

Vax Date: 02/22/2021
Onset Date: 02/24/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: hydrocodone, oxycodone, tizanidine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: She started have swelling and weight gain starting 2 days after immunization. She has a history of DVT and had more swelling and redness in one leg leading to ultrasound to rule out a DVT and labs significant for an elevated D-dimer which then led to a CTA of her chest because of additional complaints of breathlessness. The ultrasound and CTA were negative for any clots. She was prescribed furosemide for the swelling. D-dimer was 2.26 micrograms/mL. Due to the temporal nature of events, I felt filing a report was necessary.

Other Meds: Outpatient Medications as of 3/22/2021 Disp Refills Start End furosemide (Lasix) 40 mg tablet 30 Tablet 1 3/15/2021 Sig: Take 1 Tablet (40 mg) by mouth daily. As needed for swelling Class: E-Prescribe Route: Oral triamterene-hydroCHLOROt

Current Illness:

ID: 1122274
Sex: M
Age: 75
State: PA

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt c/o dizziness a few minutes after vaccine administration. Drank juice. Felt better after a few minutes.

Other Meds:

Current Illness:

ID: 1122275
Sex: F
Age: 59
State: TX

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
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

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

Symptoms: ?Moderna COVID?19 Vaccine EUA shot 3/19/21 1:30pm, woke up Saturday morning 9:00 am dizzy and still have dizziness. My face is also red.

Other Meds: viibryd

Current Illness: none

ID: 1122276
Sex: F
Age: 74
State: MN

Vax Date: 02/24/2021
Onset Date: 02/28/2021
Rec V Date: 03/22/2021
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 known

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Four days after receiving Covid 19 Pfizer vaccine I developed a severe case of shingles on left torso.

Other Meds: Lipitor, Vitamin D supplement

Current Illness: no

ID: 1122277
Sex: M
Age: 42
State: IL

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Trouble swallowing, throat pain

Other Meds:

Current Illness:

ID: 1122278
Sex: F
Age: 60
State: TN

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: azithromycin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt complained of feeling dizzy after 12 minutes of post observation. Pt lost consciousness for brief period. Blood pressure dropped from 120/73 to 98/59. Pt regained consciousness and was able to give one word answers. EMS was called. IV was started and IV fluids were administered. Upon EMS arrival, pts blood pressure was noted to by 70/50 and she again lost consciousness. Pt was transported to local ER by EMS. Pt was later diagnosed with a vasovagal response to vaccination.

Other Meds: Lisinopril 20mg daily, Atorvastatin calcium 10mg daily, Zyrtec 10mg daily, Tramadol 50mg daily, Hydrocodone-acetaminophen 7.5/325 daily

Current Illness: history of breast cancer, heart disease, hypertension

ID: 1122279
Sex: M
Age: 28
State:

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
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: Following administration of covid vaccine client stated he did not "feel well" He complained of being "light headed" Blood pressure 118/63 pulse 62 and oxygen saturation 97%. Reaction started 5 minutes after administration. Second Blood pressure in 5 minutes 118/72 Pulse 70 with oxygen saturation 100%. Client was reclined for a short time. Client released when symptoms resolved.

Other Meds:

Current Illness:

ID: 1122280
Sex: F
Age: 53
State: FL

Vax Date: 03/13/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Erythro-mycin No other allergies known

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

Symptoms: The day of the first injection and the following day, I had a sore arm only. On day 8 after the Moderna vaccine, my left arm at the site of injection started itching. I also developed a bright red spot about 2 inches in diameter around the site of injections and it was warm to the touch. My left eye was also itchy on the lower left lid, but I honestly don't know if that can be attributed to the vaccine or the fact that we were painting the inside of our house. It might have been the paint. On day 8, I did have a little bit of a rapid heartbeat, but noticed this before I noticed my arm itching and being red. Not sure if that was related to reaction or not.

Other Meds: None

Current Illness: No known illnesses at time of vaccination or one month prior

ID: 1122281
Sex: F
Age: 41
State: PA

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 03/22/2021
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: Allegra: heart races

Symptom List: Rash, Urticaria

Symptoms: Fever up to 102.1, nausea, severe headache, fatigue, muscle pain throughout body

Other Meds: None

Current Illness: None

ID: 1122282
Sex: F
Age: 16
State: KS

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/22/2021
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: patient received vaccine at the age of 16

Other Meds:

Current Illness:

ID: 1122283
Sex: F
Age: 73
State: IL

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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: Penicillin, sulfa Grass, trees, animals

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

Symptoms: Evening of administered dose sore and itchy arm. Woke up the morning after injection (3/18/2021) had tired feeling of eyes, white of left eye appeared to have bleeding across entire bottom area as well as up both sides, top area remained white in appearanceor bleeding was unresolved in three weeks AS

Other Meds: Anasrozole 1mg daily Vitamin D 1000u every other day

Current Illness: none

ID: 1122284
Sex: F
Age: 71
State: MI

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/22/2021
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: no

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

Symptoms: Patient lives in the neighborhood and became confused about her second dose date. She received her first dose from her PCP the week prior and thought she was to return a week later. As that clinic was closed she heard about the church event and was a walk-in. Second dose was administered a week later. Patient's son also seemed confused as to why she was returning for a second dose so early, Agency vaccine card explicitly stated return date. Our intake nurse overlooked the consent form stating that they had received a vaccine in 14 days. We have reinforced full review of the consent form to ensure this does not happen again. Nurse was coached onsite.

Other Meds: Unknown

Current Illness:

ID: 1122285
Sex: F
Age: 30
State: OH

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Very intense pain, very sore. My arm has been hurting for 11 days. Rashes appeared on both feet and ankles 7 days later.

Other Meds:

Current Illness:

ID: 1122286
Sex: F
Age: 51
State: SC

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Starting having chest pain 5 minutes after shot. they are very sharp and a tightness in my chest. It has been on and off for five days now.

Other Meds: tylenol, lamotrigine, metoprolol,

Current Illness: none

ID: 1122287
Sex: F
Age: 30
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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: Developed lightheartedness , abdominal cramps, nausea, hypotension.

Other Meds:

Current Illness:

ID: 1122288
Sex: F
Age: 73
State: FL

Vax Date: 03/02/2021
Onset Date: 03/13/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: arm and shoulder pain f/u call made; caller reports decrease in intensity of arm and shoulder pain

Other Meds: lisinopril hctz aleve

Current Illness:

ID: 1122289
Sex: F
Age: 73
State: MA

Vax Date: 02/20/2021
Onset Date: 03/01/2021
Rec V Date: 03/22/2021
Hospital: Y

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

Lab Data:

Allergies: trimethoprim sulfamethoxazole

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

Symptoms: Pathology confirmed: OXALATE NEPHROPATHY. Unclear trigger for abrupt onset of AKI requiring initiation of dialysis in this lady with hyperoxaluria. Her hyperoxaluria is thought due to roux-en-y bypass. But unclear why she abruptly had Cr go from 1.2 mg/dl in Dec 2020 to 11 on 3/10/21 with oliguria. I - her attending hospitalist - am unsure what precipitated the crisis. I've attending renal pathology conference which discussed case. Some nephrologist entertained attributing it to Cdiff colitis, but the existing literature for this is very limited and her infection seems to have followed her AKI, rather than preceded it. Although unlikely, I've considered that patient may have existed with supersaturate hyperoxaluric state that experienced shock to equilibrium after small PEG injection of pfizer vaccine.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet Taking No Yes TAKE 1 TABLET BY MOUTH EVERY 8 HOURS. amoxicillin (AMOXIL) 500 MG capsule Taking No Yes Take 4 capsules (2,000 mg total) by mouth as directed. Take 30-60 minutes prior to dental procedur

Current Illness: severe hypertension

ID: 1122290
Sex: F
Age: 67
State: CA

Vax Date: 02/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/22/2021
Hospital: Y

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: unknown

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

Symptoms: Pt admitted to the hospital the day after receiving second vaccination. Pt received vaccinations 2/10/2021 and 3/10/2021 at a facility, Moderna Lot # 025LZOA for both shots. Per pt husband she had started complaining of feeling tired and weak a few hours after receiving shot. She took a nap and when she awakened her legs were weak and she could not stand without assist and did end up falling a couple of times. When she was not feeling better in AM husband took her to the hospital.

Other Meds: unknown

Current Illness: none

ID: 1122291
Sex: F
Age: 83
State:

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/22/2021
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: Unevaluable event

Symptoms: Pt c/o feeling dizzy 15 min after administration. Pt was wearing a double lined cloth mask and says she feels that the dizziness resulted from wearing the mask so long. Pt felt fine and amb out of tent to remove mask and "get some fresh air." Pt then amb to car with spouse.

Other Meds:

Current Illness:

ID: 1122292
Sex: F
Age: 67
State: CO

Vax Date: 03/06/2021
Onset Date: 03/01/2021
Rec V Date: 03/22/2021
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: NKA

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

Symptoms: My pre existing tinnitus has gotten worse.

Other Meds: I withheld all supplements the day of vaccination magnesium, multi vit, dandelion root, turmeric

Current Illness: none

ID: 1122293
Sex: F
Age: 29
State: ID

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
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: Morphine

Symptom List: Injection site pain, Pain

Symptoms: I had a bad headache. It wasn't terrible, didn't need any other treatment. Just bed rest for the morning until it abated.

Other Meds: None

Current Illness: None

ID: 1122294
Sex: F
Age: 31
State: TN

Vax Date: 03/10/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: Injection site pain, Menorrhagia

Symptoms: Flu like symptoms appeared 1 hour for 24 hours after shot. Swelling, itching, red rash at injection site 9 days after shot. Over the counter medication hasn't worked on any of the disconfort.

Other Meds: None

Current Illness: None

ID: 1122295
Sex: F
Age: 17
State: KS

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/22/2021
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:

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

Symptoms: Received dose when she was 17

Other Meds:

Current Illness:

ID: 1122296
Sex: F
Age: 23
State: CO

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Within about 5 minutes of patient receiving the vaccine, she began to feel dizzy and nausea. She proceeded to have several episodes of vomiting afterward. She was treated with oral Benadryl 25mg PO x1, but vomited afterward. She was later administered Benadryl 25mg IM x1 and Zofran 4mg ODT x1 with improvement in her symptoms. Vital signs remained stable throughout 2 hours of observation and she was discharged home. Subsequent telephone follow-up indicated patient's initial symptoms continued to improve by the evening and the following day. Patient never developed syncope, rash/hives/SOB/lip, tongue or throat swelling.

Other Meds: Prozac, Wellbutrin XL, Ambien CR

Current Illness: None

ID: 1122297
Sex: M
Age: 68
State: AZ

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: I am lactose intolerant, some mild food allergies and a bunch of environmental allergies.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Low grade fever (100.6 - 100.9) starting between 6 and 7 PM and back to normal by morning. Two nights in a row. A definite lack of energy and very mild stiffness.

Other Meds: metoprolol 25mg, simvastatin 20 mg, flonase.

Current Illness: none

ID: 1122298
Sex: F
Age: 58
State: NC

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: Patient complained of SOB, chest pain, throat tightness

Other Meds:

Current Illness:

ID: 1122299
Sex: F
Age: 45
State: TX

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
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: PT C/O NAUSEA, HEADACHE,ANXIOUS, V/S CHECKED O2 SAT 100%,PULSE 99,BP127/77.GATORADE GIVEN,EDUCATE PT TO EAT SALTINE CRACKER SLOWLY,AVOID FRIED GREASY SWEET FOOD. OBSERVED PT FOR 15MINS,PT STATES THAT SHE IS MUCH BETTER,PT WAS SENT HOME PULSE 79.

Other Meds: HYDROXYZINE,ATIVAN

Current Illness: MIGRAINE HEADACHE

ID: 1122300
Sex: F
Age: 46
State: IN

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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 that I am aware.

Symptom List: Injection site pain

Symptoms: Itching 25 minutes after the injection. Itching on arm, neck, back, ears, legs. Nausea and vomiting the next day. Mild nausea the third day.

Other Meds: Anti-depressant

Current Illness: Sore throat

ID: 1122301
Sex: F
Age: 68
State: OH

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: light headed, very slight headache

Other Meds: premidone, lexapro,lamictal abilifytrazadone norvasc melatonin vitamin d3 pantoprazole tolcylen amlodipine, phillips milk magnesia

Current Illness: none

ID: 1122302
Sex: F
Age: 26
State: TN

Vax Date: 03/20/2021
Onset Date: 03/21/2021
Rec V Date: 03/22/2021
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: Nausea day 1 accompanied with loss of appetite and hot flashes, Day 2 rash and itchiness at injection site, chills while sleeping, muscle aches, headache, fatigue, Hot flashes after chills went away

Other Meds: OTC allergy medicine: 10mg Equate brand Cetirizine Hydrochloride Antihistamine .

Current Illness: None

ID: 1122303
Sex: F
Age: 61
State: TN

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: Demerol: Rash

Symptom List: Tremor

Symptoms: Patient reported to nurse after receiving first dose of Pfizer that 3-5 minutes later her left side of neck/throat felt tight and tingled. Nurse alerted Doctor and myself to assist patient. We arrived to patient's car in front of garage at 10:55 AM and walked beside car as the husband pulled forward to park. Patient stated she received her vaccine about 10:45 and then as her husband started pulling forward, she told him about her symptoms. Dr. assessed patient and stayed with patient until 11:13AM. Patient left in passenger seat with her husband driving stating that she no longer felt the tightness in her neck or throat.

Other Meds: Losartan Pantoprazole Daily vitamins

Current Illness: None

ID: 1122304
Sex: F
Age: 55
State: CT

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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: NKDA

Symptom List: Erythema, Pruritus

Symptoms: Aprrox. 15min after first dose of Moderna vaccine patient reported feeling dizzy. Patients significant other reported patient feels dizzy prior to a seizure. Patient lowered to the floor and had a seizure lasting about 45 seconds. Paramedics activated @ 3:10pm. Patient alert with intermittent confusion. Blood sugar 94. Patient refused transport to the hospital. Paramedics stayed by, patient had a second seizure lasting about 15 seconds. Post seizure patient agreed to go to hospital for eval. Transported via paramedics to hospital.

Other Meds: No list of meds on hand.

Current Illness:

ID: 1122305
Sex: F
Age: 23
State: NM

Vax Date: 03/11/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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

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

Symptoms: Rash at location of shot on arm. Rash is about 2 inches by 3 inches in size.

Other Meds: Birth Control

Current Illness: none

ID: 1122306
Sex: M
Age: 64
State: CO

Vax Date: 03/16/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: aspirin

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

Symptoms: Moderna COVID- 19 Vaccine EUA: patient presents to the emergency department (ED) with shortness of breath, dizziness, abdominal pain, nausea, cough, malaise, and headaches. Symptoms started four days prior to arriving in the ED when shoveling snow. Three days prior to arriving in the ED patient received vaccination and reports fever and persistent shortness of breath ever since. Seen by primary care provider one day before presenting to the ED and prescribed prednisone but did not take it. Initial vital signs showed tachycardia, fever, tachypnea, and decreased oxygen saturations on room air. Physical exam noted faint wheezing. Patient placed on oxygen, received albuterol, ipratropium, and steroids with improvement. Patient discharged to home with steroids, inhalers, and oxygen.

Other Meds: prednisone, albuterol, fluticasone-salmeterol, ipratropium

Current Illness: asthma attack

ID: 1122307
Sex: M
Age: 47
State: CA

Vax Date: 03/11/2021
Onset Date: 03/16/2021
Rec V Date: 03/22/2021
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: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: total body pruritic started about 6 hours after administration: per pt, started from feet, then spread to legs, lower back, sides, then forearms. he took two Benadryl and it subsided while he slept (so exact duration unknown). he did use a dose of sildenafil the night prior to getting the vaccine.

Other Meds: Sildenafil

Current Illness: none

ID: 1122308
Sex: M
Age: 71
State: AZ

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
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: There are no side effects. You r'e info said I missed my appointment, I did not. My Wife and I were there and received our Second Shot to complete our Vaccination. When We got to the staging area, your people could not find our reservation, even though we showed them your paperwork. So they put us in as a Walk-in. \ Once again, We should up, and received our Vaccination.

Other Meds: none

Current Illness: none

ID: 1122309
Sex: M
Age: 31
State: NY

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 20minutes after vaccine as per patient was diaphoretic. had palpitations and dizziness. The vaccine center called a rapid response. the team transferred patient to ED. Patient stated that after he was seen by a physician ,he spent 2 hours in waiting area and then went home

Other Meds:

Current Illness:

ID: 1122310
Sex: M
Age: 46
State: AR

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
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: Pain in extremity

Symptoms: Experienced mild swelling in hands and angles due to water retention.

Other Meds: Omeprazole, Lisinopril, Atorvastatin, multi-vitamin, and D3.

Current Illness: None

ID: 1122311
Sex: F
Age: 58
State: CA

Vax Date: 03/14/2021
Onset Date: 03/22/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Painful, itchy rash at vaccination site 1 week after vaccine. Just started today so I will try Benadryl and Advil.

Other Meds: Vitamins: zinc, D, C, B-12, omega-3

Current Illness: None

ID: 1122312
Sex: F
Age: 54
State: VA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/22/2021
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: Feeling of tingling midline that radiated down mid chest to l/r; feeling of cold; no sob; no chest pain; No heart or lung hx; Ambulatory with crew; requested transport for followup as recommended by Dr. Transported to Hospital. BP 185/70 at 1543 BP 175/82 at 1549

Other Meds:

Current Illness:

ID: 1122313
Sex: F
Age: 49
State: TX

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
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: Upon injection reaction was similar to allergies; runny nose and congestion. Later in the afternoon and overnight chills, fatigue, body ache. Left arm at injection site was sore and could not be raised over her shoulder. Thursday - fatigue and body aches and arm sore. Friday - free range of movement with arm, fatigue no aches no fever no chills, Saturday same but dizziness like vertigo started; Sunday - irritation on left side of body, left foot itched like a rash but no visible rash; Monday morning left side of neck visibly swollen, right side swollen but not as severe; left foot still itches; vertigo still an issue, patient says it feels like the whole left side of body is swollen.

Other Meds: singulair and symbicort

Current Illness: none

ID: 1122314
Sex: M
Age: 67
State: TX

Vax Date: 03/02/2021
Onset Date: 03/08/2021
Rec V Date: 03/22/2021
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: Fluoroquinolones, metronidazole

Symptom List: Vomiting

Symptoms: existing idiopathic peripheral neuropathy spread from extremities to my entire body and has increased in intensity from a level 1 to a level 3 and has not receded.

Other Meds: Losartan, Metoprolol, Warfarin, aspirin, folic acid

Current Illness: none

ID: 1122315
Sex: M
Age: 74
State: KY

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received 1 dose at the health department on 1-13-21. He received another dose (what we were led to believe was his 1st dose) at our store on 2-17-21. His second dose for the health department (third dose total) was shortly after that (possibly 2-18-21 but I'm unable to confirm the exact date). What we though was his second dose (in reality, his fourth dose) was given 3-18-21. We tried to phone him over the weekend, but no answer. We were able to get in touch with him today (3-22-21) and he stated he hasn't had any symptoms from any of his 4 doses of vaccine. His primary care physician was notified this morning.

Other Meds:

Current Illness:

ID: 1122316
Sex: M
Age: 48
State: GA

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Moderna COVID-19 Vaccine EUA

Other Meds: None

Current Illness:

ID: 1122317
Sex: F
Age: 53
State: LA

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 03/22/2021
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: acute autoimmune hemolytic anemia; patient had a history of PCR documented mild COVID in 4/2020

Other Meds: none

Current Illness: none

Date Died: 03/18/2021

ID: 1122318
Sex: M
Age: 72
State:

Vax Date: 03/15/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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: Received second dose of Pfizer Covid vaccine on 3-15 and he passed away 3 days later on 3/18/21

Other Meds:

Current Illness:

ID: 1122319
Sex: F
Age: 56
State: NJ

Vax Date: 01/02/2021
Onset Date: 01/04/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: A few days post vaccine #1 I noticed small rash on lower extremities, which progressed to hives all over body. Saw dermatologist and started taking Allegra 4x/day. Symptoms seemed to subside. Received vaccine #2 on Jan 30th, and hives increased severely. Went to ER on Jan 9th with swollen lips and eyes, and hives over entire body. Received IV Solumedrol, IV Benadryl. Followed up with Allergist who said I was having a reaction to the vaccine. Am currently taking Doxepin 3 tabs/ nightly, Zyrtec 2x/day and Singulair. I am on week # 12 with hives with no relief.

Other Meds: Pristiq

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm